The pregnant woman’s guide to nutrition

Unpasteurized soft cheeses, smoked salmonsushi—the list of foods women should avoid while pregnant is long. But what women should eat is equally important.

“We know that what a baby is exposed to from conception through age two has long-term impacts on health and wellbeing, including cognitive functioning and immunity,” says Nicole Avena, Ph.D., author of What to Eat When You’re Pregnant and an assistant professor of neuroscience at Mount Sinai School of Medicine in New York City, where she focuses on nutrition.

The right diet also supports expecting women when uncomfortable issues like nausea and heartburn set in. Knowing what to eat, and when, can ease some of the most common side effects.

Here, the experts weigh in on nutritional dos and don'ts, from pre-conception to the final trimester.

Before conception:

“Women don’t often know that they’re pregnant until the neural tube, which eventually becomes the brain and spinal cord, has already formed,” says Avena. If you’re trying to conceive, taking 0.4 milligrams of folic acid daily can reduce the risk of neural tube defect like spina bifida. Women can get the mineral from prenatal vitamins, which they should continue taking throughout all three trimesters. (As always, get approval from a doc before taking supplements.)

In the first trimester:

Side effects like morning sickness and nausea are most common in the early stages of pregnancy, which can make it hard to keep food down. The good news: Women don’t need extra calories in the first trimester, Avena says.

Many women also find it hard to stomach foods that are high in fat and protein. The American Pregnancy Association recommends eating at least three servings daily, which looks something like three ounces of grilled chicken, two tablespoons of peanut butter, and one cup of yogurt.

But most people have enough of a caloric store that skimping on it won’t hurt, says Jacques Moritz, MD, an associate clinical professor of obstetrics and gynecology at Cornell Medicine in New York City and a member of the Equinox Health Advisory Board. As a general guide, the APA suggests that women also eat two to four servings of fruit, four or more servings of vegetables, and four servings of dairy products daily.

Avena recommends upping vitamin B6 intake to 1.9 milligrams per day, which has been shown to ease morning sickness, she says. Foods full of the nutrient but free of strong odors (a trigger for nausea) include chickpeas, boiled potatoes, and bananas.

During pregnancy, foods take longer to digest. Starting now and for the rest of the pregnancy, Moritz suggests eating smaller portions more frequently instead of three main meals. “You have to eat like a gazelle instead of a lion,” he says.

In the second trimester:

“This is the honeymoon phase of the pregnancy,” Moritz says. Women have more energy and overall, they feel better than they did in the first trimester. If they lost weight because of morning sickness and aversions to foods, they’ll probably regain it during these three months, he adds.

Now is the time to focus on a balanced diet high in complex carbs from things like broccoli, spinach, and whole grains, he says. Stay away from simple carbs and other sources of pure sugar, like smoothies, juice, and white breads and pasta, which can lead to high birth weight. Women also need to eat about 340 more calories per day than they did pre-pregnancy, Avena adds.

Taking at least 18 milligrams of iron daily, either from prenatal vitamins or foods, reduces the risk of anemia. Avena suggests getting it from beef, pumpkin seeds, spinach, eggs, and fortified cereals.

But high iron intake can cause a separate side effect: constipation, which affects about half of all women at some point during pregnancy. To combat it, hydrate and eat plenty of fiber, Moritz says. Consider drinking water with magnesium, which can help even more, he adds.

The change in hormone levels can cause pregnancy gingivitis, or swollen gums, making them more sensitive. Vitamin C (from red peppers, kiwis, and strawberries) and calcium (from milk and other dairy products) can ease the discomfort, Avena says.

In the third trimester:

This is when all the symptoms of the first trimester come back, Moritz says, like morning sickness and trouble keeping foods down. Heartburn can also set in during the final stages of pregnancy. To quell it, keep eating lots of fiber and avoid overly spicy foods, Avena suggests.

The baby continues to gain more weight and build their own nutrient stores in the last three months, Avena says. She recommends taking in 450 calories more per day than normal, mostly from foods that are dense in more than one nutrient. One example: Coho salmon, which is high in protein, niacin, and vitamin B12, as well as healthy fats. (Just make sure to eat it cooked, not raw.)

“It’s important to get a proper balance of nutrients throughout the third trimester,” Avena says. “That way, once the baby is born and they don’t have you or the placenta to nourish them, they can sustain themselves.”