Normal pregnancy nutritional guidelines focus on several dietary elements. Major topics include: caloric intake, macronutrient proportion, vitamins and minerals, and alcohol consumption. The energy requirements of the fetus must be met to ensure proper development and provide for postpartum lactation without causing excessive maternal weight gain. The energy standard to support a pregnancy has been debated heavily and will be explored in the GDM nutritional therapy section below. The American College of Obstetricians and Gynecologists advocates several basic concepts for a balanced diet for pregnant women. They suggest eating three to four servings of fruits and vegetables, nine servings of whole grains for energy, three servings of dairy for calcium, and three servings of meat to reach daily protein requirements. Vitamin supplementation to achieve daily nutrients, as an adjunct to a healthy diet, is encouraged when recommended by the woman's physician. Certain foods should be avoided in pregnancy due to fetal developmental harm. These include: deli meat, certain preparations of smoked fish, soft cheeses, unpasteurized milk, refrigerated pate, raw meat, and raw eggs, which have been associated with bacterial infections such as Salmonella, Listeria, and Escherichia coli. Toxoplasma gondii, the protozoan that causes toxoplasmosis, has also been found as contaminant in unwashed vegetables and raw meat. Fish containing mercury and raw shellfish should be avoided. Caffeine has been associated with miscarriage, premature birth, low birthweight, and withdrawal symptoms in the neonate when consumed in large amounts in pregnancy. However, other studies have implicated caffeine intake in modest levels to be non-detrimental in pregnancy. Until further studies can evaluate the effects of caffeine, it is recommended to be avoided altogether.8,9 Alcohol should not be used in any amount during pregnancy. In utero exposure has been linked to developmental disorders such as fetal alcohol syndrome. Also, alcohol should be avoided postpartum while breast feeding.10
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