Category Archives: Pregnancy

Women Need More Protein In Pregnancy

This article was originally printed in the Natural Medicine Journal–if you would like to see the references, Click here
Especially during a first pregnancy, many women have a pronounced concern about diet: how to eat, what to eat, and when to eat. As providers, we have the opportunity to help guide them towards optimal nutrition and provide reassurance that they are making sound choices. Within the context of so many “don’ts” regarding maternal nutrition–foods to avoid because of possible bacterial contamination, mercury, lead, pesticides, nitrates, blood sugar dysregulation, insufficient or too much weight gain etc–it is good to also have some advice that helps women relax and trust their intuition. This study finds that the protein needs of women throughout pregnancy is higher than previously recommended and possibly closer to what women may be craving.

IAAO is a relatively new method that has become popular for determining protein requirements in human subjects.1-4 In the past, protein requirements were assessed by the nitrogen balance method which can be difficult because it requires that all nitrogen intake and output is carefully recorded and that the subject stays in the testing facility for the duration of the testing to measure nitrogen loss from urine, feces, saliva, and wounds. This testing takes much longer to perform and requires that subjects are put in a deficiency state for longer, which makes it unsuitable for pregnant women. For this reason, the current recommendations for protein intake during pregnancy (Estimated Average Requirement (EAR) of .88 g/kg and RDA of 1.1 g/kg) have been based on nitrogen balance studies of nonpregnant adults that have been extrapolated with total body potassium studies of protein deposition during pregnancy. 5 With the development of IAAO, researchers have been able to more accurately determine protein needs during pregnancy because they can run this study on pregnant women. Additionally, this is one of the first studies to distinguish maternal needs during early and late gestation.

Understanding protein requirements during pregnancy is important because protein is the macronutrient with the most influence on birth weight. This study assumes caloric sufficiency; for well nourished non-diabetic women, increasing protein intake is the macronutrient most likely to increase birth weight.6,7 In addition to neonatal complications and increased mortality, low birth weight is also correlated with long-term health problems such as type 2 diabetes, kidney disease, cardiovascular disease, and respiratory problems. 8-11 Ensuring that pregnant women have a protein-sufficient diet is therefore crucial for the short- and long-term health of their children.

It is important to keep in mind, however, that while this study showed protein needs to be higher than current recommendations, it is still by no means extraordinarily high. The average weight of the subjects during early pregnancy was 64.4 kilos, indicating a need for 78.6 grams of protein per day, or 314 calories. Calculated resting energy expenditures (REE) averaged 1370 calories per day, so subjects were given an average of 2329 calories (1.7 REE), putting sufficient protein consumption at 13% of calories. In late pregnancy, average weight was 71.1 kg, with a need for 108.1 grams of protein or 432 calories per day. REE was 1480, so subjects were given an average of 2516 calories, with sufficient protein consumption at 15% of calories. 13-15% of calories from protein is far lower than the recommended amounts in virtually any contemporary dietary plan save for some raw, vegan and pritikin diets which are rarely recommended or undertaken during pregnancy.

Based on these new recommendations the example below provides sufficient protein sources on average for late pregnancy with far fewer calories than necessary for a day; a pregnant woman could be encouraged to include these foods within the context of whatever other foods she prefers to meet her additional caloric needs:

Breakfast: 2 eggs, 2 slices toast=21g

Snack: One ounce of cheese=7g

Lunch: 1 cup cooked lentils with steamed veggies=18g

Snack: 2 Tbsp peanut butter on 2 rye krisp crackers=12g

Dinner: 1 cup cooked chicken breast with 1 cup quinoa and steamed veggies=51g

Total: 109g protein, approximately 1300 calories

With this in mind, practitioners may find that their patients may intuitively be eating an appropriate amount of protein: a current Canadian study found pregnant women generally eating amounts of protein more consistent with the findings of this study, rather than the current DRI.12 This assumes, of course, that women have adequate caloric intake and the financial and practical means to choose what foods they eat.

One question that is relevant to how complete the information is from the study is the possible impact of the types of food consumed rather than just macronutrient content. On the day of the study, all of the calories for the day were consumed as a shake consisting of the protein supplement which was based on an egg-white composition, kool aid or tang, and a shake base powder consisting of palm, soy, coconut and sunflower oils, corn syrup, corn starch, sucrose, calcium phosphate, sodium citrate, vitamins and minerals, plus unspecified “protein-free cookies.” This does meet the requirements of the macronutrient breakdown desired for the purpose of the research study, but certainly doesn’t resemble a dietary plan that would be advocated by most providers who would be counseling a pregnant woman. While this study certainly gives us a good baseline from which to advise patients, it is certainly within the realm of possibility that a pregnant woman’s metabolic and protein needs will shift if fiber, complex carbohydrates, and phytonutrients are present in the diet.

While it can be confusing to create an optimal diet for each individual during pregnancy, the findings from this study indicate that advising for protein intake may be a little more intuitive. For women who are adequately nourished with the financial means to choose what foods they eat, as long as they feel well enough and remember to eat some protein-containing food every few hours, they will probably be able to approximately meet their protein needs each day. For women who struggle to meet this recommendation for increased protein intake, it is important to instruct them on which foods contain protein and remind them to eat these foods every few hours. This will help to optimize the health of their baby as a newborn and throughout life.

BPA: Minimize Exposure to Optimize Reproductive Health

I was recently reading a New York Times article entitled “In Plastics and Cans, a Threat to Women,” (1) which talked about some of the more recent research that has been showing the reproductive effects of Bisphenol A, or BPA. The studies quoted in this article show that BPA restricts development of healthy eggs in animal models. Exposure to BPA at any time of life: in the womb, in childhood, and in adulthood all will have a negative effect on female fertility. In a study conducted on discarded eggs from an IVF clinic, they found “Higher levels of BPA were linked to stunted human oocytes, as well as indications of chromosomal damage.” Higher serum levels of BPA have also been linked to greater risk of miscarriage.(2) Studies have also found BPA to have a negative impact on male reproductive function, most profoundly when exposure occurs in utero. Effects on male fetuses included, among other issues, feminization and testicular atrophe. (3)

Although reproductive problems are only one of the ways in which BPA can affect human health (it has also been associated with diabetes, heart disease, thyroid problems and weight gain), this issue is particularly alarming because of the profound impact it can have on our and our children’s quality of life. Infertility is a huge issue in the United States, and it is important for us to look to the future to protect the reproductive health of our children. The choices we make for our children during pregnancy and in their early years can profoundly influence their overall health and reproductive capability in the future. So how can we minimize exposure to and negative effects from BPA?

BPA is an extremely common compound; 5-6 billion tons are produced annually worldwide. The CDC estimates that 93% of people in this country have detectable levels of BPA in their bloodstream, so most of us are coming into contact with it on a regular basis. It can be found in:
Protective layers of canned food containers
wine vat linings
lining water pipes
plastic food storage containers
epoxy resin based paints
dental composites and sealants
automobile parts
baby bottles
plastic dinnerware
eyeglass lenses
thermal receipts
impact resistant safety equipment
Some PVC plastics (4)
A recent study found that people who had extensive contact with BPA-coated receipts (such as grocery store checkers) did not have significant elevation in their blood levels of BPA. (5) So coming into skin contact with BPA is probably of less concern to most of us. For most people, the primary route of entry into the body is by ingesting food that has been in contact with BPA. For this reason, the primary way to avoid BPA exposure is to be conscientious about how your food is stored.

The good news is that many companies have switched to BPA-free plastics for food storage. Most baby bottles, water bottles, and many storage containers produced in the past 2-3 years will now be BPA free. In general, it is a good idea to avoid any food or water containers made of plastic with a number 7 on the bottom. This is not a guarantee that the plastic contains BPA, but it could. Rubbermaid has switched their storage containers to be BPA-free as well. However, even plastics that are BPA-free may contain other less-studied substances that can also influence the function of the endocrine (hormone) systems, so moving towards glass and ceramic storage containers is generally a good idea.

Another way to avoid BPA is to eat more fresh, homemade foods. There are many companies that have started switching the lining of their cans to be BPA-free (here’s a nice list of these companies)(6), but in addition to all the other health promoting reasons it is a good idea to make your food yourself, you will be minimizing the risk of exposure from BPA-lined cans.

While minimizing exposure to BPA is obviously a primary goal, it is clear that most of us will come into contact with it in our daily lives. Assuming that most of us have BPA in our system, the final question is how we can mitigate its effects. While there is less research so far in this area, one thing we know is that at least some of its negative effects result from oxidative damage to cells or DNA. It stands to reason then to look to some of our natural antioxidants to counteract the oxidative effects of BPA. In one in vitro study, oxidative damage to red blood cells was reversed using green tea.(7) Another study showed that the effects of oxidation by BPA were reduced in young women by consumption of wheat sprout juice. (8)

BPA is an extremely common substance: most of us come into contact with it on a daily basis, and almost all of us have it in our bodies. While we must live in our world and not spend our time worrying about every detail, it makes sense to minimize exposure to BPA, especially during pregnancy and childhood. The best way to do this is to focus on eating fresh, home-prepared foods, store our foods in glass and ceramic containers, and eat plant foods that are rich in antioxidants. This will help us to maintain good health and preserve the reproductive health of our children.
2. Lathi RB1, Liebert CA2, Brookfield KF3, et al. Conjugated bisphenol A in maternal serum in relation to miscarriage risk.Fertil Steril. 2014 Jul;102(1):123-8.
3.Manfo FP1, Jubendradass R, Nantia EA et al. Adverse effects of bisphenol A on male reproductive function.Rev Environ Contam Toxicol. 2014;228:57-82. ,
5. Porras SP1, Heinälä M2, Santonen T2. Bisphenol A exposure via thermal paper receipts.Toxicol Lett. 2014 Aug 28. pii: S0378-4274(14)01310-1.
7.Suthar H, Verma RJ, Patel S, Jasrai YT. Green tea potentially ameliorates bisphenol a-induced oxidative stress: an in vitro and in silico study. Biochem Res Int. 2014;2014:259763. Epub 2014 Aug 10.
8.Yi B1, Kasai H, Lee HS, et al.Inhibition by wheat sprout (Triticum aestivum) juice of bisphenol A-induced oxidative stress in young women. Mutat Res. 2011 Sep 18;724(1-2):64-8.