EATING FOR TWO

Pregnancy can be daunting enough -- all of those physical changes, and hormonal issues, and the great unknown of the birth process itself -- but if an expectant mother is trying to consume the best possible diet for herself and her baby, things can get downright confusing. Consider:

The U.S. Environmental Protection Agency advises pregnant mothers, women who may become pregnant, nursing mothers and young children to consume no more than 12 ounces of fish per week.

Yet the National Healthy Babies, Healthy Mothers Coalition recommends that those in the same groups consume at least 12 ounces of fish per week.

What's a mother to do?

Actually, it boils down to two basic things: Remember that the Omega-3 fatty acids that are found in fish -- and in some much more than others -- are essential to the nervous system of the developing baby and may affect visual, motor, behavioral and cognitive skills, maybe for life. And it's also a good source of lean protein.

Yet the mercury that's in some fish -- and in some much more than others -- can adversely affect the developing nervous system.

"It's a little confusing, because we know all these great things about fish oil," said Molly Michelman, a registered dietitian and lecturer in nutrition sciences at the University of Nevada, Las Vegas.

But first, let's consider the reality of the American diet. Considering that a serving of fish is generally about 3 or 4 ounces, that's three to four servings of fish per week.

"I don't know a lot of clients in general who are eating fish three to four times a week," said Joanna Gorman, a registered dietitian and certified diabetic educator at University Medical Center.

While "there are people who culturally eat fish all the time, I would say no" in general, Michelman said. "If there were, we would have a lot fewer health problems."

Gorman noted that The Lancet, the medical journal of the United Kingdom, recently reported research that pregnant woman are not eating as much fish as they need.

So eating too much fish seems to be less of a problem than not eating enough of it. And the key is to be sure you're eating the right fish.

Those that the government suggests avoiding, Gorman said, are swordfish, shark, tilefish and king mackerel.

"But how many of us get mackerel?" she asked.

Indeed. Michelman noted that more "commonly eaten fish like shrimp and canned tuna and salmon" contain the beneficial Omega-3 oils and yet don't have a high risk of mercury contamination -- with the exception of canned albacore or "solid white" tuna, which tends to contain more mercury than canned chunk-light tuna.

"People don't have to avoid fish," Michelman said.

"For most people, the risk of mercury from eating fish is not a health concern," Gorman said. But, she added, not only pregnant women but all of us need to be careful of how much and which fish we're eating.

"If it's not recommended for pregnant women, I'm not going to jump up and down and eat it," Gorman said.

But a pregnant or soon-to-be pregnant woman's nutritional concerns should not be limited to the fish she is or isn't eating, Michelman and Gorman said.

Gorman said that while most dietary guidelines haven't changed much in the past few decades, the link between folic acid (or folate) and fetal development became clear about 10 years ago.

At that time, she said, "it got to the point that research showed that it was such an important nutrient that breakfast cereals started being fortified with that."

Most modern breakfast cereals contain 25 percent to 100 percent of the recommended daily allowance of folic acid per serving.

"The interesting thing," she said, "is how many of us just eat one serving. We usually have a couple of servings."

Michelman noted that folate is most crucial in avoiding neural tube defects. The neural tube, she said -- essentially the spinal cord and brain -- is formed in the first 21 days of conception, when "a lot of people don't even know they're pregnant." Insufficient folate intake, she said, can lead to such defects as spina bifida.

"It's something that's really avoidable. It's so exciting when we know there's something that you can eat or not eat and it will really make a big difference. It's something that my mom didn't know about," said Michelman, who's 38.

Besides breakfast cereals, sources of folic acid include dark green, leafy vegetables; whole-grain products; brown rice; and fortified foods.

Something else pregnant women should be aware of, Michelman said, is how much vitamin A they consume.

Excessive amounts of Vitamin A -- usually from taking such medications as Accutane or Retin-A -- "can be very dangerous," she said, leading to birth defects such as missing ears or brain malformation or heart problems.

"It's a toxicity problem," she said. "It doesn't mean somebody's eating too many carrots. It's taking supplements or one of these medications."

Calcium is something else Michelman said she doesn't think her mother knew about. But it's now known that calcium is important during pregnancy for strong bones and teeth, and for the muscles to contract, she said.

"We need a constant supply in the bloodstream, and so does the developing fetus," she added.

Sources of calcium are dairy or "dairylike" foods, such as calcium-fortified soy milk, plus calcium-fortified orange juice, cereals and crackers.

Iron is another concern.

"Iron-deficiency anemia remains a problem in pregnancy," Michelman said, "even in a country like the United States." She noted that blood volume more than doubles during pregnancy; "to support that, you need more iron to get the oxygen to the tissues for not only the mother but for the baby."

Often, she said, iron supplements are required during pregnancy.

Alcohol also raises red flags during pregnancy, she said.

"You see all different kinds of thoughts on this," Michelman said. "Bottom line: We don't really know how much and when alcohol is dangerous" during a pregnancy. "We have to say avoid it, because no safe level of alcohol intake has been identified."

Water is especially crucial in our desert climate, she said, and pregnant women should keep it with them at all times to stay hydrated.

"What happens is when people get further and further into their pregnancy, they have to pee all the time," she said. "They don't drink as much, but that doesn't help keep them hydrated."

But foremost, she said, is the importance of prenatal care in general, which includes nutrition and myriad other issues.

Some women don't think they need prenatal care, she said, or are concerned that their doctor will tell them they're gaining too much weight or not gaining enough. But she said prenatal care is vitally important to the health of mother and baby.

And Michelman adds one last caveat, for those who relate stories of hard-drinking expectant moms who ate nothing but potato chips and had strong, healthy babies.

"You can do everything wrong and have things come out beautifully," she said. "You can do everything right in a pregnancy. There are no guarantees."

Contact reporter Heidi Knapp Rinella at hrinella@reviewjournal.com or (702) 383-0474.