The right diet can help you have a healthier pregnancy
by Debbi Donovan, IBCLC
Dr. Brewer, a pioneer in the field of nutrition and pregnancy, has spent the past 47 years of his life working as a trained obstetrician, counseling women in both research and clinical settings during their pregnancies. He has fought a lifelong -- and uphill -- battle to conquer disorders of pregnancy and complications of birth, by doing something as simple as making it his business to see that pregnant moms are properly nourished.
Over the past five decades, Dr. Brewer has been frustrated by the failure on the part of health care providers to recognize the important role played by good nutrition during pregnancy and, moreover, to make this an important part of their practice, counseling pregnant mothers in the importance of good nutrition. Brewer believes that it is crucial that pregnant women eat a healthful, balanced diet every day during their pregnancy. Rarely does a pregnant woman get asked by her obstetrician what she is eating. Though they usually take an otherwise complete history, this important part of the puzzle is ignored. Why is one of the simplest solutions (like a good, balanced diet) often ignored and ultimately forgotten?
What set Dr. Brewer on this path? As a medical student, Dr. Brewer worked on the ward at the Charity Hospital in New Orleans. He was fascinated by teachings about toxemia. He was told that it was a disease of poverty, and also commonly seen in teens and poorly controlled diabetics. James Ferguson, his first instructor at Tulane and New Orleans Charity Hospital, made a big impact on him as he discussed how the high rates of disorders such as toxemia seen in poor women in the South were due to the extremely poor diets of these impoverished women. He began to ask the women in the wards what they were eating. Many were living on hominy grits, cornbread and sorghum. It was not long before Dr. Brewer became convinced -- the missing link was nutrition.
From 1953 to 1954, he served his family practice residency in the Lallie Kemp Charity Hospital in Louisiana. Twenty-five percent of the women admitted had toxemia. They had something in common -- they were poor and malnourished. Later, as he worked in family practice in the more affluent community of Fulton, Missouri, he rarely saw problems with toxemia.
At Contra Cosa Hospital in Martinez, California, (between the years of 1963 and 1976), Brewer completed a retrospective study of 5,615 births. He did not see one case of convulsive toxemia in the mostly high-risk group of women who followed his diet throughout their pregnancies. Each women was counseled in nutrition at each prenatal visit and asked what she was eating. Mild toxemia was present in fewer than one percent of the women studied. Toxemia is preventable, says Dr. Brewer.
Prevention is the key to a healthy pregnancy, a good birth and a healthy baby. Dr. Brewer believes that by eating properly during your pregnancy, you will help to protect yourself and your baby from many complications such as:
- Miscarriage
- Metabolic Toxemia of Late Pregnancy (Eclampsia)
- Anemia
- IUGR
- Premature Rupture of Membranes
- Low birth weight or premature baby
- Stillbirth
- Placental abruption
- Babies who are prone to illness
Dr. Brewer Answers Your 7 Most-Asked Questions
- What is the best advice you have for a newly pregnant mom?
Diet is the most important thing that you can take care of. In clinical practice, I would assume that everyone was undernourished, and then would I would set about educating them about the nutritional requirements for a healthy pregnancy and a healthy baby. We need someone with the authority of a physician to speak with every pregnant woman. But, even today, not much time is spent educating doctors about nutrition in medical school. - What do you consider a healthy pregnancy weight gain?
As long as the pregnant mother is eating an adequate diet, there is a large variation in what is considered to be a normal and healthy pregnancy weight gain. Some women lose weight during a pregnancy, while others may gain 70 pounds. It is the quality of the diet that is most important. - Your diet recommends 2,400 calories each day? Isn't that awfully high?
Don't concentrate on calories. Instead, eat the healthy foods included in a good diet, making sure to get between 80 and 100 grams of protein each day. Dr. Maurice Strauss of Harvard, in the 1930s, found that women with toxemia who were placed on very high protein diets (260 grams a day) were able to turn their conditions around. - What if I suffer from nausea and vomiting -- how important is it for me to eat everything on the diet?
Malnutrition at the end of pregnancy is a much bigger threat, particularly during the last trimester. The quality of your diet is still of utmost importance, though the quantity is not as big an issue. Morning sickness usually fades away by around the 12th to 14th week of pregnancy. Up until that time, small meals containing some protein and carbohydrates should be eaten frequently. This can even help to relieve morning sickness in some mothers. - How about salting my foods to taste -- will it cause my blood pressure to rise?
Salting foods to taste is very important. During pregnancy, blood volume must increase 40 to 50 percent. The goal of the Brewer Diet is to provide you with the foods and nutrients necessary to help with this protective increase. It is normal to have swelling in late pregnancy while following a good diet. Extra water protects in case of excessive bleeding after the birth, and helps to protect the new mother from going into shock. - How would you adapt your diet if you are overweight at the start of a pregnancy?
Normally you should eat the same foods. Eat to appetite. Overweight women usually have bigger babies with fewer problems. Women who are too thin are more at risk for complications than moms who are overweight. - What about moms of twins?
I recommend that mothers eat for the number of babies they are carrying. With twins, it is important to take in between 130 and 150 grams of protein each day, and with triplets, 200 grams. Get plenty of salt in your diet. Women are usually told that they can expect for their twins to be born early. Today, it is considered normal for twins to be born at 34 to 35 weeks and triplets at 32 to 33 weeks. The fact is that their nutritional needs are not being met.
Is Metabolic Toxemia of Late Pregnancy (Preeclampsia) totally preventable by following your program?
Metabolic Toxemia of Late Pregnancy (MTLP) is a disease of low blood plasma volume, rather than high blood pressure. It is caused by not enough high-quality proteins and vitamins in the diet, and from salt deprivation. Women with MTLP suffer convulsions, coma, heart failure, shock and often death for both mother and baby.
MTLP is often diagnosed today when a woman has an observed rise in blood pressure, coupled with edema (swelling). Blood pressure can rise for many reasons totally unrelated to preeclampsia. Ninety percent of women have swelling of their extremities during late pregnancy, and 65 percent will have swelling of their hands and face. I won't blindly diagnose without a complete dietary history. Women exhibiting these symptoms, while following an adequate diet, have less infant mortality than the general population.
Some doctors continue to prescribe a low-calorie, low-salt diet for women, particularly those starting out their pregnancy overweight. This can be very dangerous to both the mother and baby.
The World Health Organization reports that there are 75,000 deaths per year worldwide from this disease. MTLP would be totally preventable, but people don't believe the missing link in its treatment is adequate nutrition. If a health care provider doesn't know it himself, and if he doesn't believe it, he can't teach it.
It isn't always easy to eat well during pregnancy. With the hectic schedules many families have today it may seem very hard to take the time to eat right. But, it pays to remember that what you eat affects your baby's health for life.
What Makes up a Good, Nutritious, Balanced Daily Diet During Pregnancy?
4 exchanges of milk (1 cup each): whole milk, low fat, skim, buttermilk. If using soy milk, 1.5 cups per serving. One serving of cheese is approximately 1.25 ounces.
2 calcium replacements for each serving of unfortified soy: almonds, walnuts, sunflower seeds brazil nuts, broccoli, molasses, wheat germ*
2 eggs
6 exchanges of fish, liver, chicken, lean beef, lamb or pork, any kind of cheese. Beans, grains, nuts and seeds and vegetables may also be included in this area, but do not count an item twice. (Average exchange is 1 ounce meat or hard cheese, 1/4 cup of tuna or soft cheese, 1 cup of milk, 1 egg, 1/2 cup beans or grains, 2 to 3 ounces of nuts, and about 5 ounces of most vegetables.)
2 exchanges of fresh, dark green, leafy vegetables: broccoli, brussels sprouts, spinach, romaine lettuce... (Average exchange is 1/2 to 1 cup)
5 exchanges of whole grain bread, starchy vegetables and fruits. (An average exchange is 1 slice bread, 1/2 cup cereal, pasta or rice, and 1/2 piece of fruit.)
2 exchanges Vitamin C foods: orange, grapefruit, pepper, tomato, cantaloupe, potatoes, cabbage, cauliflower (Average exchange is 1 fruit or 1/2 cup.)
5 exchanges fats and oils. (1 tablespoon butter, oil or mayonnaise...)
1 exchange Vitamin A food: carrots, peaches, sweet potato or yam, cantaloupe, apricots Drink to thirst
Salt foods to taste
Liver (4 ounces) once a week
This diet can be adapted for vegetarians, by using complementary protein at one meal. Choose to eat 2 plant proteins at the same time, such as rice and beans, or to eat some animal protein along with plant protein, such as eggs, cheese or milk.*
*Adapted diet in The Brewer Medical Diet for Normal and High Risk Pregnancy, 1983
Adapted with permission from Metabolic Toxemia of Late Pregnancy, Thomas Brewer, MD, 1982
