The Dr. Brewer Pregnancy Diet
The Medical Reasons
The Diet
Weekly Record
Special Needs
No-Risk Diet
Weight Gain
Bed Rest
Herbal Diuretics
Twin Pregnancy
The Twin Diet
Premature Labor
Blood Pressure
Mistaken Diagnoses
Underweight Babies
Gestational Diabetes
In Memory
Other Issues
Morning Sickness
Colds and Flu
Registry II
Registry III

Three Pregnancy Nutrition Principles

The following is the "Introduction" reprinted from Eating for Two, by Isaac Cronin and Gail Sforza Brewer, 1983.

"A Cookbook for Pregnancy: The Medical Reasons", by Tom Brewer, M.D. (p.ix)

On my list of concerns about my pregnant patients' welfare, nutrition ranks second only to breathing. The reason is simple: well-nourished women develop far fewer complications in pregnancy, have more efficient labors, and give birth more easily to healthier babies than do their poorly nourished sisters. This makes my job as an obstetrician much easier--and a lot more enjoyable! I am always interested in anything that will assist mothers in improving their nutrition. This cookbook is such a tool.

This cookbook is not like any other cookbook in the world. Far more than a collection of delicious recipes (though it is, indeed, that), it is a comprehensive eating plan for pregnancy, designed to provide all the nutrients needed during every day of gestation to keep you and your baby in good health. In other words, it is an insurance policy, a form of protection against some of the most common and most serious problems that could befall you or your unborn baby--those caused by poor nutrition.

Research done over the past fifty years [as of 1983], including some of my own, has made it increasingly clear that if the mother's diet is inadequate in any of several different ways, these difficulties may result:

  • spontaneous abortions (miscarriages)
  • abruption of the placenta (premature separation of the afterbirth from the wall of the uterus)
  • intrauterine growth retardation (a slowdown of the baby's growth during pregnancy)
  • prolonged and difficult labor
  • increased need for Cesarean delivery
  • increased need for intravenous fluids and/or blood transfusions due to hemorrhage
  • metabolic toxemia of late pregnancy (a shrinkage of the mother's blood supply due to a damaged liver; may end in convulsions or coma for mother; a leading cause of maternal and infant death)
  • premature labor
  • premature/immature/underweight babies (at highest risk for breathing problems at birth and long-term aftereffects such as cerebral palsy, epilepsy, learning disabilities, and poor motor coordination)
  • higher rates of severe infections or mother and baby after delivery
  • increased difficulties with breastfeeding (cracked, sore nipples, scanty milk supply, milk of compromised nutrtional value, a weak suckling reflex in the baby, breast infections)
  • increased rates of admissions to "high risk" hospital units during pregnancy and after birth
  • No mother knowingly puts herself and her baby at higher risk for these complications. With very few exceptions, the mothers I've counseled about the importance of their diets have appreciated the information and put it into daily practice for the rest of their pregnancies. You will be able to do the same for yourself in your own kitchen when you use this cookbook as the basis of your pregnancy meal-planning.

    In my own practice as director of a prenatal nutrition education program in the public prenatal clinics of the Contra Costa County (San Francisco Bay area) Medical Services between 1963 and 1976, I did research and managed over seven thousand pregnancies using the pregnancy nutrition basics presented in this cookbook. I learned a great deal from my patients, their friends, and their families after I adopted a seminar-style format for nutrition counseling, with individual follow-ups with each expectant mother as part of her regular prenatal visits. This method of working brought the authority of the doctor to bear on the mother's attitudes toward nutrition, and made concern for the mother's nutrition an ongoing part of her care, not merely a one-time discussion or just a diet sheet handed across a desk.

    Because I was doing obstetrics with sound nutrition as my first point of reference, I viewed my detailed knowledge of each patient's diet as essential medical information--just as important as all the other routine biochemical tests (blood work, tests on urine, other laboratory workups) and physical assessments (weight, blood pressure, palpation of the abdomen, internal examinations) that constitute good prenatal care. In fact, it soon became apparent to me that many of these standard tests and assessments are greatly affected by the status of the mother's daily diet, and that women who follow excellent diets often "test out" differently than those whose diets are less nutritious. In short, I began to question the "normality" of the numbers given for many standard tests since those numbers had been determined without regard for the nutritional status of the subjects. So, for example, when I knew the mother's diet was excellent, I learned not to worry about a red cell count (hematocrit) in the thirty to thirty-three per cent range at the eighth month of pregnancy, even though the standard numbers said the count should be much higher. I realized that the well-nourished mother has a more greatly expanded plasma volume (the water component of the blood) than had previously been recognized, so her red blood cells were somewhat diluted.

    Learning not to panic in the face of such test results, and instead re-evaluating the basis upon which the test results had been obtained, became a constant part of my clinical research and practice in those years. It was a hard part of the work, because medical training is so authoritarian--it encourages the student to replicate the exact method taught by the professor. It was also hard because for decades my specialty, obstetrics and gynecology, has been primarily surgical--with little reference to the internal relationships of the body systems that support a pregnancy, and most attention paid to emergencies that often surface only at the time of labor. I became firmly convinced that not only was nutrition important to the successful outcome of the nine months of pregnancy, but it also held great promise in preventing so many of the ost common conditions that send women rushing to emergency rooms in the middle of the night (see list given previously).

    My own research specialty has been in a disease that I term metabolic toxemia of late pregnancy (MTLP), but which is called by many other names around the world: in England, pre-eclamptic toxemia (or, PET); on the Continent, EPH gestosis (edema, proteinuria, and hypertension of pregnancy); also known as pre-eclampsia/eclampsia (from the Greek for "flash of lightning", referring to the sudden convulsions which, to ancient physicians, seemed to strike the pregnant woman like lightning bolts from the blue), or, more generally, "toxemia of pregnancy" (a very broad term applied to several different disorders which can be caused by many unrelated diseases).

    I became interested in the relation beween maternal nutrition and this disease while a third-year medical student at Tulane in 1950. My ob/gyn instructor, Dr. James Henry Ferguson, had been studying the backgrounds of women who had died in rural Mississippi of eclampsia (the convulsive/coma stage of sever MTLP). In his lectures to us, he noted the terribly inadequate diets of the mothers, diets he had reconstructed after talking with member of their families, public health workers who had known them, and, in some cases, friends with whom they had been living or working. Most of the eclampsia victims had been living or nothing but fatback, field peas, water gravy, an occasional plate of greens, candy and soda water. Deficient in most essential nutrients except calories, this diet--and urban variations of it--was starting to be linked with onset of eclampsia in work being reported from many other medical centers, including Harvard (work done by the internist Maurice B. Strauss, later a medical school dean at Tufts), Philadelphia Lying-In Hospital (research by Winslow Tompkins, then chief of ob/gyn, later director of the Children's Bureau in the U.S. Department of Health), and the University of North Carolina (papers by Robert A. Ross, later to become president of the American College of Obstetricians and Gynecologists).

    It was a time of great interest in the possibilities of the new science of human nutrition--particularly with respect to the role of good nutrition in the prevention of medical diseases--so, like students everywhere, I accepted my professor's appraisal of malnutrition as the possible culprit in eclampsia and checked his theory by asking women hospitalized on the toxemia wards at Charity Hospital in New Orleans what they'd been eating before they became ill and entered the hospital. Ferguson's diet list was repeated to me again and again. The women also told me they had been unable to eat anything for a few days before they were admitted. They complained of severe stomach aches and lack of appetite, commonly followed by a day or two of acute nausea and vomiting. These mothers weren't just malnourished. They were literally starving. And our treatment at the time (low-salt, low-calorie diets and diuretics designed to eliminate the massive swelling and bring down the blood pressure) did nothing to correct their basic problem.

    These mothers usually gave birth to tiny, immature babies, half of whom were too weak from prolonged prenatal malnutrition to survive being born. A large percentage of the survivors were left with lifelong disabilities such as mental retardation. This brief encounter with the profound and stark realities of what poor nutrition meant to the lives of these mothers and their families stayed with me for the rest of my medical school, internship, and residency years. In 1958 I began an ob/gyn residency at the University of Miami, where Ferguson had become head of the department. My goal was to establish a research basis for the connection between malnutrition and MTLP.

    My work in the Contra Costa clinics took the ideas one step further: I wanted to organize a prenatal care service that would have the patients' nutrition as a top priority, hoping to see a disappearance of MTLP as a result. This would not be an academic setting for an experiment in which some women would be adequately fed according to a planned regimen and other left on poor diets, or systematically denied nutrients, for the sake of "seeing what would happen." I had seen very clearly what would happen during my medical training, and I was interested in truly preventing such tragic outcomes through nutritional counseling methods alone. Several times during the course of the Contra Costa project, I was offered research funds with just that sort of "control group" as a condition of receiving the grant. But, in good conscience, knowing what I did then about the consequences of malnutrition in human pregnancy, I had to refuse such proposals. My single-minded, all-consuming drive was to get the nutrition message home to every woman who came to our clinics for care so she would act on the information.

    Knowing about it wasn't enough. Each mother had to carry through with the required diet every day, no matter what else happened in her life, in order to obtain the benefits of sound nutrition for herself and her new child. And, as with any action program, the day-to-day situations that sometimes stood in the way of the mothers being able to eat well enough for pregnancy. Over the thirteen years of the project I also developed a set of key concepts in pregnancy nutrition--a set of principles that guided me in counseling mothers and, ultimately, in training other young doctors who passed through the clinics as part of their residency training programs. We have just completed a book [as pf 1983] detailing all these situations and how to handle them, The Brewer Medical Diet for Normal and High-Risk Pregnancy (New York: Simon and Schuster, 1983), but we include here a brief summary, to show how many ways your nutrition really does matter during pregnancy.


    For years everyone thought the baby was a parasite, that it could extract nutrients from the mother's body irrespective of what she ate, that it would be a certain length, weight, and degree of development at birth due to genetics or heredity--in short, that the mother's diet had very little to do with the baby's growth in utero.

    We now know, thanks to some brilliant work on placental function done in the early 1960s, that only nutrients actually present in the mother's bloodstream are available to pass through the placenta to feed your baby during pregnancy. Furthermore, because of increased metabolic demands of all sorts during this period, nutrients in the bloodstream are used up more quickly than when you're not pregnant. So, you diet must provide all the necessary nutrients in larger amounts than before, and you must eat more often to maintain blood levels at an optimal level. This translates into more food, more often--a "grazing" plan that is especially important in the last weeks of pregnancy when you simply cannot sit down to a full-course dinner and enjoy it because of your over-crowded abdomen.

    This cookbook recognizes these needs and provides a daily, diet-planner chapter, complete with nutritious snack suggestions, to help you make the change to this food pattern. Most women have little trouble during mid-pregnancy: their appetites tell them that they need more food, anyway. Just keep in mind that there will never be another time in your life when making each bite count nutritionally will be more important. Also, because of the fact that most substances cross the placental membrane readily, this is a good time to avoid all substances that can reduce your desire for food. These include tobacco, alcoholic beverages, additive-laden synthetic foods, street drugs, and over-the-counter drugs. Prescription drugs should also be avoided, unless absolutely essential for the treatment of some major medical condition; even in this case, you'd be wise to check the label on the drug and see what it says about use during pregnancy--I'm sorry to say that many of my colleagues prescribe,often needlessly, a wide variety of drugs that are absolutely incompatible with a healthy pregnancy. The American Academy of Pediatrics states that no drug has been proved absolutely safe for the unborn child (even those approved by the FDA). Since drug compounds are carried by the bloodstream, they count as part of your total nutrition picture...and that of your unborn baby.

    It is well established that the interconnections between nutrition, embryology, and pharmacology are extraordinarily complex. A very thorough presentation of the current state of knowledge [as of 1983] regarding chemicals in our environment and their effects on the unborn is Christopher Norwood's At Highest Risk, (New York: McGraw Hill, 1981).

    Because your liver does its more efficient job of detoxifying your body of harmful substances when your diet is at its best, a sound pregnancy nutrition program is your baby's strongest line of defense when you are inadvertently exposed to such agents. For instance, even in areas where highly toxic chemicals have been used in defoliating large forested lands, not all pregnant women exposed to the spray developed problems with their pregnancies. It may well be found after considerably more research is done that the unaffected mothers' nutritional status proved to be the factor that protected their unborn babies.

    In animal studies of drug side effects, the nutritional status of the experimental subjects is carefully recorded to control for any potential contribution malnutrition might make to defective offspring. This assures the researchers that the side effects they do discover can be attributed to the drug being tested. When the nutritional status of humans participating in drug or other chemical research is similarly accounted for, we will have a much clearer idea of which substances are truly troublemakers in pregnancy, and which of the adverse outcomes are related to undiagnosed poor nutrition. Failure to control this criticl variable unfortunately holds much of today's research into these problems up to serious question.

    Nowhere does this defect in contemporary research design appear more glaringly than in the enormous attention currently being paid to the issues of smoking and alcohol ingestion by pregnant women. While we are absolutely in favor of pregnant women (all women, for that matter) refraining from smoking because of the long-term health problems it causes (heart disease, emphysema, lung, mouth, and bladder cancer), there is no sound research [as of 1983] proving that smoking causes low-birth-weight babies. In fact, every experienced physician can cite case after case of mothers who have not been able to give up smoking and still gave birth to eight- and nine-pound babies! If smoking is the crucial factor in low birthweight, as so many of the current advisories from government and private health organizations proclaim, then every woman who smokes ought to have a baby weighing less than five and a half pounds at birth. This is simply not the case. It may, however, be true that if the mothers who smoked and had good-sized babies had not smoked, their babies might have weighed another four to eight ounces each at birth. The narrowing of maternal blood vessels associated with smoking is well-documented, and it may contribute to a certain reduction in birthweight. In an otherwise normal-sized infant, however, this small reduction appears to have no significance, either at birth or later on.

    Again, the design of smoking research has not included careful controls to establish the mothers' nutritional status. The definitive answer will be forthcoming only when a group of smoking mothers is well-nourished according to a well-defined set of clinical measures and their pregnancies and babies are compared at the end of the experiment with a second group of smoking mothers whose nutritional needs have not been so well cared for.

    It is widely known that when you stop smoking, your appetite picks up. After thirty years as an obstetrician it is my impression that the major nutritional problem of pregnant women who smoke is that smoking replaces food for many of them. Smoking mothers who eat well do not develop the range of pregnancy complications we see in smokers who do not eat well. But it's the nutrition, not the smoking habit, that makes such a vast difference. The low-birthweight infants born to heavy smokers who do not eat well are a result of the mother's malnutrition. If a mother's finances are tight, money spent on cigarettes is just that much less she has to spend on good food--another reason why smoking contributes to poor nutrition for so many people. These, of course, are not direct effects of the smoke itself entering the body, but in our view they are far more significant in terms of harming a mother's nutritional status during pregnancy.

    The alcohol research follows along the same lines. It is inappropriate to alarm every woman who enjoys a glass of wine with dinner about the risks of fetal alcohol syndrome, a problem in babies born to chronic alcoholics--a group of women known to be profoundly malnourished even before they become pregnant. If one or two glasses of wine or beer, or a single cocktail, were enough to cause problems in the newborn, surely all of Europe would have been depopulated long ago! By no means do I want to encourage the consumption of alcohol, but it is clear that the well-nourished mother easily metabolizes small amounts of alcohol taken along with food, whereas her poorly nourished neighbor, who obtains most of her calories from alcohol and is deficient in almost all other essential nutrients because she rarely eats a meal, is not going to withstand the nutritional stress of pregnancy, nor is her unborn baby going to develop normally. Our advice is to refrain from alcohol consumption if it makes you dizzy or bothers your digestive system. Otherwise, limit yourself to no more than two ounces a day, always with a meal.

    Caffeine presents another consideration: it is a stimulant. As a result, beverages containing caffeine not only take up space in your diet that might better be given over to more nutritious foods, the caffeine itself revs up your nervous system so you feel bouncy and full of pep even though you haven't obtained all the nutrients you need. Small wonder that test results show a higher proportion of birth defects and prematurity in studies where mothers consumed more than eight cups of caffeine-containing beverages (coffee, tea, colas) a day. Remember, that's a half gallon a day--a large percentage of your stomach capacity--taken up by no-nutrient beverages. There may be some women who do this out of habit while working, but their numbers aren't that many. If you absolutely can't face the day without your morning coffee, so be it. But for the rest of the day, drink milk, real fruit juices, or an occasional mild herbal tea. You may experience caffeine withdrawal (headaches, lethargy, jitters) for a few days, but once you're weaned from it, you'll appreciate your calmer disposition and your improved ability to sleep--another important part of your complete pregnancy care program.


    It's been known for several decades [as of 1983] that the baby's organs develop in the first three months of pregnancy. The heart, for instance, starts beating by the twelfth day after the embryo implants in the mother's uterus. Arms, legs, eyes, lungs, digestive system--all are present by the twelfth week. But recent research on the brain [as of 1983] presents a different story. Though some parts of it exist by the end of three months, there are two periods of rapid growth later in pregnancy; one beginning at the fifth month, and the second beginning one month before birth. These growth spurts are essential to the normal formation of brain cells and their organization into systems that can process information and regulate responses to stimuli.

    Dr. John Dobbing, a British expert on the brain, writes that even mild degrees of undernutrition during these critical phases of brain development can interfere with optimal growth and function later on in life. In other words, if your diet doesn't meet the needs of your pregnancy, your baby is far more likely to have difficulty learning in school, swinging a baseball bat, or enjoying other activities that require muscular coordination. Some people studying the phenomena surrounding sudden infant death syndrome (SIDS) also wonder whether maternal undernutrition might adversely affect the portion of the brain that regulates the baby's breathing mechanism so that, on occasion, the baby "forgets" to breathe for prolonged intervals. Without resorting to speculation, though, it's been well-documented that smaller babies have fewer brain cells with less information-carrying potential. The simple way to prevent most of this type of brain damage is to feed your baby well before it's born--and that means feeding yourself well every day until you go into labor.

    In addition to the pattern of brain development there are several other reasons why pregnancy causes a nutritional stress. These factors are related to the internal changes that take place in your body to support a healthy pregnancy. The blood volume, that is, the actual amount of blood circulating in your blood vessels, must increase dramatically to service the increased demands of the placenta, an organ you did not have to perfuse when you weren't pregnant. If the placenta doesn't have adequate blood circulating through it, it doesn't grow as large as it should, it doesn't transfer nutrients and waste products between mother and baby as it should, and it doesn't adhere well to the surface of the uterus as it should--making it more likely to shear off before the baby is born. All of these placental problems threaten the continuance of your pregnancy and, because over a given period of time your baby receives fewer nutrients due to the reduced blood flow through the placenta, they also threaten your baby's well-being.

    Unfortunately, your blood volume doesn't expand automatically when you become pregnant. Blood volume expansion is a direct response of your body, chiefly determined by the liver, to the quality of your daily diet. Not enough protein, calories, vitamins, minerals (including salt) or water and the blood volume fails to expand, the placenta isn't perfused very well, the baby grows slowly or not at all, and all your other organs also suffer from a reduction in blood flow. For many years women were advised to restrict their food intakes in order to stay on a weight gain chart that gradually reached a peak of twenty-four pounds at the end of pregnancy. Today, we know that this approach to pregnancy nutrition can thwart the necessary blood volume expansion for a healthy pregnancy and place mother and baby at higher risk for complications. Instead, progressive midwives and doctors these days are encouraging their patients to eat to appetite from a diet list of highly nutritious foods in order to insure that the blood volume expands to the fifty to sixty per cent above pre-pregnancy level that correlates with best outcomes for mothers and babies. The shift in emphasis means that mothers should be spending far less time worrying about the numbers of pounds that show up on their scales; that time is better spent filling in diet checksheets to make sure you've eaten a complete diet every day. The following chapter provides all the forms you need to do just that.


    When people are under stress, they often don't eat regularly or they may not feel like eating the foods they need. Pregnancy itself can provoke stress within families and events unrelated to a woman's pregnancy can have great impact upon it, such as the illness of a parent or child, loss of one's job, or abandonment of the pregnant woman by her mate. Also, an expectant mother can become ill with any disease that affects the non-pregnant population, often with damaging results toher nutritional status. Some of the most common situations that wave the red flag of possible undernutrition to me:

  • moving--It's so easy to fall behind on your diet when your kitchen is in disarray for several weeks and you're depending on "road food" to keep you going. Also, the closer you get to moving day, the more likely you are to be working long hours packing up your household and simply forgetting meals. Check the section on "portable" meals later in this book for some suggestions on highly nutritious, easy-to-prepare-and-serve-later dishes. And remind yourself when it's time to eat: set an alarm clock if you have to, but make time for mealtimes. Better yet, whenever possible, wait to move until after your baby is born.
  • working full-time--This is similar to the above, since a full work schedule means extra calories spent on the job, tight time in the morning when you need a good breakfast, hurried lunch hours, limited access to nutritious snacks (unless you bring your own), and fatigue when you get home, often to the point where you prefer to sleep rather than prepare and eat dinner. Any mother who plans to work full-time throughout pregnancy should follow a "multiples" diet plan (see next chapter) since she has to eat for herself, her baby, and the job.
  • strenuous exercise--Jogging six miles a day, swimming fifty laps, dancing professionally, engaging in competitive sports that require hard conditioning, lifting or carrying heavy loads, long-distance bicycling--there's no reason to stop doing any of these until your enlarging abdomen and loosening back joints demand it. However, you must supplement your diet with the additional calories these activities require, so that your body's energy requirements don't burn up the protein foods you're eating. A method for calculating your individual energy needs is included in the following chapter.
  • nausea and/or vomiting--While this can be tolerated in early pregnancy when the developing baby is very tiny and does not require large amounts of additional nutrients, nausea and/or vomiting constitutes an outright emergency in late pregnancy when nutritional demands are at their peak. If the mother truly cannot keep food down and is losing weight, she may have to be hospitalized and fed intravenously. It is possible, in the last trimester of pregnancy, for a mother to get into trouble after only two or three weeks on very low-protein, low-calorie, low-salt regimens. All of these nutrients are lost if the mother is unable to eat. The best advice is to try and keep up with the nausea and/or vomiting by eating a few nibbles of food every hour (emphasize high-protein foods because they give the most help in leveling blood sugar) and making sure to snack on something nutritious during the night (an egg, a piece of cheese, a slice of meat, a slice of high-protein bread with nut butter) so your blood sugar doesn't drop too low by early morning, setting off that jittery stomach.
  • depression/worry--Much has been written about the effects of the mother's psychological state on the developing baby, but seldom is the connection made between emotional states and nutrition. Many people, when they are worried or unhappy about something, fail to eat, or eat in a binge fashion, often choosing foods for their comfort value rather than their nutritional value. Alcoholic beverages and use of other drugs may also play a part. So, while the precipitating cause is emotional, the effect is physical, since the pregnant woman isn't getting an adequate diet under these circumstances. Counseling can sometimes relieve the mother's anxieties or provide a clue as to other social service agencies that might be of help when there are financial, employment, or marital problems to be worked out.
  • multiple pregnancy (undiagnosed in half the cases)--Take everything said so far and multiply it by two or three or more! The mother must eat enough to form two babies, two placentas, fill two amniotic sacs with salty water, pump nearly one hundred per cent more blood through her body, eliminate wastes from two babies, and grow a uterus that will be strong enough to deliver two infants without giving out over the course of labor. Multiples represent an exceptional nutritional stress--a minimum of thirty additional grams of high-quality protein and five hundred additional calories are needed every day to carry the babies to full term and give each a normal birthweight.
  • medical problems complicating pregnancy--Hypertension, diabetes, obesity, food allergy/intolerance, gall bladder disease, heart disease--all require special dietary management to make sure that the mother obtains all the nutrients she needs without aggravating her medical problem. With the exception of heart patients, nutritional inadequacies may be at the root of these diseases in the first place. Correcting the mother's diet and allowing enough calories, protein and salt for blood volume expansion are the keys to healthful management.
  • unusual diets--We are living in the Age of Diets, as a once-over inspection of your local newsstand will tell you. Many of these diets can satisfy the nutritional requirements of a non-pregnant person, but are a disaster in pregnancy. No mother should be on a weight-reduction-via-calorie-restriction diet during pregnancy. Even the American College of Obstetricians and Gynecologists now [as of 1983] advises a natural weight gain on good food for the overweight mother, with weight-loss diets to be reserved for periods between pregnancies. If you have any question about the safety of a particular diet during pregnancy, just compare it with the list of foods in the following chapter to see how complete it is. Vegetarians can remain on vegetarian diets, but generally have to consume far greater quantities of vegetable proteins to meet the increased needs of pregnancy. An alternative is to add eggs, milk, and milk products back to the diet, for the remainder of the pregnancy in order to have a reliable concentrated protein source. Vegetarian main dishes are featured in their own chapter further on in this book.
  • lack of information/misinformation--This is a more common problem than most people would guess. We live in a culture in which food is equated with recreation, not health; a great deal of money is spent advertising precisely those food substances which contribute least to a healthful diet--that is, the "empty calories" of snack foods, cakes, cookies, pastries, chips, flavored drinks, candies, ice cream made of synthetic ingredients instead of real milk and eggs, diet sodas, and prepared foods. All these can, for the most part, be made at home more economically and more nutritiously, with far fewer questionable additives. Diets in which these sorts of foods play a prominent role are usually high in calories, but deficient in many other essential nutrients like protein, vitamins, and minerals. These foods satisfy one's hunger and craving for sweets (which some nutritionists view as a form of addiction), but not one's need for all essential nutrients in appropriate balance. Obviously, people on this type of diet can become obese easily while at the same time becoming very malnourished.
  • When you are pregnant, choosing foods from the high-nutrition diet list makes it very unlikely that you will gain excessively during pregnancy (a weight gain of thirty to forty pounds is about average, though some women gain a little less and others more, depending on their pre-pregnancy fat stores, their energy output during pregnancy, their individual metabolic rate, and, of course, the number of babies they are carrying). Mothers expecting twins can anticipate a weight gain of fifty to sixty pounds (and a postpartum weight loss of all that gained by about six months after birth), all of which will be healthy pounds if a sound nutritional program is the basis of daily eating. Attempts to restrict weight gain to some arbitrary rate of gain per month or total overall are foolhardy because of the serious deprivation of protein, vitamins, and minerals that accompany weight control diets (for complete information see: What Every Pregnant Woman Should Know: The Truth About Diets and Drugs in Pregnancy, a book we wrote in 1977 for Random House, now available as a Penguin paperback). Unfortunately, pregnant women are still sometimes advised to restrict calories and salt by health professionals who have not kept up with work that proves these practices to be harmful. A sourcebook of papers in the medical literature, analyzed and discussed for doctors and others involved in prenatal care, is Maternal Nutrition And Child Health by well-known pathologist and ob/gyn expert Douglas Shanklin, M.D., and bio-statistician Jay Hodin. (Springfield, IL: Charles C. Thomas, 1979). Do your doctor/midwife/nurse-practitioner a favor (not to mention the other women in this person's practice) and donate a copy to their office library. It could make for some lively discussions at future prenatal visits!

    Using these fundamentals, counseling my patients at every prenatal appointment, making sure each woman understood her diet, trying to catch early any problems each might be having in following the diet--these all paid off. In our clinics, according to data from the National Institute of Health, which spent three years collecting information from our 1965-1970 prenatal charts and another five years analyzing it, there was not one case of eclampsia in over five thousand pregnancies, and mild MTLP fell to less than one per cent in mothers having their first babies (traditionally viewed as those at greatest risk of developing the disease). Other public clinics report anywhere from fifteen to forty per cent of their first pregnancies complicated by MTLP. Furthermore, women in our program were ten times less likely to develop hypertension (high blood pressure) in pregnancy, a problem that can occur separately or as part of the symptoms of MTLP. Finally, the incidence of low birth weight (five-and-a-half pounds or less at birth) dropped to 2.2 per cent overall and 2.8 per cent in first-time mothers, as compared to another clinic serving the same population but not using these nutrition methods where the rate stayed at 13.8 per cent. I was gratified to have NIH confirmation of our approach, but not surprised by it, since this was the correct way to conduct prenatal care if we were seriously interested in producing the healthiest possible babies and mothers.

    The success of your pregnancy is largely in your own hands. I hope this cookbook will help you to have an enjoyable, problem-free, and rewarding experience.

    Eating for Two (by Gail Brewer and Isaac Cronin) available here...

    Perinatal Support Services: