What to avoid during pregnancy

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That motherly instinct kicks in as soon as a woman finds out she is pregnant. Part of this is a mother’s active undertaking to cut out all foods and substances potentially harmful to her unborn child. The Good Life Dietitians look into the foods and substances that should be avoided or limited during pregnancy, as well as those which are safe for use.
 

1. Smoking

Cigarette smoking during pregnancy (and even whilst breastfeeding) is strongly discouraged by health care professionals. Carbon monoxide and nicotine from smoking reduces block flow to the placenta, the result of which is a limited oxygen supply to the growing baby. Less oxygen ultimately results in poorer growth and a smaller baby at birth.

Cigarette smoking during pregnancy is associated with greater risk of miscarriage, placenta previa (a condition where the placenta is attached to the uterus wall covering the cervix), ectopic pregnancy (a pregnancy outside of the uterus), premature birth, fetal growth restriction, and a condition called sudden infant death syndrome. Smoking during breastfeeding is also discouraged as the taste of breast milk is affected. Interestingly, smoking after pregnancy has been shown to have slightly poorer academic achievement in the offspring. While we do not recommend smoking, if you chose to smoke while breastfeeding smoke immediately after and not before a feed. 

2. Alcohol

Alcohol should not be consumed by pregnant women or those women who are trying to conceive as drinking during pregnancy is associated with major neurological and developmental birth defects. Even moderate drinking during pregnancy may have behavioural or developmental consequences on your child. The risks associated with prenatal alcohol use are even greater in older mothers and in binge drinkers. New evidence also shows a relationship between alcohol intake of the father and the size of a baby at birth.

Fetal Alcohol Syndrome (FAS) is a condition affecting babies of mothers who drink excessively through pregnancy. Features include failure to grow (both during pregnancy and after birth), developmental delays, as well as facial, visual and joint abnormalities.

3. Illicit Drugs

Marijuana (the most commonly abused substance), cocaine, and other illicit drugs should be avoided during pregnancy as well as during breastfeeding. Substance abuse during pregnancy increases the risk of a low birth weight baby, small head circumference, premature birth, and other developmental problems. Long-term follow-up studies of children exposed prenatally to marijuana have found more depressive symptoms and poor attention skills. 

4. Sweeteners

Pregnant women, particularly those who are diabetic or overweight, can rest assured that sweeteners can safely be used throughout pregnancy. Acesulfame K, aspartame, saccharin, sucralose and neotame is considered safe during pregnancy when consumed within acceptable daily intakes (about 10 tablets/sachets per day).

5. Caffeine

High caffeine intake is associated with a delayed conception, spontaneous miscarriages and low birth weight, but not associated with any birth defects. The current position of the American Dietetic Association (ADA) is that pregnant women should avoid caffeine intakes above 300 mg/day.

However it is often overlooked that other foods and food products also contain caffeine. It remains sensible though to limit caffeine intake during pregnancy to two cups daily. The caffeine content of various foods and food products is summarized in the table below.

CAFFEINE CONTENT OF VARIOUS FOODS AND FOOD PRODUCTS

Food/product	Caffeine Content	Amount allowed per day: 300mg/day
Instant coffee	57mg per teaspoon	5 teaspoons per day
Brewed coffee	78-100mg per 180ml	2 cups per day
Decaffeinated coffee	2mg per 180ml	Unrestricted
Tea	35mg per 180ml	8 cups per day
Rooibos tea	0mg	Unrestricted
Chocolates*	20mg per 30g	300g
Carbonated beverages*	35-50 mg per 360ml can	6-8 can per day
Energy drinks*	75 mg per 250ml	4 x 250ml cans
Cocoa beverages*	4mg per 180ml	Unrestricted

*Despite being relative low in caffeine, these foods are high in empty calories and should be limited regardless.

6. Herbal/Botanical/Alternative Remedies

Many pregnant women who would not consider taking over-the-counter medications view herbal and botanical products as a safe and natural alternative. However, very few clinical trials have examined the safety and efficacy of alternative therapies during pregnancy. Pregnant women should be advised to consider herbal treatments as suspect until their safety during pregnancy can be ascertained.

It is advised that pregnant women should not take herbal and botanical supplements containing the following substances (ADA, 2002):

• aloe
• apricot kernel
• black cohosh
• borage
• calendula
• chaparral
• chasteberry
• comfrey
• dong quai
• ephedra
• euphorbia
• feverfew
• foxglove
• gentian
• ginseng
• golden seal
• hawthorne
• hoehound
• horse radish
• juniper
• licorice root
• nettle
• plantain
• pokeroot
• prickly ash
• red clover
• rhubarb
• sassafras
• saw palmetto
• senna
• skullcap
• St. John’s wort
• Tansy
• Wild carrot
• Willow
• Willow bark
• Wormwood
• Yarrow
• Yohimbe

Sources

Escott-Stump, S. Nutrition and diagnosis-related care. 2008. 6^th Edition. Lippincott Williams and Wilkins.

Mahan, LK and Escott-Stump, S. Krause’s Food and Nutrition Therapy. 2008. 12^th Edition. Lippincott Williams and Wilkins.