Pregnancy Nutrition: Eat This, Not That

Intro: MemorialCare Health System: Excellence in Healthcare presents Weekly Dose of Wellness. Here's your host, Deborah Howell.

Deborah Howell (Host): Welcome to the show. You know, more foods can affect your health or your babies than you might realize. But do you know what foods to avoid during pregnancy? Dr. Elizabeth West, OBGYN physician with MemorialCare Medical Group, lets us in on the things pregnant women should and should not eat to help them make the healthiest choices for themselves and their baby. MemorialCare Medical Group recently welcomed a group of OBGYN physicians, including Dr. West, in a beautiful new office located at Douglas Park in Long Beach. We're thrilled to have her on our show today. Welcome, Dr. West.

Elizabeth West, MD: Thank you so much for having me.

Deborah Howell (Host): Now, everybody's told me you're very, very passionate about this topic. Why so?

Elizabeth West, MD: Yeah, they are completely right. Before I decided to go to medical school, I thought I was going to become a nutritionist. And so I spent a lot of time doing research in nutrition and working in a nutrition lab and then I realized I really liked working with patients one-on-one. And so once I decided that I wanted to become a doctor and work directly with patients, I knew that I wanted to incorporate nutrition directly into my practice.

Deborah Howell (Host): Fabulous. Well, I'm glad you did. What food and drinks should women avoid while they're pregnant?

Elizabeth West, MD: Well, we have a long list for patients that we always provide to them at their first prenatal visit, but it's certainly foods that we want to avoid bacteria exposure during pregnancy as much as possible, so really focusing on well-cooked foods is important. So avoiding raw meat, avoiding sushi, and then avoiding potentially bacteria-infested peels of fruits and vegetables. So we have patients just wash all of their fruits and vegetables really, really well. And then avoiding smoked meats, unpasteurized cheeses and milk products, and unpasteurized raw eggs. So, you know, in cookie dough and hollandaise sauce, certain products like that, raw eggs are included. So we just have patients be really, really careful and ask the people providing them their food at restaurants and things like that if foods have been pasteurized as well.

Deborah Howell (Host): Okay, now when you say meats, you say raw meats, like I'm thinking like carpaccio or something like that. But what, you know, should they have all their meat well done or medium well while they're pregnant?

Elizabeth West, MD: Yeah. Yeah, I would say for red meat, certainly having it well done is, For deli meat, because there is a risk of listeria exposure, we do tell patients to microwave deli sandwiches until they're steaming hot, which would kill the bacteria. And then avoiding pate, avoiding sushi, and avoiding undercooked rice. Avoiding meats like carpaccio and things like that would certainly be our recommendation. You know, no raw shellfish, no raw oysters, things like that.

Deborah Howell (Host): That brings me to my next question. Seafood is a great source of protein, but of course there seems to be quite a bit of confusion around fish and seafood. What should women know about this as they're pregnant?

Elizabeth West, MD: Yeah, it's a huge concern because, you know, on the one hand, as you said, fish is a lean source of protein. It has a tremendous amount of omega-3 fatty acids in it, which are great for fetal brain development and eye development. But at the same time, it can be a potential for mercury poisoning. And mercury is essentially a toxin that's from pollution in the waters, and then it gets incorporated into the meat of the fish. And so we want patients to avoid fish that have the highest levels of mercury. So shark, swordfish, king mackerel, tilefish, large tuna, all of those have high you can't cook the mercury out of fish. But there are a lot of types of fish that are very low in mercury. So salmon, tilapia, shrimp, even like light canned tuna, cod, catfish, all of those fish are very, very low in mercury. And so we recommend those in pregnancy. And we generally recommend patients have about two servings of fish per week just to avoid, again, mercury exposure.

Deborah Howell (Host): What about fish oil pills?

Elizabeth West, MD: You know, in general, in pregnancy, we do want patients to be getting omega-3 fatty acids. And so if they're eating fish twice a week, they don't need to supplement with omega-3s. However, if a lot of patients, because of their nausea and food intolerance during pregnancy, food aversion, don't want to have any fish just because of the smell or the taste, and so we just tell those patients that they can take an omega-3 fatty acid supplement, which is actually included in a lot of the brands of prenatal vitamins you can get over the counter. The recommendation is 650 milligrams of omega-3 fatty acids per day, 300 milligrams of DHA supplement. but that would be included in the prenatal vitamin. Or there are omega-3 fatty acid-rich foods like salmon, certain nuts like walnuts, flaxseed, flaxseed oil. So we would be happy to provide our patients a list of those things if they didn't want to take it in a pill form.

Deborah Howell (Host): Oh, that is great. Great to know. Can we talk about some of the important nutrients that pregnant women need?

Elizabeth West, MD: Yeah, absolutely. So I think for our pregnant patients, it's really about a balanced diet that's as varied as possible and remembering that patients really are not eating for two. That's sort of a common misconception that everyone likes to think about in pregnancy, but really they only need to have about 300 more calories per day than a non-pregnant woman, which is not much when you think about, you know, how caloric our general foods are.

Deborah Howell (Host): It's less than a candy bar!

Elizabeth West, MD: Exactly, exactly. And so, you know, it's certainly not a time to just binge eat and go too crazy, unfortunately. But, you know, it's really about having variation in the diet so that patients are getting a good amount of protein. They're having varied exposure to fruits and vegetables, which of course, some are higher in vitamin C, some are higher in vitamin A, some are higher in vitamin E, so that they're getting that exposure. Eating whole grains as opposed to white rice, white bread, and sort of simple carbohydrates, although patients tolerate them really well in the first trimester when they're so nauseated, in the second and third trimester, I tell them, try to go to brown rice, try to go to whole grains, you know, change to sweet potatoes from white potatoes so that you're getting more and more nutrients. Taking a prenatal vitamin every day is really important because so many of those micronutrients, the vitamins and minerals, are really important throughout the pregnancy. And it's just impossible to get the complete variation from your diet.

Deborah Howell (Host): Is there a difference between prenatal vitamins and what you call, I don't know, natal vitamins while you're pregnant?

Elizabeth West, MD: Yeah. So, you know, patients often ask me, if I just take a normal vitamin, you know, a women's vitamin, what's the difference between that and a prenatal vitamin? And a prenatal vitamin basically is perfectly balanced for a pregnant woman. So it's going to have the perfect amount of folic acid, which is going to be somewhere between 400 and 800 micrograms. And folic acid is really important for neural tube development, or basically the development of a normal brain, normal spinal cord. And all of that happens extremely early in the pregnancy. Generally, before a woman even discovers she's pregnant, the fetus has already formed that neural tube.

Deborah Howell (Host): Wow.

Elizabeth West, MD: So I always recommend my patients, start taking prenatal vitamins three months before they decide to conceive. Or if they're just a young, healthy woman coming into my office for, you know, whatever reason, and she's not planning on getting pregnant yet, but she's talking to me about taking vitamins, I say, why not just take a prenatal vitamin now so that you know that your folic acid levels will be good In the event that you get pregnant, you'll know that the baby will have, you know, the least likelihood of having a neural tube problem during development.

Deborah Howell (Host): Sort of like pre-insurance. I like that.

Elizabeth West, MD: Exactly. Exactly. The other thing about the difference between prenatal vitamins and other vitamins is that there are certain vitamins that are toxic to a developing fetus if they're given in really extremely high doses. So vitamin A, we don't want patients to be taking huge amounts of vitamin A because it's actually toxic to the developing fetus. And some over-the-counter general vitamins have really high doses of vitamin A. And so that's why we always tell them, just take the prenatal vitamin because we know that the amount of vitamin and mineral content is going to be really, really designed mostly for a pregnant woman. And we know that it's not going to have toxic levels of vitamin A.

Deborah Howell (Host): Perfect. I have one final question for you. How can expectant moms know if they're eating well?

Elizabeth West, MD: Well, you know, we don't check vitamin and mineral levels throughout the pregnancy unless patients have, unless they have specific restrictions in their diet. For example, for our vegan patients, we sometimes check certain levels to make sure that they don't have anemia, to make sure that their B12 and their folate levels are okay. But for the average patient, as long as they're able to take a prenatal vitamin most days, even if they miss one or two, it's okay, and they're gaining weight appropriately, it's their urine isn't extremely concentrated, they're feeling well hydrated, and their belly is growing, we measure the belly at every visit so that we know that the baby's growing well, then we feel reassured. Because ultimately, the fetus, the growing baby is going to pull nutrients out of the mom's system. And so the baby's going to have normal calcium levels because the babies can pull calcium out of the mom's bones. The baby's going to have enough protein and enough fat, but we want to make sure that the mom is really just replenishing her own levels so that when she's postpartum, she's able to sort of restore her own levels appropriately and also be able to produce good milk for the baby if she wants to breastfeed. But we don't check vitamin and mineral levels every visit or anything like that.

Deborah Howell (Host): Okay. Well, it's an incredible system, and you've given us a lot of pointers on how to make it start and end well. Thank you so much, Dr. West, for coming on the show today and enlightening us.

Elizabeth West, MD: My pleasure.

Deborah Howell (Host): For more information or to hear a podcast of this show, go to memorialcare.org. And for this segment, go to www.memorialcare.org slash OBGYN. That's it for me, Deborah Howell. Thank you so much for listening and have yourself a fantastic, healthy day.