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I am in the second trimester of my first pregnancy. I'm in my late 20's and lead an active lifestyle. I am receiving pre-natal care at Kaiser, but have some questions that have remaied unanswered.

1) Is there a natural alternative to "pre-natal" vitamin supplements?
2) How much, and what types of exercise should I engage in?
3) Are there specific foods/drinks I should avoid (aside from alcohol, etc.)?

Thanks, Dr. Job!

Jessica
Cupertino, CA


1) Is there a natural alternative to "pre-natal" vitamin supplements?  -  First, let me congratulate you on your pregnancy! To your question: all authorities agree, holistic and conventional alike, that it is very important to maintain adequate nutrition including the intake of important vitamins in your diet while you're pregnant

That being said, a prenatal vitamin is much like a regular multivitamin with addition of two special components: Folic acid and Iron. Folic acid, which is important for your baby's nervous system development and to prevent very serious birth defects such as spina bifida, would be taken in the amount of 600 micrograms (a microgram is 1/1000th of a milligram) per day during pregnancy (400 mcg per day in the 6 or so months prior to the pregnancy). Folate can be found in largest amount naturally in green leafy vegetables (1/2 cup of boiled spinach has about 100 micrograms), asparagus (85 micrograms in 4 spears),and legumes (black eyed peas contain 105 mcg in 1/2 cup).

As you can see, you would need to eat quite a bit of this stuff to add up to 600 mcg/day! I do encourage everybody to aim for a diet this rich in vitamins and nutrients. But if your busy lifestyle prevents this, you should take a vitamin supplement.

Iron can be found in red meat, spinach, and potatoes, peas, bran, and other foods in amounts ranging from 2-10 mg. A pregnant female needs at least 27mg per day. Again, possible to do naturally, but not always easily done.

Aside from these ingredients, I don't routinely recommend vitamins A, E, or K in supplemental form in anybody, as the natural sources (yellow and orange vegetables, green leafy vegetables) are vastly superior in terms of health benefit. So in short, if your getting enough folate and iron in your diet, you may be able to hold off on a vitamin. But as always, consult with your obstetrician before making any changes to your routine.

2) How much, and what types of exercise should I engage in?  -  I tell people they should feel free to engage in any moderate intensity aerobic or light weight training activity they find enjoyable during pregnancy, provided they have no health problems and their doctor approves, especially if you exercised before the pregancy. Let your body tell you what movements and routines are uncomfortable. There are no hard and fast rules.

In general, high strain excercises such as heavy weight training are not recommended. Walking, yoga, and aquatic exercises are very fine ways of staying in shape and maintaing flexibility which will make the pregancy more comfortable and often facilitate a smoother laborperiod.

Other recommendations by the American College of Sports Medicine:
• Avoid exercising while lying down on your stomach or your back after the first trimester of pregnancy.
• Make sure that you are well hydrated and drink plenty of fluids before, during and after exercise.
• Avoid high heat and humidity, especially during the first trimester when the fetus is undergoing its most important growth.
• Stop exercising if you’re fatigued, develop persistent pain or experience any vaginal bleeding; check with your doctor if regular contractions occur more than 30 minutes after exercise (possibly a sign of pre-term labor).
• Avoid exposure to extremes of air pressure, as in high altitude exercise (unless you’re accustomed to it) or scuba diving.
• Don’t increase the intensity of your workout beyond pre-pregnancy levels.
• Eat small, frequent meals throughout the day. Sedentary pregnant women need about 3,000 calories per day during the second and third trimesters; if you’re physically active, your caloric needs will be higher to make up for the calories burned up during your workout.

3) Are there specific foods/drinks I should avoid (aside from alcohol, etc.)?  -  Everybody's pregancy is different and seems to have their own set of rules in terms of cravings. Any diet is okay in moderation. Again, let your body be your guide. In general avoid high acidity foods such as sour and spicy foods as this may complicate morning sickness and reflux. You should increase your intake of omega 3 fatty acids such as is found in fish oil, flax seed, and nuts especially during the third trimester. Again, congratulations on your pregnancy!

Dr. Craig Job, M.D.