How to feed your baby right, even before birth

Bonnie - I thought I would lend my expertise to this piece. Some of Ms. Ward's info is correct, and some is not.

Eating healthfully for two without gaining too much weight is a common problem for pregnant women. The Institute of Medicine has released new weight-gain guidelines for pregnancy. USA TODAY talked to Elizabeth Ward, a registered dietitian in Boston and the mother of three girls. Ward is the author of a new book, the American Dietetic Association's Expect the Best: Your Guide to Healthy Eating Before, During and After Pregnancy. She's also a nutrition blogger on dietchallenge.usatoday.com.

Q: Why is it important for women to maintain a healthy weight before, during and after pregnancy?

A: Being at a healthy weight increases a woman's chances of getting pregnant. If a woman has a lot of excess body fat at the time of conception, there is an increased risk of neural tube defects, such as spina bifida, even when she is consuming the recommended amount of folic acid, a B vitamin associated with a lower risk of these defects.

Starting a pregnancy at a healthy weight gives the child a better chance of developing normally. It also lowers the risk of several complications for mom during those nine months, including high blood pressure, gestational diabetes and delivering a baby that's too large and may require Cesarean delivery.

Gaining the suggested number of pounds during pregnancy helps to minimize complications for mother and child, and it helps women achieve a healthy weight after pregnancy. Studies show that women should try to take off the excess pregnancy pounds, in a safe manner, within one year of delivery. After that, they're likely to keep those pounds on.

Q: How many extra calories do women need each day when they're pregnant?

A: During the first trimester, a pregnant woman does not require any extra calories. This seems odd, given that the baby is growing by leaps and bounds. However, he or she is still far too small to require extra energy from the mother. Calorie needs increase during the second trimester. At that time, a woman should add about 350 calories to her pre-pregnancy diet and about 450 calories a day more during the third trimester. Women who begin pregnancy overweight may need fewer calories and those who are underweight may need more.

Q: What are the calcium and iron requirements for expectant mothers?

A: Calcium needs do not increase with pregnancy. That's because a woman's body becomes super efficient at absorbing calcium. However, many women begin pregnancy with a calcium shortage and need to increase their calcium consumption to make the 1,000 milligram-a-day quota. That's the amount found in about three 8-ounce glasses of milk. Fortified 100% orange juice contains as much calcium as milk, too. Other calcium-rich foods include yogurt, cheese and tofu processed with calcium sulfate. Women shouldn't rely on multivitamins or prenatal dietary supplements for calcium — they do not contain nearly enough. But if a woman can't achieve her calcium requirement with food, she should consider calcium supplements.

Bonnie - expectant mothers do need extra calcium (200-400 mg.). Otherwise, the mother may become deficient post partum. If deficient in vitamin D, the woman's body does not become super efficient in absorbing calcium. Of course, milk is the poorest source of calcium for absorption. Our Wellness Essentials for Pregnancy Prenatal provides 1/3 of what I recommend.

Many women enter pregnancy with low iron stores. Pregnancy boosts iron needs because your body produces more iron-rich red blood cells to support a growing baby. That depletes the supply of stored iron in a woman's body, so she must eat an iron-rich diet to keep up with pregnancy demands. Even with a balanced diet that includes such iron-rich foods as fortified grains, beef, poultry, pork and seafood, it's difficult for most women to achieve the 27 milligrams of iron they need every day during pregnancy.

Bonnie - I recommend 27-40 mg. in a prenatal or separately. If iron deficient during pregnancy, we add more.

That's why it's a good idea to take a multivitamin with 100% of the daily value for iron and other essential minerals and vitamins to fill in any nutrient gaps.

You are a good candidate for a prescription or over-the-counter prenatal multivitamin if:

• Your diet was poor at the outset of pregnancy, or is at any time during your pregnancy.

• Your diet had been inadequate for months or years before conception.

• You are carrying more than one child.

Bonnie - the prescription prenatals I have seen are far from complete.

Q: What are some beverages that pregnant women should avoid consuming and why?

A: Pregnant women should completely avoid alcohol. Alcohol can cause irreversible harm to a developing child. It deprives a baby of oxygen and nutrients that are required for the development of every organ, most notably the brain. Heavy drinking during pregnancy increases the risk of mental retardation, learning disabilities, birth defects and emotional and behavioral problems. There is no known safe amount of alcohol during pregnancy, and studies show even modest consumption of alcohol during pregnancy can cause problems in children.

According to the March of Dimes, pregnant women should limit caffeine to 200 milligrams a day, about the amount found in 10 ounces of brewed coffee. Caffeine has been linked to a higher risk of miscarriage in some studies but not all.

Q: Why is exercise important during pregnancy?

A: Exercise helps to foster weight control, keep blood pressure in check, reduce stress that may lead to overeating and improve circulation and strength. It may also help women sleep better. I exercised during my pregnancies because it made me feel good, and strong.

Most women with uncomplicated pregnancies can work out throughout their pregnancies, and they can start a program (most likely walking) while pregnant even if they have not worked out in the recent past. Always ask your doctor about exercise.

Bonnie - no pounding activities.