Congratulations! The weird and wonderful journey of pregnancy begins! Here’s what you need to know!
Pregnancy is a really new and exciting time for the mother and everyone around them. When it comes to food, things can be a bit confusing. With so much information out there, it can be hard to figure out what’s okay to eat and what you need to give a miss for the next nine months. There’s a lot of information out there but after looking at the evidence we’ve put together a list of some important nutrition and lifestyle advice.
First up, let’s talk about the things to avoid during pregnancy!
What’s the deal with caffeine?
While in the past expectant Mums were asked to kick caffeine to the curb, the good news is modern research illustrates that moderate caffeine consumption during pregnancy is safe. But what counts as moderation? Current guidelines suggest limiting your intake to 200mg per day during pregnancy. In practice 200mg of caffeine looks like around one-shot latte or cappuccino, 2 cups of instant coffee or 4 cups of caffeinated tea. 
Here’s a rough breakdown of some food or drinks that you might have throughout the day and how much caffeine they contain. 
Values are approximations. Please refer to product packaging for exact amounts of caffeine in your specific foods.
Tell me about Vitamin A!
Vitamin A is a nutrient vital for visual health, foetal growth and development and immune function.  Beta carotene is an orange pigment found in fruits and veggies and is a precursor or inactive form of retinol.  Foods that contain beta carotene include carrots, sweet potato, and dark leafy greens. Beta carotene is safe during pregnancy. It’s the retinol you need to be mindful of, especially in the first trimester. Liver is a food high in retinol and is best kept to less than one serving per week to stay below the upper limit for retinol during pregnancy which is 3000 µg /day.  Also, you may have used retinol in your skincare before but during pregnancy it is important to cease using it. It’s a great time to treat yourself to some new products and try skincare without retinol or vitamin A derivatives for the remainder of your pregnancy. Fortunately you’ll be glowing without it!
What about mercury?
It is important to minimise your intake of mercury during pregnancy as high doses may harm a developing baby’s brain.
- Limiting fish like orange roughy (sea perch) or catfish to one 150g serving size per week
- Limiting shark (flake) or billfish to one 150g serve per fortnight and no other fish that fortnight 
Larger fish that live longer tend to contain the most mercury, which is why there are different recommendations for different types! 
But don’t let this deter you from eating seafood! Research shows that eating 2-3 serves (where one serve is around 150g) of low mercury fish per week is good for general health plus the health of your developing baby.  Some low mercury options include sardines, silver warehouse, Atlantic salmon, canned salmon or tuna in oil and herrings. 
Let’s talk food safety!
Food safety is extra important during pregnancy, where elevated hormones like progesterone suppress your immune system.  When your immune system is suppressed this means that you’re more likely to get sick from contaminated foods. Some types of food poisoning bacteria can be a problem during pregnancy. Therefore, we want to minimise risk by practicing good hygiene and food handling while avoiding high risk foods.
Listeria is an illness caused by foods contaminated by listeria monocytogenes.  During pregnancy this bacterium can be passed on to the baby and may cause miscarriage, stillbirth or premature birth.  While listeria infection isn’t common, it is still really important to minimise your risk by following these tips. 
- Eat freshly prepared foods and avoid ready-to-eat refrigerated foods that may have been stored for long periods of time.
- Avoid raw or unpasteurised dairy foods, juices or cider.
- Avoid soft and semi-soft cheeses like Brie, Camembert, Feta, blue-veined cheeses, Gorgonzola, Hispanic-style fresh cheeses (e.g. queso blanco) unless they are cooked until 74°C, which is steaming hot.
- Avoid refrigerated pâtés, meat spreads and smoked seafood.
- Avoid pre-packaged or prepared fruit/vegetable salads and raw sprouts.
- Avoid ready-to-eat deli meats and ready-prepared meals unless they are reheated until they are 74°C, which again will be steaming hot.
- Avoid raw or undercooked meat, poultry, seafood and eggs.
- Thoroughly wash raw fruit and veggies under running water before eating them.
- Make sure to practice thorough hand hygiene.
Salmonella is another infection that can be a problem during pregnancy.  In rare cases, salmonella can trigger miscarriage or long-term complications for the mother.  Eating food that has been kept in the temperature danger zone (5-60°C) for too long is often the cause of the illness.  Other tips for minimising the risk of salmonella infection include: 
- Avoid foods that contain raw egg and cook eggs thoroughly (say a temporary goodbye to runny poacjed eggs).
- Always cook meat thoroughly. Sorry, no medium rare steaks for now!
- Avoid all sprouts whether raw or lightly cooked. Watch for these if you’re ordering pad thai!
- Reheat any leftovers until scorching hot, and ditch anything you don’t eat within 24hrs.
- Like above, ensuring you stick to good hand hygiene and your utensils are clean is important.
Toxoplasmosis, an infection caused by the Toxoplasma gondii parasite, can be very harmful to pregnant women.  Again, while the infection is rare it can have very serious consequences, such as miscarriage, stillbirth or damage to the baby’s brain and other organs.  Therefore, it’s important to follow these tips to reduce your risk of infection: 
- Continue to cook your meat well.
- Wash your hands thoroughly, especially after handling raw meat or gardening.
- Avoid contact with cat faeces. It’s time for someone else to clean the cat’s litter tray! Be mindful if neighbours’ cats venture into your garden.
- Continue to wash your fruit and veggies very well, especially if you’re eating them raw.
For more information on whether you should avoid a food during pregnancy , check out this great resource from the NSW food authority.
Alright, let’s do a lightning round!
Is sushi okay?
You may be surprised to learn that eating sushi may actually be okay during pregnancy.  This is provided that the raw fish has previously been frozen, and the rice is fresh (less than a day old).  Raw fish that hasn’t been frozen may contain small parasitic worms, called anisakis worms, which can cause infection. If the sushi isn’t from a source that you trust or you can’t ask these questions, it’s better to skip for now.
What about alcohol?
Research tells us that it isn’t safe to drink alcohol during pregnancy.  This is because alcohol in the mother’s blood stream can pass through the umbilical cord to the baby.  Even small amounts of alcohol can harm an unborn baby therefore the safest option is to not drink at all.  Save that champers for a toast after bub is born and be sure to speak to your health professional if this is a cause of concern or you’d like to get the all clear for an occasional little half glass!
Can I have artificial sweeteners while I am pregnant?
While more research is needed to fully determine the effects of artificial sweeteners during pregnancy, the data we have available does not suggest any adverse effects.  In Australia, the following artificial sweeteners have been approved for use during pregnancy and lactation. 
Right, and what about cravings?
Cravings are a very normal part of pregnancy. These weird and wonderful pregnancy cravings are likely to be caused by a range of factors including: [19-21]
- Rapidly changing hormones. This includes Human Chorionic Gonadotropin (HcG) that can actually alter our taste buds!
- Change in body physiology. As your body is working very hard, producing a lot more blood and growing another human, your need for energy and nutrients may change. Cue the carbs!
- Your body may be looking for particular nutrients or food elements. This might include sodium if you find yourself craving salty foods, or a quick hit of energy if you’re reaching for carb rich foods.
- Certain foods may provide comfort (both physical and emotional) as your body (and world) changes! This is a completely normal response to everything new happening!
It’s important to note, that if you find yourself craving non-food substances, you might be experiencing a condition known as pica.  It is really important to seek assistance from your doctor right away if this is the case.
Okay, let’s talk about the things you CAN actually eat!
How do the dietary recommendations differ for pregnant women?
The recommendations aren’t too different for pregnant women. The main differences are to meet your slightly elevated energy and nutrient needs with whole grains, lean meat, poultry or fish,  When thinking more generally about your diet, make sure to include a good variety of different foods. The Women’s Hospital and Dietitian Connection have great resources to give you an idea of what that might look like!
What about iron during pregnancy?
Iron is an important micronutrient involved in the production of red blood cells. When you’re pregnant, your body makes more blood to help grow your baby.  This means that the amount of iron you need during pregnancy is significantly more than normal (27mg per day).  There are two types of iron that we get from food, haem and non-haem iron. Haem iron is found in meat like beef, kangaroo, lamb, pork, chicken or fish.  Non-haem iron is found in legumes (kidney beans, baked beans, chickpeas and lentils), green leafy vegetables, eggs, nuts, dried fruit, wholegrain and iron fortified cereals and soy products like tofu. 
Your healthcare team will likely keep an eye on your iron levels with regular blood tests, but if you’re feeling tired, weak or short of breath, ask to have your iron studies checked. If you’re in need of a supplement, discuss with your doctor or dietitian about the right preparation and dosing for you…the last thing you need is to add constipation to the mix (a common complaint with some iron supplements), or to not be absorbing it efficiently because of competing nutrients (e.g. calcium, zinc and tannins in tea and coffee).
Following on from our previous fertility article, we know that folate is an important nutrient during pregnancy to ensure we reduce the risk of neural tube defects like spina bifida in your baby.  It is recommended you take a folate supplement for two months before you get pregnant and for the first three months of pregnancy. 
What else should I consider when I’m pregnant?
Low to moderate exercise during pregnancy is associated with a range of health benefits!  This might look like a brisk walk, swimming or cycling. Most women can exercise as normal for the first trimester, but adjustments are recommended to keep you and bub safe beyond this. If you’re new to exercise or wanting more info on a suitable program through pregnancy (as well as some much needed motivations), we recommend you link in with a women’s health physio. Pregnancy may result in dental problems in some women, including things like tooth decay and gum disease.  Just another thing to be mindful of! Make sure you keep up good dental hygiene and visit your dentist to ensure your teeth stay healthy during pregnancy. 
Progress, not perfection
Eating well isn’t always easy and can be even more confusing during pregnancy with so much information out there! There are lots of nutritional considerations during pregnancy, but understanding the basics can really support your health and the health of your baby.
It’s important to not be hard on yourself and reach out to professionals (not Google, seriously!) for help. As always, it’s best to contact your doctor, midwife and dietitian for individualised advice.
This article was written by Caity Smith, Accredited Practising Dietitian and OnCore Nutrition volunteer, with support of Lauren Atkins AdvAPD.
07 September 2020