Pregnancy

Second Trimester Recap

I can’t believe my second trimester is already over. And I have to say I truly loved this trimester. Everyone’s experience is so individual with this, but I wanted to take some time to reflect on my experience and share it with you guys.

baby

My husband and I at our gender reveal when we found out we were having a boy!

My husband and I at our gender reveal when we found out we were having a boy!

One of the craziest things about the second trimester for me, is that it really started to feel like there was a HUMAN inside me. During the first trimester, I barely had a bump and I couldn’t feel the baby at all. So I knew something was different but it definitely didn’t feel like I was carrying around a little buddy all the time. This changed second trimester. Bump kept growing and we found out his gender at our gender reveal party at 15 weeks, which, made him seem so much more real. By about 18 weeks, I could also FEEL him. At first, when he was kicking and moving it just felt like bubbles in my stomach or little flutters. These could almost be mistaken for gas or something in my tummy but I knew they definitely weren’t. The technical term for this is “quickening” (2). By about 20-21 weeks I could feel full on kicks, which, was so amazing. I remember the look on my husband’s face the first time he got to feel a kick and it was truly magical. Our little babe stayed pretty active through out the second trimester and I continued to feel kicks, punches, rolls etc. get stronger and stronger. After about 25 weeks sometimes I could even see him moving in me if he was pressing up against my abdomen.

3D image of our baby’s face from the 20 week anatomy scan!

3D image of our baby’s face from the 20 week anatomy scan!

When I was moving, baby was usually still. When a mother is moving, it usually creates a rocking motion in the uterus that lulls the baby to sleep (1). However, if I was lying down (AKA every night when I went to bed), sitting on a plane or in client meetings, or even laying down in a workout class (he did this a few times when I was doing something like chest presses) he would wake up and let me know he was in there! I did not notice any kind of schedule or regularity with his movements other than that it was most prevalent when I was still. Some days he would definitely move more than others regardless of my movement patterns so I tried not to stress if I felt him less on any given day. From what I read, all his moving around is to strengthen his bones and muscles!

I also got to see baby in the ultrasound a few times during this trimester. Even though he already started taking the shape of a human during my first trimester ultrasounds, he was so much more developed by the second trimester anatomy scan, I had mine at 20 weeks. Our obgyn even did a 3D image of our ultrasound so we could get an idea of what his face will look like! I think he looks a lot like my husband did as a baby. Of course, the anatomy scan is for so much more than seeing the baby’s face and luckily everything has been right on track with him. Overall, baby definitely became like a part of the family during the second trimester because we thought about him and his needs more (present and future), we called him by name and we could see and feel him.

physical body changes

This was 14 weeks, 20 weeks, and 27 weeks. The beginning, middle and end of second trimester.

This was 14 weeks, 20 weeks, and 27 weeks. The beginning, middle and end of second trimester.

Although my belly grew a LOT during the second trimester, I actually felt like the rest of my body changed less than it did in the first trimester. Personally, I gained more weight in the first trimester than I did in the second. I think this is because of the increased blood volume that my body needed to carry a baby and overall just increased fluid everywhere. So the scale went up more first trimester than second and I felt like my legs/arms/face changed more then too. Second trimester those other things seemed to stabilize other than my rapidly growing belly.

I bring this up just to remind people not to get too caught up in the weight gain guidelines for pregnancy. Weight gain will not always be linear, it is not necessarily predictive of future weight gain (I know some people who will calculate what they’ve gained so far and try to extrapolate what the future weight gain will be), and finally it does not always tell much about your health or the baby’s health.

Again - 14, 20, 27 weeks. Beginning middle and end of first trimester.

Again - 14, 20, 27 weeks. Beginning middle and end of first trimester.

Back to my body changes: My hair continued to thicken. However, my skin and hair remained dryer than usual (this started first trimester and I have heard it is more common in boy pregnancies, but not sure if there is evidence on that. I used these pregnancy-safe products to keep everything feeling soft and hydrated: body lotion, face lotion, hair mask. My boobs did grow more (unfortunately since I really did not want to buy a second set of bras). However, I don’t think everyone’s do, according to my mom she also went from very small to very large during pregnancy so it may be somewhat genetic (sorry mom for putting this in here). I also started experiencing edema, or fluid retention, in my ankles and lower legs. Edema accounts for about 25% of the weight gain during pregnancy and about 85% of women experience some form of it (8). This was better some days than others and I tried to relate it to weather, humidity, how much I walked but I really couldn’t find a direct correlation so I think some days were just worse than others. I did buy several pairs of compression socks to help with this (putting links and descriptions below, not at all sponsored but I have gotten a few questions about this on instagram so I figured it could be useful for other). And I also bought a magnesium lotion to rub on my feet at night (which can sooth the muscles, and also promote sleep). And yes, I checked the ingredients on Environmental Working Group to make sure they are safe!

Compression sock guide:

These go all the way up to the knee and definitely work the best but are hardest to get on. I literally need my husband to help me at this point with my belly in the way. I wear them around the house or under long dresses so you can't see them.

These are similar to the above in that they are nude and have no toe so can be worn with sandals (I wear them with Birkenstocks) but they only go a little above the ankle so it kind of just pushes the swelling up but does make your feet feel better.

These are my favorite for athletic stuff. I've worn them to work out and on a hike, which, definitely helped on the hike. They're not cute (well none of them are) but they have toe coverage so are good to wear with sneaker.

On a hike on our baby moon at 26 weeks - wearing my super awesome compression socks (but they helped so much!)

On a hike on our baby moon at 26 weeks - wearing my super awesome compression socks (but they helped so much!)

I was really in love with my body and the changes it went through during the second trimester. The first trimester was a little harder since I felt like I had an awkward in between stage where I didn’t look pregnant but also didn’t look like myself. In the second trimester I was able to embrace the appearance changes that came with pregnancy. And overall I think I really practiced body love! However, there were definitely times I would see myself in a photo or mirror and think “wow I’m HUGE!” and wonder how much bigger I would get since I still had a long ways to go and a lot of baby growing to do. It was also frustrating towards the end of the second trimester when trying to do something like tie my shoe got difficult. And I’m not going to lie, sometimes I felt self conscious about my edema. But overall, I felt a new appreciation for my body and it’s ability to know how to grow a human… I mean that’s crazy! It knows where to put all the parts and organs and help them communicate to one another without me doing anything, so it is worth getting bigger.

going potty :)

This subject really shouldn’t be taboo because it’s an important part of daily life and can change a lot during pregnancy! Both number one and number two can change a good bit during pregnancy! See my experience and tips below:

Having my walking buddy, Claudette, definitely helped with regular bowel movements but also was a hassle when I had to pee constantly. This photo was at about 20 weeks.

Having my walking buddy, Claudette, definitely helped with regular bowel movements but also was a hassle when I had to pee constantly. This photo was at about 20 weeks.

Many women experience pregnancy constipation. I am now almost 30 weeks and have not had this one bit. The pregnancy constipation is said to be caused by a lot of things: increased relaxin hormone makes intestines work less hard, expanding uterus on the intestines and synthetic iron supplements (3, 4). Here are my thoughts on those: I definitely had increased relaxin as does every pregnant women, and my uterus was definitely crowding my intestines, I have such a small torso I feel like everything crowded EARLY on me, but I was not on synthetic iron supplements. My prenatal supplement does contain iron, but it is a whole foods based supplement so it is not in the synthetic form. I think this helped prevent constipation and also prevented anemia.

At my 28-week appointment, my obgyn was pretty surprised to report that I was not anemic at all since overall pregnancy anemia rates are about 25% of women but are usually higher than that in the second and third trimester (5). I also ate iron rich foods daily like dark leafy greens and grass-fed beef.

Back to constipation… what I truly think helped the most with my regularity throughout my first and second trimester (in fact, I would say I was even more regular than before!) was diet and lifestyle. I continued eating fiber rich foods daily: mostly fruits, vegetables, nuts and seeds and hydrating tons. And I also stayed active, whether that was a workout or walking or both. Activity improves blood flow to the colon (6), improves motility and increases the gut’s production of a bacteria called Akkermansia, which improves overall gut health (7). Finally, I stayed on the best quality prebiotic and probiotic supplement! I had switched probiotics in my first trimester to Just Thrive (code PRESS15 to save) and stayed on it through out my second trimester and I truly think this made a huge difference. Just Thrive has external studies showing 100% survivability through the gastric environment, which, almost no other probiotic on the market has, and thus is truly EFFECTIVE.

I somehow made it through my entire Boston baby shower (where this photo was taken) without peeing! Huge win. Also loved when Claudette and Matt came at the end.

I somehow made it through my entire Boston baby shower (where this photo was taken) without peeing! Huge win. Also loved when Claudette and Matt came at the end.

So long story short, my pooping was great and yours can be too! Just make sure to eat plenty of fiber, hydrate like it’s your job, stay active, switch your prenatal iron supplement if it is the synthetic form and get on a good prebiotic and probiotic (this will also help your baby’s gut microbiome!) see recommendation above.

My peeing, however, was a little annoying. I think there was a combination of factors contributing to my excessive pee trips and they started at about 20 weeks, which, I think is pretty early. They weren’t unmanageable but I am definitely sick of peeing! One factor is my small torso. Like I said, everything crowded on me early, including my bladder. If you are taller or have wider hips you may not feel crowding as soon as I did but baby had nowhere to go! Another factor is that I consciously worked to maintain hydration, which, I definitely think helped prevent any constipation, but it came with a cost. I actually felt my excessive pee trips subside for a bit at the beginning of the first trimester when the uterus goes from sitting very low (on the bladder) and rises up a bit to give some bladder relief. But as soon as baby and uterus started growing significantly (18-20 weeks for me) the pee trips started coming.

appetite

Through out my whole pregnancy I have really listened to my body when it comes to eating. I truly always try to practice this but I knew it was especially important during pregnancy. Hunger is a message from our bodies (and in this case also our babies) telling us it needs fuel so there is no reason to ignore that even if you feel like you’re eating more than normal (you should be) or gaining more weight than you anticipated. As long as you are making mostly healthy choices, see my prenatal nutrition blog post here, I wouldn’t stress about it!

This photo has nothing to do with appetite but we had the best time (and ate the BEST food) on our babymoon in Ojai Valley during our second trimester and I’m so grateful for it! You can also see the edema in my ankles in this photo.

This photo has nothing to do with appetite but we had the best time (and ate the BEST food) on our babymoon in Ojai Valley during our second trimester and I’m so grateful for it! You can also see the edema in my ankles in this photo.

Anyways, my hunger has fluctuated a lot. I really never experienced a loss of appetite like some people but my extreme hunger from first trimester subsided weeks 12-16 and I felt like I was back to my usual eating amount. However, my appetite picked back up weeks 16-19 and then again stabilized for a bit. I’m not sure if these appetite shifts were due to baby’s growth spurts or what but there were definitely days and weeks I was pretty ravenous and then days that I felt like my usual self in terms of hunger.

Something that started to happen during the second half of the second trimester as the baby got bigger and my stomach began to crowd, was that I got full much more easily. I found myself eating smaller meals through out the day since large portions really felt uncomfortable. The crowding in my stomach also sometimes prevented me from noticing I was hungry and I didn’t feel hunger until I was truly starving. For the most part, I was pretty proactive about snacks so this wasn’t a huge issue but it was interesting sometimes feel completely fine and then the next moment notice my stomach was grumbling. This was because I couldn’t really feel that in between stage.

getting used to being pregnant

Embracing my bump and the fact that I “looked pregnant” was a big part of the second trimester for me.

Embracing my bump and the fact that I “looked pregnant” was a big part of the second trimester for me.

During the first trimester pregnancy is usually mostly “secret” so it partially doesn’t even feel real. This changes a lot during the second trimester. It was really nice to be able to share the exciting news with the world, and also random strangers started being extra nice to me. However, I also noticed that around 20 weeks random strangers would ask things like “when are you due” “boy or girl” etc. I know they meant well but you really never know if someone is pregnant or just appears pregnant because of some other condition. So I think it’s a little rude and presumptuous to ask things like this when you don’t know for sure the person is pregnant. I also think some (not many by any means) other pregnant women got comparative/competitive during this time about who looks like what and everyone’s body is going to go through this process SO differently.

These comments from strangers did make the pregnancy feel more real and like I was sharing it with the world. Sometimes, because I’m in my own body, I just feel like me and can forget about the pregnancy but all these external things definitely made it feel more real in the second trimester. Strangers and casual acquaintances also love to give advice about the pregnancy and being a parent. So that’s something I have gotten used to. In the first trimester pregnancy is so new and any changes you might make to your life feel new and temporary (changing the way you eat, drinking alcohol etc.) but by the end of the second trimester it just becomes your new normal.

One part of pregnancy that a lot of people struggle with is sleep. Again, I am lucky not to have had this problem very badly yet. However, I’ve heard that by the end of the third trimester that will definitely change. I haven’t invested in a “pregnancy” pillow yet. I just take my magnesium at night, put a pillow between my legs, put my eye mask on and I’m good to go. My body temperature is way higher during pregnancy so I’ve had to be mindful of that to ensure I can sleep. I pump the AC way up in our house or else I will lay there restlessly.

energy

Definitely felt my best when I could stay active! I am grateful to have had plenty of energy this trimester.

Definitely felt my best when I could stay active! I am grateful to have had plenty of energy this trimester.

Everyone told me that second trimester is the best for energy and so far I will agree with that. I was finally able to get up a little bit earlier. However, knowing this is the last time I will be able to sleep on my schedule for about 18 years (or more), and also knowing that my body is doing a lot of behind the scenes work to grow a baby, I have given myself grace with getting up and still have allowed myself to sleep in a bit every day. Since I create my own work schedule, I have had the luxury to do this. I also don’t usually feel as exhausted at the end of the night as I did first trimester. I have been getting about 9 hours of sleep nightly, sometimes 10, and once in a while 8 and that has been leaving me feeling great and energized during the day. I have been able to travel tons (10 plane trips in 3 months), go on hikes, maintain my workout schedule, cook and have plenty of play time with Claudette! We’ll see how this energy lasts into the third trimester.

emotions and preparation

Enjoying some time as adults with no baby (Claudette was at camp) in Ojai at 26 weeks.

Enjoying some time as adults with no baby (Claudette was at camp) in Ojai at 26 weeks.

I have felt a huge sense of gratitude in the second trimester. There was a time when my husband and I did not know if we would be able to have kids of our own and every time I looked down at my belly or felt the baby kick I was reminded how special he is! There were also certain times that it was like holy *@#&$ this is happening! And we would both realize that this is the last time it will be just the three of us (Claudette counts too). It made me really want to appreciate the right NOW.

I have been slightly more emotional as well… hello hormones. For example I started balling during the first episode of Pen15 and also throughout the entire remake of Dumbo. Neither one really is so sad to elicit that amount of tears but what can I say? But overall, I don’t think I have been especially moody. If anything, I’ve been a little more chilled out and relaxed than my usual self.

During the second trimester I started thinking about preparing for baby and birth more. This is when I really started doing research about different types of births, methods, interventions etc. I started interviewing doulas (at the time I am writing this blog I still have not picked one because I liked all of the ones I interviewed), and looking into birth classes and infant CPR classes. I also started to think more about the nursery, but still have not started it. Birth preferences are such an individual decision so I encourage you to do your own research. However, these are some books that really helped me through this exploration process:

  • The Ina May Gaskin Guide to Childbirth - this book is really empowering for women and I think helpful to read even if you don’t want a natural childbirth. It helps women realize that their bodies are capable of so much more than they think!

  • Cribsheet - another book by Emily Oster (who wrote Expecting Better, which, I have referenced numerous times in my pregnancy blog posts). This is a completely data driven book about what comes after pregnancy. It starts with birth but most of the book is spent on infancy and early childhood. I really appreciated that it is unbiased and just gives you the EVIDENCE so you can make decisions for yourself.

  • How to Have a Natural Hospital Birth - this book is more for people who want a natural birth but are not giving birth at home. It is written by a doula and I found a lot of helpful, practical information.

clothes

Second trimester is when it started to get really tricky to fit into my non-pregnancy clothes. Obviously as the trimester progressed this became more and more true. It can be super expensive to buy all new stuff so I thought I’d share what I liked to hopefully save someone some $$ on stuff that won’t work. However, obviously everyBODY is so different so these suggestions may not work for you but at least can be a starting point:

  • Cute clothes for going out to dinner/vacations etc. - I splurged on a few staple items (nice jean shorts, nice jeans and some white jeans), a few cute tops and a few dresses. I got most of my items at A Pea in the Pod maternity (favorite jeans were Paige and Joe’s) and also found a cute maxi dress at Old Navy. I also found some cute staples at H&M maternity but the sizing was very strange so I had to order a ton of sizes and just return whatever didn’t work. However, to be honest most of the maternity stuff I tried from Old Navy and Gap did not work for me so I ended up deciding to spend more per item but just buy less items since fit is so important.

  • Workout tops - I was lucky that a girlfriend loaned me a lot of her maternity workout tops so I didn’t have to buy a ton. However, here I did find some great ones at Gap Athletic and they always have sales so were pretty reasonable!

  • Leggings - I wear leggings to workout and most days to work (since I work from home and especially now comfort is so important)! My favorites were Love and Fit (use code PRESS10 to save $$) and Lulu Lemon Align leggings. The love & fit shop leggings are amazing because they are also meant for postpartum. However, they did stop fitting me around 25 weeks (although I’ve heard some people wear them all the way through second trimester). I will definitely be rocking them again postpartum since they have a super suction waist band that I think will help hold everything in. Also, got some of the Love and Fit nursing bras and nursing sweatshirts that I will definitely be using a lot! The lulu lemon aligns are not technically maternity leggings but are super stretchy and comfortable and I have still been able to wear them through 32 weeks. I did order some Gap maternity leggings that did not work for me at all, they stretched out a lot and were “saggy” as soon as I moved.

  • Bathing suits - I got one great one-piece at A Pea in the Pod which was more of a splurge and then a really cute bikini at Old Navy which was super reasonable. For the bikini, I got maternity bikini bottoms in my regular size and then sized way up and got a non-maternity bikini top.

references

  1. https://www.webmd.com/baby/fetal-movement-feeling-baby-kick#1

  2. https://www.oviahealth.com/guide/10207/week-16

  3. https://americanpregnancy.org/pregnancy-health/constipation-during-pregnancy/

  4. https://medlineplus.gov/ency/article/007478.htm

  5. https://americanpregnancy.org/pregnancy-concerns/anemia-during-pregnancy/

  6. https://www.mayoclinic.org/diseases-conditions/intestinal-ischemia/symptoms-causes/syc-20373946

  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188999/

  8. https://americanpregnancy.org/pregnancy-health/swelling-during-pregnancy/

What You Really Need to Know about Prenatal Nutrition

I have seen several types of doctor’s regarding my fertility, and then later, my pregnancy, and I truly loved all of them. However, none of them spoke to what to eat when you are pregnant. I know most medical programs require only a few hours in nutrition training, but pregnancy is a crucial time to be choosing the right foods. The only guidance I personally received were a few handouts about what to avoid (the typical deli meat, raw eggs, certain fish) etc. Many of these guidelines are actually extremely outdated and not necessary to be avoided AND can cause women to miss out on important nutrients for their growing babies (more on that to come in a separate blog post). However, I really did not receive anything that even had basic nutrition advice like to eat lots of fruits and vegetables!

I think there is also the general inclination that if you are taking a prenatal, everything is ok. This is flawed thinking for several reasons - 1) not all prenatal vitamins are created equal, some are synthetically created in labs and will act differently in the body than those from whole food sources and different ones just have different nutrient profiles, synthetic or not and 2) you can’t out-supplement a bad diet. A 2019 study of 1,000 pregnant women in the US found that a majority of pregnant women are not receiving enough of certain nutrients despite being on a prenatal vitamin, the most deficient were Vitamin D, Vitamin E, magnesium and iron. By contrast, most pregnant women were getting too much sodium (6). Given that over 75% of sodium intake is from processed food not table salt, it means many pregnant women in the US are eating too much processed food, and relying too heavily on prenatal vitamins that aren’t holding up .

Many people take the 10 months of pregnancy as a free pass to forget nutrition since they aren’t trying to fit into their skinny jeans… so why eat healthy right? This is really unfortunate, and I am not trying to blame anyone. I think most people are genuinely trying to do their best with the information they are given. However, the information they are given is, unfortunately, not very complete. So, I’m trying to correct this by highlighting a FEW of the most important things to consider when eating while pregnant. Please note this blog post is not all inclusive, it is just a few topics that I think are not mentioned enough in the mainstream, so if you are pregnant or looking to become and want to optimize your nutrition, I recommend working with me or someone else on a one on one basis or reading a book about prenatal nutrition or a combination of the above. My two favorite books on the topic are Real Food For Pregnancy by Lily Nichols and Expecting Better by Emily Oster (this second one only has a few chapters on food but it does go into the data behind food borne illnesses and pregnancy so you know what’s actually important to avoid and what isn’t). Hint: a lot of the stuff we are told to avoid is not supported by the clinical evidence!

Vitamin A

It’s important to look closely at your prenatal and your diet to ensure you are actually getting enough of this important nutrient since it can be confusing. Many people think vitamin A is found in beta carotene rich foods (brightly colored vegetables like sweet potatoes, carrots, bell peppers). However, this is actually provitamin A, or carotenoids (5). There is nothing wrong with carotenoids but most people have a very low conversion rate of provitamin A to preformed vitamin A. Preformed vitamin A is crucial for fetal growth and gene development and specifically impacts the heart, eyes, ears, limbs and immune system (7). Lack of vitamin A (this is PREFORMED vitamin A) can lead to serious malformations of the head, face, limbs, and internal organs (8).

So back to where you can get your vitamin A. Since our conversion of provitamin A or beta carotene is low and even lower in individuals who eat a lot of beta carotene (unfortunately, since I am one of those people) (9). I actually had my conversion rate tested and assumed since I ate so healthy it would be high, but actually my healthy eating worked to my detriment since I do not convert much betacarotene into preformed vitamin A so I must eat my preformed vitamin A. Even if you don’t eat a lot of sweet potatoes and carrots, the maximum conversion rate in any human is pretty low so it’s important to get your vitamin A in it's usable form.

I always think the best source for anything is food, preformed vitamin A can come from things like pasture-raised egg yolks, grass-fed beef, full-fat grass-fed dairy and liver (be careful with liver since too much vitamin A in pregnancy can have detrimental effects and this one is the most concentrated sources). But you can also check your prenatal vitamin to see if it says the form of vitamin A. Mine says “vitamin A …. beta carotene, carrot”. This is not preformed vitamin A, I know I must eat some sources of preformed vitamin A, which, is why I’ve made sure to eat properly raised meat and eggs through out pregnancy. You can read more about what to look for in meat in blog post here.

Calories

My personal opinion is that calories oversimplify things. I don’t believe in counting calories as a means of healthier eating ever, let alone in pregnancy. Our bodies are not calculators or machines and there are SO many factors that will impact your overall nutrient need each day. And by the way calories totally ignores nutrients, it just tells you how much energy is required to raise the temperature of 1 kilogram 1 degree celsius… so really calories are not important, but the types of foods we eat are. And then in terms of quantity, I am a big believer of listening to your body. Hunger is a message from your body telling you to eat more. When you are full stop eating. This same principle applies to pregnancy.

Yes, you will need more calories when pregnant. Even when your baby is just a few cells, your body is doing A LOT behind the scenes, so you may experience increased hunger. In these cases, the calorie guidelines can seem too low. Personally, I was hungriest first trimester and was eating more than the “zero” extra calories (1) recommended by the American Academy of Dietetics, but it didn’t seem like the right time to ignore the signals from my body and stay hungry so I did not surpass recommended calorie guidelines.. However, some women experience nausea and food aversions that counteract this hunger in the first trimester. So for these people, the zero extra calories in the first trimester may work. Also each pregnancy is different. So I don’t necessarily think a very specific calorie number (340 calories in second trimester and 450 in third) is helpful (1). Like I said, each day is different and counting calories can be tedious and distracting from making healthful food choices.

Long story short, I don’t think anyone should get too hung up on the calorie guidelines during pregnancy (or ever). I will repeat it again, we are not machines or calculators and there are too many factors to count that will impact our daily nutrient needs. A much better policy, is to focus on getting a diversity of real whole foods that will nourish ourselves and our growing babies and to listen to the signals our amazing bodies will give us!

Carbohydrates

This is the only non-essential macronutrient. There are three macronutrients - carbohydrates, proteins and fats. Of these three, there are essential amino acids (which are the building blocks of proteins), essential fatty acids (fats) but no such thing as essential carbs (2). Essential nutrients are ones that your body cannot produce itself, but needs to survive. I am not saying everyone should go 100% carb-free, or even low carb. However, there are lots of non-nutritive carbs in the modern diet. So I am definitely saying be wary of these. And also noting that if you don’t include as many carb-dense foods, it won’t necessarily be detrimental.

One of my favorite colorful, unprocessed ways to get carbohydrates and load it up with fat, fiber, protein and other nutrients is sweet potato toast. Recipe is on my website!

One of my favorite colorful, unprocessed ways to get carbohydrates and load it up with fat, fiber, protein and other nutrients is sweet potato toast. Recipe is on my website!

In fact there is lots of data to support that too many carbohydrates can have detrimental outcomes for pregnancy. Most people know about gestational diabetes as one of these risks but there are risks even before women reach the gestational diabetes threshold. I think processed carbohydrates are overemphasized during pregnancy, which, inevitably crowds out more nutrient dense items from people’s plates and causes chronically spiked insulin levels (which, is problematic even if one does not have gestational diabetes). As my clients and those who follow me closely know, I always recommend colorful carbs first (carbs that come from whole foods like fruits and vegetables) since these are rich in phytonutrients (vitamins, minerals, antioxidants etc.) and are naturally paired with fiber. I also recommend avoiding “naked carbs” to help manage blood sugar, by pairing carbohydrates with a quality protein and/or a fat. You can read more about this in my balanced plate blog post here.

Now, back to what can happen when you don’t manage your blood sugar in pregnancy. Reminder: the food that will impact blood sugar/insulin the most is carbohydrates, so you can manage it by choosing whole foods carbs and pairing them with protein, fat and fiber. A 2015 Stanford University study that shows that elevated blood sugar far below the threshold for gestational diabetes is linked to significantly higher risk of congenital heart malformations in the babies of those mothers (3). Another study shows that high insulin levels in early pregnancy were linked to significantly higher risk of neural tube defects in babies (4). A higher carbohydrate diet during pregnancy is also linked to a higher risk of developing gestational diabetes, preeclampsia (high blood pressure), gall bladder diseases in pregnancy and for your baby to grow unhealthily large (macrosomia) and increases baby’s chances of having heart disease, diabetes and impaired lung development (5). A little processed carbs won’t kill you or your baby or give you a completely unhealthy baby. I don’t think it’s a good use of time to stress about every morsel that goes into your mouth. However, I do think we need to all take our carbohydrate consumption during pregnancy a little more seriously given that they are non-essential, so there is in’t a minimum required for life AND there can be detrimental outcomes of eating too many, especially of the non-nutritive ones.

My favorite sources of carbohydrates for anyone, pregnancy included, are COLORFUL whole foods sources. Whole foods means unrefined carbohydrates as close as possible to their original source. So if you look at the label on whole wheat bread, there are usually 20 plus ingredients and each of those ingredients may be processed. That’s not necessarily very close to the source. However, if you look at a sweet potato or some lentils those ARE the original source so they are great whole foods carb sources. And nature is so smart it filled these foods with nutrients that are important for the developing baby. The things that gives fruits and vegetables their colors also have so many health benefits. The phytonutrients are what gives these fruits and veggie carbs their colors (and yes white is a color so I’m pro potatoes, cauliflower, coconut, garlic etc.) Plus, the less processed the carb, the more it will allow your blood sugar to remain balanced (which means it is less likely to cause the complications mentioned above with gestational diabetes or really just high insulin variability even before GD kicks in. So moral of the story here is to choose your carbs wisely (whole foods carbs) and if you don’t choose to eat that many every day, you may just be fine, as long as you are eating enough overall since carbohydrates are not essential.

Choline

One of my favorite choline-rich meal prep recipes is my easy frittata! This is a version of the one on my website in the recipes section.

One of my favorite choline-rich meal prep recipes is my easy frittata! This is a version of the one on my website in the recipes section.

This nutrient is very often forgotten or not mentioned when it comes to prenatal nutrition but it is extremely important. Choline is required for fetal brain development, prevents neural tube defects and helps with placental function (23). In fact, some of its functions are actually similar to folate, which is commonly discussed, however, choline is rarely discussed.. One of the best sources of choline, and my personal favorite is egg yolks. Beef liver is also rich in choline. However, it is very hard to get choline from a plant-based diet. The recommended minimum of choline in pregnancy is 450 mg a day. One egg with the yolk provides 115 mg, by comparison 1/2 cup of cooked pinto beans, brussels sprouts, or broccoli provides 30 mg (30 mg). So you could have 4 eggs with yolks and get to your daily choline requirement, or have 8 cups of broccoli, pinto beans or brussels sprouts. I LOVE broccoli and that even seems like a lot to me. Feel free to get your choline how you want, but in my opinion it is easiest to get enough choline when eating animal foods. I also specifically picked a prenatal for myself that contained some choline as insurance for if I’m not eating 4 eggs a day, which let’s be honest, I definitely do some days (I LOVE eggs), but there are days I don’t eat any eggs.

Although 450 mg is the minimum required amount of choline (I made sure to find a prenatal that includes choline, this is honestly pretty rare!) and also ate a lot of eggs during pregnancy (those who follow my social media probably noticed this), studies have shown that the optimal amount of choline is more than 900 mg per day. This level is specifically beneficial to fetal brain development and placental function (24, 25). A 2018 randomized, double-blind, controlled study (AKA the gold standard when it comes to clinical studies) tested the effect of a prenatal diet containing 480 mg of choline per day compared to a diet of 930 mg per day on infant brain development. The infants of mothers who were given both the 480 mg and 930 mg choline per day during the third trimester were tested at 4, 7, 10, and 13 months of time for visuospatial memory and information processing speed. The infants born to the mothers who got 930 mg of choline per day had significantly faster reaction times at all four age testing intervals (26), thus showing that perhaps our current choline guidelines are not enough or mothers do fine with the current choline recommendations but would do better with more choline.

Vitamin D

Here I am shading myself from the sun (so therefore reducing my vitamin D exposure) and hence why supplementation is often necessary. I’m also snacking on nuts and fruit! Great, portable, unprocessed combo that hits PFFP.

Here I am shading myself from the sun (so therefore reducing my vitamin D exposure) and hence why supplementation is often necessary. I’m also snacking on nuts and fruit! Great, portable, unprocessed combo that hits PFFP.

Most prenatal vitamins only contain about 400 IU of vitamin D but at this level most pregnant women are still deficient in vitamin D. 40-60% of the pregnant population in the US is deficient in vitamin D (6, 10). That’s a lot! So additional supplementation clearly seems necessary or making sure to eat lots of vitamin D rich foods (or both). Studies have shown that 4,000 IU of vitamin D daily is ideal for both mother and baby during pregnancy (11). Unfortunately so many of our modern diet resources tell us to avoid naturally vitamin D rich foods (ex: eat only low-fat dairy when vitamin D is a fat soluble vitamin and will be more bioavailable and present in full fat dairy, or eat only egg whites even though the yolks contain the fat necessary to absorb vitamin D and vitamin D itself). But by sticking to a more whole foods based way of eating we can make sure we are getting more usable vitamin D, whether we are pregnant or not. I consider full fat dairy to be more of a whole food than reduced fat, since they replace the fat with sugars, chemicals etc. and it decreases the nutrient value of things like vitamin D, and same with eating whole eggs vs. egg whites.

Since vitamin D is so important for the mother’s health, and there are increased needs during pregnancy, it is related to immune function, healthy cell division, bone health, metabolic function, insulin sensitivity, good sleep and brain health and has even been shown to be preventative for many types of disease such as cancer (11). That being said vitamin D is super important for mama and she has increased needs because baby is taking some, so I don’t think 400 IU cuts it!

Another factor to consider when thinking about vitamin D, is vitamin K2 since vitamin K2 will impact the absorption of vitamin D and also vitamin A (all fat soluble vitamins). Vitamin K2 is different from the plant form of the vitamin (vitamin K1) which does not help with vitamin D and calcium absorption and therefore bone health in the same way. Vitamin K2 is important for mineral metabolism in the body (making sure all the minerals get to the right place, i.e. making sure baby’s skeleton, teeth etc. are all formed correctly and are strong!) It is also important for mother’s bone health and if she does not have enough to provide for baby, her body will leech vitamin K2 from her bones and tissues to give to baby, which, is a good thing for baby but can leave mom with all sorts of complications postpartum, like maternal osteoporosis (5). So the solution here is to get a vitamin D supplement that also includes K2 (I like this one) and/or eat vitamin K2 rich foods such as full fat dairy, egg yolks (yep the same ones that include vitamin D, how smart is nature!?), liver, grass-fed butter and ghee, grass-fed beef, dark chicken meat (12). Finally, vitamin D can be absorbed from the sun. However, if you live somewhere with short days part of the year and do not spend the majority of your day outside and/or avoid sun exposure, you can’t rely on the sun for your vitamin D. Again, I’d look at your total intake and assess how much supplementing you think you will need, but most people need at least SOME.

Omega-3 Fatty Acids - DHA

One of my favorite meals during pregnancy was salmon with zoodles and my avocado pesto (SO creamy and decadent!) Recipe for the pesto is on my website. This salmon is Sizzlefish of course! See link and discount below.

One of my favorite meals during pregnancy was salmon with zoodles and my avocado pesto (SO creamy and decadent!) Recipe for the pesto is on my website. This salmon is Sizzlefish of course! See link and discount below.

There are several types of omega-3 fats: ALA (the plant-based form), EPA and DHA. DHA is by far the most important for brain health and baby’s and toddlers brain development, in fact the plant-based form has almost no impact on baby’s brain development because the conversion into the usable form of DHA is so low (5). These important DHA fatty acids are found almost exclusively and most prevalently in wild caught seafood. Unfortunately, many pregnant women have been told to avoid seafood or to limit it to very small amounts. The reasoning behind this is mercury toxicity which could be a very harmful neurotoxin, however, if you are smart about your fish consumption this should not be an issue (more on this below). Avoiding fish can have a detrimental effect on their baby’s developing brain. A study of over 1,200 mother-infant pairs looked for a correlation between fish consumption and IQ and eating over 12 oz of fish per week correlated strongly with the baby’s with the highest IQs and actually the babies with the lowest IQs came from mothers who consumed no fish at all (13).

Well if mercury is a neurotoxin and some fish contain mercury, how can eating fish be good for you? First of all, fish are also naturally high in selenium (even more so in their raw form so the sushi off limits thing does not make total sense either but again that’s another blog post). Selenium helps the body detox mercury (14). Mother nature at it again with how amazingly smart she is! So the net effect of any mercury should be minimal especially if you are choosing the right type of fish. Fish to avoid:

  • Farm-raised fish, these are usually given antibiotics and hormones that you and baby don’t need in your body, and also can be hosts to antibiotic resistant bacteria that can be harmful (15, 16, 17). Additionally, farm raised fish are also proven to have higher levels of mercury than wild-caught fish.

  • High mercury fish like tilefish, king mackerel, swordfish and shark. The amount of mercury is pretty directly correlated to the size of the fish and if it was wild caught or not (5).

  • What about tuna? Skipjack is one of the smallest kinds and therefore contains way less mercury, this is mostly what I ate during pregnancy. Larger breeds like bluefin and albacore have much higher mercury ratings (22), the recommendation is to keep this to less than 6oz a week. Also wild caught is still important here! That will greatly reduce mercury amount.

More Sizzlefish wild caught salmon, cooked with avocado oil and Trader Joe’s bagel seasoning (another one of my fave combos)

More Sizzlefish wild caught salmon, cooked with avocado oil and Trader Joe’s bagel seasoning (another one of my fave combos)

Now, back to why DHA is so darn important! If the study above didn’t convince you that DHA helps the baby’s brain develop and have a higher IQ here are some more facts. DHA is incorporated into the rapidly developing brain and eyes of the fetus in utero where it forms neurons (brain cells) and protects the brain from inflammation and damage (18). It is crucial during pregnancy, and remains crucial during the first two years of life. If you are planning to breastfeed, it is important to get enough DHA since the amount of DHA found in breast milk is directly correlated to mother’s consumption (19).

So where to get your DHA? Personally, I have been eating a lot of wild caught salmon. Not only is it delicious but it’s loaded with DHA. It’s the top pregnancy-safe fish source of DHA (20). I like to order mine from Sizzlefish (code PRESS10 to save 10% on any non-subscription order). Other good sources of DHA are trout, oysters (these should be completely safe during pregnancy if from a reputable source (21) but if you don’t feel comfortable I totally understand, cod and other smaller whitefish, sardines, shrimp. Some of these are also available on Sizzlefish if online ordering is your thing (it’s mine). I also have been eating low mercury tuna as I mentioned, like skipjack and also have been keeping this to wild caught.

Folate vs. Folic Acid

You have most likely heard of folate and/or folic acid and the importance of this nutrient in preventing neural tube defects in the baby. Folate deficiencies can also lead to problems in mother's during pregnancy too (like anemia and peripheral neuropathy) (30, 31). Most sources suggest supplementing at least 3 months before you plan to get pregnant. This is one nutrient that supplementation is definitely necessary for since folate in foods diminishes the longer they are on the shelf, and the needs during pregnancy are high. However, many practitioners do not distinguish between folate and folic acid. And the truth is, these two are not exactly the same thing, as you may have been told.

Folic acid is the synthetic form of folate. The fact that is synthetic is not the problem, it's the fact that most people's bodies just can't use this synthetic version quite as well. In fact, 40-60% of the population can't convert folic acid properly to folate. And with this being such an important nutrient during pregnancy, I'd say use the most bioavailable (usable) form for your body and baby. Additionally, unconverted folic acid in the bloodstream may also cause problems (29). So if you are among the half of the population that does not convert it well, not only might your baby not be getting enough folate, but you might run into other problems for your own health.

Some of the best food sources of folate are dark leafy greens like spinach, lentils, beef liver and some nuts and seeds. However, like I mentioned, we actually need about 800 mcg per day during pregnancy, which would mean several cups of one of the above foods (29). This is also assuming those foods kept all their folate content, which, is rare unless you are picking the spinach right from your garden with perfect soil. So what should you look for in your prenatal vitamin? Look for folate, not folic acid, but also make sure that folate is not misrepresented. Sometimes it says “folate” with an * that says something like “as folic acid”. So it’s really just the synthetic form. Other terms for folate that you may see on a prenatal or another supplement are: L5MTHF, Methylfolate, 5-MTHF, Quatrefolic (a brand name of methylfolate). For instance, the prenatal I take says “Folate… L-5-MTHF as broccoli”.

Glycine

Glycine is conditionally essential during pregnancy. This means that when you’re not pregnant your body may be able to make enough glycine to support your bones, skin, nails, dental health & gut lining on its own. During pregnancy, this changes. Your body’s demand for this amino acid increases so much that you must consume glycine from food sources to support a healthy pregnancy. While there is no RDA for glycine, researches estimate that the minimum amount of glycine needed in the diet (this is in addition to what your body is able to make itself) for non-pregnant adults is 10 grams or 10,000 mg (27, 5). So even when you are not pregnant, it's advisable to eat glycine-rich foods in addition to just relying on your body's natural production.

I have been sneaking in collagen peptides (one of the best sources of glycine) EVERYWHERE. Especially places like home-baked goods. I made so many loaves of my no-sugar added paleo banana bread and would usually put about 1/4-1/2 cup of collagen in each batch. Recipe is on my site!

I have been sneaking in collagen peptides (one of the best sources of glycine) EVERYWHERE. Especially places like home-baked goods. I made so many loaves of my no-sugar added paleo banana bread and would usually put about 1/4-1/2 cup of collagen in each batch. Recipe is on my site!

During pregnancy, glycine supports the growth of the baby’s teeth, internal organs, skeletal system, hair, skin, nails and is important for mama’s growing uterus and placenta and stretching skin. Glycine is the simplest amino acid structure so it serves as the building block of SO many parts of our bodies and our fetuses. It is also an important metabolic precursor (28). Since glycine is a structural amino acid, found mostly in connective tissue, skin and bones, it’s not actually contained in high amounts in most usual animal protein sources such as muscle meat, and is contained in very low concentrations in any form of plant-based protein. The best sources for glycine are connective-tissue based which may not be a part of everyone's diet.

My favorite source during pregnancy was a grass-fed collagen protein supplement (I actually take this when not pregnant too since it is one of the best ways to support a healthy gut and your own connective tissue - skin elasticity, nails etc.). I use Further Food (code START10 to save). Another great source is bone broth, since this is made by soaking connective tissue (bones and ligaments) it will contain some of those amino acids. Also eating any animal connective tissue is also a great source, for instance pork rinds or eating chicken or fish with the skin on will give you some glycine.

Magnesium

About half the American population is deficient in Magnesium (31). So I think we ALL need to consider this mineral a little more, not just pregnant people. As I mentioned previously, magnesium was one of the top nutrients that pregnant women who ARE on a prenatal vitamin supplement are still deficient in(6). Additionally, women with gestational diabetes are more likely to be deficient in magnesium. Magnesium deficiency can also be made worse in the presence of excess calcium and this combination can make pregnant women more susceptible to conditions like preeclampsia (32). I think the importance of calcium is often over-emphasized at the detriment of magnesium. Magnesium is also essential for many metabolic functions, nerve and muscle communication, protein synthesis and and regulations body temperature (36). These functions are all important in pregnancy or not but pregnancy is a good time to get your ducks in a row, since postpartum can be a little hectic and adding a magnesium supplement to your regimen may not be top of mind.

This picture doesn’t have much to do with magnesium but pregnancy overalls are the best and so is Claudette the frenchie!

This picture doesn’t have much to do with magnesium but pregnancy overalls are the best and so is Claudette the frenchie!

Magnesium has particular importance during pregnancy. It helps reduce muscle cramps during pregnancy, reduce the risk of high blood pressure/hypertension and preeclampsia in pregnant women. Magnesium supplementation has been shown to reduce or prevent these medical complications in over 50% of those who supplemented with additional magnesium (33, 34). Magnesium can also prevent fetal growth restriction and prevent small for gestational age babies (35). A 2017 study showed that pregnant women who supplemented with 200 mg of magnesium daily had significantly lower risk of numerous complications including: intrauterine growth retardation, preterm labor, maternal body mass index (BMI) that was too high, neonatal weight, pregnancy-induced hypertension, preeclampsia, gestational diabetes mellitus, cramps (36).

Anecdotally, I have been supplementing with magnesium glycinate (there are many kinds of magnesium so I would check with a practitioner to see which one is right for you before supplementing) orally since the beginning of my pregnancy, and have not experienced any of these symptoms. The nausea was to my particular surprise. I’m not sure if the magnesium is the cause of my minimal nausea during the first trimester, but I’m sure it didn’t hurt. Now that I am in my third trimester and it’s the middle of summer and my feet and ankles are swelling, I have been using magnesium topically in the form of a lotion in the evenings on my feet.

Probiotics

Probiotics are the “friendly bacteria” that live in and on our bodies (no they are not a traditional “nutrient” like many of the other things we discussed but they are still very important for prenatal, or any health). They actually outnumber our own human cells (and genes) in a 10:1 ratio. So we are 90% probiotics. Whoa, that’s a lot. Many of these good bacteria, funghi and single-celled organisms live in our digestive system, but they are also on our skin (our largest organ), our mouthes and in our vaginas. So they will have an impact on far more than just gut health. They impact our skin (acne, exema, rashes can all be because of probiotic dysbiosis or imbalance), our oral health (these play a huge role in propensity to get cavities and other oral diseases or not) our vaginal health (yeast infections are also when the bad bacteria outgrows the good bacteria), and of course our digestive health (everything from our metabolism, how many nutrients we are able to extract from food, how many calories we extract from food, whether we have bloating, gas, constipation, diarrhea etc.) These, among other reasons I will discuss below, are all great reasons to make sure our bacterial population are in balance.

This bowl I ate on our baby moon in Ojai, CA was loaded with probiotics (there were several types of fermented veggies in there and not to mention all the different colors) and other pregnancy-friendly foods (hello grass-fed bison burger).

This bowl I ate on our baby moon in Ojai, CA was loaded with probiotics (there were several types of fermented veggies in there and not to mention all the different colors) and other pregnancy-friendly foods (hello grass-fed bison burger).

Shockingly, this is another supplement that I have heard many prenatal practitioners say is “not safe” during pregnancy. There is no clinical evidence to show that probiotics are not safe, and in fact they are extremely important during pregnancy. I would say, don’t go taking a “homemade probiotic” from an unreputable source, but other than that, make sure you are getting a good source of probiotics. This is another one I recommend supplementing with to ensure survivability through the gastric juices in the stomach. Early in my pregnancy, I actually switched to Just Thrive probiotic (and prebiotic) supplement because they have the strongest clinical evidence to support 100% survivability through the gastric juices. You can use code PRESS15 to save on your own, whether you are pregnant or not.

Now back to probiotics and pregnancy. First of all, we populate our baby’s microbiome (friendly bacteria population) when they pass through our birth canal and even those who give birth via cesarean pass on bacterial populations through the placenta and also breast-milk if breastfeeding (29). So if we want to give our baby the best start at life, I recommend taking care as to what bacteria is living in and on you. In addition to the important roles I mentioned above, our gut is home to our enteric nervous system (ENS) which plays a huge role in how our brain functions and our mood. In fact, 90% of our serotonin is produced in our gut (37, 39). Happier gut = happier moms and babies! Additionally, our guts are home to something called GALT, or gut activated lymphatic tissue. Lymphatic tissue refers to immune tissue. So this is a fancy way for saying our gut health plays a huge role in our immune system. About 75-80% of our immune system is actually controlled by our gut (40). Additionally, our gut helps our bodies detox harmful substances like small particle LDL cholesterol and can help prevent things like the onset of cardiovascular disease (38) and, when in the right “balance” can help reduce inflammation in the body, which is the root cause of almost every disease (41). However, when not in “balance”, or when the gut is in a state of “dysbiosis” it can cause widespread inflammation in the body, which can cause many diseases. So by taking care of your gut, you can stay healthy during pregnancy and give your baby the best chance at starting life out happy (serotonin) and not sick (immune system) and so much more.

Our microbiome, or bacterial balance in our bodies also has some other direct impacts on pregnancy outcomes. Studies have shown that dysbiosis (imbalance of unhealthy and healthy bacteria in the gut) can increase the mother’s risk of excessive weight gain during pregnancy, preeclampsia, gestational diabetes and preterm birth (42). Probiotics can actually help prevent mother’s who do have gestational diabetes for having a too large baby (which is common in this population) and can help balance blood sugar in both mothers with gestational diabetes and without (see carbs paragraph for why balanced blood sugar is important) (44). Additionally, a good probiotic supplement can reduce inflammation in the placenta, which, can prevent many other conditions. In fact, the placenta has recently been discovered to have its own microbiome (or bacterial population), which, of course is entirely populated by the mother in utero (43). In addition to a quality probiotic supplement that will survive (see above, most do NOT survive gastric juices which is why I have carefully chosen mine), it is important to care for our microbiome and thus our baby’s micro biome by eating a diversity of colorful, whole foods, and avoiding things that harm gut bacteria such as traditional cleaning chemicals, phthalates, BPA and BPS, many compounds in traditional beauty products, antibiotics (such as those in conventionally raised meat and seafood), gluten (to the extent possible) and much more. If you want more guidance on this, please contact me.

summary

Another plate loaded up with the pregnancy goods! Eggs (hi choline, protein, DHA, vitamin D, vitamin K) and sweet potatoes for those unrefined carbohydrates and green veggies for folate. So you don’t need to eat out of the ordinary foods, just be mindful of what you’re taking in!

Another plate loaded up with the pregnancy goods! Eggs (hi choline, protein, DHA, vitamin D, vitamin K) and sweet potatoes for those unrefined carbohydrates and green veggies for folate. So you don’t need to eat out of the ordinary foods, just be mindful of what you’re taking in!

Whoa, that was a lot of information. If you made it this far, thank you for reading! Like I said, this should not replace working with a practitioner to optimize your prenatal nutrition, but hopefully, can teach you some new things to at least look into for your own prenatal diet and care. I always advocate for a diverse diet of whole foods (minimally processed). But I also think pregnancy is as good a time as any to listen to your body. So I am not trying to impose guilt or shame on anyone who ate some bread or pasta or candy during pregnancy, but rather trying to clue you in on what other things you might want to consider including, whether that’s a supplement or a food group or both. And finally, I will put a link to the main prenatal vitamin that I took during pregnancy again here since I know I will get questions about it. However, please note that this is NOT the only supplement I took, and I still recommend working with someone to see what you might need in addition. And finally, if you are mama to be reading this, CONGRATS and try to enjoy the process!

References:

  1. https://www.eatright.org/health/pregnancy/prenatal-wellness/healthy-weight-during-pregnancy

  2. https://academic.oup.com/ajcn/article/75/5/951/4689417

  3. https://www.ncbi.nlm.nih.gov/pubmed/26457543

  4. https://www.ncbi.nlm.nih.gov/pubmed/11679789

  5. Nichols, L. (2018). Real food for pregnancy: The science and wisdom of optimal prenatal nutrition. {United States?: Lily Nichols.

  6. https://www.reuters.com/article/us-health-pregnancy-diet/average-pregnant-woman-in-u-s-may-have-poor-nutrition-idUSKCN1TM2KL

  7. https://academic.oup.com/nutritionreviews/article-abstract/57/11/350/1812707?redirectedFrom=fulltext

  8. Ross, A. Catharine. “Modern Nutrition in Health and Disease / Edition 11|Hardcover.” Barnes & Noble, barnesandnoble.com/w/modern-nutrition-in-health-and-disease-a-catharine-ross/1118877753.

  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855261/

  10. https://academic.oup.com/jn/article/137/2/447/4664564

  11. https://americanpregnancy.org/pregnancy-health/vitamin-d-and-pregnancy/

  12. https://www.todaysdietitian.com/newarchives/060113p54.shtml

  13. https://www.ncbi.nlm.nih.gov/pubmed/17307104

  14. https://www.ncbi.nlm.nih.gov/pubmed/20561558

  15. https://jamanetwork.com/journals/jama/fullarticle/203640

  16. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)00100-6/fulltext

  17. https://www.sciencedirect.com/science/article/pii/S095671351400632X

  18. https://academic.oup.com/jn/article/137/4/855/4664682

  19. https://www.medicalnewstoday.com/articles/323144.php

  20. https://www.medicalnewstoday.com/articles/323144.php

  21. Oster, Emily. Cribsheet: a Data-Driven Guide to Better, More Relaxed Parenting, from Birth to Preschool. Penguin Press, 2019.

  22. http://seafood.edf.org/tuna

  23. https://www.ncbi.nlm.nih.gov/pubmed/23637565

  24. https://www.ncbi.nlm.nih.gov/pubmed/22549509

  25. https://www.ncbi.nlm.nih.gov/pubmed/23195033

  26. https://www.ncbi.nlm.nih.gov/pubmed/29217669

  27. https://link.springer.com/article/10.1007/s12038-009-0100-9

  28. https://academic.oup.com/jcem/article/90/3/1594/2836828

  29. Wolfe, Liz. “Baby Making & Beyond.” Baby Making & Beyond, Dec. 2018, www.babymakingandbeyond.com/products/bmb-core-four.

  30. https://www.ncbi.nlm.nih.gov/pubmed/30976786

  31. https://www.ncbi.nlm.nih.gov/pubmed/22364157

  32. https://www.ncbi.nlm.nih.gov/pubmed/7892840

  33. https://www.ncbi.nlm.nih.gov/pubmed/7631676

  34. https://www.sciencedirect.com/science/article/pii/S2210778914004115

  35. https://www.ncbi.nlm.nih.gov/pubmed/24696187

  36. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590399/

  37. https://www.ncbi.nlm.nih.gov/pubmed/28164854

  38. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579652/

  39. https://www.scientificamerican.com/article/gut-second-brain/

  40. https://www.ncbi.nlm.nih.gov/pubmed/28164850

  41. https://www.ncbi.nlm.nih.gov/pubmed/28089638

  42. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4658310/

  43. https://www.ncbi.nlm.nih.gov/pubmed/24848255

  44. https://www.ncbi.nlm.nih.gov/pubmed/20128938

My First Trimester

Pregnancy is such an exciting time, and like I said, I did not have an easy time getting here, so I have truly felt grateful for every second that I have been pregnant. I wanted to take some time to write a little more about all the intimate details of my first trimester for those who are curious. Of course, every person and every pregnancy is SO different, so I don’t expect any of this to determine how I will feel in my next pregnancy or how you will feel in yours. Just reminiscing about and documenting those first weird/exciting/transitional 13 weeks.

Physical Body Changes

The first thing that comes to mind when most people hear the word “pregnant” is a huge belly. And while your belly definitely changes, it’s not one of the first things to change. During the first few weeks, I’d say my belly was very slightly bloated. I definitely didn’t have a bump and all my pants still fit, they were just a little more snug. I kind of had a weird feeling of being “fake pregnant” since I didn’t look pregnant but knew there was something tiny growing inside me.

I am wearing the exact same sports bra in these two pictures, so you can see the difference in fit. Image on the left was week 4 (AKA the day I found out I was pregnant), on the right was week 14 (so technically right after the first trimester)

I am wearing the exact same sports bra in these two pictures, so you can see the difference in fit. Image on the left was week 4 (AKA the day I found out I was pregnant), on the right was week 14 (so technically right after the first trimester)

One unexpected change I noticed was that my skin was way more dry. I felt like I needed to constantly put on lotion (so I did). But my body had that feeling where it is just “sucking up” lotion, that you usually have after you are sunburned or something. My eyes were also more dry. I wear contacts most days and can usually get through the entire day without feeling uncomfortable but as soon as I got pregnant, I had to remove them at about 8PM (after about 12 hours of wear) or else my eyes would feel dry and itchy. My optometrist said this is common during pregnancy.

Another change I noticed almost immediately, was my boobs (not sure if it is unprofessional to talk about that on here but, hey, we are all adults). I went from about a B to a large C in the first two weeks and after about a month, I was already a D. This sounds great, but, my boobs were super painful. Any touch or slight bouncing during exercise HURT. I had to continually buy new bras, since the ones I bought for the first few weeks, I grew out of quickly. I have remained in my second set of bras through the beginning of the second trimester (although I’m already starting to outgrow them).

Image on the left was week 4 (AKA the day I found out I was pregnant), on the right was week 14 (so technically right after the first trimester) but you can see my “bump” developing.

Image on the left was week 4 (AKA the day I found out I was pregnant), on the right was week 14 (so technically right after the first trimester) but you can see my “bump” developing.

I did start developing a small bump around week 7/8, but again, looked more like bloating. This really developed into a “bump” around week 12 at which point it “popped”. This may be because I’m so short and the baby has nowhere to go but out, so even though the baby was the size of a lime, my body didn’t have much space to hide the lime (plus it is surrounded by an enlarged uterus and placenta).. I didn’t truly need maternity clothes at this point, but my old pants and leggings were definitely starting to pinch and pull more than I wanted so I started researching maternity wear and bought it around week 13/14.

Another fun side effect of the the first trimester was that I peed ALL the time. At this stage, the uterus is sitting lower (right on the bladder) and I felt like I literally had to go every 5 minutes or at least multiple times an hour! This definitely let up for me around week 12.5/13 as the uterus raised in my body. I have heard it will get bad again in the third trimester when the uterus is pushing on the bladder the most, but that hasn’t happened yet so I am enjoying this second trimester pee break.

Although a lot of people are frustrated by the early body changes, since many people feel like they are in an awkward in between stage where they don’t look pregnant but they don’t look like their normal selves, I was so grateful for what was happening inside me, that I really didn’t mind that awkward stage.

Appetite & Nausea

I was SUPER lucky to have very minimal nausea. I am not sure what to attribute this to, so unfortunately I don’t have any tips for any of you queasy mamas to be. Some people theorize it’s because I’m having a boy, some people theorize it’s my diet, and I personally have read that vitamin B6 helps with nausea (1), and I stayed on my vitamin B complex (which has plenty of B6) through out my first trimester. When I did feel nausea, it was usually when I was hungry or tired. So eating was a pretty good solution for me. Exercising or even going for a walk also helped. I never threw up, my nausea was more like a “hungover” feeling in my throat". I would say my peak “nausea” was from weeks 5-8, and after this it started to diminish (it was still there through about week 11). But, like I said, it was pretty minimal compared to what I have heard from friends and clients. I guess it could have just been luck.

Speaking of eating, I was STARVING from the moment I knew I was pregnant, which was the earliest time you can take a pregnancy test, so I was 4 weeks pregnant at this point. I basically felt like I did a really intense workout every day (since I am always hungrier on those days) but I was actually taking it a lot easier with exercise and took quite a few days off but was still super hungry every day despite my activity level. I definitely ignored the calorie guidelines of not needing ANY extra calories during the first trimester (2) plus you guys all know how I feel about calorie guidelines (eye roll). If your body is growing a baby, and you are HUNGRY then I think your body needs extra food to grow that baby. And since I was not nauseous like many women are, I was still eating very balanced meals of properly sourced protein, healthy fats, and tons of veggies, so I wasn’t starving because I was filling up on empty carbs, my body truly needed more fuel. I basically had 4 meal sized portions a day with at least 2 snacks. My extreme hunger began to let up around week 12 and I felt like my appetite went back to what it usually is.

Now that I’m in my second trimester, and the guidelines say I need around 350 extra calories, I actually feel like eating my regular amount. Moral of the story is listen to your body, those guidelines are based on averages and are, in my opinion, outdated and oversimplified. If you are eating real, good foods, I think your body knows better than some number, granted, it’s doing all the human-growing work!

Food Aversions & Cravings

A lot of pregnant women who followed my instagram asked me if I was really eating all those veggies in my first trimester, and the answer is yes. I completely understand, not everyone is able to do that, but this was my experience. I still loaded my plate up with PFFP (protein, fat, fiber, phytonutrients) which you can read more about in my balanced breakfast blog post. I felt even more motivated to get as many nutrients as possible in my body since I knew these nutrients would be helping to build my baby. I have done multiple pregnancy nutrition certifications and read numerous books on the topic, so perhaps in this case, ignorance is bliss and I subconsciously did not want to put “non-nutritive” food in my baby. The other possible reasons I was able to maintain my normal eating habits were 1) because I did not have crippling nausea that made vegetables and meat seem repulsive and 2) because healthy food is my comfort food, I grew up eating that way since I was a kid so that’s truly my craving food.

The only real food aversion I had was to shrimp. One night I decided I wanted cauliflower pizza and picked shrimp as the topping (I was trying to mix up the protein sources we ate and also get in lots of omega 3 fatty acids for my baby’s brain development) (8). However, as soon as we cooked up the shrimp and put it on the pizza, I took one bite and could not eat any more. I picked off all the shrimp and haven’t eaten it since. Something about the smell combined with the taste was truly repulsive to me (this was a food I used to LOVE).

This was Claudette the frenchie helping us with our pregnancy announcement to our friends and family.

This was Claudette the frenchie helping us with our pregnancy announcement to our friends and family.

I also haven’t had any crazy cravings, or strong desires for foods that I would never desire when not pregnant. But there have been some foods that I have had a stronger affinity for than usual. First of all, I usually am an exclusively sweet for breakfast person. I don’t start my day with a bowl of sugar but I love a berry smoothie or paleo baked good with some yogurt. However, during my “peak nausea” weeks (5-8) I was really craving savory for breakfast more than sweet. I had more eggs, grainfree pizza, even salmon and veggies, but I still had some sweet for breakfast days too.

Another food I really wanted was dairy. My body doesn’t usually digest dairy well, but I had read the hcg hormone can help certain women tolerate dairy better during pregnancy (3) so I decided to try reintroducing it since my body was wanting it (and I do think the body knows best). Sure enough, I did not experience the usual digestive symptoms I experienced when eating dairy, so I decided to add it back in. I focused on full fat dairy (since this is less processed and helps your body absorb the vitamin D, a fat soluble vitamin found in diary) (4) and fermented dairy, since this improves digestion (5). When it came to cheeses, I picked either cheeses made in the USA specifically labeled grass-fed, hormone-free and antibiotic-free (I don’t want GMOS, antibiotics or hormones going into my tiny baby!) or imported cheeses from Europe or New Zealand (since grass-feeding cattle is standard practice there). I have still been wanting and enjoying dairy through my second trimester so far.

Fatigue

There were a few days when I was extremely tired, before I found out I was pregnant. According to my calculations, this was when the embryo was implanting. I felt like I ran a marathon even though I literally didn’t move these 2 days and I napped a lot. It’s crazy to think of all the hard work the body is going through even though it’s “invisible”. My fatigue continued through the first trimester but it was not terrible like in those few days.

This picture was taken at 12.5 weeks, when the fatigue had already started to let up.

This picture was taken at 12.5 weeks, when the fatigue had already started to let up.

For the entire first trimester, I found I could not rise in the morning at my usual time (6/6:30AM) and really needed to sleep until anywhere between 7 and 8AM on most days. Since I have the luxury of setting my own scheduled, I just did not make any early client appointments and was able to let my body sleep as much as it needed to. This meant an average of 9-10 hours every single night. This sounds like a lot, but that was how I dealt with the typical “first trimester fatigue”. A lot of people complain of not being able to get through the days without a nap during the first trimester, and I definitely would have felt the same if I was only sleeping 7 or 8 hours, but this extra sleep made it so that I felt pretty much “normal” during the hours I was awake. There were a few days during weeks 8-10 when I still had to lie down on the couch for a few minutes because I felt extremely tired in the afternoons, but for the most part I managed it with my extra sleep.

Now that I’m in my second trimester, I already feel this diminishing a bit and am hoping to be able to wake up a little bit earlier soon.

Workouts & health scares

If it were up to me, I would have worked out a lot more during my first trimester. Workouts are a great stress/anxiety reliever (I was super anxious about miscarrying the entire first trimester, since it is so common) and also working out can make pregnant mom and baby healthier (6). During the first week that I knew I was pregnant, I was working out pretty regularly just keeping it lower impact and slightly lighter weight (this was probably not necessary, like I said, I was just nervous about miscarriage). However, one day when I was walking on the treadmill at the gym and went to the bathroom, I saw tons of blood. This was very alarming since almost everything you read about miscarriage says “you’re probably fine unless you see tons of blood” (yikes). I frantically called my doctor who said I should lay down the rest of the day and come in the next day for an ultrasound (I was 5 weeks at this point). The heavy bleeding continued for about 8 hours then stopped completely but I was a nervous wreck.

My husband came to the ultrasound the next day with me and luckily, the doctor was able to see the “gestational sac” right away. This meant I didn’t miscarry and there was still a little embryo growing in there (yay)! My doctor also saw a subchorionic blood clot (7), which, was what she suspected had caused the bleeding. She said these bleeds were fairly common and don’t always mean doomsday but I did need to take it really easy so another bleed din’t happen, she also said these blood clots can often go away on their own. I scheduled another ultrasound in exactly one week, and like I was instructed, I barely moved between those two ultrasounds, I walked around a tiny bit and cooked etc. but nothing you would call “exercise”.

Gym selfie at 9 weeks pregnant.

Gym selfie at 9 weeks pregnant.

At the 6 week ultrasound we got to hear the baby’s heartbeat, which was AMAZING! And also checked on my subchorionic clot, which was still there but hadn’t grown and was still small. Since I hadn’t had any more bleeding, my doctor said it was fine to resume light exercise, nothing too strenuous and no heavy weights. I took this to mean walking, yoga and barre and a few workouts I made up on my own using lighter than usual weights. It truly felt so good to move and really helped with my anxiety (which had greatly increased since the bleed). At the 8-week ultrasound my doctor saw that the clot had been reabsorbed and I was cleared to go back to exercising (which I did immediately). Of course, I put my baby’s health first when I was told not to exercise, but as I said, it was hard on me mentally since it was a very anxious time for me.

Once I was able to resume normal workouts, I did through out my entire first trimester. I definitely modified things and kept things lower impact, but generally working out actually energized me rather than make me more fatigued. My body definitely got way more sore more easily, since instead of sending resources to muscle recovery, it sent resources to the baby. I definitely took a full rest day each week and also 1 or 2 lighter intensity days (walking and stretching or yoga). Overall, I’m just doing what feels good to me and that may change as the pregnancy progresses.

Dreams & Emotions

I was 14.5 weeks in this picture, not too far out of the first trimester.

I was 14.5 weeks in this picture, not too far out of the first trimester.

Hormones are running high during pregnancy and so are emotions. For the most part, I have not been extra moody or emotional but I have definitely had my moments (you can ask my husband). However, the second I got pregnant I started having the CRAZIEST and most vivid dreams. I have heard this from other pregnant women (including my mom, who experienced the same thing) as well. Every night I remember my dreams, which I usually don’t when I’m not pregnant, and I honestly don’t even know how my brain comes up with them. Everything from seeing a pack of wild tigers outside my parents house in Boston to being stranded at sea in a kayak to a lot of other stuff in between.

Like I said, I did not have an easy time getting pregnant so the emotions I felt the most were gratitude, disbelief and giddy excitement. This was cut with intermittent spurts of anxiety, largely caused by the bleeding scare and just an overall fear of miscarriage, a “this is too good to be true” feeling. However, after about week 10, I started to lean into it and accept that my body was carrying a baby and I needed to enjoy the process rather than worry about it. I still get a little bit nervous before each doctor’s appointment but slowly but surely my anxiety is turning into pure joy. Feel free to reach out with any questions you have and I’m sure there will be lots to come on this topic!

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4649576/

  2. https://www.eatright.org/health/pregnancy/prenatal-wellness/healthy-weight-during-pregnancy

  3. Nichols, L. (2018). Real food for pregnancy: The science and wisdom of optimal prenatal nutrition. {United States?: Lily Nichols.

  4. https://www.ncbi.nlm.nih.gov/books/NBK234920/

  5. https://www.bewell.com/blog/all-dairy-is-not-created-equal/

  6. https://americanpregnancy.org/pregnancy-health/exercise-during-pregnancy/

  7. https://www.medicalnewstoday.com/articles/323307.php

  8. https://americanpregnancy.org/pregnancy-health/omega-3-fish-oil/