Pregnancy Nutrition — What to Eat, Supplements, and Hydration

Pregnancy nutrition doesn't require perfection — it requires consistency with a few key priorities. You need about 340 extra calories per day in the second trimester and 450 extra in the third (none extra in the first trimester). That's roughly an extra snack or small meal, not 'eating for two' in the way popular culture suggests.

The foundation of pregnancy nutrition is a varied diet rich in whole foods: fruits and vegetables (aim for at least 5 servings daily, with a mix of colors for diverse micronutrients), lean proteins (poultry, fish, beans, lentils, tofu, eggs — aim for 75-100 grams of protein daily), whole grains (brown rice, oats, whole wheat bread, quinoa for sustained energy and fiber), dairy or calcium-rich alternatives (milk, yogurt, cheese, fortified plant milks for calcium), and healthy fats (avocado, nuts, olive oil, fatty fish for omega-3s).

Beyond the basics, there are specific micronutrients that demand attention during pregnancy. Folate prevents neural tube defects and is critical in the first trimester. Iron supports the massive increase in blood volume and prevents anemia. Calcium and vitamin D build your baby's bones and teeth. DHA (an omega-3 fatty acid) supports brain and eye development. Iodine is essential for thyroid function and fetal brain development.

A quality prenatal vitamin fills nutritional gaps but doesn't replace a good diet. Think of it as insurance, not a substitute. If you have specific dietary restrictions (vegetarian, vegan, lactose intolerant, or food allergies), work with a registered dietitian who specializes in prenatal nutrition to ensure you're meeting all needs.

If you're in the first trimester and can barely look at a salad without gagging, here's the truth many nutrition guides won't tell you: survival eating is completely valid. When you're battling morning sickness, the best food is whatever you can keep down. Your baby is tiny at this stage and drawing from your existing nutrient stores — a few weeks of crackers and ginger ale won't cause lasting harm.

That said, there are strategies to get nutrition in despite nausea. Eat small amounts frequently — every 2-3 hours — because an empty stomach makes nausea worse. Keep bland, easy-to-digest foods accessible at all times: crackers, dry toast, pretzels, rice, bananas, applesauce, and plain pasta. Many women tolerate cold foods better than hot ones because they have less smell. Smoothies can be a way to get fruit, protein, and nutrients in liquid form when solid food is unappealing.

Protein can help stabilize blood sugar and reduce nausea — try nut butter on toast, cheese and crackers, hard-boiled eggs, or a handful of almonds. Sour and tart flavors (lemon water, sour candies, lemonade) cut through nausea for some women. Ginger in any form — tea, chews, capsules, or flat ginger ale — has clinical evidence supporting its anti-nausea effects.

Stay hydrated even if you can't eat much. If plain water is unappealing, try adding lemon or cucumber slices, sipping electrolyte drinks, eating popsicles or frozen fruit bars, or drinking coconut water. Watermelon and grapes are also good sources of hydration.

The good news: nausea typically peaks around weeks 8-11 and resolves by weeks 14-16 for most women. Once it passes, you can focus on building back a more nutrient-dense diet. Your prenatal vitamin is doing important work during this time, so take it when you're least nauseous (many women do better taking it at night with a snack).

Iron and folate are two of the most critical nutrients in pregnancy, each playing essential roles in your baby's development and your own health.

Folate (vitamin B9) is vital for the formation of the neural tube, which becomes the baby's brain and spinal cord. This structure closes between weeks 6-7 of pregnancy — often before many women know they're pregnant. Inadequate folate increases the risk of neural tube defects like spina bifida by up to 70%. The recommendation is at least 600mcg DFE (dietary folate equivalents) daily during pregnancy, with 400-800mcg coming from supplements or fortified foods. Excellent food sources include dark leafy greens (spinach, kale, romaine), legumes (lentils, chickpeas, black beans), fortified cereals and breads, asparagus, broccoli, and citrus fruits.

Iron requirements nearly double during pregnancy — from 18mg to 27mg daily — to support the 50% increase in blood volume and provide for fetal and placental development. Iron deficiency anemia affects up to 30% of pregnant women worldwide and is associated with preterm birth, low birth weight, and increased maternal fatigue. The best food sources are heme iron (from animal sources, which is absorbed more efficiently): red meat, poultry, fish, and organ meats. Non-heme iron sources include fortified cereals, beans, lentils, spinach, tofu, and dried fruits.

To maximize iron absorption, pair iron-rich foods with vitamin C (bell peppers, strawberries, citrus, tomatoes) — this can increase absorption by 2-3 times. Avoid taking iron supplements with calcium, coffee, or tea, which interfere with absorption. If your prenatal vitamin's iron causes constipation or nausea, talk to your provider about slow-release iron formulations or taking it with food.

Your provider will check your iron levels via CBC at your first visit and again around weeks 24-28. If levels are low, additional iron supplementation (30-60mg of elemental iron) may be prescribed.

Calcium and vitamin D work as a team during pregnancy — calcium builds your baby's bones, teeth, heart, nerves, and muscles, while vitamin D is essential for calcium absorption and plays its own critical roles in immune function and cell division.

Pregnant women need 1,000mg of calcium daily (1,300mg if under 19). If you don't consume enough calcium through diet, your body will pull it from your bones to meet the baby's needs — potentially compromising your own bone density. The third trimester is especially demanding, as the baby's skeleton hardens rapidly, requiring about 250-300mg of calcium per day from your supply.

Excellent calcium sources include dairy products (one cup of milk or yogurt provides about 300mg), fortified plant milks (check labels — most provide 300-450mg per cup), cheese (especially hard cheeses like cheddar and Parmesan), tofu made with calcium sulfate, sardines with bones, almonds, broccoli, kale, and bok choy.

Vitamin D is harder to get from food alone. The recommended amount during pregnancy is 600 IU daily, though many experts and recent research suggest that 1,000-2,000 IU may be more appropriate, especially if you have darker skin, limited sun exposure, or live in a northern latitude. Food sources include fatty fish (salmon, sardines, mackerel), fortified milk and orange juice, egg yolks, and fortified cereals. Most prenatal vitamins contain 400-600 IU.

Vitamin D deficiency is surprisingly common in pregnancy — studies suggest 40-60% of pregnant women have insufficient levels. Deficiency is associated with increased risk of gestational diabetes, preeclampsia, preterm birth, and low birth weight. Ask your provider to check your vitamin D level (25-hydroxyvitamin D) at your first prenatal visit, especially if you have risk factors for deficiency.

Hydration during pregnancy is more important than most women realize. You need about 8-12 cups (64-96 ounces) of fluids daily — and more if you're exercising, in a hot climate, or experiencing vomiting. This is significantly more than pre-pregnancy needs because your blood volume is expanding by 40-50%, amniotic fluid must be maintained, nutrients need to be transported to the baby, and your kidneys are working harder to filter waste for two.

Dehydration during pregnancy can contribute to constipation (one of the most common complaints), urinary tract infections (which are more dangerous during pregnancy), headaches, Braxton Hicks contractions (dehydration can trigger them), reduced amniotic fluid levels, and in severe cases, preterm labor. Even mild dehydration can make you feel more fatigued and dizzy.

Practical strategies to stay hydrated include carrying a water bottle everywhere and setting phone reminders if you tend to forget, starting each morning with a full glass of water, eating water-rich foods like watermelon, cucumber, oranges, strawberries, and soups, flavoring water with lemon, lime, cucumber, mint, or berries if plain water is unappealing, and tracking your intake with an app or simple tally marks.

If plain water triggers nausea (common in the first trimester), try sparkling water, coconut water, herbal teas (ginger, peppermint, and rooibos are safe), electrolyte drinks (choose low-sugar options), frozen fruit popsicles, and ice chips or frozen grapes.

A quick hydration check: your urine should be pale yellow to almost clear. Dark yellow urine is a sign you need more fluids. Limit caffeine to 200mg daily (about one 12-ounce cup of coffee), as it has a mild diuretic effect and crosses the placenta.

Certain foods pose specific risks during pregnancy due to harmful bacteria, parasites, or substances that can affect fetal development. The key categories to avoid or limit include raw or undercooked meats, poultry, seafood, and eggs — these can harbor Listeria, Salmonella, and Toxoplasma, all of which are more dangerous during pregnancy due to your suppressed immune system. Cook all meats to safe internal temperatures and avoid sushi with raw fish, rare steak, and runny eggs.

High-mercury fish — shark, swordfish, king mackerel, tilefish, bigeye tuna, and marlin — should be avoided entirely. Mercury can damage the developing nervous system. However, don't avoid fish altogether — low-mercury options like salmon, sardines, trout, shrimp, and canned light tuna provide essential omega-3 fatty acids. Aim for 2-3 servings (8-12 ounces) per week.

Unpasteurized products pose a Listeria risk. Avoid soft cheeses made from unpasteurized milk (check labels for 'pasteurized' — most cheese sold in the U.S. is pasteurized), unpasteurized juice and cider, and raw (unpasteurized) milk. Deli meats and hot dogs should be heated until steaming (165°F) before eating, as they can harbor Listeria even when refrigerated.

Alcohol should be completely avoided — there is no known safe amount during pregnancy. Fetal alcohol spectrum disorders can result from alcohol exposure at any stage. Caffeine should be limited to 200mg daily (roughly one 12-ounce coffee). Higher intake is associated with increased miscarriage risk and may affect fetal growth.

Wash all fruits and vegetables thoroughly, avoid pre-made salads from deli counters, refrigerate leftovers promptly and consume within 2-3 days, and practice good kitchen hygiene to prevent cross-contamination.