Diet for a healthy pregnancy

Should I eat differently now I'm pregnant?

That depends on what you were eating before! If you already eat healthily, you may only need to make a few tweaks to your daily diet.

But if you've been living on ready meals or takeaways, or you have a crisps or chocolate habit, it might be time for a nutritional makeover.

What does a healthy pregnancy diet include?

Eating a healthy pregnancy diet means you'll get all the nutrients you and your developing baby need (BNF 2015a, BNF 2016, NHS 2017a).

You'll need to include in your daily meals a variety of foods from these main groups:

• Fruits and vegetables. Aim to eat between five portions and seven portions of fruit and vegetables each day, choosing more veg than fruit. Frozen, tinned, and dried fruits and vegetables are fine, and varieties with no added salt or sugar are the best choice. Juices and smoothies also count, but they are sugary - even if they're all-natural - so it's best to limit the amount you drink.
• Starchy foods. These include some root vegetables such as potatoes, plantain and yams, and wholegrain cereals such as brown rice and quinoa. Breads, crackers, pasta, and breakfast cereals are also in this group. Choose wholegrain varieties when you can.
• Foods rich in protein. These include lean meat, fish, eggs, and pulses, such as beans and lentils. Aim to eat two or more portions of fish a week, including at least one - but no more than two - portions of oily fish such as mackerel or sardines.
• Dairy foods. These include milk, cheese and yoghurt, which are a good source of calcium. Varieties that are low in fat and sugar are the healthiest options (NHS 2017a, NHS 2019, BNF 2016, RCOG 2014).

Should I take any vitamin supplements?

Yes, the NHS recommends that you take 400 micrograms (mcg) of folic acid every day for the first 12 weeks of your pregnancy. This is to protect your baby against brain and spinal defects (neural tube defects), such as spina bifida (NHS 2017b).

You may need to take a higher daily dose of folic acid (5mg) if:

• You or your partner has a neural tube defect (NTD).
• You have had a previous pregnancy affected by an NTD.
• Your family or your partner's family has a history of NTDs.
• You have coeliac disease or diabetes.
• You take anti-epilepsy medicine.
• Your BMI is 30 or more (Huang et al 2017, NHS 2017b, RCOG 2014).

If you have sickle-cell disease or thalassaemia, you are more likely to have anaemia during pregnancy. So your doctor may also recommend a higher dose of folic acid to help prevent and treat anaemia (RCOG 2014).

The Department of Health and Social Care also advises you to take 10mcg of vitamin D a day throughout your pregnancy. It can be hard to get enough vitamin D from food and from sunlight year-round in the UK (NHS 2017b, SACN 2016).

If you live in England, Wales or Northern Ireland and claim certain benefits or have a low income, you may be eligible for a scheme called Healthy StartOpens a new window. You will receive a card that can be exchanged for healthy foods and pregnancy vitamins. You're also eligible if you're under 18 and pregnant. There is a similar scheme called Best Start FoodsOpens a new window in Scotland.

As long as you're eating a healthy, balanced diet, you shouldn't need to take a multivitamin supplement. If you want to take a multivitamin, make sure it's made specifically for pregnant women (RCOG 2014).

It's worth getting guidance from your doctor or midwife before buying extra supplements (NHS 2017c). Some over-the-counter multivitamins may contain retinol, the type of vitamin A that's found in liver, that can be toxic to unborn babies (NHS 2017b, c, RCOG 2014). It's easy to get safe, plant-based, vitamin A from your diet by eating:

• Yellow, orange, and red vegetables, such as carrots, sweet potatoes and red peppers.
• Green leafy vegetables, such as spinach.
• Yellow and orange fruit, such as mango, papaya and apricots (BNF 2016, NHS 2017c).

Your body needs more iron while you're pregnant, particularly after 32 weeks, when you need 7mg a day (BNF 2015a, Robson et al 2014). That's more than five times as much as you needed before pregnancy, and explains why iron-deficiency anaemia is very common in pregnancy (Robson et al 2014).

Even so, you can get enough by eating plenty of iron-rich foods and shouldn't need to take iron supplements (Robson et al 2014). Red meat, eggs, beans and pulses, leafy green vegetables, wholemeal bread, dried fruit, nuts and fortified cereal are all good sources of iron (BNF 2015a, NHS 2017b).

You'll only need to take an iron supplement if your midwife or doctor advises you to. Your midwife will check your blood for signs of iron-deficiency anaemia (Robson et al 2014). If you're worried that you may be anaemic, speak to your midwife or doctor (BNF 2015a, NHS 2017b).

Many people have low levels of iodine in their diet. Iodine is a mineral that's essential for your baby's brain development (BDA 2016, WHO 2019). Dairy foods, white fish, and cooked prawns, are a good source of iodine (BDA 2016). You don't need to take an iodine supplement, just do your best to include foods with iodine in your meals (Harding et al 2017).

Talk to your GP or midwife about special supplements that you may need if you:

• Eat a vegetarian or vegan diet.
• Eat a restricted diet, for example because of a food intolerance, or for religious reasons.
• Have diabetes or gestational diabetes (NHS 2017b).

Do I need to eat more calories now I’m pregnant?

You don’t need extra calories for the first six months of pregnancy (NHS 2017a, RCOG 2014). Your body is cleverly adapted to cope with the extra demands of pregnancy, and to process enough nutrients to benefit your baby. Your metabolism steps up to get the balance right between nourishing you, and nourishing your baby (Robson et al 2014).

For the last three months of your pregnancy, you only need about 200 extra calories a day to help your baby grow (NICE 2010, RCOG 2014). A 200-calorie snack would be:

• A banana shake with one banana, semi-skimmed milk, and low-fat yoghurt.
• 30g serving of porridge with semi-skimmed milk and a dessert spoon of raisins.
• A small handful of unsalted, mixed nuts.
• A slice of wholegrain toast with peanut butter.
• A couple of oatcakes with low-fat cheese or sardines, and a tomato.
• Two tablespoons of hummus with half a pitta bread, carrot and red pepper sticks (BNF 2015b).

It's normal for your appetite to fluctuate throughout your pregnancy (Robson et al 2014). In the first few weeks of pregnancy, your appetite may fall away dramatically and you may not feel like eating proper meals, especially if you have nausea or sickness. Bland, starchy foods such as plain crackers may be all you can manage (BDA 2016).

If you suffer from heartburn or a full feeling after eating you may find it easier to have smaller, more frequent meals, instead of breakfast, lunch and dinner (NICE 2017).

Are there any foods and drinks I shouldn’t have during pregnancy?

Yes, the following may be unsafe for you or your baby:

• Pates, unpasteurised milk and cheese, and mould-ripened cheeses, may contain a dangerous bacteria called listeria. Avoid cheeses that have a white rind, such as brie or camembert, and soft, blue-veined cheeses such as roquefort (BNF 2018, NHS 2017d, RCOG 2014).
• Cured or undercooked meats may contain a parasite that causes toxoplasmosis, an illness that can cause pregnancy and birth complications. Ready-meals may be another source, so always cook them thoroughly (BNF 2018, NHS 2017d).
• Raw shellfish, such as oysters and prawns may contain bacteria and viruses. Sushi that has not been frozen before making should also be avoided, as it may contain parasitic worms. Most sushi sold in shops is safe, but if you're in any doubt, it is best not to risk eating it. (NHS 2017d).
• Ready-to-eat smoked fish, such as salmon, trout or mackerel may contain listeria. If you like the flavour of smoked fish, you can make it safe before you eat it by thoroughly cooking it until it is piping hot (FSA 2022).
• Avoid raw or undercooked eggs, unless they are marked with a red British Lion Quality stamp. Some eggs can cause salmonella food poisoning, but British Lion eggs have such a low risk of carrying salmonella bacteria that they are safe to eat runny. Foods made from raw egg, such as homemade mayonnaise, are also fine to eat if you're certain British Lion eggs were used, or if the eggs have been pasteurised. Other foods that may cause salmonella food poisoning are raw shellfish, and raw or undercooked meat (BEIC nd, BNF 2018, NHS 2017d).
• Shark, swordfish and marlin contain unsafe levels of mercury, which can affect your baby's nervous system. Tuna contains some mercury too, so it’s best not to eat more than four medium-sized cans or two fresh tuna steaks each week (BNF 2018, NHS 2017d, RCOG 2014).
• Don't eat liver and liver products such as pate, liver sausage and fish oil supplements. Liver may contain large amounts of retinol, the animal form of vitamin A. Too much of this could be harmful to your developing baby (BNF 2018, NHS 2017d, RCOG 2014).
• Doctors advise pregnant women to stop drinking alcohol during pregnancy. There’s no way to know how much alcohol is safe, if any. We do know that the more you drink, the higher your baby's risk of long-term health problems. In the first trimester, alcohol can also increase your risk of miscarriage. That’s why experts recommend avoiding it altogether while you're pregnant (BNF 2018, NHS 2017e).
• Don't have more than 200mg of caffeine a day. That’s about two mugs of tea or instant coffee. Fizzy drinks and energy drinks also contain caffeine so check the labels of these when choosing what to drink. You could switch to decaffeinated drinks instead (BNF 2018, RCOG 2014).

Some research has suggested that eating starchy foods that have been over-cooked until they're brown and crispy may be associated with low birth weight. This is due to a natural chemical called acrylamide that's formed as foods such as potatoes and bread are fried, baked, roasted, or grilled at high temperatures (PHE 2017).

More research is needed to be sure if acrylamide from food poses a risk to your unborn baby (PHE 2017). However, it's easy to reduce acrylamide in your diet, so you may think it's worth doing:

• Don't overcook starchy food. For example, fry potatoes and chips so they take on only a light colour, and eat toast that's no darker than pale brown.
• Cook pre-prepared foods that need frying or oven-heating according to the packet instructions.
• Try not to eat too many packet biscuits or ready meals, as acrylamides have been found in processed foods (EFSA 2015).

Store potatoes somewhere dark, cool and dry, but not in the fridge. Putting them in the fridge can increase the amount of sugar they hold, which could lead to higher levels of acrylamide when you bake, roast or fry them (EFSA nd).

Is it safe to go on a diet during pregnancy?

Dieting during pregnancy could harm you and your developing baby. Some diets can leave you low on iron, folic acid, and other important vitamins and minerals (BNF 2015b, NHS 2017f, RCOG 2014).

Remember, weight gain is a positive sign that you’re having a healthy pregnancy. As long as you're eating fresh, wholesome foods and gaining weight, just relax. You're supposed to be getting bigger (BNF 2015b)!

If you were overweight before you became pregnant, ask your GP or midwife for more advice about managing your weight during pregnancy (NHS 2017f).

How much weight will I gain in pregnancy?

It's hard to say, as it depends on lots of things, including how heavy you were before you became pregnant (NHS 2018).

The average pregnancy weight gain is between 10kg and 12.5kg (22lb to 26lb). You'll put on most weight in your second and third trimesters (Murray and Hassall 2014, NHS 2018).

Your growing baby, the placenta, and amniotic fluid, make up a lot of your pregnancy weight gain. You're also hoarding more fluid to boost your blood system, and you're laying down fat to help your body make breastmilk for your newborn (Murray and Hassall 2014, NHS 2018).

During the middle part of your pregnancy, your appetite may be the same as before you were pregnant, or slightly increased. Towards the end of your pregnancy, your appetite will probably increase.

The best approach is to eat a balance of foods and try to do some activity every day. That way you’ll gain weight at a steady, healthy rate as your baby grows (Muktabhant et al 2015).

Can I still have occasional treats during pregnancy?

You don't have to give up all your favourite foods just because you're pregnant. But try to limit foods that are high in fat, salt and sugar (BNF 2015b, RCOG 2014). Healthy snacks are a good way to keep up your energy levels, especially if you can only manage small meals (BNF 2015b).

Instead of a packet of crisps or a bowl of ice cream, try eating something healthier such as beans on toast, a piece of fresh fruit, or a plain yoghurt (NHS 2019). But don't feel guilty if you're tempted by the occasional biscuit.

To make healthy eating easier, check out our trimester-by-trimester pregnancy meal planners, plus our guide to eating more fruit and veg.