The Truth About the First Trimester

At the time I'm writing this post, I have just passed the 12 weeks of pregnancy mark. POP THE CHAMPAGNE (Errr...sparkling water?). I have had 2 prenatal appointments, the first trimester screening (everything looks perfect), have seen my baby's heartbeat (three times! It's magical), and have done the blood work to determine any chromosomal issues, gene mutations, etc., as well as the gender (Pssst: it's a girl!). I've also endured a couple months of intense morning sickness (which should, more appropriately, be renamed to "all day flu-like sickness"), and food aversions, among every other first-trimester symptom (they've filed in like clockwork during their designated week). As a nutrition professional and dietetics (clinical nutrition) student, this is a kiss-of-death to my everyday existence.

I've wanted to write a post about my experience to both dispel some pregnancy myths, as well as shed light on the realities that don't get enough attention.

So what are these first trimester symptoms I speak of? Let's go down the list: huge boobs, nausea, pimples (that glowing skin? It's caused by Sebum, which is the end result of an increased level of androgen hormones-- thank you anatomy class for that one), food aversions, fatigue (literally can't lift a 5 pound weight), headaches, body aches, peeing every 2-3 hours (including throughout the night), digestive problems... It's a very confusing and frustrating experience indeed, especially because it's all out of your control. 

I've felt guilty that 3 months in, I DON'T LOVE being pregnant. Don't get me wrong! I'm incredibly thankful for the gift of being able to bring life into this world, and when Baby K arrives, I'm sure the few months of hell will be worth it. That said, this post is a little less rose-tinted; a little rawer. I wanted to capture the experience in earnest before the symptoms fade and Oxytocin completely grabs hold of my heartstrings (and memory).

Maybe you haven't had children yet and this post will help you better understand what to expect. Maybe you've had kids and this post will offer something of a kindred, relatable connection to your own experience(s).

Whatever your situation, and wherever you're at in life-- I want to be completely honest with you about what I've experienced in my first trimester, what I've learned, and how I've coped with it.

I'll spare you the exhaustive scientific explanations, and summarize some things I've found useful, and that you might as well if you are pregnant, planning to become pregnant, or curious about what a typical pregnancy is like.

1). Contrary to What Many People Say/Think, You Don't Get to "Just Eat Whatever You Want"

If you are experiencing or have experienced extreme first-trimester nausea and food aversions, then you can relate to what it feels like to literally grasp at straws to find foods you can tolerate. Sometimes literally nothing sounds good. I've woken up some mornings with stabbing hunger and nausea at the same time. So unlike the "flu," which morning sickness is so often compared to, you need to eat frequently during your first trimester despite nothing sounding good.

Our bodies become hyper-intuitive when we're pregnant and usually do a pretty good job of telling us exactly what they can handle and how much-- when we listen. 

The times I've gotten physically sick have involved eating foods I can't tolerate right now (high in sugar or fat), too much of anything in one sitting (I can only handle very small portions, and have to eat really slow), or eating when I'm not physically hungry. I can't eat anything spicy, buttery, saucy...really anything that tastes delicious. My "tolerable" list seems to change daily/weekly, too, so what sounded good yesterday won't necessarily sound good today or tomorrow. I'm like a freaking juggler on a monocycle in the circus. 

Everyone is different, but I've found that the best solution for me is listening to my body, eating very plain and easy to digest food, and breaking meals up into several small snacks throughout the day.  My Nutritionist brain is always yelling "PROTEIN, HEALTHY FATS, VEGGIES," but my first-trimester senses/hormones are much louder, screaming "RITZ CRACKERS, SOUP, PLAIN HUMMUS, CHEDDAR CHEESE." That's a typical day.

Which brings me to...

2). You should NOT be eating more or putting on lots of weight during your first trimester. Your body doesn't need it. 

In fact, many moms I've talked to have told me they LOST weight in their first trimester due to food aversions and morning sickness.

I put on a few pounds the first 2 weeks of pregnancy from my boobs growing an entire cup size, and fluid retention (which happens), but after morning sickness and food aversions kicked in, I slid slowly below my wedding weight. I haven't dieted/tried to lose weight. PREGNANCY IS NOT THE TIME TO DIET. But learning to adapt to my body's needs RIGHT NOW, as opposed to trying to force certain foods because of my Nutritionist brain, is allowing my body to grow at the rate it needs to. Make no mistake, I am storing fat in the necessary places, my boobs continue to grow, and I am definitely retaining more fluids-- but I am also losing muscle mass (your body gets the nutrients it needs from stored fat and muscle tissue to provide nutrients to your growing embryo/fetus when you aren't able to get them from the foods you eat). All this is to say that our bodies will do what they need to do-- they are equipped to-- with very little help/intervention from us in the early months of pregnancy. The key is just getting calories in, via whatever means you can tolerate, and not more calories than you typically consume, especially if your physical activity decreases due to nausea and fatigue.

We don't start needing extra calories until our second trimester, and even then, only about 300 calories additional per-day. This equates to an extra ounce of protein at each meal (which satisfies your increased protein needs) and an ounce of cheese (dairy!)-- that's not very much. During our third trimester, we need an extra 400-500 calories-per-day. That's equivalent to a hearty bowl of chili.

Variety is key. Studies have shown that pregnant women who consume a variety of mostly whole, unprocessed foods, including vegetables, nuts, fruits, legumes, whole grains, and animal protein, are less likely to have children with food allergies. What you eat during pregnancy matters, which is why it's important to think about what you're putting in your body. 

3). Finding ways to sneak in essential vitamins and minerals wherever possible is a necessity.

My normal diet consists of a variety of mostly whole, organic foods, lots of protein, and healthy fats. My first-trimester diet has been a travesty to the world of Nutrition Science.

Biscuits, bread, potatoes, soups, pickles and pickled anything, sharp cheddar cheese, saltines and Ritz crackers, pita and hummus. I've craved Asian noodles, too-- pho and ramen. 

My diet has severely lacked the variety and nutritional value it needs, so I had to get creative to sneak things in where I can.

To sneak in fiber and vitamins/minerals I was lacking in the first weeks of pregnancy (and trust me-- Constipation that occurs starting in the first trimester means you NEED to get fiber in your diet to help move things along; it's very uncomfortable when you don't), I started buying fortified low-sugar oatmeal and Cream of Wheat, which are packed with many of the vitamins and minerals pregnant women need more of to support their growing fetus.  I also throw in Chia seeds to get more fiber into breakfast.

Buying instant packs of oatmeal and Cream of Wheat also help me better control my portions. This is key because, in previous weeks, I would give in to the intense hunger I felt at certain times of the day, eating too fast and subsequently too much and end up getting sick. Sticking to single portions also forces me to eat more frequently throughout the day (since my diet is mostly carbohydrate right now) which in turn keeps my blood sugar more stable/balanced and nausea at bay. 

4). Staying Hydrated is Really Important and Also Really Hard

One of the weirdest experiences for me has been an aversion to water. I am usually a very good water drinker and carry a liter Camelback with me everywhere I go. But once food aversions kicked in, water aversion did as well. I can literally taste the minerals in it-- it's absurd! 

When water is virtually the only thing you can drink, but you don't want it, staying hydrating becomes a major challenge. To combat my aversion, I've had to force sips in throughout the day. I also incorporate flavored waters or add fruit or mint to water at home. But the trick is ensuring I don't add too much sugar. I made the mistake of drinking a lemonade one afternoon because it sounded delicious (lemons! You should see my fruit bin in the fridge-- can't get enough of them), but the combo of lemon AND tons of added sugar made me violently ill.

I'm hoping that as morning sickness and food aversions fade away in the second trimester, water consumption will become easy again, but for now, I'm suffering through forced hydration to keep Baby K's ecosystem healthy. 

5). Combatting Fatigue is Sometimes a Necessity

I've heard so much on podcasts and read in parenting books about sleeping as much as you can during pregnancy...but what do you do when it's not possible?

I don't have a 9-5 day job, so I totally empathize with expecting moms who have to force themselves to stay awake for meetings/calls/etc. that are out of their control throughout the day despite extreme fatigue.

However, with a full-time school load that includes a night class, a 6-hour lecture and lab day, and hours of studying, there are days when I have to force myself through the unbearable fatigue as well and let me tell you, it ain't easy.

You are allowed 100 mg/day of caffeine during pregnancy (you'll read different advice in many publications, but this is the current standard amongst the Nutrition Science community). This equates to a cup of regular caffeinated coffee. Just one cup. If coffee is something you can tolerate (congrats!), and one cup just doesn't cut it, try switching to decaf and then you can have 2 cups.

In my first trimester, coffee is just about the last thing on the planet that sounds good, so I haven't had a single cup in 3 months. However, to make it through really tough fatigue days, I have consumed 1/2 can of caffeinated diet soda or energy water (never more than 1/2). The fizziness of these drinks is usually really calming to my belly and allows me to get some caffeine in without suffering the digestive upset.  These are drinks I generally avoid when not pregnant, but extreme fatigue is INSANE. Desperate measures are needed when you simply have to get through the day and your dietary options are already so severely limited.

Another trick is exercise. Late afternoon has been the most difficult for me, so I usually take my dog for a walk at this time or do a workout tape or class (depending on how I feel), which is like an instant energy booster.  

So while sleep is really important during pregnancy, incorporating a little caffeine or physical activity can help you battle through the fatigue when you need to.

When you can sleep though, do it. I am merely giving advice for when it isn't an option.

6). Take a Prenatal Vitamin that Contains Folate and DHA.

If you are trying to get pregnant, you should already be taking a prenatal vitamin. But if pregnancy happens quickly and you didn't start beforehand (raises hand-- hubby and I were literally a one-shot wonder. My womb was made for baby making, apparently), you need to start taking a prenatal vitamin as soon as you find out you are pregnant.

Our bodies require an increased intake of certain vitamins and minerals-- such as iron, folate, and B vitamins-- during pregnancy, and it is really difficult to get the amount we need from the food we eat, even if our diet consists of a wide variety of meat, dairy, fruits, vegetables, legumes, whole grains, nuts, etc.

Taking a prenatal vitamin is even more important for women with dietary restrictions, health issues, or pregnancy complications. This includes women who:

  • Are vegetarians or vegans 
  • Are lactose intolerant or have other food intolerances
  • Smoke or abuse other substances
  • Have a blood disorder
  • Suffer from a chronic disease
  • Are having twins or multiples

Folate
I recommend taking a prenatal vitamin that has folate, not folic acid. Folic acid is a synthetic form of vitamin B9. Folate, on the other hand, is found naturally in foods like liver, spinach, lentils and garbanzo beans. 

Most folic acid is not easily converted to the active form of vitamin B-9. It needs to be converted in our liver or other tissues. This process can be slow and inefficient and can lead to a build-up of unmetabolized folic acid in our bloodstream.  Studies have shown that high levels of unmetabolized folic acid are associated with increased cancer risk.

I have been taking The Honest Company's Multi Complete Prenatal Once Daily, which contains folate, plus 2 DHA complete daily. (To be honest, some days I can't keep them down when I get sick-- so if you skip a day or have a similar issue-- don't freak out! Your baby will be fine. I've also heard gummies work better for some women who can't stand the aftertaste of the horse pill-like vitamins).

DHA
DHA is a form of Omega 3 fatty acid that is incredibly important for healthy fetal brain and eye development. Pregnant women require at least 300 mg per day, and since it is recommended that we limit fish intake to twice-per-week (specifically, fish high in Omega-3 fatty acid, like salmon) to avoid exposure to too much mercury, a supplement is necessary to ensure adequate intake of this essential nutrient (these we must get from the food we eat because our body can't synthesize them).

Vitamin D
Which goes hand in hand with Calcium. As our Calcium needs increase during pregnancy, so must Vitamin D. We need Vitamin D to absorb calcium, which is why you'll often find many dairy products fortified with Vitamin D. Unless you're an early riser who can take advantage of those less harmful early morning rays, your best sources of Vitamin D are fortified dairy/dairy alternatives (such as almond milk) and/or a supplement. Most prenatal vitamins include Vitamin D.

Other B Vitamins
Some B vitamins come only from animal sources, which is why Vitamin B supplementation is especially important for vegetarians and vegans-- you will simply not get the amount of B Vitamins your body needs from food. 
Riboflavin (B2) helps us maintain energy, good eyesight, and skin. Thiamin (B1) also promotes energy and helps regulate our nervous system (This you can get from fortified cereals, whole grains, pasta, nuts, and legumes, in addition to certain animal products). Vitamin B6 supports red blood cell formation and can also help reduce morning sickness (oats and bananas have really helped me-- especially in the morning when nausea is at its peak).  Niacin (B3) promotes healthy skin, nerves, and digestion.

Vitamin B12 is something most of us are familiar with. It is involved in the metabolism of EVERY cell in the human body, and a vital part of DNA synthesis. It may also help prevent neural tube defects in a fetus. Supplementation is highly recommended, especially for vegetarians/vegans (this one you can only get from animal foods).

There are many reasons a person might choose to not eat animal products; however, I would urge you to consider at least eating eggs and dairy products while pregnant. It is so important for the healthy development of a baby to consume enough of the vital nutrients we need...which leads me to...

7). It IS Possible to Stay Healthy and Balanced

And I repeat, a lot of people will tell you that when you're pregnant you "can eat whatever you want. You're eating for two!"

For one thing, at no point are you actually eating for two. At your most pregnant stage, you are eating for 1.15. It is true that food cravings can be intense-- I haven't experienced these yet (I don't count "tolerable" foods as cravings). And while I don't agree with denying yourself the things your body wants, I also don't agree with indulging in them all the time.

Why?

Because I'm not that way in my normal life. I LIKE being healthy. It makes me feel good. And if it makes me feel good, that probably means it will be good for my baby, too. I personally wish to eat as many healthy foods as possible to ensure my baby is as healthy as possible. That is one aspect of my Nutrition-brain I can't turn off.

One of my biggest takeaways from pregnancy thus-far is that EVERYONE has an opinion. Literally. Everyone. But NO ONE knows your pregnancy like you do. Just because your mom or aunt or friend tell you something doesn't mean you have to do it.

I'm sure I'll hear a million bits of advice, and a lot more "oh let your hair down! You can eat what you want when you're pregnant!" (when someone says this after I just puked up 4 olives an hour before...you can understand why these words bother me right now).  I have the same feeling about this while pregnant as I do when not-- my choices have nothing to do with anyone else, and are in no way a judgment of others' choices. If I choose to give in to my cravings 1/4 of the time just like I do when I'm not pregnant, I am not saying every woman should be doing that. It's just my choice.

It is recommended that healthy women gain between 25-35 pounds during pregnancy.  I know women who only gained 20 and others who gained much more, all with the same outcome of delivering healthy babies. Weight gain will vary depending on the person, so I don't think anyone should use the scale as a determination of their health. I think it's possible to maintain steady and appropriate weight gain for your body, while still eating healthy and exercising moderately. I think our bodies are hardwired to do what they need to do and to store fat where they need to store it (MY BOOBS THO-- and with no help from diet). You don't need to do that much extra work.  Humans have been popping out kids for 200K+ years!

The first trimester has been really tough physically and emotionally, but I keep remembering that seeing the face of my little girl and holding her against my chest will make all of this worth it. Only 6 1/2 months to go!