The Dr. Brewer Pregnancy Diet
Special Needs
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

Adapting the Brewer Diet to Your Unique Needs

Please be aware that traveling and moving can disrupt your eating routine just enough to trigger a low blood volume problem which can start the rising BP/pre-eclampsia/HELLP/premature labor/IUGR/abruption process. Putting the brakes on that process can be more difficult than preventing it. Sometimes just being aware of this risk is enough to help you to remind yourself to continue providing for your nutritional needs, in spite of any changes and stresses which may be going on in your life.

And please be aware that as your baby and the placenta grow, and as the seasons change, and as other changes occur in your life, you may find that your unique version of the Brewer Diet, which you used effectively last week, may no longer be adequate this week, or next week, or next month. To get the most benefit out of the Brewer Diet, you will need to stay in tune with what your unique needs are every single day.

Scroll to one third of the way down the page for the details on how to adjust your diet
to fit your lifestyle
~ "Corrective Allowances" ~

The following is the "Chapter 1" reprinted from Eating for Two, by Isaac Cronin and Gail Sforza Brewer, 1983.

"The Complete Pregnancy Diet: Meeting Your Special Needs", by Gail Sforza Brewer (p.1)

Making your diet satisfy your pregnancy nutrition needs may be as easy as adding a few servings of high quality foods to what you usually eat, or it may be so complicated that you will want to consult a dietician or nutrition counselor for expert advice. What makes the difference are the special circumstances you find yourself in during this pregnancy, the unique combination of strengths and stresses in your life right now that create nutritional pluses or minuses. No two pregnancies are ever conducted under exactly the same conditions, so even if you've had a pregnancy before, you need to plan your diet based on your current lifestyle, appetite, philosophical beliefs, religious practices, family traditions, medical care, and all the many other factors that affect your everyday eating habits.

The goal, of course, is to obtain every day throughout gestation all the essential nutrients you and your unborn baby need for healthful growth and development. A complete pregnancy diet consists of all the foods necessary to provide those nutrients in the proper proportions, and in forms that are easily assimilated and used by your body. This means that your diet must contain adequate proteins, fats, carbohydrates, vitamins, minerals (including sodium), fiber, water, and calories to meet the daily demands of your particular pregnancy.

A minimum adequate diet for pregnancy, a concept introduced by Winslow Tompkins, M.D. of Philadelphia Lying-In Hospital in the 1930s, has been outlined in the medical and nutrition professional literature by numerous researchers. Whenever there has been a conscientious effort made to insure that pregnant women actually followed this basic pregnancy diet, researchers have reported dramatic reductions in pregnancy and pediatric problems. (An annotated bibliography of much of this work is available from the Foundation for Perinatal Education, Box 221, Bedford Hills, NY 10507.) [as of 1983] This has been true not only in the United States, but also in clinics located in countries with as diverse populations as Scotland, India, Australia, Ethiopia, and the Philippines. Pregnant women everywhere have the same biological makeup: the support systems that are responsible for a successful pregnancy do not vary from country to country, age group to age group, or social class to social class. While there are obviously many different kinds of diets that can be adequate for pregnancy in terms of the food choices made, all of the adequate diets somehow provide the essential nutrients that are universally needed by expectant mothers. In other words, they are complete.

This cookbook focuses on getting the most, nutritionally, from the foods you eat. We include the minimum adequate diet list as a guide to those foods which are of highest nutritional value--that is, they provide the most essential nutrients in their respective food groups per given serving. The recipes demonstrate how to use the highest quality foods as the basis for daily family cooking and how to arrange the recipes in interesting combinations to create menus that assure balanced and complete nutrition every day of your pregnancy.

The Complete Pregnancy Diet list which follows was originally designed for use in the nutrition education program of the California's Contra Costa County prenatal clinics. It has been used in other clinics throughout North America and has appeared, with minor modifications, in numerous books dealing with childbirth preparation and in brochures distributed by public and private health agencies and organizations working to improve maternal and child health.

The foods on this list are generally available to most people in ordinary supermarkets. Some seasonal and ethnic variations are mentioned; vegetarian alternatives to animal products are also suggested. However, a single diet list cannot possibly be all-inclusive. If you have particular food requirements that differ markedly from the foods on this list, you may well need to consult a professional nutritionist to construct a diet plan that will be both adequate for pregnancy and within your range of acceptability. The bibliography at the end of this book can direct you to some resources for reliable information about diets that diverge from the norm.

See here for vegetarian versions of the Brewer Diet -- Lacto-Ovo and Vegan

The portion sizes on this diet list are geared to average needs and should be viewed as a nutritional floor, not a ceiling. Of course, the "average" woman for whom this diet would be perfect does not really exist: she is a statistical abstraction--neither overweight nor underweight, neither very short nor very tall, with a metabolism neither exceedingly fast nor exceedingly slow, moderately active, and carrying a single baby. You are a unique individual, so keep in mind that this diet is the minimum adequate diet for the "average" woman, and that most mothers will need to eat more of everything on the diet to obtain the extra calories they need to feel their best. In most cases, your appetite will tell you (you will feel hungry) when you need a snack between regular meals. Most pregnant women find themselves eating at least seven times a day: breakfast, midmorning, lunch, midafternoon, dinner, before bed, and middle of the night (when they have to go to the bathroom). Nutritious snack foods and other "portable" foods can be found in Chapter 10. An occasional indulgence in a piece of cake or a candy bar doesn't mean you are harming your baby (these foods do contribute needed calories, if almost nothing else, to your nutritional requirements). Pregnancy is not meant to be a time of dietary martyrdom--just the opposite--but as a general rule your should be trying to get your extra calories from more nutritious sources.

See here for the Basic Plan of the Brewer Pregnancy Diet

What the Complete Pregnancy Diet Provides

When you follow the diet, eating to appetite, salting to taste and drinking to thirst each day, you will obtain these key nutrients from your food. Each key nutrient is listed, along with the amount of each provided by the Complete Pregnancy Diet and the sources of each among the twelve food groups named by the diet. Figures are approximate, reflecting variations in daily intake depending on specific foods chosen. These figures meet all recommended allowances of the National Academy of Science/National Research Council [as of 1983], and, in most cases, provide additional amounts of nutrients where clinical work in obstetrics has shown that healthier mothers and babies result with additional intakes. When key nutrients are supplied in abundance from a wide variety of foods, deficiencies of other essential nutrients required in much smaller quantities (such as trace minerals) do not occur.


CALORIES (ENERGY) -- 2,600-3,000 -- Groups 1,2,3,4,5,6,7,8,9,12 -- Supply food for all the work of the body. Extra required in pregnancy to spare protein for tissue growth. Not getting enough calories results in protein being burned for energy and mother and baby suffering from protein deficiency.

PROTEIN (complete in all eight essential amino acids) -- 80-100 grams -- Groups 1,2,3,5,9) -- Supports growth via its component element, nitrogen. Extra needed in pregnancy, 1)to develop baby's tissues and brain, 2)to promote growth of mother's uterus, breasts, and blood volume, 3)to form the placenta, 4)to meet increased demands on the liver for detoxification and synthesis of plasma proteins, and 5)to form hormones, enzymes and antibodies to provide reserves for labor, delivery and lactation.


(oil soluble, stored in liver in large amounts) -- 15,000-30,000 International Units (I.U.) -- Groups 1,2,4,6,8,9 -- Assists in preventing infection by maintaining integrity of mucous membranes. Helps regulate thyroid gland. Necessary for cell formation, bone growth, normal vision, strong hair and nails, and the depositing of enamel on the unborn baby's teeth.

D (oil soluble, stored in liver and fatty tissues, synthesized by skin after exposure to ultraviolet light) -- 400 I.U. -- Groups 1,7 -- Influences absorption of the minerals calcium and phosphorus. Essential to bone formation and calcification (hardness). Deficiency of vitamin D causes rickets.

E (fat soluble, mixed tocopherols) -- 15 I.U. -- Groups 1,2,3,4,5,8 -- In experiments, has been shown necessary for proper placental implantation. Promotes longevity of living cells by slowing oxidation. Protects function and structure of smooth muscles (like the uterus), skeletal muscles, cardiac muscle (your heart has to pump all that extra blood as pregnancy advances), and vascular tissue (supplemental E has been shown effective clinically in the treatment of varicose veins of the legs, vulva and anus). Helps maintain integrity of liver tissue (liver works overtime all during pregnancy).

B-COMPLEX (water soluble) -- B1 Thiamine (3 mg) -- B2 Riboflavin (4.5 mg) -- Niacin (40 mg) -- B6 Pyridoxine,synthesized in the gut (2 mg) -- B9 Cobalamine, synthesized in the gut (6 mg) -- Groups 1,2,3,4,5,9 -- Essential to proper metabolism of proteins, carbohydrates, and fats. Increased quantities of food require increased amounts of the B vitamins. Helps in formation of red blood cells which carry oxygen to developing baby via the placenta. Too low an intake of B vitamins results in loss of appetite, indigestion, deficient hydrochloric acid secretion, apathy and fatigue, tingling and/or numbness in the hands and feet, failure to heal, skin eruptions. One tablespoon daily of brewer's yeast and dessicated liver tablets (if you won't eat liver) are excellent sources.

C (water soluble) -- 400-700 mg. -- Groups 4,6,8 -- Essential for formation of collagen (the substance that bonds cells together)--especially needed by rapidly growing uterus for efficient action and strength during labor. Promotes wound healing and healthy capillary walls (if you are bruising easily or your gums are tender and bleed after brushing, you may be an individual with needs above the average). Helps maintain resistance to infection when the body has optimum tissue stores. Stored in adrenal tissue for response to stress. Promotes absorption of iron and maturation of red blood cells.


(stored in bone, plus additional .5 g in body fluids) -- 1.5-2 g. -- Groups 1,2,4,5 -- Builds and maintains skeletal tissue and teeth in mother and baby. Promotes normal blood clotting after birth. Essential to normal contraction-relaxation cycle in muscles, especially heart. Required for proper functioning of central nervous system of mother and baby.

SODIUM (stored in bone and in body fluids) -- 3-4 g. from foods on list and widely varying amounts from table salt used to taste -- Groups 1,3,10 -- Assists in maintaining dramatically expanded blood volume needed for placental circulation. Needed for normal functioning of muscles--lack of sodium often causes leg cramps during pregnancy, a clear sign to add more at the table. Essential component of amniotic fluid surrounding baby. A major element in control of the body's fluid balance, glucose transport through cell walls (getting energy into each cell so it can perform), and the acid-base balance essential to life itself. Inadequate sodium intake can result from vomiting, diarrhea, failure to consume enough high-protein foods of animal origin (meats, seafood, milk, eggs--all of which also happen to be high in naturally occurring sodium), excess losses in perspiration during hot weather, in overheated workplaces or while engaging in strenuous sports. All these are indication for adding more salt at the table; generally your food will taste flat and unappetizing when you need sodium, a response of your taste buds to your body's need. Deliberate attempts to restrict sodium in the diet, were at one time a popular component of standard prenatal advice--advice which has now been proven to be detrimental to normal pregnancy adjustments in the mother's body. Salt to taste. Use iodized salt.

IRON (stored in red blood cells as part of hemoglobin, and in liver, spleen and bone marrow in combination with protein) -- 30-40 mg. -- Groups 1,2,3,4,5,6,8,9 -- Required for formation of the hemoglobin molecule, the carrier of oxygen to all body cells. Extra needs in pregnancy due to 1) expansion of red cells in circulation by approximately 25 per cent, 2)increased stores required in anticipation of blood loss at delivery, and 3)demands of developing baby for iron stores (well-nourished baby at birth has iron stores in liver that last for 4-6 months). Cessation of menstruation during pregnancy prevents the monthly loss of approximately 20 mg. toward buildup of reserves. Virtually everything grown in the earth's crust contains some iron. Most of the time, only about 20 per cent of iron ingested is actually absorbed. Absorption of iron is enhanced by presence of adequate hydrochloric acid in the stomach, and by calcium and vitamin C in the diet. Occasional use of cast iron cookware will boost iron intake higher than amount listed. When tissues are saturated and additional iron is not needed, excess is excreted in feces (your stool will look very dark, nearly black, with extremely high doses of supplemental iron from pills or tonics). Excessive iron intake can irritate the gut, causing nausea and/or constipation.

FATS (stored in body as adipose tissue, a metabolically active tissue once thought to be only a static deposit, located in a layer just below the skin, in the abdominal lining, and in muscular connective tissue) -- 140-180 g. -- Groups 1,2,3,5,7,9 -- Concentrated source of fuel (9 calories per gram) for all the extra work of the body in pregnancy. Essential for the body's absorption of fat soluble vitamins. Protects vital organs from external injury. Insulates body against rapid temperature changes and excessive heat loss. Fat-related compounds affect the production of sex hormones and adrenal hormones--necessary to support pregnancy--and the function of brain and nerve tissues. Help to maintain skin integrity by strengthening capillary and cell wall structure, resulting in fewer skin eruptions.

CARBOHYDRATES (stored in very small amounts in liver and muscle) -- 350-400 g. -- Groups 1,3,4,5,6,8,12 -- Major source of energy for the body (4 calories per gram). Carbohydrates must be consumed regularly and at frequent intervals to keep energy availability optimal; the body stores only enough for about eight hours of moderate activity in pregnancy so if you miss dinner, you are likely to have ketones in your urine at the doctor's office the next morning. Helps liver in detoxification. Helps regulate protein and fat metabolism. Provides glycogen stores in the heart for contractile action. Brain and nervous tissue contain no stored glucose, and therefore must rely on minute-to-minute supply from the bloodstream. Carbohydrates provide a first-choice source of energy, thereby freeing proteins for their vital work in tissue-building: so to get the most benefit from your protein intake during pregnancy you must eat heartily from foods high in carbohydrates. Because absorption of glucose into cells is sodium-dependent, obtaining adequate amounts of sodium is essential also.


Agnes Higgins, past president of the Canadian Dietetic Society and director of the Montreal Diet Dispensary [as of 1983], has developed a procedure for estimating calorie and protein requirements in excess of the pregnancy levels we've already established as a baseline. She emphasizes that any of the following factors increases a mother's nutritional needs:

  • Vomiting past the third month of pregnancy.
  • Pregnancies spaced less than a year apart.
  • Previous pregnancy with low birthweight, neurologically handicapped, or stillborn child as the outcome.
  • A history of two or more miscarriages.
  • A history of toxemia.
  • Failure to gain ten pounds by the twentieth week of pregnancy.
  • Serious emotional problems.
  • Working full-time at a demanding job.
  • Breastfeeding an older baby during pregnancy.
  • Multiple pregnancy (twins or more).
  • As a corrective allowance, Mrs. Higgins and her staff counsel mothers to add twenty grams of protein and two hundred calories to their basic daily pregnancy diets for each condition listed above (an individual mother may be experiencing more than one of these stress conditions).

    Multiple pregnancy is the only exception: each extra baby requires a nutritional supplement of thirty grams of protein and five hundred calories per day. Higgins comments that this requirement can be met most economically by adding one quart of whole milk a day to the expectant mother's diet (to be drunk, used in cream soups, custards, milkshakes, cream pies and tarts, or as exchanges in yogurt, ice milk, and natural cheeses). Of course, there are many other ways to increase the protein and calories during pregnancy by eating an additional four-ounce serving of meat, fish, shellfish, poultry, or meat substitute as detailed on the diet list. A sample daily menu plan for a mother expecting twins would look something like this:

    Twin Brewer Pregnancy Diet (click for details)

    You must have, every day, at least:
    (plus 30 g protein and 500 calories for each additional baby):

    Group 1 (milk and milk products)--8 choices
    Group 2 (calcium replacements)--as needed
    Group 3 (eggs)--2 choices
    Group 4 (protein sources)--12 choices
    Group 5 (dark green vegetables)--2 choices
    Group 6 (whole grains, starchy vegetables & fruits)--5 choices
    Group 7 (potato)--1 choice
    Group 8 (vitamin C sources)--3 choices
    Group 9 (fats and oils)--5 choices
    Group 10 (vitamin A sources)--1 choice
    Group 11 (liver)--Optional
    Group 12 (salt and sodium sources)--unlimited, to taste
    Group 13 (water)--unlimited, to thirst
    Group 14 (snacks)--4 or more
    Group 15 (supplements)--as needed

    See here for more details on serving suggestions and portion sizes

    See here for twin diet checklist for printing and putting on your refrigerator

    Generally speaking, these conditions result in an increased appetite; however, women who are working, moving their households, or under emotional stress sometimes fail to pay attention to their bodies' signals for more food. Calling special attention to their extra needs by assigning specific goals for extra protein and calorie consumption makes it much less likely that their nutritional needs will go unfulfilled.

    At the Montreal Diet Dispensary, underweight is defined as weighing five per cent or more less than the weight recommended for your height in the Table of Desirable Weights of the Metropolitan Life Insurance Company, a standard used for thirty years. You should use the column for a "large frame" as the company recently disclosed that they have been underestimating all the optimal weights on the chart by ten per cent ever since they first published it! If you really do have a large frame, use the standard for the next taller height.

    Undernutrition means any protein deficit between what you're used to getting from your food and the minimum adequate pregnancy requirement (eighty to a hundred grams per day). The Higgins nutrition intervention method uses a twenty-four hour diet recall, a technique you can use on your own to see how close your regular diet has been coming to what you actually need. You will need to write down everything you've eaten for the past twenty-four hours (pick a typical day for you), including all snacks, all beverages, and all second helpings. Note what the food was, how much you ate, then consult the Protein-Calorie Counter (see Appendix) to check the amount of protein contained in those portions of those foods. For each gram of protein you lack, add that to your personal protein goal, plus an additional ten calories to free that protein for its most important work in pregnancy: keeping you own tissues healthy and building those of your unborn baby. If you come up with a deficit of ten grams of protein, then, you also need to add a hundred calories to your basic requirements.

    If you take supplemental vitamins and minerals, brewer's yeast, wheat germ, or other dietary supplements (such as protein drinks, powders, or pills), be sure to take them with meals, since their absorption is enhanced in the presence of complete foods, which provide enzymes necessary for their metabolism. Many people turn to these nutritional aids when they find they have significant nutritional problems in pregnancy; however, it's important to keep in mind that a pill two or three times a day cannot substitute for the foods on the Complete Pregnancy Diet list. These preparations must be viewed strictly as supplements to a good diet, not the diet itself. There are many factors in food substances, such as enzymes, that are not contained in pills or powders, and there may be other substances in foods that are essential to human life that have not yet been isolated by nutrition scientists. So relying on the protective foods on the diet list is the best guarantee of satisfactory pregnancy nutrition.

    This food record chart should help you keep track of your daily progress on the diet. Just check off each requirement as you meet it, day by day, week by week, month by month.

    See the Brewer Pregnancy Diet Basic Plan Weekly Record here

    If you encounter any difficulties with any aspect of the diet, or any questions about the nutritional management of your pregnancy, you may telephone a national pregnancy nutrition hotline, co-sponsored by the Foundation for Perinatal Education and the Toxemia of Pregnancy Foundation. The line is staffed twenty-four hours a day and referrals to pregnancy nutrition consultants can be had for many parts of the country. The number: (914)666-5199.

    May all your meals bring you and your family pleasure, an energetic pregnancy, and a strong baby born in excellent health.

    Note from Joy: Unfortunately, I was unable to find either of these two organizations on the internet, so it's probably the case that neither one still exists. If anyone knows otherwise, please let me know and I will post their contact information.

    Eating for Two, by Gail Sforza Brewer and Isaac Cronin, available here

    At the first sign of a rising BP, pathological edema, pre-eclampsia, IUGR, premature labor, or HELLP, a Brewer Diet counselor should sit down with the mother and help her to evaluate her lifestyle and her diet to see if any adjustments can be made to optimize the fit between her pregnancy, her diet, and her lifestyle. For example, to compensate for her salt and calorie losses, she can cut back on her exercise program and her work schedule, she can stay out of the heat (outdoors, at work, or at home), she can postpone a move until after the birth (and 6 weeks postpartum), and she can increase her salt/calorie/protein intake. As described by Gail Brewer earlier on this page, one way that she can increase her diet intake is to add 200 calories and 20 grams of protein for each of the following situations:

  • Vomiting past the third month of pregnancy.
  • Pregnancies spaced less than a year apart.
  • Previous pregnancy with low birthweight, neurologically handicapped, or stillborn child as the outcome.
  • A history of two or more miscarriages.
  • A history of toxemia.
  • Failure to gain ten pounds by the twentieth week of pregnancy.
  • Serious emotional problems.
  • Working full-time at a demanding job.
  • Breastfeeding an older baby during pregnancy.
  • Multiple pregnancy (twins or more)--add 500 calories & 30 g. protein for each baby.
  • The following is excerpted from 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)


    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...

    In September of this year (2008) a study came out from Denmark which seems to emphatically support something which the Brewers and their supporters have been saying for over 30 years. That is that pregnant women who lose extra salt, or burn extra calories, through extra exercise NEED to compensate for those losses by adding extra salt and calories to their diets. When they do not make special allowances for their unique needs in this way, their blood volume will drop, and they will develop rising BPs, pathological edema, pre-eclampsia, HELLP, IUGR, premature labor, underweight babies, and other complications associated with low blood volume. This particular study was looking at only pre-eclampsia, and only at recreational exercise, but those of us who understand the Brewer principles understand that the same principles do apply to all of these other complications, and to any source of salt/fluid/calorie loss, as well.

    "Pregnant exercise 'unsafe'"

    Read more.......

    "Women who exercise during pregnancy face risk of pre-eclampsia, researchers warn"

    Read more.......

    "Exercise in pregnancy linked to fatal raised blood pressure condition"

    Read more.......

    Lifestyle Adjustments: As you evaluate your nutrition and lifestyle, it would also be helpful to evaluate your level of activity and add extra nutritious calories if you use extra calories during the week, with jogging, biking, skating, skiing, or other sports, or other extra calorie-depleting activities, like teaching, dancing, waitressing, nursing, doctoring, or other activities that keep you on your feet all day. Caring for other children, working both outside and in the home, caring for other family members, and housework would also use up a lot of calories, especially as the baby gets bigger and you burn up calories just carrying around the extra weight of the baby, uterus and extra blood volume. You can also evaluate whether other stresses in your life might be using up extra calories. If you have had extra stresses in your life, then adding extra nutritious calories and other nutrients to compensate for those calorie-burning stresses would help to keep your blood volume expanded and your pregnancy and baby healthy.

    See here to help you evaluate your daily nutrition patterns

    See here for a nutrition/lifestyle self-assessment which I highly recommend

    Eating Patterns:The usual eating pattern that we suggest that pregnant women can use to keep up with their nutritional needs is as follows: breakfast, mid-morning snack, lunch, mid-afternoon snack, supper, bedtime snack, middle-of-the-night snack. If you are having trouble keeping up with the amount of food that you need, or if you are having trouble keeping your blood pressure within a normal range, we suggest that you eat something with protein in it (glass of milk, cheese cubes, handful of nuts, handful of trail mix, etc), every hour that you are awake.

    Please be aware that traveling and moving can break up your eating routine just enough to trigger a low blood volume problem which can start the rising BP/pre-eclampsia/HELLP/premature labor/IUGR/abruption process. Putting the brakes on that process can be more difficult than preventing it. Sometimes just being aware of this danger is enough to help you to remind yourself to continue providing for your nutritional needs, in spite of any changes and stresses which may be going on in your life.

    Morning Sickness: If you are dealing with nausea, vomiting, or diarrhea, it is vitally important to try to alleviate those problems as soon as possible, since they also can contribute to depleting your blood volume. You can try frequent, small snacks, herbs, and homeopathy to help you in this effort. If you decide to try using ginger, which can be very effective for "morning" sickness, use it only in small amounts, and only just before eating some kind of food, since too much ginger can cause bleeding and possibly miscarriage.

    See a resource for homeopathy for morning sickness here

    See here for more information on ways to alleviate morning sickness

    Adjusting for Salt Loss: It would also be helpful for you to evaluate whether you are ever in situations that result in your losing extra sweat and salt--situations such as gardening in hot weather, exercising, living in hot homes during the winter, or living without air-conditioning in the summer, or working in over-heated working conditions. If you do have one of those situations, it would be helpful for you to add extra salt and nutritious fluids to your daily nutrition. This extra effort will help to keep your blood volume expanded to where it needs to be to prevent elevated blood pressure, pre-eclampsia, and other complications.

    See here for more information about the importance of salt in pregnancy

    Calories plus Salt plus Protein: Eating the recommended amount of protein every day isn't enough to keep your blood volume expanded to where it needs to be for preventing complications in pregnancy. It is also vitally important to make sure that your intake of nutritious calories and salt are also at the recommended levels, with special extra allowances added as needed for your unique situation.

    See here for more information on the importance of calories in pregnancy

    Herbal Diuretics: Unfortunately, some areas of the "alternative medicine" community have followed mainstream medicine in the belief that diuretics are important and useful for treating edema and elevated blood pressure in pregnancy. Many pregnancy teas and some supplements and juices include nettle, dandelion, alfalfa, bilberry, or celery, all of which have diuretic properties. Diuretics are no safer for pregnancy in herbal form than they are in prescription medications, so it is important for pregnant women to watch which herbs they are taking.

    See here for more information about the use of herbal diuretics in pregnancy

    Empowering Women: I would also like to add here the assurance that Dr. Brewer was not blaming the mother for her situation, as some would claim that he was, and neither am I. He is clearly blaming her doctor for not having the routine of examining her nutritional status and doing a differential diagnosis for her. He is saying that if her doctor is not doing this with her, then it is most important for her to do it for herself, for the sake of her own health and that of her baby.

    Perinatal Support Services: