Nutrition Essentials | What To Eat During Pregnancy with Cara Dolin, MD

Podcast Transcript

John Horton:

Hey there, and welcome to another episode of Nutrition Essentials, an offshoot of our long-running Health Essentials Podcast. I'm John Horton, your co-host, with registered dietitian Julia Zumpano.

Julia Zumpano:

Hey, John. Being pregnant is one of the most exciting and stressful times of a woman's life. I've been pregnant three times. I will say, each time was vastly different. It's important, so important, to meet the woman's, the mother's, nutrient needs, as well as the baby's.

John Horton:

Well, what you eat is so important when you're pregnant, Julia. And I know that can seem very overwhelming when you're trying to figure all this out. You wonder if you're doing it right.

Julia Zumpano:

Yeah, and that's why we brought in our guest, Dr. Cara Dolin, who's a maternal fetal medicine specialist, to sort through nutrition and overall health for the baby and mom.

John Horton:

I know there's a lot of people who are interested in this, Julia, so let's get to it. Welcome to the podcast, Dr. Dolin. We are really happy that you could join us here today.

Dr. Cara Dolin:

Thanks so much for having me. I'm excited to be here. This is something that I'm really passionate about, because I see every day how much nutrition during pregnancy can influence both a mother's health and a baby's development. Nutrition is important at every stage of life, but in pregnancy, it's particularly important because what you eat is supporting your own health, how your baby's developing. It shapes how the baby grows. It can affect how a mom feels during pregnancy, and even her long-term health after the baby's born. This is actually something that my research has focused on — really understanding how what we eat during pregnancy shapes outcomes for mom and baby, and how we can better support women in making informed and realistic diet choices. I'm also part of the American College of Obstetricians and Gynecologists Nutrition Expert Work Group. It's a mouthful, but we're working to improve how nutrition is integrated into clinical care.

Julia Zumpano:

Thank you so much, Dr. Dolin, for your expertise — and the support that nutrition plays is so essential coming from a physician. Really, as you know, it's so important, and I really thank you for valuing it so much.

John Horton:

And obviously, everything you just laid out is exactly why we have you here with us today because we know it's a big topic. If you're pregnant, you're excited, but you're also… there's a little worry, a little angst in there. You want to make sure you do everything right.

Dr. Cara Dolin:

Absolutely.

John Horton:

Yeah. It sounds like this is something you get asked about a lot as far as what women need to eat. What kind of questions do you get in the office?

Dr. Cara Dolin:

Well, I think an important place to start is with micronutrients, or vitamins and minerals. I see this every day in my practice. As you said, patients come in, they're newly pregnant, they're feeling overwhelmed, they're hearing all about nutrition, and what to eat, what not to eat on social media, and they just want to make sure that they're doing right for themselves and their baby.

And so, during pregnancy, your body changes a lot. You have increased needs for certain vitamins and minerals because you're supporting both your own health and the growth of the baby. And so, while it can feel like a lot, the goal really isn't perfection, but rather, understanding what are the key nutrients that make the biggest difference, and then finding real-world ways to incorporate them into your diet.

John Horton:

Do you find now ... I know social media is obviously everywhere, and there's so much out there...

Dr. Cara Dolin:

Mm-hmm.

John Horton:

Do people come in with a lot of misinformation and questions based on that?

Dr. Cara Dolin:

Absolutely. I get shown TikTok videos every day. They're like, "But I saw this on TikTok." I think there's a lot of great information out there on the internet, but there's also a lot of misinformation. And I think it's really important just for all listeners to make sure you review everything with your own provider, your own personal case with your pregnancy, and just make sure you're following the right guidance.

Julia Zumpano:

Dr. Dolin, that was the main reason we actually developed this podcast, was to help debunk some of those nutrition myths that are floating around out there on social media and all over the place. Because, as you see TikTok and YouTube videos every day, me too, it's crazy. So that's our main goal here today.

Dr. Cara Dolin:

Yeah, I'm so glad we're doing this.

John Horton:

Yeah. Well, let's dive in then, and let's start breaking down some of those key nutrients that pregnant women really need to make sure that they work into their diet. Dr. Dolin, where would be a good spot to start there?

Dr. Cara Dolin:

I think starting with folate or folic acid would be a great place to start. This is one of the most important nutrients in early pregnancy. Folate is a B vitamin, and it plays a critical role in the fetal brain development, especially early on, even before someone knows they're pregnant, which is why this is one nutrient that people probably hear about a lot. There's so much emphasis on getting that folic acid in even preconception. And so, what we recommend is getting at least 400 micrograms of folic acid daily starting one month before pregnancy, and then continuing it through early pregnancy. And like I said, it's important because it can help prevent neural tube defects or problems with the baby's spine and brain.

John Horton:

How easy is it to get those 400 milligrams? Because I know I look at my cupboard, I don't just see milligrams and everything like that. Is this just something that is in just the basic foods that we eat? Do we really need to search it out? Where are we going to find it?

Julia Zumpano:

Well, the good news is it's fortified in a lot of breakfast cereals, breads, pasta, rice. You do have to check the label, make sure that it does include folic acid and it is fortified. Other dietary sources, natural sources include legumes, lentils, leafy greens like spinach, beets, and then asparagus. You can get it through your diet, through natural sources, but it's also fortified, so it's pretty easy to get in.

John Horton:

Well, that's good, so people don't need to go looking for it specifically at the store. It sounds like you're just naturally going to stumble into a lot of what you need.

Julia Zumpano:

Well, it is important to check those nutrition labels to make sure some of those cereals that you are purchasing are fortified, and breads, so just double-check that ingredient list.

Dr. Cara Dolin:

Absolutely. And it is one of the reasons why we recommend that prenatal vitamin that has at least 400 micrograms of folic acid. I say this often that we should get all of our nutrition from food, but that prenatal vitamin is like your nutrition insurance to ensure that you're getting what you need for you and the baby.

John Horton:

Do you have to worry about overdoing it? If somebody's like, "Hey, I want to make sure that brain and spine development goes just perfect," can you do too much? Do you have to watch that, too?

Dr. Cara Dolin:

Yeah, that's a really good question. It's a water-soluble vitamin, which means that you essentially urinate or pee out all the extra. It isn't one that you necessarily can get a toxicity from having too much.

Julia Zumpano:

Regardless, you always want to just be mindful. Just a well-balanced diet will give you everything you need instead of just focusing on one nutrient.

Dr. Cara Dolin:

Mm-hmm.

John Horton:

Well, let's move on to some of those as we're balancing that diet out. I have a feeling we're going to hit some of these other nutrients.

Dr. Cara Dolin:

Mm-hmm.

John Horton:

I know another one we had on the list we wanted to make sure to touch on was iron. And I know, Dr. Dolin, you said this sometimes could be an issue because a lot of times, women may be a little low in this area.

Dr. Cara Dolin:

Yeah, absolutely. This is another really important micronutrient. During pregnancy, iron needs increase by 50%. And so, this is something that I personally pay really close attention to in my practice, and with my patients, because, as you said, iron deficiency, anemia in pregnancy, is really common. It occurs overall in about 20% of patients. And in the third trimester, we see it in one to three patients, one out of every three patients. And the reason that we care so much is because iron supports oxygen delivery throughout your body. And so, it's essential for the baby's growth and brain development. And low iron levels have been linked to preterm birth, increased risk of bleeding after delivery. And so, it's really important to make sure that you're getting that iron in.

John Horton:

50% increase, that is a lot. How can women really hit that bar, and clear it? What's the best foods they can look for?

Julia Zumpano:

One of the best sources is actually liver, so chicken or beef liver. Dr. Dolin, is it safe for a pregnant woman to consume liver?

Dr. Cara Dolin:

Yeah, that's a good question. Liver also contains a lot of vitamin A. And I was just talking about water-soluble vitamins. This is a fat-soluble vitamin, which means if you take too much of it, it actually can build up in your tissues and cause a toxic effect. And too much vitamin A can be dangerous for a baby, so you do want to be careful with liver consumption.

Julia Zumpano:

Got it. Maybe a couple of times a week? Well, we'll get there next, but it is also a great source of choline, so it packs a punch, so small amounts-

Dr. Cara Dolin:

…small amounts.

Julia Zumpano:

...can help you really get a really good nutrient-dense food if you're searching for some food sources. But other than liver, of course, we have red meats, beef, lamb, pork. Dark-meat poultry is also a great source. You can get iron from fish, shellfish and, then, fortified foods like fortified cereals, beans and legumes all have a great source of iron, and then nuts and seeds as well.

John Horton:

Dr. Dolin, you had mentioned that 50% increase, and I'm just trying to visualize what that might mean. If you're pregnant, does that mean you need to really increase maybe your meat consumption or something else? I guess, visually, how would that look on your plate?

Dr. Cara Dolin:

I wouldn't necessarily recommend increasing your meat consumption. There is iron in the prenatal vitamin. I think we're going to talk a little more about prenatal vitamins in a little bit. A lot of people during pregnancy will also need a separate iron supplement, so that's just one way to get it instead of piling your plate high with red meat, which may come with other health risks.

Julia Zumpano:

Definitely. Well, we also want to consider plant-based sources. Overall protein needs are very important during pregnancies, so you can certainly aim to get some of that extra protein, iron and other vitamins and minerals, like folate from your leaf, from your legumes, lentils and split peas, and anything in the bean family is a great way to get some of those nutrients you need. Now, if you're looking to get iron from a non … what we call non-heme, which means a non-animal source, you really want to pair that food with a source of vitamin C to increase its absorption. It might look like lentils that you might put some lemon juice on, or a spinach salad with tomatoes for the vitamin C. That pairing does really help increase its absorption, and it does provide you, again, additional nutrients. Vitamin C is something we certainly need.

Dr. Cara Dolin:

Absolutely.

John Horton:

Julia, I know you always talk about the importance of nutrition and having these nutrient-dense meals. It seems like that becomes even more of a focus when you're pregnant.

Julia Zumpano:

Absolutely. I'm having a large variety of foods. When we're pregnant, depending on how you feel, a good majority of women don't feel very good, especially in their first trimester, myself included, I felt awful. It's important to be able to plan foods that you know that you can tolerate and you will enjoy, that have some nutrient density. Meeting with a dietitian is a great way, but even I often suggest smoothies or protein smoothies or shakes in some way to get in some of these nutrients. You can blend in some of that spinach, and some of the sources of vitamin C like oranges, and Greek yogurt, so you can really pack a punch in something liquid. It tends to be tolerated better. Or some women really do crave more comfort foods, like carbohydrate-rich foods, and that's where you want to make sure those carbs you are eating are whole grain, and they are fortified with folate and iron if possible. So there's a lot of options.

John Horton:

It's amazing how all this stuff seems to interconnect when you start looking at the dietary needs that ... or what the foods you should be looking at, they all seem to provide a lot of the same stuff, so you really do need to focus just on getting those good products that you just mentioned.

Julia Zumpano:

Right, a good variety.

John Horton:

You always talk about having a good variety, so that seems to be the key to healthy, nutritious eating.

Julia Zumpano:

Definitely is.

John Horton:

Moving through the micronutrients, I think on my list here, because when we were talking ahead of time, I wrote these down: vitamin D.

Dr. Dolin, why is that so essential during pregnancy?

Dr. Cara Dolin:

Vitamin D plays a really important role in the baby's growth and bone development. There's also some emerging research linking it to brain development. It may help reduce complications like preeclampsia, which is a blood pressure problem in pregnancy, and even preterm birth. This is another micronutrient that is really commonly deficient, especially in people who have limited sun exposure or are living in colder climates. I know here in Cleveland, Ohio, where we have long, gray, cold winters, all my patients have vitamin D deficiency. This is a really important one to pay attention to during pregnancy.

Julia Zumpano:

That's a great point, Dr. Dolin, because we need 20 minutes of direct sunlight, without sunscreen, to be able to meet around what we need in vitamin D every day from the sunlight. But it's gray and cloudy here today, so it's challenging to get that, again, depending on where you live. But here in Cleveland, Ohio, it's not happening. Dietary sources are also pretty tough. It's hard to get all your needs through diet alone. But some food sources include fatty fish, milk that's fortified with vitamin D, dairy products, so those are really going to be the best sources. It's important to make sure your prenatal vitamin has some vitamin D in it.

John Horton:

It seems like a lot eventually goes back to that prenatal vitamin, which we will talk about a little bit more as we move along in this discussion. Another micronutrient on the list was iodine. And Dr. Dolin, I loved the one story you told, which I would've never thought about, regarding, you think you're going to get iodine from salt, but it might not be in some of the salt people are using.

Dr. Cara Dolin:

Yeah, exactly. This is another nutrient that I think doesn't get enough attention. This one's not on TikTok, but it is really important in pregnancy. In pregnancy, your needs increase from 150 micrograms a day to 220 micrograms a day, so pretty big increase. And it is a super important nutrient for the baby's brain development. A lot of this goes back to the baby's brain, and we want those smart kiddos. And so, the way that the majority of Americans get iodine is through iodized salt in their diet, so just that table salt that you're sprinkling on your food or cooking with. But recently, in the past couple years, there's been all these trendy salts, Himalayan salts that aren't iodized. Even though this wasn't a nutrient that people were at risk of deficiency in the past, we're starting to see it a little bit more frequently as people are using some of these fancier salts and aren't using just regular table salt.

John Horton:

Who would think?

Dr. Cara Dolin:

Yeah, mm-hmm.

Julia Zumpano:

In addition to the iodized table salt, other food sources include dairy products and some seafood. So important to build in those on a regular basis. We'll talk about fish later.

Dr. Cara Dolin:

I'd say in terms of the prenatal vitamin, many don't contain iodine, so super important to check the label for that one.

John Horton:

Dr. Dolin, is there a worry, because when you talk about salt, you obviously think of high blood pressure and things like that. I take it, you don't want to overdo it either when you're taking that shaker out.

Dr. Cara Dolin:

Right. Just like outside of pregnancy, the recommended limit of salt is less than 2,300 milligrams per day, probably significantly less than that is even healthier. You don't want to just start putting salt on all your food, don't get me wrong there. But when you choose a little bit of salt for a taste, or to cook with, making sure you're using that just regular iodized salt.

Julia Zumpano:

One thing to keep in mind is most Americans do exceed their sodium intake, but it's mainly through processed food. If we're eating whole food, real food, fresh food, and adding salt, a majority of the time, that's not where people are exceeding their sodium intake. It's really from the packaged foods, the processed foods, the snack foods, condiments. If you're eating fresh food and adding a little salt, it's rarely ever an issue.

John Horton:

And I'd imagine, too, if you're following this fresh-food approach, as we've touched on with every one of these micronutrients, that's also going to help with other issues that come up during pregnancy. There's sometimes worry about weight gain, about gestational diabetes, things like that. I take it, this healthy approach, this micronutrient-focused approach, would that also help in those areas?

Dr. Cara Dolin:

Yeah, there is data that following a whole-food, healthy, minimally processed diet can help prevent gestational diabetes, prevent preeclampsia, limit excessive weight gain, limit the postpartum weight retention, meaning how much weight you keep after the baby's born. And so, really following just a healthy, whole-food diet from the beginning has so many benefits through the pregnancy.

Julia Zumpano:

I often hear a misconception as “you're eating for two.” Well, really, in the beginning, the first trimester, you really don't even need any extra calories.

Dr. Cara Dolin:

Mm-hmm.

Julia Zumpano:

You can maintain your normal caloric intake all through the first trimester. The second trimester, your calories go up slightly, about 350 additional calories, which again, is not that much. It might be like two glasses of milk or a large apple with some peanut butter. And then, the third trimester, your calories go up again just ever so slightly to 450 greater than what your normal needs are. Caloric intake is assumed to be much, much higher than really we need during pregnancy. Now, if you have multiples, you do need to increase that even more, but just focusing on whole foods is really the primary goal here versus even looking at calories. I just mentioned calories to recognize that you really don't need an excessive amount.

John Horton:

It sounds like with everything, it's more what you're eating sometimes as opposed to how much.

Julia Zumpano:

Absolutely, because those nutrient-dense foods are pretty low in calories, actually. They're all very, very giving you what you need. And the calories that are there, your body is utilizing every single calorie in every part of your body. It's way different than calories from a bag of potato chips.

John Horton:

Yeah. You never recommend a bag of potato chips, Julie. I'm still waiting for the one podcast where you toss that out there, but I think it's going to be a long wait.

Julia Zumpano:

No.

John Horton:

And looking at all this great stuff that we're getting in, I guess, the one last thing we really want to make sure we hit on is choline. And Dr. Dolin, what is that, and what is it doing?

Dr. Cara Dolin:

Yeah, so this is another nutrient that's really important in pregnancy and is often overlooked. Choline needs also increase in pregnancy, so we see a theme here. But actually, the majority of people don't get enough choline from their diet. In studies, about 90% of pregnant people aren't getting the recommended amount of choline, so this is really a key one to pay attention to. It also helps support fetal brain development, things like memory and learning. Definitely a nutrient to pay attention to. Also, often not in prenatal vitamins, or in prenatal vitamins in small amounts, so checking the label for this one.

Julia Zumpano:

The most accessible source of choline is egg yolks. Certainly, make sure you're including those on a regular basis. Organ meats is the best source of choline. And then, we have fish and seafood and poultry.

John Horton:

You're really pushing that liver, Julia.

Julia Zumpano:

Yeah.

Dr. Cara Dolin:

In moderation.

Julia Zumpano:

In moderation, or just recognize that that's one reason why it's challenging. Iron and choline, some of the best sources are iron, so you ... I'm sorry, liver, so you really do have to look at those other foods that you can get in.

John Horton:

Through this whole discussion, I'd say I'm really struck with how there's just this direct correlation between the foods that you eat, and that fetal development that's going on. And I'd say, do people really see that direct connection, or understand it, because it's amazing how tied in it seems to be.

Dr. Cara Dolin:

Yeah, this is one of the reasons I'm so interested in it, and it's been such a huge part of my career. And one of my goals is to make sure people do see that connection. Lifestyle changes and thinking about the foods you're eating and how you're nourishing your body in pregnancy, it's not a medication, it's not a surgery. It's something that's accessible to everybody that can have a real impact on pregnancy outcomes for the mom and baby.

Julia Zumpano:

One thing, Dr. Dolin, we didn't touch on was DHA, and that I think is a very important fat. It's an omega-3 fatty acid. It's found in more fattier fish. It's essential to get in, too. As we go along, we will look at trying to get that in through our prenatal vitamin, but fish is also something that is safe to eat in moderation.

Dr. Cara Dolin:

Yeah, absolutely. A fish is actually a really healthy food choice during pregnancy. Fish is low in saturated fat. It's high in protein. It has so many essential vitamins, including being a main dietary source of that omega-3 fatty acid, which is something that our bodies can't make ourselves, so we have to get it from food sources like DHA and EPA. Also important for the baby's brain development, again, a theme here.

We recommend people have two to three servings of fish per week, focusing on the ones that are high in omega-3 fatty acids, but low in mercury, so it has to be a balance. It's really important to be mindful of the mercury. This is a metal that can be found in some fish, and it's been linked to risk for babies, including risk of impaired brain development, neurodevelopment. Fish that are high in mercury that you definitely want to avoid in pregnancy are your bigger fish that have been feeding on the smaller fish. You think your shark, swordfish, big eye tuna, king mackerel. White or albacore tuna, you can have, but you want to limit to about six ounces per week.

John Horton:

Well, since we're talking food safety here with some of that, too, how does sushi come into play, because I know that is a big item that a lot of people like, if you're pregnant, should you stay away from it, or are there just certain types you should gravitate toward?

Dr. Cara Dolin:

Yeah, so this is something people ask about all the time. I myself love sushi, and was very sad to give it up during my pregnancies. But unfortunately, raw fish, like traditional sushi and sashimi, can carry bacteria and parasites that are risky during pregnancy. And so, it's really best to avoid them. That being said, there are safe alternatives, like cooked sushi. That can be your shrimp or eel or the crab that you find in a California roll. Those are all great choices. Also, veggie rolls, or even trying something different, like some of the tofu rolls, can be fun to play with during pregnancy.

Julia Zumpano:

One thing I also do recommend often is getting in some omega-3. Since you're so limited with fish and sushi and other things, is getting in through some plant-based sources in the form of alpha-linolenic acid, which is ground flax seeds, chia seeds, hemp seeds, pumpkin seeds. Those are another great way to get in. Of course, our body's not going to convert it as well. But bonus is they have a lot of other nutrients, including fiber and protein, so they can be very helpful in overall meeting nutrient needs.

John Horton:

I love this little food safety detour that we're going on here because that is important. I know we focus a lot on what you should eat, but it seems like there are also some no-no’s in there. And we just brought up some of them with the fish and sushi. Just, you have to be careful with what you choose.

Dr. Dolin, what are a few other items that people should be wary of a little bit while they're pregnant?

Dr. Cara Dolin:

Yeah, so the other big category of foods that you want to be careful and avoid during pregnancy is unpasteurized foods. These are certain cheeses, raw milk. I know that's also having a moment on social media right now. These foods can carry dangerous bacteria such as E. coli, Salmonella and Listeria that can be really dangerous during pregnancy, specifically Listeria that can lead to listeriosis. And pregnant people are 20 times more likely to develop listeriosis than the general population. And unfortunately, if it crosses the placenta and reaches the baby, it can lead to miscarriage and stillbirth. And so, it's super important to read the labels and make sure that you're only consuming pasteurized products.

Julia Zumpano:

Dr. Dolin, when I was doing some research for this, I found that your immune system actually is depressed a little bit during pregnancy. Can you talk a little bit about that?

Dr. Cara Dolin:

I'm always fascinated by pregnancy. It's incredible what our bodies do to grow this other human. But one of the things it does is actually suppress your own immune system, and that's because you essentially have this foreign thing growing in your uterus, in your belly. And so, it's so your own body doesn't attack this foreign thing, the baby. And so, because that immune system is suppressed during pregnancy to support the growth of the baby, you are more susceptible to all sorts of bacterial infections, viruses, things like that during pregnancy, so that's why this food safety topic is really important.

Julia Zumpano:

Yeah. Another reason to just keep nutrient density high, like vitamin C and zinc as well. How about-

Dr. Cara Dolin:

…absolutely.

Julia Zumpano:

...deli meats. Deli meats are another thing I usually advise pregnant women not to necessarily consume unless cooked.

Dr. Cara Dolin:

Yes. Yeah, I absolutely agree with that. In fact, deli meats actually account for over 90% of Listeria cases in the U.S. And so, that's really important not to be having that deli meat during pregnancy. That's actually probably the most common source because I think people avoid the unpasteurized foods.

Julia Zumpano:

Right.

John Horton:

Do you have to watch then even when you're eating meat to make sure then it's maybe a little more well-cooked and things like that, just to avoid any potential problems?

Dr. Cara Dolin:

Yeah, you absolutely want to make sure all the meat that you're eating is well-cooked. Even fruits and vegetables, which you should be filling your plate with throughout the day, that they're washed, that you're getting all, any anti-bacteria or pesticides off them.

Julia Zumpano:

Also, making sure you do proper hand washing and checking labels and dates, checking dates on meats, making sure you're smelling the meat, observing it, or fish, making sure you're just being very extra careful not to consume anything that's past date or just doesn't look like it's safe to eat.

John Horton:

Early mom training right there. You got to make sure everything's good in the fridge going forward, too.

Dr. Cara Dolin:

Yep.

Julia Zumpano:

Definitely.

John Horton:

Another big thing that comes up when we talk about food safety, and just whether you should or shouldn't consume it when you're pregnant, involves caffeine. So many of us need that cup of coffee to get going in the morning. When you're pregnant, do you need to give it up, Dr. Dolin, or is it something you can sneak in a little here and there?

Dr. Cara Dolin:

Yeah, great question. Coffee is something that I know people love. I have my coffee right here with me right now. I love coffee. And so, the good news is that caffeine is OK in moderate amounts. We recommend limiting it to less than 200 milligrams of caffeine per day, and that's the amount in about a 12-ounce cup of coffee. And so, that is safe in pregnancy. It's also important to remember, though, caffeine is in things other than just coffee. It can be found in tea and chocolate, in energy drinks, in soft drinks, and it's even in some medications. It's again, really important to look at the labels, and just be conscious about how much caffeine you're consuming throughout the day.

Julia Zumpano:

And it also gives you another reason to get some more rest, right, Dr. Dolin? Rest is so essential during pregnancy. Take the moment to get a couple extra hours of sleep, so you're not so dependent on that caffeine.

Dr. Cara Dolin:

Absolutely.

John Horton:

And I think everybody knows this, but obviously alcohol, that is just a strict no-go throughout pregnancy, correct?

Dr. Cara Dolin:

Yeah. There is no safe amount of alcohol during pregnancy, so you must avoid it entirely. That is the safest approach, no alcohol.

John Horton:

That seems pretty basic at this point, but it seems like something that you want to make sure that we mention.

We've been talking so much about eating whole, healthy, nutritious foods. But I know, my wife, we had three kids. You get some cravings, and some of them are some sugary stuff, some treats, things like that. How careful do you have to be when you're looking to those, and drawing a line as to how much is too much?

Dr. Cara Dolin:

Yeah. Well, I think it's important to be realistic. It is normal to crave sweets when you're pregnant. Your body's hormones are changing, blood sugar levels are changing, your taste buds are changing. And so, I think going back to that concept of moderation is really important. You don't need to eliminate treats completely, but you want to balance them with those nutrient-rich foods. And so, if you're craving something sweet, maybe pairing a piece of fruit with something with a little protein or healthy fat, like apple and peanut butter, or berries and yogurt, so you can satisfy that sweet craving while still nourishing your pregnancy.

Julia Zumpano:

Those are all great points. Another thing I often recommend is just trying to avoid commercially baked goods and desserts. Trying not to go to the grocery store and filling up on candy bars and ice cream and store-made cookies, but making those things at home. Being able to make them at home really can help you adjust the ingredients. You can decrease the added sugar, you can adjust the oil, use whole-grain flour. You can also look up … there's millions of wonderful lower-sugar desserts and sweets that are out there. Or just modifying some of your favorite recipes to include a little less sugar, using applesauce, et cetera. There's so many great tricks that you can do in the kitchen that will help. I think that's one thing I recommend often.

And if you're not up for baking or cooking, doing something very simple like a little bit of dark chocolate, or a chocolate pudding where you're going to get a little bit of some nutrients, like some calcium and protein, looking at like a chia seed pudding, or a granola, a granola, lower sugar granola, or trail mix that's homemade. Something of that sort that you're at least knowing you're getting some nutrition in with that sweet treat.

John Horton:

Throughout this, we've covered so much stuff, and hit on all these micronutrients, and all these needs that you have. It really seems like you need to go into your pregnancy diet with a little bit of a plan. Dr. Dolin, how do you advise your patients as to maybe how they should set that up, or what they should do to make sure they're on stable footing?

Dr. Cara Dolin:

This is a great question. I first want to give a shout-out to my dietitian colleagues, my nutrition colleagues, because unfortunately, physicians actually don't have a ton of education on nutrition unless they read about it on their own and educate themselves on their own. And we also have a really limited time during prenatal visits to cover so many different things that there often isn't a lot of time to go through nutrition. I'd love to put a plugin for my nutrition colleagues.

If you're a patient, advocate for yourself, ask if you can have a referral to a dietitian. Then, they have so much more time to really sit down with you, go through the foods you like to eat, and come up with a personalized plan to support you during the pregnancy. I think that's the best approach is to see a dietitian if you're able to.

Julia Zumpano:

I couldn't agree more. One note, too, is what a dietitian can do for you, too, is, if you are having some symptoms, which oftentimes, being pregnant comes with symptoms like irregular digestive system and some nausea, maybe vomiting, fatigue. Food can resolve some of those symptoms, or just at least improve them or help you get through them. We can help you overcome some of those symptoms or eat better to help relieve some of those symptoms, or at least decrease it. In so many ways, not only meeting nutrient needs, but also helping you just feel your best during pregnancy, dietitians and nutritionists can really help.

John Horton:

It's that whole concept that we always talk about, Julia, which is that food is medicine.

Julia Zumpano:

Absolutely.

John Horton:

And it sounds like this is really a case where you need to approach it that way.

Julia Zumpano:

Absolutely.

John Horton:

Well, we've teased this throughout the entire podcast, but let's really now dive in and talk about prenatal vitamins. Dr. Dolin, there's so many choices. You go to the store, the vitamin aisle is just stacked. What do people need to look for if you're going to get a good prenatal vitamin?

Dr. Cara Dolin:

This is a question that I hear every single day from my patients. Which prenatal vitamin should I get? Again, just to reiterate, it is best to get your nutrition from food. And we're going to think of the prenatal vitamin as our nutrition insurance. Primarily, we're getting all our fruits, vegetables, healthy grains, proteins, lean meats that get ... because there's so many things in food that help our body absorb those nutrients, and use them in ways that just can't be replicated in a pill. But when we're taking our nutrition insurance, our prenatal vitamin, which I recommend everyone take, there really isn't a single best prenatal vitamin. And so, the optimal choice is the one that has the key nutrients that you need. And we talked a lot about them at the top of the show, but is importantly one that you'll actually take every day.

Julia Zumpano:

Yeah. You probably hear often, "Can I just take a gummy vitamin?" What are your thoughts on gummies?

Dr. Cara Dolin:

Yeah, so gummy vitamins are really popular because they taste better and they can be easier to swallow than that big prenatal pill, especially in the first trimester when you might be having a lot of nausea and vomiting and stomach aching, that big pill just is not possible. But there are some trade-offs. Many gummy vitamins do not contain iron — and we talked about how this is a critical nutrient during pregnancy — and they also can be really inconsistent with the other nutrients that they contain. When people have done studies looking at gummy vitamins, often, when they actually analyze what's in the gummy itself, it doesn't match what's on the label, so you have to be careful. But in the end, if you absolutely can't stomach that big pill, taking a gummy vitamin is better than taking no vitamin.

Julia Zumpano:

Yeah, I can't agree more. But one thing that you mentioned is just making sure that the vitamins you do take have what they're claiming is in them. I do recommend oftentimes getting vitamins and minerals that are third-party tested, meaning that have been tested and have been accountable to saying what's in there is actually the percentage of the daily value is actually in there. Another thing I often recommend is a liquid dropper form of a multivitamin, which can be found … or a powdered multivitamin that can also be scooped into water or a beverage. Those are two additional options you can consider.

John Horton:

Are there percentages that you should look to hit with the vitamin when you're looking at these micronutrients that you want to make sure you get to? I don't know if you're looking for 100%, 50%, since you were using this to supplement with food. What would be the target people should have?

Julia Zumpano:

I generally recommend you're looking at ideally 75% or greater, especially during pregnancy, especially during that first trimester when maybe you're not feeling so great. That's a nice buffer. Dr. Dolin, what do you generally recommend?

Dr. Cara Dolin:

Yeah, I agree with that. If you want to look at the actual amounts, folic acid, at least 400 micrograms. When it comes to elemental iron, 27 to 30 milligrams, 200 to 300 milligrams of calcium, and 400 to 600 international units of vitamin D as a minimum.

Julia Zumpano:

Great.

John Horton:

I'll tell you, we have laid out a great plan for people to make sure that they're going to get those nutrients that are just so essential during pregnancy. To bring everything together here, what are the things you want to make sure that women get out of this podcast just to make sure that those kids are getting those brains developed and spines developed, and everything else that we're looking to do with this healthy eating?

Dr. Cara Dolin:

Yeah, I think it is so important to really think about what you're eating during pregnancy. Everything you're eating, the baby's eating. And so, this is really such a critical time for a healthy diet and good nutrition. And lifestyle changes that you make during pregnancy, they can continue after pregnancy and set the stage for a healthy household for how everybody's eating

 A good, simple way to think about it, I love the MyPlate method, where half your plate is fruits and vegetables, the other half has your protein and healthy fats, making sure you're getting at least five fruits and vegetables a day, eating the rainbow. That will really ensure that you're getting the nutrition that you need.

Julia Zumpano:

Yeah. I would piggyback on that, saying what you eat really does matter. It matters for yourself and it matters for the growing baby. I think it's essential to really keep in mind, plan ahead healthy meals, make sure you have healthy food on hand, because oftentimes, people fall off healthy eating plans because they're not prepared. They don't have the food at home. They didn't plan dinner. They're in a pinch, and they go through a drive-through or a gas station, whatever that might be, so planning ahead is key. It will help you feel the best, too.

And then, just making sure, as Dr. Dolin said, that healthy plates … ideally we want seven to nine servings of fruits and veggies a day. I know that sounds a lot, but seven to nine is the guideline for fruits and veggies. And making sure you're getting in whole grains, so avoiding refined grains, and making sure those grains are fortified. But really, nutrition's key, and planning is most important.

John Horton:

Well, I'll tell you, if every pregnant mom follows this advice, we are going to have genius kids coming forward because those brains are going to be so developed.

Dr. Cara Dolin:

That's right.

John Horton:

Dr. Dolin, I can't tell you how much we appreciate you coming in and really sharing your passion for this topic. I know it's something you talk about all the time, and we're really thankful we were able to get a little bit of your time so you can share it with our audience.

Dr. Cara Dolin:

Thanks so much for having me. This was fun.

Julia Zumpano:

Thanks, Dr. Dolin.

John Horton:

Julia, I have to tell you, we covered so much there. I know my head's spinning a little bit. But I really think that there's a simplicity to it, too, if you really just focus on eating these nutrient-dense foods and just hitting those key micronutrients that we talked about.

Julia Zumpano:

Yeah, we unpacked a lot, and it can be very overwhelming, so really to simplify: eating whole foods, listen to your body, and focus on healthy eating habits as we mentioned. Instead of getting really deep into the nitty-gritty, taking a prenatal vitamin will really help give you that nutrition insurance, but balanced meals, healthy, whole foods.

John Horton:

And maybe even squeeze in a little bit of liver here and there, if you're willing, it sounds like.

Julia Zumpano:

Absolutely. Get that liver in.

John Horton:

Well, if you liked what you heard today, please hit the subscribe button, and leave a comment to share your thoughts. Until next time, eat well.

Speaker 4:

Thank you for listening to Nutrition Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.