By Lindsay Morris

Expecting? From essential nutrients to smart supplements and simple strategies to ease morning sickness, this expert-backed guide helps you confidently nourish yourself and your baby throughout pregnancy.

In this article:

The latest edition of the Office of Disease Prevention and Health Promotion’s Dietary Guidelines for Americans (2020-2025) is the first to provide specialized guidance for all life stages, including an entire chapter dedicated to pregnant and lactating women. Research shows that diet during pregnancy affects a child’s health and development, and the 1,000 days from conception to a child’s second birthday are a particularly critical window. Yet many women fall short of recommended nutrient intake.

So how do those guidelines translate into daily meals? That’s where nutrition experts like Middleberg Nutrition founder Stephanie Middleberg, RD, MS, CDN, come in.

The best-selling author of The Big Book of Pregnancy Nutrition, The Big Book of Organic Baby Food, and The Big Book of Organic Toddler Food helps women nourish themselves and their families with practical, balanced advice tailored to every stage of life.

She provided us with an essential guide to what to eat, what to avoid, and how to supplement smartly throughout pregnancy, along with practical tips for managing morning sickness and supporting overall prenatal health.

The Nutrients Every Pregnant Person Needs

The Dietary Guidelines for Americans 2020-2025 report follows research highlighting that a significant number of pregnant women aren’t getting enough essential nutrients, even when taking dietary supplements.

Middleberg recommends prioritizing the following to maintain a healthy pregnancy diet:

Top 3 Nutrients Critical for Your Growing Baby

The following three nutrients are commonly deficient during pregnancy, and each plays a crucial, proven role in supporting fetal development.

• Iron: An estimated 40% of pregnant women globally are anemic; at least half may stem from iron deficiency.

  Iron-deficiency anemia is linked to premature birth or low birth weight.

  Iron supports:

  • Forming fetal red blood cells
  • Transporting oxygen throughout the body
  • Needs increase by 1.5× during pregnancy; get tested in each trimester.

“Iron needs increase by one and a half times during pregnancy, so be sure to get your levels tested at the start of pregnancy, midway, and in your third trimester,” she explains.

Adequate iron intake is crucial as blood volume peaks in the third trimester—the recommended daily allowance is 30 milligrams.

A variety of foods are rich in iron, but how your body absorbs the nutrient depends on the source.

*Absorption improves with vitamin C foods like citrus and bell peppers.

“You will most likely need to supplement with additional iron if you are a vegetarian/vegan or have a history of iron deficiency anemia or heavy periods,” Middleberg adds. “Plus, not all prenatals contain iron or in the amounts that your body needs right now.”

• Choline: Research has demonstrated the importance of choline in a baby’s brain and overall development. Prenatal choline may also protect against neural tube defects.
  
  “While you can obtain a decent amount of choline from food (e.g., eggs, organ meat, red meat, some fish, and plant-based foods like legumes and cruciferous veggies), many women’s diets fall short (especially if you don’t eat eggs), and not all prenatals include choline,” says Middleberg.
  
  Most pregnant women benefit from taking choline supplements to reach the recommended daily intake of 450 milligrams.

• Folate: The recommended daily allowance of folate is higher during pregnancy than at any other life stage. This water-soluble B-complex vitamin (also known as B9) benefits cell production. It also plays a protective role against heart abnormalities, cleft palate/cleft lip, and low birth weight in babies, while lowering a mother’s risk of developing anemia or experiencing miscarriage or preterm delivery. Most notably, it helps prevent neural tube conditions such as spina bifida and encephalocele.
  
  Middleberg advises finding a prenatal that includes folate rather than folic acid (its synthetic form) to meet the National Institutes of Health’s recommended daily intake of 600 micrograms. Folate-rich foods include dark green vegetables, beans, lentils, nuts and seeds, and enriched grains, such as bread, cereal, pasta, and rice.

Healthy Fats to Build Cells and Balance Hormones

Healthy fats—especially omega-3 fatty acids—play a vital role in pregnancy. They help form fetal cells, regulate hormones, reduce inflammation, and support the brain and nervous system.  

• Omega-3 fatty acids (or omega-3s) are polyunsaturated (healthy) fats essential to providing cells with structure and support. They may protect heart health by reducing inflammation, improving blood pressure and blood sugar levels, and supporting the health of blood vessels. During pregnancy, omega-3s may also promote brain health, behavioral outcomes, and reduce the risk of early delivery (preterm birth) and preeclampsia (high blood pressure during or after pregnancy). 

Omega-3s come in multiple forms: 

• EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid): Found in fatty fish like tuna or mackerel.
  
  
• ALA (alpha-linolenic acid): Found in plant-based foods like ground flaxseed, walnuts, and edamame.
  

Because dietary intake isn’t always sufficient, many women take omega-3 supplements.

According to a clinical practice guideline published in December 2023 in the American Journal of Obstetrics and Gynecology, women of childbearing age should consume at least 250 milligrams per day (mg/d), with an increase of 100 to 200 mg/d during pregnancy.

In fact, a study published in May 2022 in Human Reproduction demonstrated that women who consumed omega-3 supplements were about 1.5 times more likely to give birth naturally than those who didn’t.

“I recommend a supplement that contains both DHA/EPA, which is typically derived from fish oil,” says Middleberg. “If you are a vegetarian or vegan, be aware that most algae-based supplements contain DHA, not EPA, so it’s essential to check the label carefully. I also recommend checking to see whether a product is third-party verified by the International Fish Oil Standards or looking for the GOED quality seal on the label, as well as being sustainably sourced by Friend of the Sea.”

• Fat-soluble vitamins: Vitamins A, D, and E play essential roles in hormone production and balance, but your body can’t absorb them properly without fats.
  
  
  • Vitamin A may help boost progesterone levels, which are critical for preparing the uterus for implantation and later in maintaining a healthy pregnancy. 
    
    
  • Vitamin D supports the production of ovarian steroid hormones, including progesterone and estradiol. 
    
    
  • Vitamin E may support and regulate women’s hormones, particularly in those with Polycystic Ovary Syndrome (PCOS)
    

To get the best benefits, Middleberg recommends complementing your diet with full-fat dairy products, poultry, and meat, as well as plant-based sources of healthy fats like avocados, olives, nuts, seeds, and coconut.

Protein to Support Growth and Repair

Protein is vital throughout pregnancy to support your baby’s developing tissues, especially the brain, muscles, and organs, as well as your own expanding blood volume and uterine growth.

“Proteins are the building blocks of life,” says Middleberg. “They support every aspect of your baby’s development, from their blood to their muscles to their metabolism, and your needs increase considerably during pregnancy.”

The American Pregnancy Association recommends that pregnant women consume 75 to 100 grams of protein a day, which might look like:

• Two to three servings of meat (3 ounces each, about the size of a deck of cards)
  
  
• One serving of tofu (½ cup)
  
  
• Two to three servings of legumes (½ cup each)

Protein also helps stabilize blood sugar and energy levels, especially helpful during the second and third trimesters when both tend to fluctuate more.

Foods Pregnant Women Should Avoid

Middleberg’s books emphasize what women can feel empowered to do. That said, she also highlights certain foods to avoid during pregnancy.

• High-Mercury Fish: While ACOG recommends that fish eaters consume two or three servings of fish or shellfish a week (4 ounces each), they advise pregnant women to avoid bigeye tuna, king mackerel, marlin, orange roughy, swordfish, and tilefish. These species are high in mercury, a metal that can cross the placenta and result in birth defects, including small head size, brain damage, developmental delay, intellectual disability, blindness, muscle weakness, and seizures.
  
  If you eat white (albacore) tuna (the kind you’ll find most frequently in cans), limit it to 6 ounces a week, and heed advisories about locally caught fish. Local health departments and the Environmental Protection Agency (EPA) monitor freshwater sources and provide contacts at fishadvisoryonline.epa.gov/Contacts.aspx. The EPA also provides consumers with a comprehensive list of reports accessible by location at mywaterway.epa.gov.

• Unpasteurized Dairy: While legal in many states, raw and unpasteurized milk and dairy products can cause bacterial infections from pathogens, such as Brucella species, Campylobacter jejuni, Escherichia coli O157, Listeria monocytogenes, and Salmonella species. Both healthy and immunocompromised individuals are at risk, and, in the case of pregnant women and their unborn fetuses, life-threatening infections and miscarriage can occur.
  
  
• Raw or Undercooked Meats: Raw, undercooked, or cold meats (also known as cold cuts or deli meats) and seafood can harbor dangerous and even deadly bacteria and parasites. And consumption of contaminated foods has been linked to several pregnancy risks, including miscarriage, preterm delivery, or infections. Some infections, such as toxoplasmosis, can lead to birth defects, long-term health problems like vision or hearing loss, or developmental delays in the child.

• Premade salads. Beware, especially of coleslaws, potato salads, tuna salads, chicken salads, or egg salads displayed at your deli. These can also be breeding grounds for foodborne illnesses, according to the U.S. Centers for Disease Control and Prevention.

• Artificial sweeteners/sugar alcohols: While moderate use of nutritive sweeteners (such as table sugar, honey, and fructose) and non-nutritive sweeteners (such as rebaudioside A, acesulfame potassium, aspartame, and sucralose) are generally safe during pregnancy, women with carbohydrate intolerance, including those with gestational diabetes or insulin resistance, should limit their intake. Worth noting: these ingredients add calories to your food with little nutritional value. 
  
  The American Pregnancy Association recommends that pregnant women avoid the following artificial sweeteners:
  
  
  • Saccharin: Commonly sold as Sweet ‘N Low, this ingredient appears in many foods and beverages. Studies demonstrate that saccharin can cross the placenta and remain in fetal tissue, so while the FDA considers it safe for the general public, its use for pregnant women remains questionable.
    
    
  • Cyclamate: While there may be insufficient data regarding this additive’s use during pregnancy, it’s been banned since 1970 from use in the U.S. due to its potential link to bladder cancer.
    

How Diet Affects Morning Sickness

About 70% of pregnant women experience nausea and vomiting in their first trimester. Despite its common name, “morning sickness” can occur throughout the day. Making small changes to your diet can help settle your troubled tummy and stabilize your blood sugar (fluctuations are a common nausea culprit, says Middleberg). 

Here are some quick and easy morning sickness reduction tips:

• Eat protein before bed. Your stomach, like your heart, has a rhythm that sets the pace for muscle contractions. Instead of pumping blood, it moves and mixes food. A steady, slow-wave rhythm supports healthy digestion, but when it’s too fast or too slow, contractions become irregular, food empties more slowly, and nausea can set in.
  
  Research shows that protein may reduce both nausea and abnormal rhythms more effectively than carb-heavy, fat-heavy, or calorie-free meals. Middleberg recommends a spoonful of peanut butter or a small serving of Greek yogurt.
  

• Take frequent snack breaks. You may not feel like eating much during this period, but it’s important to pause for small meals several times throughout the day. Waiting too long between meals can actually make you feel worse.
  
  “These should ideally include some protein and fat alongside any carbs you eat,” Middleberg advises.

• Avoid acid reflux triggers: Coffee, carbonation, citrus, tomato sauce, chocolate, onions, and garlic can contribute to acid reflux, which Middleberg explains can also cause nausea during pregnancy.
  
  
•  Vitamin B6: Some studies show that vitamin B6 supplements can help treat morning sickness, but overall, the results are mixed. When combined with doxylamine (an antihistamine), randomized trials demonstrate about a 70% reduction in nausea and vomiting, along with lower hospitalization rates for severe symptoms. Therefore, the American College of Obstetrics and Gynecology (ACOG) recommends starting treatment with vitamin B6 alone (10 to 25 milligrams, three or four times daily) before adding doxylamine (if symptoms persist). Pregnant women should always seek medical advice to ensure safe dosing.

• Hydration: Nausea and vomiting can quickly lead to dehydration. Pregnant women require more water. ACOG recommends aiming for 8 to 12 cups of water a day and not just when you are thirsty. 
  
  But rather than down it all at once, Middleberg recommends “sipping fluids throughout the day—especially at meals.”
  
  
• Eat or drink ginger. A common remedy for nausea with medicinal use dating back thousands of years, ginger root can be consumed fresh or as a dried powder. While researchers aren’t exactly sure how it works, one theory is that ginger affects serotonin receptors in the digestive system.

• Keep a lemon nearby. “Often smelling or licking a lemon can help alleviate nausea,” says Middleberg. 
  
  There is some evidence that lemon juice may help stabilize blood sugar levels and improve digestive efficiency, which can reduce feelings of hunger and nausea. And even just inhaling its scent may reduce pregnancy-related nausea and vomiting.
  
  
• Mind when you take your prenatal vitamins. “Try taking them with food or in the evening, rather than in the morning,” advises Middleberg.

• Consider anti-nausea wristbands. A 2001 study of over 100 pregnant women in southern Michigan found that 68 who wore Sea-Bands with acupressure buttons reported less frequent and severe morning sickness symptoms compared to 42 women in the placebo group who wore bands without buttons. Researchers based these findings on questionnaire responses, supporting anti-nausea wristbands as an effective tool for reducing morning sickness.
  

Take the Next Step Toward Confident Prenatal Nutrition

Nourishing your body is critical, especially when your meals support more than just you. Your growing baby needs you to prioritize nutrient-rich foods. And your health depends on your ability to manage common symptoms like nausea, while supplementing wisely under medical guidance. 

“Don’t be afraid to ask your MD questions and advocate for yourself!” Middleberg says. “No one knows how you feel better than yourself.”

Guided by expert advice and leaning on trusted resources, you can eat more mindfully and feel confident that you’re giving your baby the healthiest start possible.