Healthy Eating & Weight Gain

Key Messages

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These are the main health messages that should be conveyed to all future and new parents. They have been written in the second person and at a reading level appropriate for the general public so that they can be shared with them directly. They are based on a consensus founded in scientific research and professional practice. Clicking an underlined word or group of words in the text will redirect you to the section in Supporting Evidence that deals with that topic.

key message

A healthy, balanced diet will help provide the nutrients you and your baby need during the pregnancy and after the birth.

For a healthy, balanced diet and information about serving sizes, follow Canada’s Food Guide. This will help you have enough energy and most of the nutrients you need. The guide recommends a daily intake of the following foods:

  • Vegetables and Fruit (seven to eight servings).
  • Grain Products (six to seven servings).
  • Milk and Alternatives (two to four servings).
  • Meat and Alternatives (two servings).

In the second and third trimesters, you will need slightly more calories, protein, vitamins, and minerals. Add an extra two or three servings per day from any food group. Here are a few examples of foods you can add to your meals and snacks:

  • Hummus, whole-wheat pita and carrots, or
  • A bowl of of whole-grain breakfast cereal with a cup of milk and a banana, or
  • A piece of cheese and a slice of of whole-grain bread, or
  • A mixture of nuts and dried fruit and a hard-boiled egg.


key message

Take a multivitamin daily before and during your pregnancy.

A daily multivitamin provides important vitamins and minerals, including folic acid and iron. Some women need more folic acid or iron. It is important to take only what is recommended by your health care provider. Check the label on your multivitamin to make sure it contains what and how much your health care provider recommends. Not all prenatal vitamins and multivitamins are the same.
Folic acid helps cells develop and reduces the risk of some birth defects. Folic acid is important early in pregnancy. Folic acid is recommended for:

  • All women who could get pregnant.
  • All pregnant women.
  • All breastfeeding women.

Pregnant women often have difficulty getting enough iron from their food. A daily multivitamin can help you get enough iron. Talk to your health care provider if you have side effects from the multivitamin.


key message

Some foods are unsafe during pregnancy.

Some foods pose a risk during pregnancy.
Choose

  • Foods such as fully-cooked meat, poultry, and fish; canned pates and meats; pasteurized milk products and hard cheese.
  • Fish with lower levels of mercury (such as canned light tuna, shell fish, salmon, and trout).
  • Milk, water, or decaffeinated coffee and tea.

Avoid

  • Foods most likely to cause listeriosis (such as raw or undercooked meat, poultry, and fish; deli meats; and raw or unpasteurized milk products, fruit juices, or cider).
  • Fish containing high levels of mercury (such as fresh/frozen tuna, shark, swordfish, marlin, orange roughy, and escolar).
  • Excess caffeine, have no more than 300 mg/day (i.e., two to three cups of coffee).
  • Liver and liver products, due to their high concentrations of vitamin A.

Discuss the safety of herbal teas, artificial sweeteners, and natural health products with your health care provider.

key message

Weight gain is normal and healthy during pregnancy. Weight gain recommendations vary depending on different factors.

It is important to gain a healthy amount of weight for you and your growing baby. This amount depends on your weight before you were pregnant and other factors (e.g. teen pregnancy, pregnant with more than one baby, etc.) The amount of weight you gain includes the weight of your baby, your uterus, the amniotic fluid, etc. A healthy diet plus physical activity during pregnancy will help you gain weight gradually.

There are risks to gaining too much or too little weight during your pregnancy. Talk to your health care provider about how much weight you should gain.

It is important to pay attention to how quickly you gain weight. Weight gain is usually slow during the first three months. Most weight gain will happen in the second and third trimesters. Gaining weight at a steady pace is a sign of a healthy pregnancy. Talk to your health care provider if you are gaining a lot more than 0.4 kg (1 pound) a week, or a lot less.


key message

Learn more about nutrition and healthy weight gain in pregnancy.

You can find out more about nutrition and healthy weight gain in pregnancy from the following resources. More suggestions can be found in the Resources and Links section.

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Supporting Evidence



The supporting evidence is written in third person and is aimed at prenatal education providers. It is not intended to be shared directly with new and expectant families; it is meant to provide the background information and evidence for the key messages.
This information is intended for healthy women who are pregnant with a singleton. It does not deal with multiple pregnancies, teenage pregnancy, and special circumstances like nutritional risks, physical, or mental illness. Special recommendations are made in cases that require an assessment, treatment plan, and personalized follow-up care.

About Healthy Eating During Pregnancy

Introduction

A healthy and varied diet contributes to a pregnant woman’s health and helps meet the demands of her changing body. It also provides the calories and nutrients needed for fetal growth and development. This allows the expectant mother and her baby to store and use nutrients they need during the pregnancy and during the postnatal period.1
Defining a healthy diet

A healthy diet during pregnancy is based on Eating Well with Canada’s Food Guide and includes a variety of:

  • Vegetables and fruits, with a focus on green and yellow/orange choices like spinach, broccoli, kale, sweet potato, carrots, mango, and apricots.
  • Whole-grains like brown or wild rice, whole-wheat breads and pastas, or quinoa.
  • Pasteurized milk and milk alternatives, including yogurt and cheese. A fortified soy beverage is also a suitable choice. Low-fat choices are lower in saturated fats.
  • Meats and alternatives like lean meats, chicken, and fish; tofu; legumes such as lentils, chickpeas, or beans as well as nuts and seeds or eggs.

General Tips

  • Canada’s Food Guide recommends at least two servings of fish each week.
  • Include healthy fats such as vegetable oils like canola oil, olive oil, or sunflower oil.
  • Minimize foods with limited nutritional value, high in salt, fat, and sugars like cakes, chips, ice cream, or fast foods.
  • Canada’s Food Guide includes milk and meat alternatives making it an appropriate tool for vegetarian pregnant women to follow.2

In general, Canada’s Food Guide recommends that women between the ages of 19 – 50 enjoy:

  • Seven to eight servings of Vegetables and Fruit.
  • Six to seven servings of Grain Products.
  • Two servings of Milk and Alternatives.
  • Two servings of Meat and Alternatives.2
Serving size examples according to Canada’s Food Guide

Vegetables and Fruit

  • 125 mL (1/2 cup) of cooked or raw vegetables.
  • 125 mL (1/2 cup) 100% vegetable juice.
  • 250 mL (1 cup) of leafy, raw vegetables.
  • 125 mL (1/2 cup) of fresh, frozen, or canned fruit.

Grain Products

  • 35 grams (one slice) of bread.
  • 45 grams (half) of a bagel.
  • 35 grams (half) of a pita, tortilla, naan, or other flat bread.
  • 125 mL (1/2 cup) cooked grains like rice, pasta, quinoa, or barley.
  • 30 grams of cold breakfast cereal; see the side panel for exact amounts. Different cereals will take up more volume depending on how dense they are.
  • 175 mL (3/4 cup) of cooked cereal like oatmeal.

Milk and Alternatives

  • 250 mL (1 cup) of fluid milk or fortified soy beverage.
  • 125 mL (1/2 cup) evaporated milk.
  • 175 grams (3/4 cup) of yogurt or kefir.
  • 50 grams (1.5 ounces) of cheese.

Meat and Alternatives

  • 75 grams (2.5 ounces or 1/2 cup) of cooked meat, chicken, fish, shellfish, or poultry.
  • 175 mL (3/4 cup) of cooked legumes like lentils, split peas, or any type of bean (e.g., kidney beans, navy beans, black beans).
  • 175 mL (3/4 cup) tofu.
  • Two eggs.
  • 30 mL (2 Tablespoons) of peanut or other nut/seed butters like almond or cashew butter or tahini (sesame seed taste).
  • 60 mL (1/4 cup) of shelled nuts or seeds.
Food servings during pregnancy

Nutrient and calorie needs change throughout pregnancy. The recommended number of servings is the same during the first trimester of pregnancy (i.e., for the first 14 weeks). During the second and third trimesters, pregnant women need two to three extra Food Guide servings per day from any of the four food groups.2
Tips to maintaining a healthy diet

  • Enjoy three meals per day and snacks if required. This helps to maintain energy levels throughout the day.2
  • Avoid skipping meals. Include breakfast to prevent hunger later in the day.1,2
  • Drink plenty of fluids to maintain proper hydration. Aim for 3.0 litres, or about 12 cups, of total fluid from a variety of healthy beverages each day.5 Healthy choices include milk, water, or 100% juice.2,3
  • Aim to meet your dietary fibre needs of 28 grams per day.5 Dietary sources of fibre include whole-grains, legumes, nuts and seeds, and fruits and vegetables. This aids in digestion and helps to avoid constipation.3,4

See the Resources and Links section for more information about the recommendations in Canada’s Food Guide.

Nutritional Requirements during Pregnancy

Introduction

Nutrient requirements increase during pregnancy; this helps support fetal and maternal growth and development. Due to changes in maternal metabolism and hormonal changes, nutrients are used more efficiently and the recommended intake of some nutrients remains the same during pregnancy when compared to a non-pregnant state. Calcium is an example of a nutrient whose requirement remains the same. The requirements for other nutrients like iron and folic acid change as a result of pregnancy and are of particular interest.3,5,6
Calories

A woman’s caloric needs increase gradually throughout pregnancy. During the first trimester, calorie needs remain the same as a woman’s pre-pregnant requirements. Calorie needs increase at the start of the second trimester (i.e., from the 15th week).2
On average, pregnant women need approximately:

  • 340 extra calories per day during the second trimester.5
  • 452 extra calories per day during the third trimester.5

These recommendations are based on the average energy needs of a pregnant woman. Energy requirements for pregnant women who are overweight, obese, and underweight or who have high levels of physical activity are unknown.7 The actual number of additional calories may also vary depending on a woman’s pre-pregnant weight.
Women who are underweight (BMI < 18.5) before pregnancy may need more calories than women who are within a healthy BMI range. Women who are overweight or obese (BMI ≥ 25) may need fewer additional calories than the recommended average.8

Meeting caloric needs

The extra calories needed during pregnancy translate into two or three extra food guide servings. They can come from any of the four food groups.
Here are four examples of snacks that provide 350 – 450 extra calories:

  • A small home-made muffin, yogurt, and an apple.
  • A bowl of breakfast cereal, a cup of milk, and a banana.
  • A bowl of vegetable soup, a piece of cheese, and a slice of bread.
  • Unsalted mixed nuts with dried fruit, an egg, and half a bagel.9

A mother’s personal preferences, culture, or financial situation can dictate what foods are added. Choices may also be based on nutritional gaps noticed in her diet. For example, if a woman does not normally eat the recommended number of servings of Milk and Alternatives, she may choose foods from this food group to increase her calorie and nutrient intake.
Canada’s Food Guide provides most of the nutrients women need. Use Canada’s Food Guide as a teaching tool to compare the expectant mother’s current diet with the recommendations set out within the Food Guide. For example, does her diet include foods from each of the four food groups? Does it include the suggested number of Food Guide servings and proper serving sizes? Determine what adjustments should be made.
Note:
Not all pregnant women start their pregnancy with the same nutritional reserves. Some women are at greater risk for nutritional deficiencies and may have greater needs than others. Depending on the situation, the health care professional can discuss suitable community resources to help (e.g., programs offering integrated prenatal and early childhood services to vulnerable families, free dietary advice phone advice, or associations for people with allergies) and refer them to a registered dietitian if necessary.

Protein

Proteins are components of nearly all cells, including the cells that make up our blood, muscles, and vital organs. Enzymes, hormones, and antibodies are also comprised of proteins. As well, proteins are involved in cell formation, function, and maintenance. During pregnancy, they are essential to fetal and placental development as well as to blood-volume expansion.

Requirements

Protein requirements increase as the pregnancy progresses.
During the first half of pregnancy (the first 20 weeks), a woman’s protein needs remain at 0.8 gram/kg/day (about 46 grams).5
The recommended intake for the second half of pregnancy (from the 20th week until delivery) is 1.1 grams/kg/day (about 71 grams per day).5
According to the most-recent Canadian Community Healthy Survey, over 99 percent of Canadian adults consumed adequate amounts of protein to meet their needs. In Ontario 99.2 percent to 99.6 percent of adult women met their needs for dietary protein.10

Dietary sources of protein

Protein can be found in varying degrees in each of the four food groups. Primary sources of protein can be found in the Meats and Alternatives food group and the Milk and Alternatives food group. This includes red meats, poultry, fish, seafood, legumes, eggs, nuts and seeds as well as milk, soy beverage, yogurt, and cheese. Smaller amounts are found in the Grain Products food group as well as the Vegetables and Fruit food group.9

Table 1: Primary sources of dietary protein

Food Food Guide serving Protein content (grams)
Meat and Alternatives
Beef, cooked, various cuts 75 grams, 1/2 cup 30
Chicken, cooked, various cuts 75 grams, 1/2 cup 19 – 23
Fish (various varieties, including whitefish, perch, salmon, tuna) 75 grams, 1/2 cup 17 – 22
Seafood (including shrimp, scallops, and lobster) 75 grams, 1/2 cup 15 – 18
Eggs two large 12
Tofu (medium-firm) 150 grams, 3/4 cup 17
Nuts (almonds, peanuts, walnuts, hazelnuts, cashews, sesame) 60 mL, 1/4 cup 4 – 9
Seeds (sunflower, flax, chia) 60 mL, 1/4 cup 6 – 8
Pumpkin seeds 60 mL, 1/4 cup 17
Nut and seed butters (peanut, almond, tahini) 30 mL, 2 Tablespoons 5 – 7
Legumes, cooked, (lentils, chickpeas, red kidney beans) 175 mL, 3/4 cup 11 – 13
Milk and Alternatives
Milk (skim, 1%, 2%, 3.25% milk fat) 250 mL, 1 cup 8
Yogurt plain (0% – 2% milk fat) 175 grams, 3/4 cup 9
Cottage cheese (2% milk fat) 250 mL, 1 cup 28
Hard cheese (cheddar, brick, Swiss) 50 grams, 1.5 ounces 12 – 14
Grain Products
Various grain products one serving 3
Vegetables and Fruit
Various vegetables and fruits one serving 1


Data from Health Canada (2010). Canadian Nutrient File, Health Canada9
Calcium

Calcium is a mineral involved in the formation and maintenance of bones and teeth. It also plays a role in nervous system and muscle function, as well as in blood coagulation. The body makes various adjustments to calcium metabolism during pregnancy. This allows for better absorption of the mineral as well as reduced excretion from the kidneys, which enhances fetal utilization of calcium to help form the skeletal system.11

Requirements

Calcium requirements remain the same during pregnancy as compared to a pre-pregnant state. Recommended daily requirements are defined as 1,000 mg per day.5

Dietary sources of calcium

The following are the main sources of calcium:

  • Milk and milk alternatives, including milk, yogurt, cheese, and fortified soy beverages.
  • Foods prepared with milk and milk alternatives, including puddings, cheese dishes, and soups containing milk or cream.9

Other dietary sources include:

  • Broccoli and dark-green, leafy vegetables like kale, collards, and mustard greens.
  • Almonds, sesame seeds, and tahini.
  • Canned salmon and sardines with the bones.
  • Firm and extra-firm tofu, prepared with calcium sulphate.9

Table 2: Primary sources of dietary calcium

Food Food Guide serving Calcium content (milligrams)
Milk and Alternatives
Milk (skim, 1%, 2%, 3.25% milk fat) 250 mL, 1 cup 300
Buttermilk 250 mL, 1 cup 370
Fortified soy milk 250 mL, 1 cup 322
Goat’s milk, enriched 250 mL, 1 cup 345
Kefir 190 mL, 3/4 cup 187
Cottage cheese (2% milk fat) 250 mL, 1 cup 217
Hard cheese (cheddar, brick, Swiss) 50 grams, 1.5 ounces 337 – 452
Yogurt plain (0% – 2% milk fat) 175 grams, 3/4 cup 294 – 320
Yogurt drink 200 mL 190
Meat and Alternatives
Sardines (Atlantic with bones) 75 grams, 1/2 cup 286
Sardines (Pacific with bones) 75 grams, 1/2 cup 180
Salmon, various types (with bones) 75 grams, 1/2 cup 190
Mackerel, canned 75 grams, 1/2 cup 181
Tofu made with calcium (medium to firm) 150 grams, 3/4 cup 347
Tahini (sesame butter) 30 mL, 2 Tablespoons 130
Almonds 60 mL, 1/4 cup 93
Baked beans 150 grams, 3/4 cup 95
Beans (black, Roman, kidney) 150 grams, 3/4cup 34 – 65
Vegetables and Fruit
Collards, cooked 125 mL, 1/2 cup 141
Spinach, cooked 125 mL, 1/2 cup 129
Turnip greens, cooked 125 mL, 1/2 cup 104
Kale, cooked 125 mL, 1/2 cup 95
Orange juice, fortified with calcium 125 mL, 1/2 cup 155
Miscellaneous
Molasses, blackstrap 15 mL, 1 Tablespoon* 179
Grain Products
Not a source of calcium N/A N/A


Health Canada (2010), Canadian Nutrient File, Health Canada9
*Suggested serving
Vitamin D

Vitamin D plays an important role in calcium metabolism and in bone and tooth health. It is also involved in cell-growth regulation, immunity, and cell metabolism. A large number of studies have been published in recent years on the link between vitamin D and cancer, autoimmune diseases, and cardiovascular diseases; however, a clear benefit for vitamin D supplements has not been established.12,13,14,15,16

Requirements

The recommended dietary intake for vitamin D in pregnancy is 15 micrograms (µg) or 600 international units (IU) per day.17 Vitamin D is not widely found in many dietary sources, therefore, obtaining all our needs through food can be challenging.
Health Canada encourages pregnant women to follow the recommendations in Eating Well with Canada’s Food Guide, stressing the need to consume 500 mL (2 cups or 16 ounces) of milk or fortified soy beverage daily.2

Dietary sources of vitamin D

Dietary sources of vitamin D include the following:

  • Cow’s milk. Vitamin D fortification is mandatory in Canada.
  • Vitamin D fortified goat’s milk. The fortification of goat’s milk is optional in Canada. Consumers should be encouraged to read labels.
  • Fortified soy, rice, and almond beverages.
  • Fatty fish such as salmon, trout, and sardines.
  • Eggs.
  • Margarine.9

Table 3: Primary sources of dietary vitamin D

Food Food Guide serving Vitamin D content (IU)
Milk and Alternatives
Milk (skim, 1%, 2%, 3.25% milk fat) 250 mL, 1cup 104
Soy milk, fortified 250 mL, 1cup 110
Goat’s milk, fortified 250 mL, 1cup 100
Meat and Alternatives
Eggs two 70
Beef liver 175 grams, 1/2 cup 36
Snapper 175 grams, 1/2 cup 392
Whitefish, lake 175 grams, 1/2 cup 369
Mackerel 175 grams, 1/2 cup 342
Sardines, Pacific 175 grams, 1/2 cup 144
Salmon, Atlantic 175 grams, 1/2 cup 229
Salmon, Pink 175 grams, 1/2 cup 436
Salmon, Coho 175 grams, 1/2 cup 352
Salmon, Sockeye 175 grams, 1/2 cup 560
Grain Products
Typically not a source of vitamin D  N/A  N/A
Vegetables and Fruit
Typically not a source of vitamin D  N/A  N/A


Source Health Canada (2010), Canadian Nutrient File, Health Canada9
Vitamin B6

Vitamin B6 is a water-soluble vitamin and is also known as pyridoxine. The body uses vitamin B6 to make and store protein and glycogen. Vitamin B6 helps to form hemoglobin, which transports oxygen throughout the body. Vitamin B6 is involved in the metabolism of neurotransmitters and helps in the formation of the myelin sheaths of all nerve cells. It is also essential for proper fetal development.8
Although some studies have suggested that a vitamin B6 supplement may reduce the incidence of pre-eclampsia in pregnant women or improve newborns’ Apgar scores, a systematic review reveals no clinical benefits from vitamin B6 supplementation during pregnancy.18

Requirements

The recommended dietary intake for vitamin B6 in pregnancy is 1.9 mg per day. This is considered an adequate intake.5 This vitamin is found in many different foods and can be obtained readily in a vegetarian and vegan diet.

Dietary sources of vitamin B6

Dietary sources of vitamin B6 include the following:

  • Meat, fish, and poultry.
  • Legumes like lentils, split peas, and kidney beans.
  • Some vegetables and fruits like banana, Irish and sweet potato, and avocado.
  • Dried fruits like prunes, dates, and figs.
  • Grains like oatmeal and wheat bran.
  • Nuts like pistachios and different seeds like sesame and sunflower.9

Omega-3 fatty acids

A number of pregnancy-related studies have been conducted on the consumption of fatty acids and in particular, omega-3 fatty acids. They reveal that these fatty acids are essential to fetal development, especially docosahexaenoic acid (DHA).
DHA concentration in the fetal brain increases very quickly during pregnancy.19 DHA is found in cell membranes, including nervous tissue and the retina. DHA plays a role in gene expression as well as brain, nerve, and visual functioning.20

Requirements

There are three types of omega-3 fatty acids:

  • ALA (alpha-linolenic acid).
  • EPA (eicosapentaenoic acid).
  • DHA (docosahexaenoic acid).

Our body can form EPA and DHA from ALA; therefore, EPA and DHA are not considered essential nutrients. There is no established Dietary Reference Intakes for these two fatty acids.
ALA is the only omega-3 fatty acid that is considered to be essential, meaning we must obtain it from foods. The established adequate intake for ALA during pregnancy is 1.4 grams per day.5

Dietary sources of omega-3 fatty acids

Dietary sources of omega-3 fatty acids include the following:

  • Fatty fish like salmon, trout, mackerel, sardines, and herring.
  • Some seafood like mussels and oysters.
  • Flaxseed and flaxseed oil.
  • Soy beans and soybean oil.
  • Canola oil.
  • Walnuts.
  • Some seaweed.9

A healthy diet should stress healthier types of unsaturated fats like polyunsaturated and monounsaturated fats, including polyunsaturated fats like omega-3 and omega-6 fatty acids.21
Eating fish at least twice a week is recommended.2 Other methods to ensure adequate omega-3 intake include cooking with canola oil, adding ground flaxseed to cereal in the morning, or baking with or snacking on walnuts.9

Table 4: Primary sources of dietary omega-3 fats

Food Food Guide serving ALA content (grams) EPA and DHA content (grams)
Meat and Alternatives
Eggs two 0.06 – 0.28 0.7
Omega-3 eggs two 0.52 0.16 – 0.27
Clams 75 grams, 1/2 cup 0.1 1.96
Cod, Atlantic 75 grams, 1/2 cup 0.0 0.11
Cod, Pacific 75 grams, 1/2 cup 0.04 0.79
Crab 75 grams, 1/2 cup 0.01 0.36
Halibut 75 grams, 1/2 cup 0.05 0.6
Mackerel 75 grams, 1/2 cup 0.12 3.43
Mussels 75 grams, 1/2 cup 0.03 0.59
Salmon, Atlantic 75 grams, 1/2 cup 0.26 1.23
Scallops 75 grams, 1/2 cup 0.0 0.27
Shrimp 75 grams, 1/2 cup 0.01 0.24
Soybeans, cooked 175 grams, 3/4 cup 0.76 0.0
Chia seeds 60 mL, 4 Tablespoon 1.9 0.0
Flaxseed, ground 60 mL, 4 Tablespoon 2.46 0.0
Walnuts, English 60 mL, 4 Tablespoon 2.30 0.0
Vegetables and Fruit
Not a source of Omega-3 fats N/A N/A N/A
Grain Products
Generally not a source of Omega-3 fats N/A N/A N/A
Milk and Alternatives
Generally not a source of Omega-3 fats N/A N/A N/A
Oils and fats N/A N/A N/A
Canola oil 1 teaspoon 0.42 0.0
Flaxseed oil 1 teaspoon 2.58 0.0
Margarine made with canola oil 1 teaspoon 0.34 0.0


Source Health Canada (2010), Canadian Nutrient File, Health Canada9
Folic acid

Folate, or vitamin B9, is part of the B-vitamin family and is naturally present in different foods. The synthetic form, folic acid, is found in fortified foods and supplements. The term “dietary folate” describes all forms of folate present in foods, including natural folate and the folic acid in fortified foods.

Folate plays an important role in cell division, amino acid production, and the production of certain nucleic acids, such as DNA. During periods of rapid growth, such as pregnancy, folate plays a part in new cell formation. This nutrient also supports blood-volume expansion in pregnant women as well as maternal and fetal tissue growth.22,23

Given the high rate of cell division and new cell formation during pregnancy, the embryo and fetus are more sensitive to folate deficiency and to errors in its metabolism.23 Folic acid deficiency is linked with an increased risk of birth defects, including neural tube defects.24,25

Birth defects

In the first few weeks after fertilization, a band of cells develops along the dorsal surface of the embryo forming first a groove and then a hollow tube called the neural tube. That tube is the precursor to the spinal cord and brain; it closes between the 25th and 29th day of gestation. Incomplete closure of the neural tube results in a malformation.
Neural tube closure defects are some of the most common birth defects resulting in a variety of functional limitations. Spina bifida is the best-known and the most common form of these defects. The affected child is born with part of the spinal cord or spinal nerves outside of the vertebral canal.24,25

Requirements

The recommended intake during pregnancy is 600 micrograms (µg)/0.6 milligrams (mg) of dietary folate per day.5 Most pregnant women in North America have difficulty getting that amount of folate from food sources alone.
In order to reduce the risk of neural tube defects and to meet their higher folate needs during pregnancy, all pregnant women and women who wish to become pregnant should take a daily multivitamin containing 400 µg (0.4 mg) of folic acid.22
Although this universal recommendation applies to most pregnant women, some have more specific needs. The Society of Obstetricians and Gynaecologists of Canada, together with the Motherisk program, has proposed adjustments to take into account the various factors that may affect folic acid intake.26

Folic acid intake recommendations

1. Women with:

  • Low-risk, planned pregnancies and high compliancy rates.

Recommendations
A folate-rich diet along with the use of a daily multivitamin containing 0.4 – 1.0 mg of folic acid for at least three months prior to conception and then throughout the pregnancy and the postpartum period (for four to six weeks, or as long as they continue breastfeeding).26

2. Women with the following risk factors:

  • A previous history of giving birth to an infant with a neural tube defect.
  • An immediate family member with a neural tube defect.
  • Ethnic backgrounds known to be at greater risk for having a child with a neural tube defect (e.g., Sikhs).
  • Epilepsy, insulin-dependent diabetes, or obesity (BMI > 35).

Recommendations
A folate-rich diet along with the use of daily multivitamin containing 5 mg of folic acid for at least three months prior to conception and then for 10 – 12 weeks after conception. This can be followed by the use of a daily prenatal multivitamin containing 0.4 – 1.0 mg of folic acid throughout the pregnancy and during the postnatal period (for four to six weeks after the birth, or as long as they continue breastfeeding).26

3. Women with the following risk factors:

  • Low-compliancy rate with medical prescriptions.
  • Poor diet.
  • Lack of contraception.
  • Drug or alcohol use.

Recommendations
There is potential benefit in these women receiving birth defect prevention counselling (with referral to a specialist if they wish). This should occur at least three months prior to becoming pregnant.
A folate-rich diet and use of a daily multivitamin containing 5 mg of folic acid throughout the pregnancy and during the postnatal period (for four to six weeks after the birth, or as long as they continue breastfeeding).26

Folic acid supplement versus multivitamin use

The use of a multivitamin is preferable over the use of a single-nutrient folic acid supplement. A multivitamin can provide iron and folic acid as well as other important nutrients.
A number of recent studies have shown that the use of a multivitamin containing folic acid can:

  • Decrease the risk of birth defects other than neural tube defects, including cardiovascular defects and defects affecting the limbs.
  • Help protect against other problems, such as cleft lips or palates.
  • Decrease the risk of pre-eclampsia in pregnant women.4,27,28

Taking a multivitamin has also been shown to be preferable over the use of different supplements providing one or two single micro-nutrients.29,30,31
Studies among women (those using and those not using a folic acid supplement) reveal that:

  • Knowledge of the benefits of folic acid increases the likelihood of supplement use, both before and during pregnancy.32
  • Women who have discussed the use of folic acid with a health care professional are more likely to take a supplement and to take it regularly (at least four days a week).23,33
Dietary sources of folate

Dietary sources of folate include the following:

  • Fortified grain products such as breads, cereals, and pastas.
  • Dark-green vegetables like spinach, romaine lettuce, broccoli, and Brussels sprouts.
  • Legumes, including lentils and dried beans.
  • Oranges and orange juice.9

Table 5: Primary sources of dietary folate

Food Food Guide serving Folate content (micrograms)
Vegetables and Fruit
Okra, cooked 125 mL, 1/2 cup 142
Spinach, cooked 125 mL, 1/2 cup 139
Asparagus, cooked four spears 81
Turnip greens, cooked 125 mL, 1/2 cup 100
Collards, cooked 125 mL, 1/2 cup 93
Broccoli, raw 125 mL, 1/2 cup 81
Green peas 125 mL, 1/2 cup 50
Brussel sprouts four sprouts 50
Romaine lettuce 250 mL, 1 cup 80
Raw cabbage 250 mL, 1cup 65
Lettuce (springmix) mesclun 250 mL, 1 cup 65
Avocado, all varieties one half 81
Orange juice 125 mL, 1/2 cup 58
Orange one medium 48
Meat and Alternatives
Roman beans, cooked 175 mL, 3/4cup 271
Black-eyed peas, cooked 175 mL, 3/4cup 265
Lentils, cooked 175 mL, 3/4cup 265
Edamame, cooked 175 mL, 3/4cup 255
Chickpeas, cooked 175 mL, 3/4cup 209
Roasted soy beans 175 mL, 3/4cup 172
Beef liver, fried 75 grams, 1/2cup 195
Peanuts 60 mL, 1/4 cup 54
Sunflower seeds 60 mL, 1/4 cup 83
Tofu 175 mL, 3/4cup 40
Eggs two 54
Grain Products
Italian bread one slice 56
Naan bread a quarter of a piece 35
White bread one slice 30
Whole-wheat bread one slice 28
Rye bread one slice 22
Milk and Alternatives
Generally not a significant source of folate N/A N/A
Miscellaneous
Yeast extract spread 30 mL, 2 Tablespoons* 371
Kelp seaweed, raw 125 mL, 1/2 cup 76
Wakame seaweed 125 mL, 1/2 cup 83


Source Health Canada (2010), Canadian Nutrient File, Health Canada9
*Suggested serving size
Iron

Iron is a mineral and is an essential nutrient. It is an integral part of several proteins, including hemoglobin found in red blood cells and is a part of many different enzymes. It plays an important role in oxygen delivery and energy metabolism. Iron is also involved in several vital physiological processes, such as cell-growth regulation and cell differentiation.
The role of iron during pregnancy explains the increase in iron requirements during pregnancy.
Iron aids in the following processes:

  • Expansion of maternal blood volume and hemoglobin mass.
  • Supporting fetal and placental growth.
  • Building fetal iron stores required to support growth in the first six months of life.34
Iron deficiency in pregnancy

In pregnancy, iron deficiency decreases serum hemoglobin concentration resulting in a decrease of oxygen delivery from the maternal lungs to fetal tissues.
Iron is an immunoregulator; iron deficiency can suppress immune function.
Iron deficiency may lead to maternal anemia potentially resulting in fatigue, preterm delivery, low birth weight, and the increased the risk of infant mortality.34

Requirements

The Recommended Dietary Allowance for pregnancy is 27 mg of iron per day.5 Most pregnant women in North America have difficulty getting that amount of iron from dietary sources alone.
In order to meet their increased iron needs, it is recommended that pregnant women take a daily multivitamin supplement containing 16 – 20 mg of iron.,35
Taking such a supplement on a daily basis increases the amount of hemoglobin in the mother’s blood. Women who take a daily multivitamin can decrease their risk of developing iron-deficiency anemia.36
Note that women who are iron deficient or anemic need medical assessment to determine how much extra supplemental iron they require.

Dietary sources of iron

Dietary sources of iron include the following:

  • Meat, poultry, fish, and seafood.
  • Iron-fortified grain products such as breads, cereals, cream of wheat, and pastas.
  • Legumes including chickpeas, black beans, and lentils.
  • Some vegetables and fruits like dried apricots, spinach, snow peas, and potatoes cooked with their skins.
  • Nuts, including pecans, pistachios and almonds.9

Table 6: Primary sources of dietary iron

Food Food Guide serving Iron content (milligrams)
Meat and Alternatives
Beef, various cuts 75 grams, 1/2 cup 2.5 – 3.3
Oysters, cooked 75 grams, 1/2 cup 3.25 – 4.6
Beef liver, cooked 75 grams, 1/2 cup 4.9
Ground beef, lean 75 grams, 1/2 cup 2.2
Scallops, cooked 75 grams, 1/2 cup 2.25
Sardines (Atlantic ), canned 75 grams, 1/2 cup 2.2
Fish (trout, bass, mackerel) 75 grams, 1/2 cup 1.4 – 1.7
Tuna, light, canned 75 grams, 1/2 cup 1.2
Shrimp 75 grams, 1/2 cup 2.32
Lamb, various cuts 75 grams, 1/2 cup 1.3 – 2.1
Chicken, various cuts 75 grams, 1/2 cup 0.4 – 2.0
Pork, various cuts 75 grams, 1/2 cup 0.8 – 1.2
Eggs two 1.6
Tofu (firm to extra-firm) 175 mL, 3/4 cup 2.4
Soy beans, cooked 175 mL, 3/4 cup 6.5
Kidney beans, cooked 175 mL, 3/4 cup 3.9
Baked beans, canned 175 mL, 3/4 cup 6.1
White beans, cooked 175 mL, 3/4 cup 5.8
Lentils 175 mL, 3/4 cup 4.9
Pumpkin seeds 60 mL, 1/4 cup 3.1
Sunflower seeds 60 mL, 1/4 cup 2.3
Cashews 60 mL, 1/4 cup 2.2
Tahini (sesame seed butter) 30 mL, 2 Tablespoons 6.2
Grain Products
Cream of wheat, cooked 175 mL, 3/4 cup 5.66
Ready-to-eat boxed breakfast cereal (e.g., Shreddies, Mini-Wheats, All-Bran, Corn Flakes) 30 grams 4.0
Vegetables and Fruit
Spinach, cooked 125 mL, 1/2 cup 3.39
Swiss chard, cooked 125 mL, 1/2 cup 2.09
Snow peas, cooked 125 mL, 1/2 cup 1.7
Prune juice 125 mL, 1/2 cup 1.6
Kale cooked 125 mL, 1/2 cup 1.3
Green peas, cooked 125 mL, 1/2 cup 1.3
Milk and Alternatives
Fortified soy beverage 250 mL, 1 cup 1.08
Miscellaneous
Blackstrap molasses 15 mL, 1 Tablespoon 3.64
Yeast extract spread 30 mL, 2 Tablespoons* 1.4


Source Health Canada (2010), Canadian Nutrient File, Health Canada9          *Suggested serving size

Two forms of dietary iron exist:

  • Heme iron, which is found only in meat, poultry, fish, and seafood.
  • Non-heme iron, which is found in both animal and plant-based foods like vegetables, grain products, eggs, and legumes.

Heme iron is more readily absorbed than non-heme iron.34
Various foods can affect the absorption of iron.
To enhance the absorption of non-heme iron, pregnant woman can:

  • Consume foods rich in vitamin C (e.g., orange juice, tomatoes, broccoli, and sweet pepper) at the same time.
  • Enjoy meat, poultry, fish, or seafood (even in small quantities) together with non-heme food sources.14

Conversely, some substances in foods may reduce the absorption of iron from plants, especially if they are consumed at the same meal.
These substances include:

  • Phenolic compounds found in tea, coffee, and beet leaves.34,37
  • Phytates can bind minerals such as iron and affect absorption. They are found in legumes, unprocessed rice and grains, and unleavened breads.34,38
  • Calcium supplements and calcium-containing antacids can affect the absorption of both heme and non-heme iron. Iron and calcium supplements should be taken at least one to two hours apart.34,39

Consuming these substances at the same time as iron-containing foods should be avoided.

Potential side effects of iron supplements

Pharmacological doses of iron such as the amounts of iron found in a single-nutrient iron supplement can cause nausea, vomiting, constipation, diarrhea, dark stools, and gastric pain.40 Pregnant women are encouraged to speak with their health care professionals about any side effects they may be experiencing. Other forms or doses can be recommended to help increase tolerance and minimize side effects.

Listeriosis and other food-borne illnesses

Listeriosis is a food-borne illness. It is caused by Listeria monocytogenes (commonly called Listeria), a bacterium that is widespread in the environment (soil, vegetation, water) and may, in some cases, contaminate foods.
Listeriosis is relatively rare, but some people are more vulnerable than others. Pregnant women are at a 15 to 20 times’ greater risk of contracting the disease than other healthy adults. This vulnerability is due, in large part, to the way the bacterium multiplies. It spreads through intracellular transmission, which protects it against normal immune responses and allows it to cross the placental barrier.
Once colonized, the fetoplacental unit becomes a prime breeding ground for the bacterium.41
Listeriosis infection can have serious consequences during pregnancy, including:

  • Miscarriage or stillbirth.
  • Premature delivery.
  • Poor health outcomes for the newborn.42,43,44,45

Note that for other food-borne illnesses, such as those caused by Salmonella or E. coli, the risk to pregnant women is the same as the risk to healthy members of the general population.

Symptoms and treatment

Pregnant women who contract listeriosis often have benign, flu-like symptoms (e.g., chills, fatigue, headaches, and muscle and joint pain). They should see a their health care provider if they have a fever.
Listeriosis should be suspected if there is no obvious reason for the fever.42,44,45 The disease can be treated effectively with antibiotics. Early treatment of the pregnant woman may prevent the fetus or newborn from becoming infected.42,44,45
Unlike many bacteria, Listeria can survive and sometimes grow on foods stored in the refrigerator. However, the bacterium is destroyed during cooking. Contaminated foods look, smell, and taste normal.44,45

Prevention

To reduce the risk of contracting listeriosis and other bacterial infections such as those caused by Salmonella or E. coli, it is important for pregnant women to follow general food hygiene and safety tips, like proper food storage and handling precautions.
Pregnant women are advised to take the following precautions:

  • Drink only pasteurized milk.
  • Avoid soft cheeses like brie, feta, camembert or blue-veined cheeses, queso blanco, or queso fresco. If these cheeses are to be used, they should be used in cooked dishes and cooked to an internal temperature of 74o C.
  • Choose cheeses that are safe to eat during pregnancy, such as cheddar, Swiss, or Parmesan.
  • Heat deli meats like ham, turkey or chicken breast, or bologna until steaming before eating them. Deli meats in general should be limited due to their high fat and salt content.
  • Avoid refrigerated pate, other meat spreads, and smoked seafood.
  • Cook eggs thoroughly.
  • Avoid undercooked meat or seafood, including sushi.
  • Avoid raw sprouts such as alfalfa or other bean sprouts.
  • Avoid unpasteurized juice or cider
  • Cook all foods properly to destroy bacteria such as Listeria, Salmonella, and E coli. Use a digital food thermometer to check a food’s internal temperature; it the only way to check that food has been cooked properly and reached a safe internal temperature.46

Table 7: Cooking temperatures of various foods

Food Internal temperatures
Beef, veal, lamb (pieces and whole cuts)
Medium rare
Medium
Well done
63o C, 145o F
71o C, 160o F
77o C, 170o F
Pork (pieces and whole cuts) 71o C, 160o F
Poultry (chicken, turkey, duck, etc.) 71o C, 160o F
Poultry, pieces 74o C, 165o F
Poultry, whole 85o C, 185o F
Ground meats (hamburgers, sausages, meatballs, meat loaf) 71o C, 160o F
Eggs (whole and cooked in dishes) 74o C, 165o F
Other (hotdogs, stuffing, leftovers, seafood) 74o C, 165o F


Source: Safe internal cooking temperatures
Mercury and fish consumption

Mercury is a metal that can be found naturally in the environment. Various industrial practises cause mercury contamination of the air, water, and soil. This mercury is then converted into methyl mercury, the most hazardous form of mercury.

Methyl mercury accumulates in the flesh of fish, which fish sometimes absorb from its surrounding waters, but mainly after eating other smaller fish containing mercury. 47,48 Mercury cannot be removed from fish by cleaning or cooking.49
Concerns over mercury exposure are due, in part, to its toxicity; over 99 percent of mercury found in fish is in the form of methyl mercury. Methyl mercury is highly absorbable. Humans can absorb about 95 percent of mercury found in food.50
Various adverse effects on human health have been observed following exposure to methyl mercury. The severity of these effects depends on the absorbed dose and exposure time. The accumulation of large doses leads to different disorders affecting fine motor skills, attention, verbal learning, and memory. Methyl mercury also crosses the placenta. The fetal brain is particularly vulnerable to methyl mercury. It is important for pregnant women to monitor their predator-fish consumption.47,48

Dietary sources of methyl mercury

The table below lists the preferable fish species and those that should be eaten in moderation or less frequently during pregnancy.

Table 8: Fish consumption recommendations for women who may become pregnant, are pregnant, or breastfeeding

Fish to enjoy more often Fish to limit
Health Canada has not established an advisory on the limit of the following fish to consume for pregnant or breastfeeding women.
They are also good sources of omega-3 fats.
Albacore (white) canned tuna:
limit intake to no more than 300 grams (10 ounces) / 500 mL (2 cups) per week.
Rainbow Trout
Herring
Atlantic Mackerel
Sardines
Salmon (all varieties)
Anchovies
Fresh or frozen tuna, shark, swordfish, escolar, marlin, orange roughy:
limit intake to no more than 150 grams (5 ounces) / 250 mL (1 cup) per month.


Note: Canada’s Food Guide recommends at least two servings of fish each week. One serving is 75 grams (2 1/2 oz) or 125 mL (1/2 cup).
Source: Health Canada (2010), Canadian Nutrient File, Health Canada9
Source: Health Canada (2008) Mercury in Fish, Canada
Larger predator fish like shark or swordfish eat large amounts of smaller fish and are considered to be higher-up on the marine food chain allowing them to bio-accumulate methyl mercury. Larger freshwater fish with higher amounts of mercury include bass, walleye, and pike. Smaller fish that feed on insects or plankton tend to have lower amounts of mercury stored in the muscle or flesh of their bodies.48

Tuna: a special case

Canned tuna is a popular fish for many consumers. It is convenient, widely available, and affordable. Therefore, a few distinctions should be made:

  • Canned light tuna contains other species of tuna, such as the skipjack tuna, yellowfin tuna, or longtail tuna, whose mercury concentrations are lower. Health Canada has not established any advisory over its consumption.
Game fish

Pregnant women who eat game fish on a regular basis should check whether any related warnings have been issued in their area by contacting the Ontario Ministry of Natural Resources. To learn more see the Resources and Links section.

Caffeine

Coffee and tea are popular drinks, and their consumption has been the subject of a number of studies. Currently, there are no specific consumption pattern reports for caffeine intakes among Ontario residents.
Studies on caffeine consumption during pregnancy reveal:

  • Caffeine consumption is unlikely to lead to birth defects.51
  • There is currently not enough evidence to confirm or disprove that caffeine consumption affects birth weight or how a pregnancy will progress.52

Health Canada recommends pregnant women limit their caffeine intake to 300 mg or less per day. This is equal to about two or three cups of coffee per day, or four to six cups of tea each day.53

Dietary sources of caffeine

Dietary sources of caffeine include:

  • Coffee.
  • Black and green tea.
  • Some soft drinks (both cola and some non-cola).
  • Chocolate.
  • Some energy drinks.

Pregnant women are advised to avoid energy drinks.

Table 9: Primary sources of dietary caffeine

Food Serving Caffeine content (milligrams)
Coffee
Espresso 60 mL, 1/4 cup* 125
Latte, made with milk 250 mL, 1 cup 218
Brewed 175 mL, 3/4 cup 70
Instant 175 mL, 3/4 cup 57
Tea
Brewed 175 mL, 3/4 cup* 35
Chai latte 175 mL, 3/4 cup* 12
Green teas (green, oolong, white) 175 mL, 3/4 cup* 30 – 42
Carbonated drinks
Cola, high in caffeine 355 mL, one can 100
Cola, diet 355 mL, one can 44
Cola, other (e.g., Dr Pepper) 355 mL, one can 37
Sweets
Chocolate-coated coffee beans 5 grams 42
Chocolate milk (partly skimmed, 2%, 3.25% milk fat) 250 mL, 1 cup 3 – 5
Cocoa powder, unsweetened 5 grams 12
Chocolate 45 – 59% cocoa 40 grams 17


Source Health Canada (2010), Canadian Nutrient File, Health Canada9
*Suggested serving
Herbal teas and medicinal plants

There is not enough evidence regarding the effects of herbs and herbal teas on fetal growth and development, birth outcomes, or maternal health to draw conclusions.54
Most experts and government agencies, therefore, recommend the following:

  • Pregnant women should not take any medication, medicinal plant, or natural health product, except at the recommendation of their health care provider.
  • Ginger is an exception to the rule. Its use during pregnancy has been studied (using dosages of 0.5 – 1.5 grams per day) and proven to be effective for relieving morning sickness with no adverse effects reported.54,55
  • The following herbal teas are generally considered safe if taken in moderation (i.e., two to three cups per day): citrus peel, peppermint, Echinacea, red raspberry leaf, rosemary, ginger, orange peel and rosehip.8,56,57,58,59,60

Artificial sweeteners or sugar substitutes

Artificial sweeteners are substances that are typically many times sweeter than sugars but do not contain any or as many calories as sugar. Some, such as aspartame are used as food additives. They are added to various commercial food items, in particular, soft drinks, desserts, breakfast cereals, and chewing gum.

Others, such as saccharin and cyclamates, are used as tabletop sweeteners only, meaning that they can only be purchased for personal use, to be added to coffee or other hot drinks and dessert recipes. They are not used as food additives.61,62 Canadian Food and Drug Regulations require food labels to state that saccharin sweeteners not be used by pregnant women unless it is on the advice of their health care provider.82

In Canada, sweeteners are approved for use only after their safety has been assessed and an acceptable daily intake has been determined. The scientific data available at this point reveals that the products currently used as sweeteners in Canada can safely be consumed by the general population, including by pregnant and breastfeeding women.61,62

Pregnant women should be counselled to use these products in moderation since these types of foods may replace nutrient-rich foods that are a good source of energy.63

Natural health products

Natural health products (NHPs) are natural substances that are used for a number of health reasons, including prevention or treatment of an illness, to reduce health risks, or maintain health. They are made from plants, animals, microorganism or marine sources like aquatic plants. These products can be in the form of tablets or capsules, solutions, drops, creams or ointments; these are over-the-counter products. NHPs are popular among Canadians with about 71 percent of Canadians having tried or used these products.64
NHPs include:

  • Vitamins and minerals.
  • Herbal remedies.
  • Homeopathic medicine.
  • Traditional Chinese and East Indian medicine.
  • Probiotics.
  • Amino acids and essential fatty acids.64

Natural Health Products are not risk-free.
To help minimize risk, pregnant and breastfeeding women should:

  • Talk to their health care providers including doctors, midwives, pharmacists, dietitians, or naturopaths before taking any products.
  • Use approved products. Look for an NHP number on the label (usually an eight-digit number following the initials NHP); this identifies licensed products. To be licensed, a natural health product must be safe, effective, of high quality, and contain detailed label information.
  • Read and follow all instructions on a product label.
  • Report all unwanted side effects to health care providers and Health Canada.

Excessive vitamin A intake

Vitamin A plays several major roles in the body: it promotes good vision, is involved in bone and tooth growth, contributes to skin and mucous membrane health, and protects against infection. It is important that pregnant women get enough vitamin A to meet their needs.

To avoid confusion, pregnant women should be told that regular dietary vitamin A consumption does not cause any problems. Excess vitamin A is to be avoided.65

Women are encouraged to enjoy a diet that includes foods rich in vitamin A. This can help them meet their needs for adequate amounts of this important nutrient. Adequate amounts are defined as 2567 IU or 770 micrograms per day.5 Excessive amounts can have teratogenic effects.65

Excessive amounts of vitamin A are defined as 10,000 IU or 3000 micrograms per day.5

Women who are pregnant or wish to become pregnant are advised to limit foods with very high retinol concentrations including liver and liver products or avoid excessive amounts from supplemental forms. This is especially important during the first trimester.66,67

Pregnant women should also have no more than one daily dose of a prenatal multivitamin so that they do not exceed the recommended amount of vitamin A.22 Prenatal vitamin supplements containing beta-carotene as the form of vitamin A are safe to take during pregnancy.

Table 10: Vitamin A content of liver and liver products

Food Food Guide serving Vitamin A content (micrograms)
Beef liver, pan-fried 75 grams, 1/2 cup 5796
Chicken liver, simmered 75 grams, 1/2 cup 2984
Cod liver oil 15 mL, 1 Tablespoon 4135
Liver sausage, liverwurst, pork 75 grams, 1/2 cup 6231
Pork liver, braised 75 grams, 1/2 cup 4054


Source Health Canada (2010), Canadian Nutrient File, Health Canada9

It is logical to advise pregnant women to eat liver no more than once every two weeks based on the high vitamin content of liver compared to the upper limit set at 3000 micrograms per day. Pregnant women need 1300 micrograms per day.

Table 11: Other primary sources of dietary vitamin A

Food Food Guide serving Vitamin A content (micrograms)
Vegetables and Fruit
Sweet potato (with skin), cooked one medium 1096
Carrot juice 125 mL, 1/2 cup 966
Carrots, cooked 125 mL, 1/2 cup 680
Butternut squash, cooked 125 mL, 1/2 cup 604
Collards, cooked 125 mL, 1/2 cup 470
Spinach, cooked 125 mL, 1/2 cup 498
Romaine lettuce 250 mL, 1 cup 258
Red leaf lettuce 250 mL, 1 cup 18
Bok choy, cooked 125 mL, 1/2 cup 190
Dried apricots 60 mL, 1/4 cup 191
Cantaloupe 125 mL, 1/2 cup 143
Grain Products
Generally not a source of Vitamin A N/A N/A
Milk and Alternatives
Milk (skim, 1%, 2%,) 250 mL, 1 cup 163
Milk, homogenized 250 mL, 1 cup 119
Fortified soy milk 250 mL, 1 cup 104
Blue, gruyere, cheddar, Colby cheese 50 grams, 1 1/2 ounces 132 – 158
Ricotta cheese 125 mL, 1/2 cup 156
Soft goat-cheese 50 grams, 1 1/2 ounces 144
Brick cheese 50 grams, 1 1/2 ounces 146
Meat and Alternatives
Eggs two 190
Mackerel, baked or broiled 75 grams, 1/2 cup 189
Chicken, roasted 75 grams, 1/2 cup 165
Salmon (king or Chinook) 75 grams, 1/2 cup 118
Oysters, cooked 75 grams, 1/2 cup 110
Clams, cooked 75 grams, 1/2 cup 128


Source Health Canada (2010), Canadian Nutrient File, Health Canada9

About Weight Gain during Pregnancy

Weight gain

A woman’s pre-pregnant body mass index (BMI) and maternal weight gain both influence fetal growth. They are both linked to birth weight and to other indicators of maternal health outcomes and birth outcomes.68,69

Weight gain is a sensitive topic during pregnancy, and a sensitive approach to counselling is an important aspect of prenatal care. Maternal weight gain encompasses the baby’s weight and the weight of the placenta, uterus, maternal blood volume, amniotic fluid, and growing breast tissue.

Recommendations

Canadian recommendations on maternal weight gain are based on the recommendations of the Institute of Medicine in the United States.8 They offer weight-gain ranges that use a woman’s pre-pregnancy BMI.

Gaining weight within the recommended ranges, as set out in Table 12, is associated with optimal birth outcomes for both the mother and baby. It lowers the risk of maternal complications like gestational diabetes and complications at delivery.70,71

Women can determine their BMI using the BMI calculator on the Health Canada website. By entering their height and pre-pregnancy weight their BMI is calculated automatically. However, women are advised to discuss their weight gain recommendations directly with their health care provider.

Table 12: Recommended weight gain for a singleton pregnancy

Pre-pregnancy BMI Mean rate of weight gain in the second and third trimester Recommended total weight gain
Kg/m2 kg/week lb/week kg lbs
BMI < 18.5 0.5 1 12.5 – 18.0 28 – 40
BMI 18.5 – 24.9 0.4 1 11.5 – 16.0 25 – 35
BMI 25.0 – 29.9 0.3 0.6 7.0 – 11.5 15 – 25
BMI ≥ 30.0 0.2 0.5 5 – 9 11 – 20


Source Health Canada69 and IOM 200970

Concerns over appropriate weight gain during pregnancy arise from the most-recent trends showing a greater percentage of women entering pregnancy overweight or obese. Many women are also gaining too much weight during pregnancy.70,71,72,73,74.75

For more information about healthy weight gain during pregnancy, see the Resources and Links section.

Rate of weight gain

Weight gain during pregnancy is gradual. It is slower in the first trimester with weight gain rates increasing during second and third trimester. Women can gain no weight or can gain up to one to two kilograms in their first trimester. Expected weight gain in the subsequent trimesters is approximately 500 grams per week starting in the 15th week of gestation.72

The amount of weight gained varies from one woman to the next, and sometimes from one pregnancy to the next for the same woman.
Women experiencing excess amounts of weight gain or rapid weight gain may need dietary counselling or advice about physical activity. The same applies to women who gain too little or who lose weight, especially if they started their pregnancy with a low BMI of less than 18.5.76

Causes for Concern

Introduction

There is growing concern over the increased prevalence of overweight and obese women who become pregnant or women who gain too much weight during pregnancy. This can have negative impacts on the health of the mother and her child. Weight loss or dieting is not recommended during pregnancy.

Overweight

Women who start their pregnancy overweight are more likely to:

  • Deliver by C-section.
  • Develop gestational diabetes.68,77,78

Their children are also at greater risk for obesity and obesity-related complications.77,78,79

Excessive weight gain

Excessive weight gain during pregnancy is associated with:

  • Increased risk of complications at delivery.
  • Increased risk of developing gestational diabetes.
  • Excess weight retention after delivery.7,69,70,71,73,75,80,81

Babies whose mothers gain more than the recommended amounts of weight during pregnancy are more likely to:

  • Experience excessive fetal growth.
  • Develop fetal macrosomia.

The negative health consequences are compounded if a significant weight gain during pregnancy is combined with a high pre-pregnancy BMI.

Underweight and inadequate weight gain

Having a low pre-pregnant BMI or gaining too little weight during pregnancy is also a cause for concern.
A lack of appropriate weight gain during pregnancy is associated with an increased risk of:

  • Giving birth to a baby who is small for their gestational age.
  • Neonatal morbidity and mortality.
  • Physical and cognitive disabilities.
  • Chronic health problems later in life.70,71

The risk is higher for women who begin their pregnancy being underweight.68,73,80

Referrals

When to refer

Pregnant women with special circumstances (e.g., multiple pregnancies, teenage pregnancy, nutritional risks, physical or mental illness) require special diet and weight gain recommendations in order to promote a healthy pregnancy.

Where to refer

Professionals are encouraged to refer these women to specialized resources that will be able to offer them personalized nutritional assessment, treatment, and monitoring services.
For more information about referrals, see the Resources and Links section.

Back to the Top

Resources & Links


Please note this is not an exhaustive list of available resources, nor should any of these resources be used in place of seeking professional advice. The resources cited throughout this resource are not necessarily endorsed by the Best Start Resource Centre or the Government of Ontario.

When in doubt, professionals should contact the organization responsible for issuing a specific recommendation/practise guideline.

Professional Guidelines

Professional Associations

Reports/Publications

Websites: Resources for Clients

Websites: Resources for Professionals

Helplines

  • EatRight Ontario 1-877-510-5102
  • Motherisk Helpline 1-877-327-4636
  • Ontario Ministry of Natural Resources and Forestry (fish safety) 1-800-667-1940
  • Telehealth Ontario  1-866-797-0000, 1-866-797-0007 (TTY)

Prenatal Education Provider Tools

Client Resources and Handouts

Apps

Back to the Top

References

  1. Williamson, C. S. (2006). Nutrition in pregnancy. Nutrition Bulletin, 31(1), 28-59.
  2. Government of Canada. (2014). Eating well with Canada’s food guide. Retrieved from http://www.healthycanadians.gc.ca/eating-nutrition/food-guide-aliment/index-eng.php
  3. Health Canada. (2011). Prenatal nutrition. Retrieved from http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/index-eng.php
  4. Czeizel, A. E. (2009). Periconceptional folic acid and multivitamin supplementation for the prevention of neural tube defects and other congenital abnormalities. Birth Defects Research Part A: Clinical and Molecular Teratology, 85(4), 260-268.
  5. Health Canada. (2010). Dietary reference intake tables. Retrieved from http://www.hc-sc.gc.ca/fn-an/nutrition/reference/table/index-eng.php
  6. De-Regil, L. M., Fernández-Gaxiola, A. C., Dowswell, T., & Peña-Rosas, J. P. (2010). Effects and safety of periconceptional folate supplementation for preventing birth defects. Cochrane Database of Systematic Reviews, 2006(2). doi:10.1002/14651858.CD007950.pub2.
  7. Siega-Riz, A. M., Viswanathan, M., Moss, M. K., Deierlein, A., Mumford, S., Knaack, J., Lohr, K. N. (2009). A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: Birthweight, fetal growth, and postpartum weight retention. American Journal of Obstetrics and Gynecology, 201(4), 339.e1-339.e14. http://dx.DOI.org/10.1016/j.ajog.2009.07.002
  8. Institute of Medicine. (2009). Weight gain during pregnancy: Reexamining the guidelines. Washington, DC: National Academies Press. Retrieved from http://www.nap.edu/catalog.php?record_id=12584
  9. Health Canada. (2010). Canadian Nutrient File (CNF) – Search by food. Retrieved from http://webprod3.hc-sc.gc.ca/cnf-fce/newSearch-nouvelleRecherche.do?action=new_nouveau&lang=eng
  10. Health Canada. (2012). Do Canadian adults meet their nutrient requirements through food intake alone? Retrieved from http://www.hc-sc.gc.ca/fn-an/surveill/nutrition/commun/art-nutr-adult-eng.php#a321
  11. Mulligan, M. L., Felton, S. K., Riek, A. E., & Bernal-Mizrachi, C. (2009). Implications of vitamin D deficiency in pregnancy and lactation. American Journal of Obstetrics and Gynecology, 202(5) http://dx.doi.org/10.1016/j.ajog.2009.09.002
  12. Chung, M., Balk, E. M., Brendel, M., Ip, S., Lau, J., . . . & Trikalinos, T. A. (2009, August). Vitamin D and calcium: Systematic review of health outcomes (AHRQ Publication No. 09-E015). Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from http://www.ahrq.gov/downloads/pub/evidence/pdf/vitadcal/vitadcal.pdf
  13. Kimball, S., Fuleihan, G. E. H., &Vieth, R. (2008). Vitamin D: A growing perspective. Critical Reviews in Clinical Laboratory Sciences, 45(4), 339-414. DOI:10.1080/10408360802165295
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Health Before Pregnancy

Health Before Pregnancy

Routine Prenatal Care

Routine Prenatal Care

Physical Changes

Physical Changes

Healthy Eating & Weight Gain

Healthy Eating & Weight Gain

Active Living

Active Living

Alcohol

Alcohol

Smoking

Smoking

Medications & Drugs

Medications & Drugs

Safety During Pregnancy

Safety During Pregnancy

Abuse

Abuse

Mental Health

Mental Health

Pregnancy & Infant Loss

Pregnancy & Infant Loss

Preterm Labour

Preterm Labour

Labour Progress

Labour Progress

Labour Support

Labour Support

Interventions in Labour

Interventions in Labour

Pain Medications in Labour

Pain Medications in Labour

Caesarean Birth

Caesarean Birth

Vaginal Birth After Caesarean

Vaginal Birth After Caesarean

Breech Birth

Breech Birth

Newborn Care

Newborn Care

Newborn Safety

Newborn Safety

Breastfeeding

Breastfeeding

Recovery After Birth

Recovery After Birth

Transition to Parenthood

Transition to Parenthood