Resources for Healthy Eating

Resources for Assistance and Referral

  • The American College of Obstetricians and Gynecologists (ACOG)
    FAQ Nutrition for Pregnant Patients - A brochure with Frequently asked questions.
  • International Food Information Council Foundation
    Food Insight: Healthy Eating During Pregnancy - This brochure provides information on healthy eating during pregnancy including: how to eat a balanced diet, eating a variety of foods, healthy weight gain during pregnancy, and food safety concerns specific to pregnant women.
  • U.S. Department of Agriculture
    Dietary Reference Intakes - Features Interactive DRI tool for Healthcare Professionals, DRI Tables, DRI Reports, Resources on Individual Macronutrients, Phytonutrients, Vitamins and Minerals, and other dietary guidance.
  • Expanded Food and Nutrition Education Program (EFNEP)
    Handout - The Expanded Food and Nutrition Education Program (EFNEP) is designed to assist limited resource audiences in acquiring the knowledge, skills, attitudes, and changed behavior necessary for nutritionally sounds diets, and to contribute to their personal development and the improvement of the total family diet and nutritional well-being.
  • Nutrition Center, American Heart Association
    Tips and Recipes Handout - Provides Healthy Diet Goals, Healthy Cooking and Recipes, Heart-Smart Shopping, Dining Out tips, and Cookbooks and Health Guides.

Resources for the Pregnant Patient

  • Health & Nutrition Information for Pregnant & Breastfeeding Women - Pregnancy-specific information about: Making Healthy Choices in Each Food Group, Nutritional Needs During Pregnancy, Weight Gain during Pregnancy, Weight Loss While Breastfeeding, Nutritional Needs while Breastfeeding, Dietary Supplements, Health Needs, Food Safety for Pregnancy and Breastfeeding Women, and more.
  • March of Dimes
    Eating and Nutrition - Pregnancy-specific information on eating and nutrition including vitamin and minerals, caffeine, folic acid, food-borne illness prevention, and safe handling and cooking of food.
  • The American College of Obstetricians and Gynecologists (ACOG)
    Nutrition Handout FAQs for Pregnant Patients - Nutrition During Pregnancy Frequently Asked Questions.
  • Let's Move!
    Food and Nutrition Handout - Provides links directly to Dietary Guidelines of Americans, MyPlate, and provides Eating Healthy on a Budget tips. Also has "Healthy Moms" section that directly links to MyPlate Plan for Nursing Moms and Moms-to-Be.
  • TWEAK and T–ACE
    Screening of pregnant women for alcohol use should be conducted. The TWEAK and the T–ACE are screening tools able to detect lower levels of alcohol consumption.
  • First Trimester
    At initial intake, women's attitudes toward weight gain and nutrition during pregnancy should be assessed by asking open-ended questions. Advice should be individualized based on this discussion.

    Ongoing dietary assessments can be used to monitor nutrition throughout pregnancy and includes 24-hr diet recalls, food records, and food checklists.

    Moderate increase in calories, if any, should be advised at this period in time. According to DRI, energy needs are no higher than the estimated energy requirements for women who are not pregnant until the second trimester.

  • Second and Third Trimester
    Ongoing assessment of weight gain and nutrition.

    Discuss simple dietary additions or changes for patients to obtain 340-450 extra calories during second and third trimester (See Table 4 below for more examples).

    Table 4. Examples of 340-450 Calorie Foods for Incorporation During Second and Third Trimester (obtained from Widen & Siega-Riz, 2010)

    Table 4. Examples of 340-450 Calorie Foods for Incorporation During Second and Third Trimester (obtained from Widen & Siega-Riz, 2010)

Other Resources

  • USDA SNAP-Ed Connection
    Nutrition education and training materials: Eat Healthy Every Day, Healthy Weight, Information on Dietary Fat and Sodium/Salt, MyPlate, Dietary Guidelines and General Nutrition, Manage Your Food Resources Wisely, and Keep Your Food Safe.
  • Choose My Plate (English/Spanish)
    Dietary Guidelines for Americans, 2010
  • American Dietetic Association
  • Table 5. How to Meet Omega-3 Fatty Acids Needs During Pregnancy (obtained from Greenberg JA, Bell SJ, & Van Ausdal W., 2008.)
    How to Meet Omega-3 Fatty Acids Needs During Pregnancy

    Table 5. How to Meet Omega-3 Fatty Acids Needs During Pregnancy (obtained from Greenberg JA, Bell SJ, & Van Ausdal W., 2008.)

  • Table 6. USDA Recommended Safe Minimum Internal Cooking Temperatures (obtained from USDA Guidelines)

    Consumers should use a food thermometer to determine internal temperatures of foods.

    Food Degrees Fahrenheit (°F)
    Ground meat and meat mixtures
    Beef, pork, veal, lamb 160
    Turkey, chicken 165
    Fresh beef, veal, lamb
    Steaks, roasts, chops 145
    Poultry
    Chicken and turkey, whole 165
    Poultry breasts, roasts 165
    Poultry thighs, wings 165
    Duck and goose 165
    Stuffing (cooked alone or in bird) 165
    Fresh pork 160
    Ham
    Fresh (raw) 160
    Pre-cooked (to reheat) 140
    Eggs and egg dishes
    Eggs Cook until yolk and white are firm.
    Egg dishes 160
    Seafood
    Fish 145. Cook fish until it is opaque (milky white) and flakes with a fork.
    Shellfish
    Shrimp, lobster, scallops Cook until the flesh of shrimp and lobster are an opaque color. Scallops should be opaque and firm.
    Clams, mussels, oysters Cook until their shells open. This means that they are done. Throw away any that were already open before cooking as well as ones that did not open after cooking.
    Casseroles and reheated leftovers 165

    Table 6. USDA Recommended Safe Minimum Internal Cooking Temperatures (obtained from USDA Guidelines)

  • Figure 1. MyPyramid Meal Plan Example (obtained from Widen & Siega-Riz, 2010)

    MyPyramid for Pregnancy tool calculates average caloric needs based on weight, height, and activity level during each trimester that meets DRI requirements and creates pregnancy-specific meal plans (See Figure 1 in Appendix for example).

    MyPyramid tracker tool can be used to evaluate whether caloric and nutrient requirements are met.

    How to Meet Omega-3 Fatty Acids Needs During Pregnancy

    Figure 1. MyPyramid Meal Plan Example (obtained from Widen & Siega-Riz, 2010)

  • Starting the Conversation for Pregnant Women

    Brief screening tool for healthcare providers aids in behavior change of pregnant patients based on their readiness to change (see Figure 2 below).

    Starting the Conversation for Pregnant Women

    Figure 2. Starting the Conversation for Pregnant Women (obtained from Widen & Siega Riz-2010)

Nutritional Complications

Poor dietary practices can be improved by appropriate interventions including general nutrition education, individualized diet counseling, and referral to food assistance programs or to programs that promote healthy food behaviors and practices.

  • Underweight women may be referred to a dietician.
  • Women with disordered eating or body image issues should be referred to a dietician or mental health care provider as necessary.
  • Low-income women with food insecurity issues should be referred to Women, Infant, and Children (WIC) program.
  • Women who have gained too much weight during pregnancy should be advised to continue to engage in physical activity and to consume nutrient-dense foods such as fruits, vegetables, whole grains, lean meats, and cut back on foods that are high in calories, fat, and sugar.
  • Women who have not gained enough weight should be encouraged to eat more healthy foods and balance physical activity.

Nutritional Recommendations Supplementation

Supplements are encouraged for pregnant woman who may not be obtaining the required DRIs of specific micronutrients. However, it is important that vitamin and mineral supplements do not replace a healthy diet and nutrient dense foods. Health care providers should discuss prenatal vitamin supplements to ensure vitamins and minerals are not consumed at harmful levels and to prevent overdosing and nutrient-nutrient interactions and toxicities.

  • Iron - Iron supplementation of 27 mg/day for non-anemic women and 60 mg/day for anemic women is recommended.
  • Folic Acid - Although women who are capable of becoming pregnant are advised to consume 400 mcg of folic acid daily, pregnant women are advised to consume 600 mcg of dietary folic acid daily from a variety of sources, including beans and peas, oranges and orange juice, and dark-green leafy vegetables such as spinach and mustard greens. Consumption of folic acid should commence at least one month before a woman becomes pregnant in order to help prevent major birth defects.
  • Prenatal Vitamin - Prenatal vitamins may contain adequate iron and folic acid supplementation and should then be taken daily in addition to eating a healthy diet. However, taking excess vitamins and mineral supplements may be harmful during pregnancy.
  • Vitamin D/Calcium - Vitamin D may be obtained through diet and sunlight, but may need to be supplemented during winter months or in individuals with heavily pigmented skin.

Common Vitamins and Minerals in Fortified Foods

  • Vitamin D - Most low-fat and fat-free milks and some yogurts, fruit-juices, soymilks.
  • Iodine - Iodized salt is fortified with this essential mineral but the amount of salt and sodium consumed should be low.
  • Folic Acid - Enriched bread, flour, pasta, rice, and other grain products including ready-to-eat cereals.
  • Iron - Some ready-to-eat cooked cereals.

Foods To Avoid

Pregnant patients are particularly at risk for foodborne illnesses, especially caused by Listeria monocytogenes, Salmonella species, and Toxoplasma gondii.

Patients should be advised to avoid:
  • Raw or undercooked meat, poultry, and fish. Please see USDA Recommended Safe Minimum Internal Cooking Temperatures in Appendix.
  • Prepared meats such as deli meats and hot dogs, unless heated until steaming hot.
  • Soft-scrambled eggs and foods made with raw or lightly cooked eggs.
  • Unpasterurized juices, milk, and soft cheeses (brie, feta, Camembert, Roquefort, queso blanco, queso fresco, and panela).
  • Refrigerated pates, meat spreads, or smoked seafood (does not include canned and shelf-stable versions).
  • Herbal supplements and teas.
  • Fish high in mercury (albacore tuna, shark, swordfish, kind mackerel, tilefish)
  • Alcohol (and tobacco and drug use) as no safe level of consumption during pregnancy has been established.
  • Nonfoods such as clay, starch, paraffin, and coffee grounds. Pica is a condition characterized by strong urges to consume nonfood items during pregnancy. It is important to discuss pica to avoid harmful effects during pregnancy.

References:

  • American College of Obstetricians and Gynecologists. Nutrition During Pregnancy Frequently Asked Questions. Available at: http://www.acog.org/~/media/For%20Patients/faq001.pdf?dmc=1&ts=20120614T1520585132. Accessed June 2, 2012.
  • American Dietetic Association. Position of the American Dietician Association: Nutrition and lifestyle for a healthy pregnancy outcome. American Dietetic Association. 2008;108(3):553-561.
  • Chang G. Alcohol-screening instruments for pregnant women. Alcohol Res Health 2001;25(3):204-9.
  • Committee on Nutritional Status During Pregnancy and Lactation, Institute of Medicine. "Front Matter." Nutrition During Pregnancy: Part I: Weight Gain, Part II: Nutrient Supplements. Washington, DC: The National Academies Press, 1990.
  • Greenberg JA, Bell SJ, Van Ausdal W. Omega-3 fatty acid supplementation during pregnancy. Rev Obstet Gynecol. 2008;1(4):162-169.
  • National Center on Birth Defects and Developmental Disorders. Facts About Folic Acid. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/ncbddd/folicacid/about.html. Accessed April 24, 2012.
  • U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, December 2010.
  • U.S. Preventive Services Task Force. Behavioral Counseling in Primary Care to Promote a Healthy Diet. Available from: http://www.uspreventiveservicestaskforce.org/3rduspstf/diet/dietrr.htm/.
  • U.S. Department of Agriculture. Health and Nutrition Information for Pregnant and Breastfeeding Women. ChooseMyPlate.gov. Available at: http://www.choosemyplate.gov/pregnancy-breastfeeding.html. Accessed June 19, 2012.
  • U.S. Preventive Services Task Force. Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse: Recommendation Statement. April 2004. Available at: http://www.uspreventiveservicestaskforce.org/3rduspstf/alcohol/alcomisrs.htm.
  • Siega-Riz AM, Deierlen A, Stuebe A. Implementation of the New Institute of Medicine Gestational Weight Gain Guidelines. American College of Nurse-Midwives. 2010;55(6):512-519.
  • Widen E, Siega-Riz AM. Prenatal nutrition: A practical guide for assessment and counseling. American College of Nurse-Midwives. 2010;55(6):540-548.