We are probably all aware that doctors do not encourage ‘eating for two’ during pregnancy. Many pregnant women may consider that this is unfortunate, because they find that they feel both ravenously hungry, and quite sick if they don’t eat regularly. There is also plenty of other advice about what to eat and not eat during pregnancy. For example, in the UK and US, you are advised to avoid soft cheeses and shellfish, not to drink too much coffee, and to stop drinking alcohol at all.

However, the dietary advice to pregnant women is not consistent around the world. It may also not be based on science—or based on outdated science that we now know is incorrect. This page explores some of the myths around eating and diet during pregnancy to try to unpick the issue.

Pregnancy and Diet: The International Situation

There are no shared international guidelines on what to eat and not eat in pregnancy.

The World Health Organization provides precisely three tips on the subject of eating healthy food during pregnancy and after childbirth:

• Eat a variety of foods, for example, vegetables, milk, meat, poultry, fish, whole grains, seeds and nuts;

• Take supplements like folic acid and iron if advised to do so by a healthcare worker; and

• Make sure food is clean and safe.

This is a far cry from the long list of foods that women in the US and UK are advised to avoid during pregnancy. This includes soft cheeses, pâté, unpasteurised milk and cheese, sushi, raw eggs, shellfish, and many more. However, many of these are staple foods in other countries, and nobody would think of avoiding them, pregnant or not.

One particular area of controversy is coffee, tea and caffeine.

Guidelines from the US and UK recommend limiting your intake of caffeine to just one mug of real coffee (two of instant) or two of tea each day. Women in the US are advised to switch to decaffeinated alternatives during pregnancy.

However, no such advice is given to women in Italy, who continue to consume cappuccinos, macchiatos and espressos whenever they want.

Western women are often discouraged from drinking herbal and green teas during pregnancy because of fears of miscarriage. However, in Japan, drinking green and herbal teas is actively encouraged, because it is thought to have beneficial effects for the baby.

Recommendations to avoid alcohol are based on fears that the baby will develop foetal alcohol syndrome.

However, this is very rare, affecting fewer than 2% of babies of very heavy drinkers. Studies among pregnant women who had drunk occasionally during pregnancy (usually before they knew that they were pregnant) showed no harm to the baby.

What about fish? Most women tend to avoid raw fish and sushi during pregnancy, because of the risk of infection.

However, this doesn’t fit with most guidelines, which encourage eating fish, especially oily fish. Women in France are advised to avoid smoked salmon and trout. In Japan, women eat sushi throughout pregnancy. However, they limit the consumption of fish with high levels of mercury (tuna, marlin and swordfish, for example) to ‘once or twice a week’. These fish are on the ‘banned in pregnancy’ list in the US.

The situation with raw eggs is even more contradictory. In Japan, pregnant women routinely eat raw eggs. In the Philippines, it is encouraged, and thought to be good for improving the health of the cervix and vagina. In the US and UK, advice has recently changed, and raw egg products are now considered safe provided they are made with pasteurised eggs.

The general situation, therefore, is that recommendations are inconsistent, and may not be science-based.

Pregnancy and Weight Gain: Eating for Two

The current understanding is that women do not need to eat more during pregnancy.

You are, in fact, NOT ‘eating for two’. In the last three months of pregnancy, some women may need up to 200 calories extra per day—but this is a very small amount.

It is not clear, then, why pregnancy seems to make you both extremely hungry, and also nauseous if you don’t eat for more than two or three hours.

It may be the result of your body being under stress, or it may be your body building up fat reserves to support breastfeeding.

This is, however, difficult to manage, because you need to gain ‘the right’ amount of weight during pregnancy.

Worryingly, there is evidence that gaining both too much and too little weight during pregnancy may have an influence on the baby’s risk of developing high blood pressure, diabetes and obesity.

However, what counts as ‘too much’ and ‘too little’?

Again, there are no consistent guidelines. In fact, in the UK, there are no guidelines at all.

Women also suggest that being ‘nagged’ about weight gain is often counter-productive, because it makes them more stressed.

Getting it Right: A Healthy Diet in Pregnancy

Fundamentally, the take-home from all this is that pretty much all dietary guidelines and restrictions for pregnant women should be taken with a (small) pinch of salt.

You don’t really need to avoid large numbers of food groups. The risks of infection, miscarriage or harm to your baby from anything you eat is extremely low in most countries—provided you have access to foods that are clean and generally safe to consume.

Instead, you should focus on eating a healthy diet, which is fundamentally the same as for everyone else.

This needs to contain plenty of fresh fruit and vegetables, to give you lots of fibre, some protein from fish, meat and dairy—but not too much of any of those, and try to eat less processed foods wherever possible. It is fine to drink tea or coffee in moderation, and even the occasional glass of wine probably won’t hurt.

There is more about this in our pages on Food, Diet and Nutrition.

To manage the hunger and nausea, it may be worth considering a different eating pattern, such as smaller meals spread across the day—but only if that works for you.

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A Final Thought

It is worth saying that the stress caused by trying to limit your diet and avoid certain foods—especially if you really like them—may be counterproductive.

Instead, it may be better for both you and your baby if you just relax a little more, and worry a little less. Before you start avoiding sushi, or soft cheese, perhaps pause to remember your counterparts in Japan or France, who are happily eating these same foods without concern.

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