Substances to Limit or Avoid in Pregnancy
Women who are pregnant or who could become pregnant should abstain from drinking alcohol to prevent the array of birth defects associated with fetal alcohol spectrum. Women should be counseled to quit smoking before becoming pregnant, but quitting at any time during pregnancy will confer benefits. Moreover, as second-hand smoke can harm the infant after birth, infants should not be exposed to cigarette smoke. Caffeine consumption should be limited to less than 200 mg/day or about two 6 oz cups of coffee or four cups of tea. Artificial sweeteners such as aspartame, sucralose, and saccharine are safe to use in moderation. The safety of many herbal supplements and remedies has not been tested, and practitioners should question their patients about their use of these products.
Food Safety During Pregnancy
There are some basic steps that can greatly reduce the risk of foodborne illness during pregnancy: washing hands often before and during food preparation and before eating; keeping raw foods separate from cooked and ready-to-eat foods; cooking foods to proper temperatures; and promptly refrigerating leftover foods and cold foods brought home from the grocery store. Women should be cautioned against eating raw or undercooked meat and eggs, including raw cookie dough, Caesar dressing, soft cooked eggs, and rare hamburgers.
The bacteria Listeria monocytogenes can cause miscarriage, premature labor, and infant death. It is unique because it can grow at refrigerated temperatures. For this reason, pregnant women should avoid eating unpasteurized dairy products, including unpasteurized cheeses, deli meats, deli salads, smoked seafood, and pates. Processed and cured meats like hot dogs must be heated until steaming.
The bacteria Toxoplasma gondii is commonly known to infect cat litter, but can also be present in raw and undercooked meats and on the surface of fruits and vegetables. Avoiding touching cat litter, thoroughly cooking meats, and rinsing fruits and vegetables before eating can reduce the risk of exposure.
The mercury content of fish is also a concern for pregnant women [12, 13]. Advice for women who are pregnant and breastfeeding is to eat 8-12 oz of a variety of fish each week from choices that are lower in mercury, such as salmon, shrimp, pollock, tuna (light canned), tilapia, catfish, and cod. Pregnant women should avoid eating shark, swordfish, king mackerel, and tilefish from the Gulf of Mexico, and albacore (white tuna) should be limited to 6 oz/week [12].
Translating Nutrition Guidelines into Practical Advice About Food
Women do not eat grams of macronutrients or milligrams of minerals, they eat portions of food. It is therefore reassuring to know that most nutrient needs will be met by a carefully selected, nutrient- dense diet. If women are familiar with a few basic concepts, they can make their food choices wisely. Food guidelines for pregnant and lactating women can be found at www.choosemyplate.gov.
