Photos: Courtney Millen, @palatetheory
For my birthday during my first pregnancy, my husband surprised me with a private chef to come in and make dinner one night. Unfortunately, it was during my first trimester, and I could barely stomach the thought of food of any kind.
After throwing up all afternoon, I made myself sit and try to enjoy the well-intentioned meal. The entrée was fish with a miso glaze that smelled absolutely delicious, in the end. As we took our first bites, a friend stopped by with a gift. A mother of two, she took one look at the fish and asked, “Should you be eating that?”
“What? Why not?” I sputtered, nausea hitting me again.
My husband, ever the alarmist, immediately started Googling. I followed suit.
“Oh, no! Oh, no. It’s mackerel,” I said. “I’ve killed our baby.”
“SPIT IT OUT!” My husband yelled. “Throw it up! There’s still time!”
A piece of fish went flying from my mouth across the table.
“Well, I can see I’ve nicely ruined your meal,” my friend said. Pandemonium ensued.
For my birthday dinner during my second pregnancy, we went out to sushi. (What a difference a few years make…) Still, the unknown can be a scary thing, especially for new moms accustomed to having done our research.
To help alleviate uncertainty around diet and nutrition during an already stressful time, we sat down with Courtney Millen, Registered and Licensed Dietitian and owner of Palate Theory, a Boston-based nutritional counseling practice.
Millen, a mom, is currently pregnant with her second baby and had pre- and post-natal nutrition top of mind.
Millen spent her early career in finance in New York, but said she became interested in nutrition after she had gall bladder surgery during her undergraduate years at Princeton. A Division 1 pole vaulter in top shape, she certainly didn’t fit the profile of a typical patient.
“I had a family history of the problem,” she said, “and I realized even very health- conscious individuals can stand to benefit from nutritional education.”
Millen, whose specialty is weight management, said she became interested in nutrition for moms in particular while pregnant for the first time.
“Most people are so focused on what foods are really bad for the baby, like unpasteurized cheeses, undercooked meat, and alcohol,” she said. “I wanted to shift the focus to what I could eat that will be helpful for my baby and me.”
Millen said expecting moms need guidance not only with what nutrients to eat, but also what foods and supplements provide that nutrition.
“The number one thing your doctor will tell you as an expecting mom, and even before you get pregnant, is to take folic acid,” Millen said.
Folic acid, a B vitamin, aids in fetal development and growth and can work to prevent certain birth defects in the brain and spine, according to the Centers for Disease Control and Prevention. Millen recommends taking 400 micrograms a day (a standard prenatal vitamin generally has at least as much), in addition to getting 200 micrograms of folate from regular diet.
Folic acid is better absorbed by your body than folate, she said, so it’s better to get the bulk of it from a supplement or fortified foods. Foods with folate include legumes, citrus fruits, and whole wheat bread.
Millen also stressed the importance of iron during pregnancy, which she said is one of the most prevalent micronutrient deficiencies in the world. She advises eating lean red meats, fish, poultry, and even iron-fortified cereals.
“Iron absorption is enhanced when consumed with vitamin C,” Millen offered, “so try pairing iron-rich foods with citrus fruits, kale, or broccoli.”
On the flip side, Millen said calcium actually inhibits iron absorption – something to keep in mind when eating a cheeseburger, for example. Also, iron found in animals versus iron found in plants is more readily absorbed – an important factor to consider if you’re a vegetarian or vegan. Meat eater or not, all women require iron supplementation to meet the increased demands during pregnancy.
I mentioned to Millen that during my second trimesters, I craved red meat. I’d worried I was anemic, but she put my mind at ease.
“There’s not a lot of significant evidence that cravings are a sign your body needs x, y, or z,” she said. “Cravings are case-specific, of course. If it’s ice cream you’re craving, be careful. But there’s no reason not to eat red meat in moderation if that’s what you’re wanting.”
As pregnancy progresses, Millen discussed the need for omega-3s, which she said have been shown to be influential for brain development and vision, especially in the third trimester.
“One thing people eat too little of is fish. Yes, we need to be cautious of mercury, but two to three servings (at 4 oz each) of fish a week is actually beneficial while pregnant and nursing.”
In January, the FDA published new guidelines for fish, intended to steer pregnant women toward those with safe levels of mercury.
Millen said she’s a personal fan of fish oil supplements to get her omega-3 fatty acids (focusing on DHA). DHA is found in animals, not plants (apart from seaweed); but for vegans, she recommends algae supplements as an excellent source of natural DHA. For vegetarians, try incorporating DHA-enriched eggs into the diet.
While many positive effects of DHA are widely accepted, the breadth of their benefits remains somewhat unclear. A 2015 study in frogs and tadpoles, for example, found that when DHA was added to a mother’s diet, brain function in her tadpoles “flourished.” Still, a study published last month in humans saw no IQ benefits in seven year-olds whose moms received DHA during pregnancy.
As for increased caloric intake while pregnant, it’s a lot lower than you might think. There isn’t a need for additional calories during the first trimester, Millen says; she recommends about 20-25% more thereafter (350 extra calories during the second trimester and 450 during the third).
Many moms struggle with their diet while breastfeeding, especially those who suspect their baby is sensitive to something she may be eating.
“If a mom struggles when she’s breastfeeding because her baby has bloody stools or is colic and crying all the time, I often suspect a dairy or soy allergy,” Millen says.
Unfortunately, dairy allergies can be tricky to pinpoint as it can take two to four weeks to completely eliminate a food from a mom’s system.
“Unless you do an elimination diet and you’re very committed to it, it’s hard to figure out the exact culprit,” Millen said.
Another issue for moms is recognizing just what contains allergens. “If you consider processed foods, most contain dairy or soy that isn’t blatantly obvious. Even dining out can become very challenging for these moms.”
When it comes to losing weigh postpartum, Millen said a focused plan is beneficial for more than just fitting into skinny jeans again.
“It’s important to get back to your pre-pregnancy weight or even below it because, especially as we age, weight gain makes us more likely to get gestational diabetes during subsequent pregnancies and increases risk of other chronic diseases.”
After the first two weeks postpartum, when the body sheds extra weight due to blood and fluid loss, Millen advises moms to focus on losing about one to two pounds per week – about the same rate that’s recommended for those who haven’t been pregnant.
“I tell most clients they should stick to a 1,500 calorie minimum per day,” Millen says. “It’s case by case, depending on age, height, weight, activity level, or she’s breast feeding or not; but I wouldn’t go below that.”
As to how many calories breastfeeding really burns, Millen said on average it generally falls between 400-500 calories a day – a great weight loss tool. Still, she cautioned against the idea that it will make moms look like supermodels overnight. “All women are different,” she said. “Some women struggle to lose weight while breastfeeding. Some people can’t keep weight on; others get stuck.”
Millen has great tips for improving diets for moms on the go. Her biggest piece of advice for weight loss, ironically, is remembering to eat throughout the day.
“If you don’t eat regular meals, you’ll find yourself suddenly starving, eating anything you can off your kids’ plates,” she said. For a fun exercise for her clients, Millen has her moms put all of a day’s tempting tray leftovers in a large Ziplock bag.
“You’ll find a bag stuffed with half-eaten waffles and toast – things you’d never make for yourself. It’s effective.”
Millen is also a fan of clever one-handed meals for moms– those she can make quickly while also holding a baby. Some of her favorite “mom” meals are smoothies.
“I love smoothies because I struggle to get enough veggies in throughout the day,” she said. “I certainly don’t crave them during pregnancy. So I throw in a handful of greens and never have to think about it.”
Millen said smoothies are also a great choice for moms because you can start making one, get distracted, and come back to it later without worrying about burning the house down.
“If I throw in some almond milk and a frozen banana and there’s a meltdown I have to deal with, the worst case scenario is I add ice in an hour later and I’m back in business,” she said.
Lastly, Millen stressed the importance of hydration – during pregnancy and beyond.
Hydrating provides many benefits during pregnancy, some of which are surprising. In addition to preventing headaches and bloody noses, drinking water counter-intuitively reduces water retention and swelling.
For nursing moms, Millen recommends a large water bottle with a straw.
“Needing a straw so that all you have to do is dunk your head toward the bottle sounds like the ultimate form of laziness,” Millen laughed. “But just try unscrewing a bottle top with a baby learning to latch!”
ABOUT COURTNEY MILLEN
Millen is a Registered + Licensed Dietitian with personal and professional experience in prenatal and postpartum nutrition, including breastfeeding. She graduated from Princeton University with a bachelor's degree in Economics and holds a master's degree in Nutrition Science and Policy from the Friedman School at Tufts University. In addition to her website Palate Theory, she serves clients locally in Boston and virtually through HIPAA-compliant virtual counseling via Healthie. She can be reached at firstname.lastname@example.org.