Nutrition for pregnancy and postpartum

“I think everyone would agree, it’s probably wise to recommend eating more food that are naturally good sources of folate versus folic acid.”

Registered Dietitian Ryann Kipping, The Prenatal Nutritionist

Any pregnant mom will tell you: Their body goes through a major transformation! And with each passing month, nutritional needs change. We hear lots about omega-3s, but did you know that protein and choline play critical roles in the baby’s development in utero? Host Jessica Rolph speaks with Registered Dietitian Ryann Kipping, founder of The Prenatal Nutritionist.

Key Takeaways:

[1:40] What is the role of protein in a pregnant person’s diet?

[5:05] In what ways should our diet shift post-pregnancy? 

[9:54] What nutrients are particularly important during the last stage of pregnancy? 

[12:35] What risks come with not gaining enough weight during pregnancy?

[15:07] What is better for preconception: Folic acid or folate?

[18:02] What are Ryann’s tips around supplementation during pregnancy?

Mentioned in this episode:

Dr. Brewer’s Pregnancy Diet

The Prenatal Nutritionist

Follow The Prenatal Nutritionist on Instagram

Transcript:

Protein in pregnancy

Ryann: Thank you so much for having me. I’m excited. I love this conversation, I love talking about protein, and I feel like I’m always putting an emphasis, “Hey, you need more protein, you need more protein.” And this is usually when I am doing… Previously, I don’t do any more one-on-one client work at this time of recording, but that is what I did for the large majority of time when I started this business, was one-to-one client work. And what I would see consistently was people under-consuming protein even before pregnancy, even pre-conceptually, or when clients would start working with me to prepare for pregnancy, I would see them not consuming enough protein. As you progress throughout pregnancy, your body needs more protein.

And when it comes to first trimester and still trying to fit in protein, we can take foods like carbohydrate-rich foods that usually sound good, are usually more tolerable, eat those first, once you feel a little bit better then try to work in those high protein sources but protein is quite literally like the building blocks of your baby, so I cannot emphasize enough how important protein is. There’s research stating that protein is the most important macro-nutrient during pregnancy, which is super interesting research, and hopefully there will be more research that kind of lends us to or leads us to believe that that is ultimately true.

Jessica: When I got pregnant with my first I didn’t think I needed to do anything really different other than just eating more fruits and vegetables and having that extra 300 calories a day. This focus on protein that you are talking about totally shifted my mindset. 

I discovered a pregnancy nutrition plan called the Brewer diet through my birthing instructor. A study on the diet done at Harvard University found that eating at ≥75 grams of protein daily can help prevent diseases of pregnancy like pre-eclampsia. It wasn’t really a diet, but was more of a nutritional guide and talked about eating to hunger. 

Our birthing instructor had our class keep a food log and check boxes every day on what we were eating.

It required 80 to 100 grams of protein a day (which when you start counting grams is a LOT), 2 servings of leafy greens every day, two to three eggs a day for choline, liver once a week, I would choke that down every month or so, a vitamin C serving, check that box of either an orange, grape fruit, or serving of strawberries, a yellow or orange vegetable every day, two servings of calcium, whole grains, some fats and oils, and water to thirst. It was really elaborate, it felt like a lot of food but what it made me realize is that growing a human is a big deal. I had to be intentional about it. 

I wasn’t able to implement this in the first trimester, but after I got rolling and started feeling better, I felt really empowered by this diet. I gained 70 pounds, and for each of my pregnancies and had big babies, but really felt good and healthy and like I was responding to what my body wanted.

So how do you think about the building blocks of nutrition for pregnancy, or how do you think about the overarching philosophy we should think about when shifting our diet from before we were pregnant? 

How diet changes with pregnancy

Ryann: Yeah, absolutely, and I get this question all the time. What is the difference between a healthy diet before pregnancy and a healthy diet during pregnancy? And to me, there is just more intentionality behind it, basically, exactly what you were just explaining. Usually, we go about life and we know that nutrition is important, and I think most of us know that the food we eat provides this energy and it helps us from getting sick and supplies us antioxidants and all of these micro-nutrients that have other functions and all these things, but we don’t think of them in the way that when we get pregnant, we’re like, Oh my gosh, this nutrient is being used directly to form a baby’s brain, this nutrient is even more specifically forming the memory portion of the brain when we’re thinking about choline for example, and I don’t think everyone needs to nerd out about the science like you and I are. I don’t think everyone needs to know those crazy details, but putting that intentionality behind it, I do think is important, just overall being aware of what nutrients are coming from which foods. We’re talking about eggs again with choline, if you have visited my Instagram page at all, you will know that I love eggs and I love to talk about choline.

So why not talk about them here? Yeah, so thinking about eggs as a source of choline, really focusing there, knowing what foods have vitamin C in them, knowing, okay, if I need to make sure I’m eating enough folate every day, what foods can I include that you enjoy? Because we don’t want to take that part out of eating at all, and this is something else that I always try to emphasize, you still want to be able to enjoy your food and eating, hopefully, if you don’t have all these crazy pregnancy symptoms and you still enjoy the food you’re eating, it’s so flavorful, and you’re not taking all of that away from eating while pregnant. So yeah, thinking about what nutrients come from which foods, which foods you want to put emphasis on, and in a way that gives you energy but still supplies those nutrients to baby, and then overall, a bigger picture, just making sure you’re getting enough of each macro nutrient distribution on your plate each time you sit down for dinner, any type of meal or snack.

Foods for baby’s brain development

Jessica: Yeah, and I think on the choline topic, that is its own sort of passion point, I think for both you and me, I think we’re really sure that, I did, on another episode right before this, speak to the authors of the study at Cornell who studied the cause of eating… Long-term impacts of choline so, it was a seven-year study, it really has great benefits for attention, and they talked about what kind of supplementation that they’ve used in the study, so you can… People can refer to that episode if they want to go deep on that. Let’s talk about other foods that are important for the baby’s brain development, which happens in that third trimester. I think oftentimes, we’re getting really full in that third trimester, I remember the guidance that I had was to really try and fit in as many small meals as I can during that last stage of pregnancy, and I think you’re kinda trying to trail off because your stomach is so… It gets so full, so fast, but that is when the baby’s brain is growing so much and when they’re putting on those extra pounds that are so great for their long-term health, and so tell me more about how you think about that very last stage of pregnancy and what we can do for babies’ brain development besides choline? 

Ryann: Yes, besides choline, definitely Omega-3s. We’re thinking about omega-3, specifically DHA, which is largely found in fatty fish, some other foods as well, but that’s going to be your main source or supplementation. You can always supplement with the fish oil or omega-3 pill as well, but I love a food-first approach. I am all about a food first approach, so we want to get these nutrients, all these nutrients we’ve been mentioning from food as much as we can before relying on supplementation. So yeah, during the third trimester, like you said, is a time when the baby’s brain is rapidly growing and accumulating these omega-3s, which is why I always like to put emphasis on fish intake during the third trimester when it… Hopefully, fish sounds okay to eat, usually when I talk about eating fish in the first trimester, people are like shunning me because they’re like, “That sounds absolutely disgusting,” which I’m like, it’s fine as long as you get to feeling better and you can start incorporating fish again, hopefully in the later stages of pregnancy. So yeah, definitely putting an emphasis on those omega-3s.

Jessica: Yeah, I found it like an easy, quick source, if you can stomach it. Wild Planet is the best brand, but if sardines, like canned sardines, I would just bring them on a trip or… You can bring them with you. They’re really easy to crack open and then you put them on crackers. They’re really not bad, and they’re a great source. One thing I wanted to get into is, and you shared this a little bit on Instagram, which I so appreciated. I feel like there’s this notion that we need to control weight gain during pregnancy. There’s this guidance of 25 to 35 pounds. I really struggle with that because my body wanted to gain 70 pounds and that was what felt healthy for me, I think I was probably extreme. I’m a big person, I’m tall. I make big babies, that’s what my body wanted to do, but I also think that there’s this notion that if you’re coming in lean into pregnancy, 35 pounds just might not be right. It might not be enough. And the risks, I don’t think OB-GYNs are talking enough about the risks of not enough weight gain during pregnancy. I’d love to hear your philosophy there, I think that it’s…

I worry that it’s a function of society’s pressure on… Controlling a person’s body size, and I think, how do we also deal with our changing bodies and how we think we’re going to look when we’re pregnant and actually just seeing your body change and trusting that process. I’d love to hear more about this.

Weight gain during pregnancy

Ryann: Yeah, I think it is a natural anxiety that so many pregnant people have about weight gain during pregnancy, and it is really a big mental health. There’s a big mental health component around it, and kind of switching your mindset from, your body is changing and growing to support this amazing life that you’re creating. So it’s easier said than done, absolutely, but overall, weight is not a focus of my practice as a dietician whatsoever. Worrying less about the number on the scale and the weight that your body wants to gain and should gain will come naturally.

And again, I know, easier said than done, but I really do think that these weight gain guidelines that the Institute of Medicine puts out are really… They’re controversial, but they’re also just hard for us because we feel like if we don’t fit into those guidelines and we don’t fit into that bubble, then somehow we failed or somehow we’re wrong or we’re doing it wrong, or we’re unhealthy, if we go one pound outside of those guidelines, which is just not the case at all. And I always say, and I think what you’re referring to on Instagram is just the number on the scale does not correlate to the outcome of your pregnancy by any means, there are so many other indicators that your pregnancy is moving along in a healthy manner, and that baby is totally fine, so as long as you’re focusing on baby’s growth and making sure you are getting in as many nutrients as you possibly can, then the number on the scale really isn’t of that much importance.

You can even tell your doctor, and this is what I have talked about and worked on with a lot of clients, is if you don’t prefer to see your weight gain then you can absolutely tell your provider that you’d prefer not to know, unless it is obviously a risk to you and the baby, then you can just tell them, you would just like not to know those numbers.

Jessica: That’s so helpful. And I also think that it’s not linear. I remember going to these appointments, and sometimes it’s flat, sometimes it’s like another plus 10 or 12 pounds, and it was something that is really… We really do have to kind of push down the societal notions, we get so many messages.

Okay, I have some questions from Instagram from our community. Folic acid versus folate for preconception. There’s lots of conflicting info. I don’t even know about this, tell me the quick and dirty, what’s going on here? What do you recommend? 

Folic acid vs folate for preconception

Ryann: Yes, so it is definitely a controversial topic somehow, I don’t know how it erupted into this debate that it has become. But let me just give a basic differentiation here, so folate is the naturally occurring form, so folate is found in leafy greens, avocados, nuts and seeds, liver, eggs, all of these foods that it’s naturally found in. Folic acid is the synthetic form of folate, so it is often found in supplements because it is also cheap to put in supplements. It’s found in things like cereal, anything with flour, honestly, they have… Back in the, I think it was the 80s, they started requiring, basically, flour be fortified with folic acid in order to reduce the incidents of neural tube defects, so they started putting folic acid in foods that were commonly consumed by Americans. Right, so it did work, it definitely decreased the amount of neural tube defects, but when we’re thinking about it, is it wise to promote eating more refined carbohydrates essentially, or is it wise to promote eating more natural forms of folate.

I think everyone would agree, it’s probably wise to recommend eating more food that are naturally good sources of folate versus folic acid. So then that’s a conversation on its own, right, and then we have to think about supplementation. I recommend a supplement with folate, the naturally occurring form, and if you can, the most active form of folate, the kind that our body actually utilizes is L-methyl folate, which is the active form, the most active form of folate, and this is also a more expensive form of folate, so usually supplements that have this type of folate are a bit more expensive. That being said, either choice you make is typically going to be okay, of course, everything with nutrition is individualized, so when it comes to supplementation, I always say get individualized guidance based off of you and your needs.

Jessica: That is so helpful. I didn’t know this, I wish I had known. But super helpful information. You mentioned supplementation, we get a ton of questions about prenatal vitamins, I bet it’s tricky for you, you don’t want to align with the brand, but no, it seems like no one vitamin has it all, and I know that you really recommend this really rich diet, which I love. Lots of variety of foods, high protein, leafy greens, yellow and orange vegetables, vitamin C, all the good stuff. Tell me more about supplementation. Can you say anything about it? 

Supplements and prenatal vitamins

Ryann: Yeah, definitely. My most frequently asked questions is, What prenatal vitamin should I take? And like I just said, it is individualized, it is going to depend on so many factors related to your health and to your lifestyle, so I can’t… It just wouldn’t be even ethical for me to come on here and recommend one prenatal vitamin to the masses since we are all such unique individuals, that being said, I always recommend making sure you’re taking a supplement that is third party tested. This is really just for supplement standards. Supplements, as most people know, aren’t well regulated, so this means that this company that has third-party testing has paid a third party to test their supplement to make sure it’s clean, it doesn’t have anything in there that they say isn’t in there, and also just truth in labeling. If they say there’s this amount of vitamin B12, making sure they’re absolutely telling the truth that there is that amount in there.

So third party testing is key, making sure that hopefully there’s some choline in there, this is becoming more common, thank goodness, supplements are understanding the research more so in putting choline in their supplements. I do recommend picking one with folate over folic acid, but again, talk to your provider and your dietician for what’s best for you. Iron and calcium, those compete for absorption, so I see a lot of supplements on the market that have high levels of both, which doesn’t really make any sense, not everyone needs to supplement with iron, so it’s best to get your levels tested and see whether or not you need to supplement with iron. So those are just a few things I’ll point out.

Jessica: Maybe I can say because I’m not associated with any brands, and this is not my total thing, but I took… I did tend to run a little bit anemic, so I took Floradix liquid iron, it was non-constipating, I took that separate from my prenatal and had my iron levels measured throughout my pregnancy to make sure I wasn’t getting too much, but also was getting enough and would definitely dip and take some Floradix. I took a separate choline supplement. I tried to develop one at Happy Family. It’s very sticky, so it’s really hard as a material to put into a mixed vitamin at sufficient amounts, and so I think that pulling that out and having that separate… It’s pretty cheap on Amazon, it’s total choline bitartrate, we had a whole episode on this, what kinds were used, if you need liquid, citrate works too. It’s a pretty straightforward supplement, but I found that it’s, from a manufacturing perspective, it’s actually really hard to put into a vitamin, and then I would end up taking extra calcium and try and separate it out. At the end of the day, I would take the calcium, in the beginning of the day, I would take my iron.

So if you want to nerd out, there is a way to nerd out on all this stuff, but I did find that it was hard to find that one prenatal that had it all. I think there are some new companies that provide packets or different ways to sort of take multiples. And I think, again, as nutrition is primary, so following a lot of your recommendations is really mostly what we need to do.

So grateful to have the chance to talk to you today. It’s been wonderful.

Ryann: Well, thank you so much for having me, it’s been great.

Here are my takeaways from the conversation with Ryann:

1. Protein provides the building blocks of your baby. It is an essential macro-nutrient when it comes to achieving a healthy pregnancy.
2. The third trimester is a time when the baby’s brain is rapidly growing and accumulating omega-3s. Small meals are a great way to get the nutrients your baby’s brain requires to grow. Especially important are choline and omega-3s (specifically DHA), so eat lots of eggs and fish!
3. The guidelines around weight gain that are recommended by the Institute of Medicine are controversial. The number on the scale does not correlate to the outcome of your pregnancy. Focus on getting as many nutrients as you can. 
4. No one prenatal vitamin has it all and each vitamin has unique benefits. Ryann recommends your vitamin be third-party tested and contain choline and folate. 

Read more about your baby’s brain development on the Lovevery blog.