December 5, 2012
Table of Contents
Nowadays, more and more women living with HIV are having healthy pregnancies and giving birth to healthy, HIV-negative babies. As is the case with all women, good nutrition is an essential part of preparing your body to grow your little one, and for supporting a healthful pregnancy.
If you or someone you know is thinking about getting pregnant, you may be wondering what an aspiring mom's next steps might be. Once you've figured out how you'll become pregnant and gotten on an HIV med regimen that's comfortable for you, how do you get on track toward eating well for you and your baby? I hope to answer some questions and demystify some of the common misconceptions around food and nutrition during pregnancy. Above all, it's important to remember that each woman will have a unique pregnancy experience.
Before becoming pregnant, it's best that your body is as healthy as can be. That means that you are as close to your ideal body weight as possible before you begin your pregnancy. If you are overweight or obese before getting pregnant, your obstetrician (OB), dietitian or midwife may recommend that you limit your weight gain to reduce your risk of additional complications. You also may want to consider having a complete physical and labs drawn to insure that your blood fats (lipids), sugars and pressure are all within normal limits. If you find that any of these tests come back abnormal, you will want to address and treat these conditions prior to becoming pregnant, as undiagnosed and uncontrolled elevated blood lipids, sugars and pressure can be very dangerous.
Once you become pregnant, you will need to make sure that you do the following:
During the first three months of your pregnancy (your first trimester), you may experience morning sickness, which may or may not come along with nausea, vomiting or not being able to eat or even smell certain foods. You should eat as tolerated, making sure that all of your meals and snacks are based on whole foods. What are some examples of whole foods?
I should add that foods should be prepared without too much added salt, sugar or fats like butter or oil; and that during pregnancy, women shouldn't eat more than two servings of fish per week. Eating whole foods will ensure that your diet is providing adequate nutrients, vitamins and minerals to support both mother and baby for the duration of a healthful pregnancy.
You will also want to stay active as this may help with morning sickness. It is important that you consume adequate amounts of lean and plant-based proteins, as well as iron, as the combination of HIV and pregnancy increases both a woman's protein and iron needs. Studies have also shown that adequate intake of antioxidant micronutrients during pregnancy reduce a woman's risk of pregnancy-related complications. What are antioxidant micronutrients? They're some of the same vitamins and minerals found in a regular multivitamin, but these provide added benefits in keeping your body's cells and tissues healthy.
You are probably wondering how much of these antioxidant micronutrients is enough, and what food sources contain them. First, you will want to make sure that your OB prescribes you a prenatal vitamin that will help you meet your nutritional needs. Second, you may want to expand upon what you're learning in this article by working one-on-one with a dietitian, if you're not already doing so. You can get a recommendation for a registered dietitian from your OB, midwife or primary care provider, or by searching for one in your area at the website eatright.org. Your local Women, Infants and Children (WIC) center can also help you connect with a dietitian (more about that later). Your dietitian will create an individual nutrition prescription tailored just for you, and adhering to that eating regimen will ensure that what you eat and drink each day will help you to meet your nutritional needs. Even if you don't have a nutrition prescription, during your entire pregnancy you should eat a healthful balanced diet that includes vegetables, fruits, whole grains, low-fat dairy (if you are not lactose intolerant) and lean and plant-based proteins. Eating this way provides plenty of antioxidant micronutrients.
Around months three through six of your pregnancy (your second trimester), you will need to consume about 340 additional calories per day. That would be about one slice of whole wheat toast with one tablespoon of peanut butter and one small apple. Yes, you are eating for two, but that does not mean that you should abandon a healthful balanced diet! As you can see, 340 extra calories does not constitute an additional full meal.
You will want to avoid the following foods and drinks throughout your pregnancy, as they contain chemicals or bacteria that can be harmful to both mother and baby:
If you are unsure about whether something is unsafe to eat, your best bet is to not eat it and check with your OB, dietitian or midwife.
In terms of exercise, pregnancy is not the time to initiate vigorous exercise. However, if you were very active before becoming pregnant, you should continue to exercise while modifying your routine to account for your increased size, as well as were you are in your pregnancy. You will of course need to check with your OB or midwife to make sure that the exercises you choose are safe. During the final months of your pregnancy (your third trimester), you will need approximately 450 additional calories per day. (That's in addition to a normal diet, not in addition to the 340 calories you added in your second trimester!) This means adding a 100-calorie snack per day, such as one snack bag of air-popped, whole-grain popcorn.
Adding healthful, wholesome foods to your diet can be an added expense. Staying within a budget and finding deals will require creativity and planning to purchase and incorporate whole foods that represent a rainbow of fruits, vegetables, legumes, whole grains and lean proteins on a daily basis. Many neighborhoods have community supported agriculture (CSA) programs that operate on a sliding scale. People that purchase a share will be able to pick up weekly portions of fresh seasonal produce.
In addition, there may be a food co-op near you. At food co-ops, each member volunteers for a set amount of time so the co-op is able to offer foods to its members at reduced prices. Families that are eligible for the Supplemental Nutrition Assistance Program (SNAP) can use their EBT cards at green markets, and may even receive additional incentives such as added dollars for each dollar spent at a green market. Pregnant women and those with children up to age 5 who are at nutritional risk and meet the income eligibility may want to explore the options that the WIC program offers in terms of nutrition education, nutrition assistance and other resources. If you are eligible, your local WIC center is also a place where you may be able to meet with a dietitian to help you develop an individual nutrition prescription, as mentioned above. You can read more about WIC and other nutrition programs here.
Once you have the baby, your nutrition still matters. If you live in a high-income country where replacement feeding is available and safe, you will most likely not be breastfeeding as this is the recommendation to reduce a baby's risk of becoming HIV positive. You will want to return to your pre-pregnancy healthful balanced diet to support healthful recovery after your birth -- or your surgery, if you delivered via Cesarean section. This will include consuming enough fluids, and returning to exercise when your OB or midwife gives the OK. And if you just came around to eating a balanced diet when you became pregnant, keep it up now that your baby is here -- for your own health!
It is important to remember that throughout your pregnancy, your number one goal is to stay healthy and have a healthy child. This means listening to your body and giving it what it needs in terms of proper nutrition, adequate hydration and rest for the duration of your pregnancy. If you have any questions, don't hesitate to reach out to your OB, midwife or dietitian -- remember, your health and the health of your baby are their goals as well!
Maya Feller, M.S., R.D., currently works as the food and nutrition program manager at a community-based organization in Brooklyn, N.Y., where she counsels clients and runs a soup kitchen and food pantry. Maya welcomes nutrition-related questions; contact her at firstname.lastname@example.org.