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Caitlin Whyte (Host): During pregnancy, it's always important to maintain the typical healthy diet, but there are also certain vitamins and foods that will support you and your growing baby. Here to tell us more about the importance of nutrition for expecting mothers is Nichele Salazar, a Certified Nurse Midwife at San Juan Health Partners Midwifery and Women's Health.

Welcome to Celebrate Health, a podcast from San Juan Regional Medical Center. I'm Caitlin Whyte. So Nichele talking about all things nutrition today, start us off with what nutrients do pregnant women need to add to their diets?

Nichele Salazar, Certified Nurse Midwife (Guest): Oh yeah. There's, you know, we get a lot in our diet already, so you take a prenatal vitamin to kind of fill in those gaps, but some of the really important ones would be folic acid, which you would get from a supplement or a folate would be the natural form of folic acid in the food. And you want it to start taking about four hundred micrograms. And the goal is to try to get this done before you get pregnant, because it does help prevent open neural tube defects like spina bifida, or anencephaly, which could occur in like the first month before a pregnancy is even known. So, you know, you can get this from leafy green vegetables, cooked dry beans, nuts seeds, many foods are fortified in it now.

So we have seen a decrease in neural tube defects because of the fortification of foods. Choline, choline is another one that a lot of people aren't aware of. With choline, it helps the baby's brain, spinal cord development. Choline you can get from eggs. Eggs is one of the big ones, but you could also get it from like meat. Pregnant women probably need about 450 milligrams of choline per day.

And that's one, I mean, like I said, a lot of people are not aware of choline. Magnesium, magnesium, I call it the medicine of pregnancy. It really helps with a lot of common discomforts that you get at pregnancy. So, magnesium can help with constipation. It can help with headaches, leg cramps, especially those ones in the middle of the night. It can help to kind of calm down the Braxton Hicks contractions as we get a little bit longer. And it also helps the sleep. Important vitamin C of course, vitamin C. I feel like for awhile there, we were seeing a little bit of a maybe deficiency in vitamin C, but it seems like it's picking back up.

Vitamin C helps with healing. So, you think about what your body goes through in pregnancy, and you want to make sure that you have some vitamin C on board to help heal your body, especially postpartum. Iron, you know, it helps carry oxygen into the blood, to other parts of the body. In pregnancy, we need more iron just because we have more blood flow. So because of that, sometimes we need a little bit of supplementation. You will have your blood checked at the beginning of your third trimester to look for iron deficiency anemia. Some of the symptoms of iron deficiency are tiredness, fatigue, feeling dizzy. Sometimes people get like, they feel like they're going to be like, they're about to faint.

If people start feelling that, then that's something that kind of makes me realize that, okay, maybe we need to check iron, iron stores. Iron stores can increase the risk of preterm birth, heavy bleeding at delivery. So, we really want to make sure that we're, we're on top of that. Side effects of supplementation with iron can be a little bit hard, kind of like a prenatal vitamin. They could cause a little bit of stomach upset. Sometimes you could get a little bit of nausea and with iron, you could get a little bit of constipation. There are different ways to take the iron supplementation. So, that way you get full benefits of it. So making sure that you're not taking it with calcium because calcium will bind to it and it just goes right straight through you, you could take it with food or right before bed, so if it causes stomach upset. So talk with your provider and see what would be the best option for you. Calcium is also a really important part of a pregnant woman's diet and nutrition. Evidence shows that calcium can decrease the risk of preeclampsia with those who have inadequate calcium stores in the beginning of pregnancy. In prenatal care, it's really important to let your provider know if you don't do a lot of dairy sources so we can figure out what kind of calcium sources would be best, whether you need a supplement or whether we add in different foods that have calcium. Vitamin D is super important, kind of got left behind a long time ago, but now we're kind of seeing the importance of it, now that everybody's a little deficient in vitamin D. You know, it's super important for healthy bones, getting calcium into your bones. So, what we're seeing in research is that low vitamin D levels can increase your risk of depression, increase the risk of pregnancy complications like preeclampsia.

So it's really important to try to look at what your dietary sources are of vitamin D, which you know, they tend to be more like your meats, fish. If you do a little bit of fish, fortified foods, again, eggs, if you don't get a lot of that, then looking at the next step of supplementation, but also how much sun do you get?

Your body will make vitamin D at skin level. If you get some UVB rays from the sun, so that can increase your vitamin D in your body. But where we live, we're not able to make vitamin D like that, because of the winter time and where we're placed compared to the sun. So we don't get strong enough UVB rays during winter time.

So we definitely should encourage some supplementation during that time. So the risk other risks of low vitamin D that are super important is low vitamin D can actually cause an increase in bacterial vaginosis, can also increase respiratory infections and preeclampsia prior to 34 weeks. I think it's one, one vitamin that we really need to start looking into to making sure that we can bring people up to a normal range.

One of the other things too, in some of the research shows that it has people who increase their vitamin D levels, they actually decrease their C-section rate. And the theory behind that is that it helps with muscle function.

Host: Oh, that's so interesting.

Nichele: And even babies, babies, once babies are born, they should be getting vitamin D drops. So they should consult with their doctor to see if they need to get started. Majority of everybody does, but -

Host: That's a really good point. That is a very good point. Well, moving from nutrients to straight up foods, are there any foods that pregnant women should not be eating at all?

Nichele: Yeah, so I think one of the big things is you don't want to be eating any thing raw like raw meat, raw eggs, unpasteurized milk, or juices, raw sprouts, you have to be really careful with too. Soft cheeses like soft cheese. You can eat hard cheese. That's fine. But the soft cheese, you have to be careful with. Those that can tolerate meat, because sometimes first trimester you get food aversions and meat's a little hard.

You want to just make sure that there's not pink inside. Deli meats, people assume that you can't have like deli meats, like hot dog or lunch meats, but you can, as long as they're reheated. So the risk of that is, you know, like getting sick from bacteria and stuff. So you want to make sure that it's reheated to look steaming hot, where you can decrease the risk of getting any type of bacteria.

Fish is another one that you have to be really careful with. The area that we're at, you know, there's, there's, we don't eat a lot of shark or swordfish or King Mackerel that I know of. So you kind of want to stay away from those ones as much as possible because they do have larger amounts of mercury in them. Farmed salmon, you can have like once a month, one meal a week, you want six ounces of like the albacore white tuna. Two meals a week, you could do shrimp, canned light tuna, canned or wild salmon, catfish, flounder, trout. But you just want to stay away from all the raw stuff. So sushi, if you like sushi if it's cooked. Sure. If it's raw. No.

Host: Well, let's talk about morning sickness. We're always looking for cures to that. Are there any foods that can help with morning sickness?

Nichele: Yeah, I think the biggest thing was morning sickness, is you want to make sure you're eating. It kind of creates a little bit of a vicious cycle there because you know, you get nauseous. And then you don't want to eat anything, but if you go for a long period of time without eating, then the nausea and the vomiting gets so much worse. So it's really important to make sure that you're having a little something, whether it's bland, you know, like some crackers. I even tell them you have a little bit of ginger ale or Sprite if needed in the morning, but a little bit of something in your stomach will help to reduce that.

You know, a lot of it is actually diet changes. You kind of want to stay away from like the, you know, like fatty fried foods, spicy foods. Those might be just a little bit much for somebody who's experienced a lot of nausea and vomiting. Ginger is something that's really good to incorporate into your diet, especially that first trimester. They have like ginger teas. There's some little ginger candies that you can nibble on and that can help to reduce some of the nausea. Supplement wise for, for nausea and vomiting, I really encourage a vitamin B6. And usually you could take like 25 milligrams three times a day, and that can help to reduce that. You can also do a Unisom tablet.

Unisom has tablet and liquid form, but a tablet form to reduce that nausea. So you take it right before bed. Other things, you know, sometimes people do really well with cold drinks, eat things with high carbs, like potatoes, noodles, rice, and toasts. Those are pretty good to helping decrease that. Another thing that works really well too, are the acupressure bands. I know that's not nutrition, but -

Host: I have heard of those. That's interesting. It's always a good tip to have to.

Nichele: Yeah. I always see our nurses walking around with the, with the little band sometimes when it's, when it's that time.

Host: Yeah. Yeah. Well, what about foods that help nurture your growing baby? Let's talk about those.

Nichele: Yeah. So, you know, a lot of the thing, it's just, you want balance because you know, we all have, nutrition's really hard to put everybody all in one box because we all have different backgrounds and tastes and whatnot. So I always tell people what's best foods for baby is something that is well balanced. You know, you get a good amount of protein. You get some carbs in there, you get some fats in there, but you also have it's nutrient dense where they have a good amount of nutrients. It's not just, calorie dense where there's really no nutrition in it, just high in calories. So as long as you could get more nutrient dense foods, that is good. Other foods, whenever you're thinking about it, you know, like I always tell people, you know, yeah. Balance is one of the keys for that, but then, moderation and variety. I think variety is super important because when you have a variety of foods, you fill in those gaps for certain nutrients that your body may be lacking maybe with the previous meal and you could cover it the next meal. So variety and balance are key for foods.

Now, you know, like a lot of people like soups, stews, those are really good. Cause you put in a lot of vegetables, you usually have a protein source, maybe a little bit of a fat source, and then you can add a carb source to that. I think that's really good. Now with summer. I don't know if I would want to do that during the summer, but the summer you can mix it up with some salads and you can be really creative with your salads too.

Host: Wonderful. Always good to hear there's so many options to mix and match during our pregnancy. Well Nichele, as we wrap up here, just remind us about the link between a healthy pregnancy and what you eat. Why is this relationship so important?

Nichele: With pregnancy we know that nutrition is a piece of the puzzle for increasing the chance of a healthy pregnancy. The research shows us that the more balanced nutrition we have, the better the outcomes for mom and baby. If people are choosing the best options that they have available to them, the chances of them having a pretty safe, healthy pregnancy is very high. And what we know is that those that, you know, maybe are not as well balanced and maybe there's some other concerns, maybe we have a little bit more weight gain, and those can lead to some, you know, not bad outcomes, but can lead to more complications in the pregnancy. So we try really hard to prevent that with making some changes, lifestyle changes through nutrition, through activity.

Host: Well, thank you for sharing today. Always important to keep our moms healthy and well. Find out more by calling San Juan Health Partners, midwifery and women's health at 505-609-2590 that's 505-609-2590. And thanks for listening to Celebrate Health, the podcast from San Juan Regional Medical Center. I'm Caitlin Whyte. Stay well.