A Trimester-by-Trimester Pregnancy Guide From a Holistic Nutritionist

*This article was written by Natalia Bragagnolo, one of the Holistic Nutritionists that's been with HEAL since the early days and that recently went on her mat leave. We hope you find it helpful!

Prior to becoming pregnant, I had a lot of thoughts about what my pregnancy would look like. As a Registered Holistic Nutritionist I was definitely conscientious of how I nourished myself and my growing baby during this time, but there were so many fluctuating symptoms that I didn’t expect that forced me to really tap into my nutritionist and wellness “toolkit”. I’ve worked with many pregnant and post-partum clients to support them nutritionally but the biggest lesson I learned throughout my own journey is that everyone’s pregnancy is a bit different and you really need to give yourself grace to see what is going to work for you.

With that in mind, Mandy asked me to share how I took care of myself during each of the four trimesters in the hopes that it provides you with some ideas of where to get started. I personally leaned on friends and other nutritionists a lot for personal recommendations. As someone who is passionate about health and fascinated by prenatal nutrition, I also received a lot of additional guidance during my pregnancy from different wellness professionals that I’m happy to share in case you don’t have access to these same resources. For example, I had support from my naturopath who specializes in fertility and pregnancy to help me determine what to supplement with and what I could take during each trimester, which was incredibly helpful.

If you want to dive deeper,  I highly recommend the book Real Food for Pregnancy by Registered Dietitian Lily Nichols. This book is an incredible resource to help you optimize your nutrition both preconception, and throughout every stage of pregnancy. She also offers some of the latest research to help dispel some common myths and calm anxieties around what you should and shouldn’t eat during pregnancy. She also has a book called Real Food for Gestational Diabetes if that is something you are dealing with.

What I’m sharing below is not personalized or medical advice, it’s just what worked for me. Please consult with your primary care provider with any questions you have.

The First Trimester

Up until about 6 weeks I felt great. The only symptom I really had was a huge appetite. Then, at almost exactly the six week mark I was hit with the nausea, fatigue and insomnia that so many people had warned me about but that I was definitely not prepared for. This was paired with some really uncomfortable bloating. Bloating isn’t a pregnancy symptom I was very familiar with but the rise in progesterone during this time slows digestion so that your body can absorb more nutrients. For some women, this leads to bloating and/or constipation.

It’s not completely clear what exactly causes the nausea, but it’s likely attributed to the significant hormonal and blood sugar changes that take place.  In my experience and what I have found with many clients is that the nausea is worse if you go too long between meals to allow your blood sugar to dip. While eating when you’re nauseous is probably the last thing you’d want to do, try to consume small meals or snacks more frequently throughout the day, and include protein at each of these meals to better balance your blood sugar. For example, if you never really ate breakfast prior to being pregnant, try to get something in your stomach within 30 minutes of waking.

I was personally repulsed by even the thought of eating most meats, fish, and vegetables! In fact, veggies seemed to make my bloating significantly worse. The reality is that some days you might just need to get through the day, and that’s okay. My recommendation is to try to find a few staple meals and snacks that you can tolerate most of the time and that can provide you with a bit of nutrition, even if that means you’re eating the same foods every day.

Here are some of the healthier meals and snacks that got me through the first trimester:

  1. Wraps with avocado, cheese, cucumber and eggs: I’m grateful that I still craved eggs during this time because they’re such an easy protein source, full of healthy fats and choline for the baby’s brain development. They were definitely a pregnancy staple of mine.
  2. Smoothies: These were hit or miss for me digestion-wise in the early days but if you can tolerate smoothies they’re a great way to sneak in protein powder and other nutrients from fruits, veggies and healthy fats.
  3. Eggs and avocado on toast
  4. Peanut butter and toast or rice crackers
  5. Oatmeal with fruit and collagen powder: I found collagen powder to be an easy way to increase my amino acid/protein intake considering so many protein options grossed me out. There’s no taste to it and you can add it to drinks and meals.
  6. Simple Mills almond flour crackers: These are a more nutritious replacement for saltines that still settled my stomach.
  7. Yogurt: Prior to becoming pregnant, I barely ate any dairy, but I found during the early stages of pregnancy that dairy products were one of the few protein sources I could tolerate. Many women actually find that their lactose intolerance improves during pregnancy, so definitely give it a try!
  8. Chicken and cheese quesadillas with any vegetables I could sneak in
  9. Chicken with rice or potatoes

I also kept some nuts and seeds on my nightstand so I could have a small amount before bed. This helped me from waking up in the middle of the night with a stomach ache and a blood sugar crash. If I woke up with a lot of nausea I could also have a small amount before even leaving my bed to settle my stomach.

Lastly, calcium needs increase during pregnancy to support the baby’s bones, muscular and nervous systems. I aimed for at least 2 servings of calcium per day. At first I could just stomach yogurt and cheese but eventually I added in cottage cheese (also a great high-protein snack) and non-dairy sources like tahini, tofu and almonds. Interestingly, in the third trimester I had really strong cravings for dairy products, probably a sign that my body wanted the calcium. 

Don’t beat yourself up if your diet is far from perfect (mine admittedly consisted of way more takeout, sweets and carbs than I’ve ever eaten) and just know that most pregnancy symptoms don’t last forever. Near the end of the first trimester my bloating and nausea really went down and I was slowly able to reincorporate some healthier foods and habits again.

First Trimester Supplementation

Prenatal: It’s important to start a prenatal as soon as you find out you’re pregnant. In an ideal world you’d actually incorporate one while trying to get pregnant to build your nutrient stores (but of course, things don’t always work like that!). Not all prenatals are created equal. You definitely want a practitioner grade supplement, not just something from the drug store and you want to ensure you’re taking one that contains the methylated form of folate (5-MTHFR or 5-methyltetrahydrofolate), and not folic acid. Folic acid is the synthetic version of folate and roughly half the population has an impaired ability to use this form of synthetic folic acid in the body. You can read more about the important difference here. I initially took NFH Prenatal SAP but Thorne’s Basic Prenatal is another good one, although there are lots of great brands out there.

Finally, I want to add that sometimes supplements made my bloating and nausea WAY worse. There was a point I had to take a break from all supplements for a few days. I found that the Megafood Prenatal was the only one I could tolerate after a while, and on really bad days I just took 1000mg of folate. It’s worth speaking to your practitioner to see if this is an option for you if you can’t get your supplements down.

Fish oil or DHA supplement: DHA is an Omega 3 that makes up 15% of the fatty acids in the brain and plays a very important role in a baby’s brain development. In one 2005 study of pregnant Canadian women, fully 90% did not meet the minimum daily recommended intake of DHA, and this is concerning considering that low levels of DHA have been linked to reduced cognitive function, depression and greater susceptibility to stress. Some good options include NutraSea high DHA liquid (the one I took) or Carlson Labs Super DHA.

Vitamin D: Vitamin D is another important nutrient for fetal growth and skeletal development, as well as the immune system. Many North Americans are deficient in vitamin D or have sub-optimal levels which can affect both the mother and the baby. Most prenatals don’t include very much vitamin D so it’s worth adding it. I like Thorne’s liquid vitamin D drops or Genestra D-mulsion.

Probiotic: A healthy microbiome (the bacteria in and on your body) supports everything from your gut health and your immune system to your mental health. Babies get their microbiome from their mother at birth, so the probiotics you have will help support your baby’s immune system. I took Genuine Health’s women’s probiotic as it contains strains of bacteria that may protect against GBS bacteria. This is a bacteria your OB or midwife will likely screen you for in the third trimester and if you have it you’ll likely need to take antibiotics during labour. (It's worth noting that HEAL has a 20% off discount code for genuinehealth.ca, which is HEAL20GH).

Electrolytes: If you do experience nausea that leads to you getting sick, you’ll need to replenish your electrolytes. Hydration is incredibly important during pregnancy (your blood volume almost triples!). I loved the LMNT electrolyte tabs and found they helped me get through many stages of pregnancy. You can also sip lemon water with a pinch of sea salt.

The first trimester is probably the strictest time for what you can and can’t take because all major organs and body systems of the developing fetus are forming. Always check with your doctor about what you can and can’t take, even when it comes to herbal teas. If you struggle with nausea, ginger tea, ginger chews and tabs are one of the few things you can take to help with this. Some nausea may be attributed to a B6 deficiency. I found Platinum Naturals B6 + ginger helped reduce my nausea by about 10%.

The supplements above are what worked for me. Keep in mind your health care provider may recommend different or additional ones for you.

The Second Trimester

You’ll notice the section on the second trimester is significantly shorter because thankfully, I felt like the fog of the first trimester was finally lifted. My nausea, bloating, and food aversions went away, I got my energy back and I could sleep through the night again (woohoo!).

I used this as an opportunity to make up for the first trimester and gradually re-establish some healthy habits and routines that I lost in the first trimester. I focused on lots of healthy fats (nuts, seeds, avocados, even some fish), vegetables, fermented foods, and prioritized protein-rich meals. I still had a lot of cravings for carbs and sweets and found myself overeating quite a bit (something that rang true throughout most of my pregnancy) but I tried not to stress too much and just focused on one meal at a time. When I prioritized blood-sugar balancing meals my cravings and hunger were way more manageable.

I also got back into a pretty regular exercise routine during this time, which mainly consisted of strength training, walking and prenatal yoga. At the advice of a few friends I also saw my physiotherapist for pelvic floor therapy from the second trimester onward. I was thankful I did this because I had tools to help with bladder control, I learned how to safely strengthen my core and pelvic floor which will hopefully help with a speedier post-partum recovery. We also went though breathing techniques for labour. I definitely recommend doing this if you can or at least looking into pelvic floor exercises for pregnancy online.

Second Trimester Supplementation

I continued with all of the supplements I started in the first trimester but I switched to the Metagenics Prenatal packs. I loved these because they covered most of the supplements I was already taking but they’re conveniently grouped into individual daily packets. This included a calcium/magnesium supplement that I added in the second trimester. If you just want to add a calcium/magnesium supplement to what you’re already taking, Genestra’s Liquid Cal/Mag is a good option before bed. It can help with heartburn if you have that, and bone and muscle support.

A Trimester-by-Trimester Pregnancy Guide from a Holistic Nutritionist

The Third Trimester

While many women experience even greater hunger during the third trimester, my hunger and cravings actually decreased. The third trimester is when many women’s iron levels drop because your blood volume increases so much, so I tried to prioritize more protein and iron rich foods like red meat, lentils, beans and spinach.

My third trimester was defined more by physical symptoms. I developed sciatica and had to really taper down the strength training. By the last month of pregnancy I could only walk, stretch and do some prenatal yoga for exercise. This was a great lesson in learning to listen to my body and adjusting my expectations, something that I’m sure will come in handy as a new mom! I had A LOT of Epsom salt baths during this time :)

Sleep also became a struggle again partially due to my growing belly and partially related to hormones. Early in the third trimester I had some night-time leg cramping but when I was consistent with the LMNT electrolyte drinks this completely went away.

A pregnancy pillow definitely helped (I liked this one from Amazon) as did magnesium citrate powder before bed and limiting sweets after dinner.

For some women, the digestive symptoms of the first trimester come back near the end of the third trimester. If that happens for you, try to go back to what worked in the beginning (eating smaller meals more frequently, prioritizing rest, sipping on ginger tea, etc.) In the very late stages of the third trimester I got some reflux at night, which I addressed by not eating too close to bed, avoiding super fatty or spicy meals, and elevating my head a bit while I slept. 

Third Trimester Supplementation

This is when I incorporated red raspberry leaf tea which may support uterine health. I started with 1 cup/day in week 32 and increased to up to 2/day from weeks 36 onward.

Labour & The Fourth Trimester

At the time of writing this, I’m about a week out from my due date. My hospital bag has electrolyte pouches for hydration during labour, protein bars for a quick energy boost, magnesium citrate for postpartum (can help with post-labour constipation), and 200C Arnica to help with tissue repair, healing and bruising for up to 2 weeks (as per the recommendation of my naturopath).

I’m also taking this time to prepare some things for my labour and postpartum recovery. I know enough people that really struggled to take care of themselves during this time so my main priority is to get my kitchen organized and stocked with simple meals and snacks. It’s important to remember that this is a time to replenish your nutrient stores from pregnancy but also prioritize your nutrient intake if you’re breastfeeding.

I was gifted the book The First Fourty Days by a friend and it’s a beautiful book all about nourishing yourself physically, emotionally and mentally during the post-partum period. I made some of the recipes in here including a Creamy Curried Lentil Soup. I also made bone broth for sipping post-partum which is a great source of glycine and minerals and actually contains quite a bit of protein. I also prepped and froze chicken liver pate, individual shepherd’s pie with grassfed ground beef, and pasta sauce with meat and liver, all recipes from Real Food for Pregnancy. These may sound weird but liver packs a high nutrient punch in a tiny size so I’m going to give it a shot and for the most part, the liver is hidden by the flavours in the recipes. I also made lactation bars. There are lots of great recipes online for lactation bars and cookies but variations mainly consist of oats, nuts and seeds, and nutritional yeast which are all meant to support milk production.

Fourth Trimester Supplementation

Since my plan is to try to breastfeed, I’ll be maintaining my pregnancy supplement routine as the nutrient needs for breastfeeding are just as high as in pregnancy.

Final Thoughts

Everyone’s pregnancy journey is unique but if you can relate to anything I’ve shared about my experience, I hope there’s something in here that helps you during this time. If you’re not yet pregnant and are trying, please don’t let any of this scare you. Pregnancy can have its challenges (you’re growing a human after all!) but it can also be a beautiful, incredibly exciting time with the highest highs.

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