Safe and healthy eating in pregnancy - HE1805

Eat a variety of foods
Choose and prepare foods low in fat, salt and sugar
Food safety and allergens
Be food smart during your pregnancy
Keeping food safe
Food safety at home
Eat well and keep active for a healthy weight gain
Buying your lunch
Supplements
Eat well to cope with pregnancy symptoms
Pull out guide to food safety in pregnancy
Useful organisations

Healthy eating and being active during pregnancy are important for you and your baby. Nutritional needs are higher when you are pregnant and meeting these needs helps protect the long-term health of both you and your baby. Food safety is particularly important as some foodborne illnesses can harm your baby.

Some people may need special advice from a health professional about eating during pregnancy.

This includes people who:

• are 18 years old or younger
• have a medical condition affecting their eating, such as diabetes
• are having more than one baby (eg, twins or triplets)
• eat very little, have a history of eating problems or are on a restricted diet for medical reasons
  
• are vegetarian or vegan
• are very overweight
• are underweight.

If you think you should see a dietitian, ask your lead maternity carer (LMC, eg, your midwife, doctor or obstetrician) to arrange this for you.

Eat a variety of foods

Eat a variety of healthy foods every day from each of the four main food groups below:

1. Vegetables and fruit

Vegetables and fruit provide carbohydrates (sugar and starch), fibre, vitamins and minerals and are low in fat.

• Eat plenty of vegetables and fruit, in a variety of colours.
• Enjoy fresh, well-washed vegetables and fruit, or canned varieties. Steaming or microwaving vegetables is best, without adding fat and salt.
• Limit juice and dried fruit because these foods have a high sugar content.

Eat at least five servings of vegetables and two servings of fruit each day.

Serving size examples
Vegetables	Fruit
½ a medium potato or similar sized piece of kūmara, taewa (Māori potato), yam, taro, cassava, or green banana	1 apple, pear, banana or orange
½ cup cooked vegetables, eg, carrot, corn, peas, cabbage, broccoli, pūhā, watercress, silverbeet, taro leaves, bok choy or Chinese cabbage	2 small apricots or plums
1 cup salad	1 cup diced or canned fruit (drained), eg, pineapple
1 medium tomato	1 cup frozen fruit, eg, mango, berries. Cook frozen berries before eating.

 

2. Breads and cereals

These provide carbohydrates (sugar and starch), fibre, and nutrients such as B vitamins and minerals.

• Eat plenty of grainy breads and cereals, including rice, pasta, breakfast cereals and other grain products.
• Choose wholegrain varieties because they provide extra nutrients and fibre. They also help to reduce constipation in pregnancy.

Choose at least eight servings of breads and cereals each day.

Serving size examples
½ medium roll	½ cup cooked cereal, eg, porridge
1 medium slice rēwena bread	½ cup cooked pasta
1 slice bread	½ cup cooked rice
⅔ cup cereal flakes	3 crispbreads or crackers
¼ cup muesli

 3. Milk and milk products

Pregnant people need milk and milk products as sources of protein, vitamins and minerals, especially calcium.

• Choose reduced- or low-fat milk and yoghurt.
• Milk and milk products provide New Zealanders with most of their calcium. If you do not eat these foods or eat very little of them, ask your midwife about other calcium sources.
• Calcium is also found, in lower amounts, in foods such as wholegrain bread, broccoli, canned salmon, sardines, spinach, baked beans and tofu.
• If you are drinking non-dairy milks, eg, soy, oat or nut milk, choose one that is calcium-fortified (check the label).
• If you follow a vegan diet, you will need to check that your non-dairy milk has vitamin B12 in it.

Have at least two servings of milk or milk products each day, preferably reduced- or low-fat products.

Serving size examples
1 large glass milk	2 slices hard cheese
¾ cup or 1 pottle yoghurt	1 large glass calcium-fortified soy milk

 

4. Legumes, nuts, seeds, fish and other seafood, eggs, poultry (eg, chicken), or red meat with the fat removed

These foods give you protein, iron, zinc and other nutrients.

• Iron helps support you and your growing baby, and helps you feel less tired.
• Iron in lean meats, chicken and seafood is absorbed well by the body. Eggs, cooked dried beans, peas and lentils, and nuts and seeds also contain iron, but the iron is not as easily absorbed.
• If choosing red meat, eat less than 500 g of cooked (700-750 g raw) red meat a week. 
• Liver is a good source of iron but eat no more than a small piece (100 g) once a week as it has lots of vitamin A which can be harmful to an unborn baby. 
• Include foods rich in vitamin C with your meals to help absorb iron. Fresh vegetables and fruit, especially taro leaves (cooked), broccoli, tomatoes, oranges, kiwifruit, mangoes and pineapple, are good sources of vitamin C. This is especially important for those who are vegetarian and vegan, who may find it hard to get enough iron.
• Fish is recommended because it is an important source of protein, iodine and some vitamins, and essential omega-3 fatty acids, which is important for the development of baby’s brain.
• Seafood and eggs are also useful sources of iodine. Your body needs more iodine during pregnancy and breastfeeding (see the pullout included and the Iodine section).

Choose at least three servings from this group each day.

Serving size examples
2 slices cooked meat, eg, beef, pork or lamb	small can of canned fish, eg, skipjack or albacore tuna, sardines, salmon or mackerel
½ cup mince or casserole	6 medium, freshly cooked mussels
½ medium steak	2 large eggs
2 drumsticks or 1/2 chicken breast	1 cup canned or cooked dried beans, eg, bean salad or lentil dish
1 large piece of cooked fish, eg, warehou or eel (see Food safety when choosing fish and seafood)	1⁄3 cup nuts or seeds
1 medium, freshly cooked pāua	¾ cup tofu

Choose and prepare foods low in fat, salt and sugar

The best way to meet your extra nutrition needs is to choose foods from the four food groups. These are good sources of fibre, vitamins and minerals.

When shopping, read labels and look for foods that are lower in fat (especially in saturated fat), sodium (salt) and sugar. If using salt, choose iodised salt.

Limit fast foods, takeaways and packaged snacks which are high in fat, sodium and/or sugar. These include foods such as fish and chips, fried chicken, hamburgers, pies, chocolate bars, muesli bars, chippies, lollies, fruit leathers, cordials and fizzy drinks.

When cooking, grill, steam, microwave, boil or bake foods, without adding fat, and eat meals without adding extra salt.

Food safety and allergens

Allergy prevention

During pregnancy, you do not need to avoid foods associated with food allergies (unless you have a food allergy to the food). Avoiding foods while pregnant or breastfeeding does not help prevent allergies in babies.

Food safety in pregnancy

In pregnancy, your immunity changes, so you and your unborn baby are more at risk than usual from the kinds of foodborne illnesses that affect everyone.

By taking some basic food safety steps, including avoiding some foods when you are pregnant, you can prevent most foodborne illnesses. If others in your house help with the cooking and shopping, ask them to follow these tips too.

Food safety in a nutshell

• Wash and dry your hands thoroughly
• Be food smart, clean, cook (or microwave) and chill your food
• Avoid high risk foods (see our pullout guide)

Foodborne illnesses

Listeria and Toxoplasma are causes of two infections you can get through food which may harm your unborn baby. (See mpi.govt.nz/food-safety-home/food-pregnancy for further information).

Other common foodborne illnesses to watch out for:

Campylobacteriosis and salmonellosis are two of the most common foodborne illnesses in New Zealand and can, on rare occasions, cause miscarriage and premature labour in pregnancy.

Salmonella is a bacterium quite commonly found in raw meats, poultry, raw (unpasteurised) milk and raw milk products, seafood, fresh produce (including sprouts), and foods such as kebabs and sandwiches handled by infected foodhandlers. In pregnancy it can cause stillbirth on rare occasions.

TOP TIP

Symptoms of foodborne illness

See your doctor as soon as possible if you have any of the following:

• nausea / vomiting (usually in addition to one or more of the other symptoms listed) 
• diarrhoea
• stomach pain or discomfort
• dehydration
• headache
• swollen glands
• flu-like symptoms including fever and muscle aches.

Be food smart during your pregnancy

Wash your hands

Washing and drying your hands properly are two of the most effective things you can do to prevent foodborne illness.

• Wash + dry = clean.
• Wash your hands thoroughly (for 20 seconds), using plenty of soap.
• Rinse them well.
• Dry hands well (for 20 seconds) on a clean, dry hand towel or paper towel.
• Keep hand towels for hands only or use paper towels – don’t use the tea towel.
• Use a fresh hand towel daily (change it more often if needed).

Don’t buy or eat:

• food in damaged packets or tins or in loose vacuum packs – vacuum packaging should be tight around the food, with no air pocket
• chilled products that are not cold to the touch
• frozen products that are not frozen solid
• canned food that is dented, bulging, cracked, or leaking
• food if you don’t know where it comes from

Keeping food safe

TOP TIP

Take food home safely

• At the supermarket, make sure raw meat and chicken are packed separately from the rest of your groceries to stop cross-contamination from raw meat juices.
• Take food straight home or transport it in a chilly bin then put it into the fridge or freezer right away – never leave food in a hot car or sitting around waiting to be put away.

Food safety when choosing fish and seafood

Cooked fish is a healthy food

Mercury and cadmium can cause serious illness in the developing baby.

All fish will have some mercury in their flesh as this chemical is naturally occurring in seawater, and while the levels found in most New Zealand fish are not of concern, if you are pregnant or trying to conceive, you can reduce your intake of mercury by eating fish with lower levels of mercury, and by eating a variety of fish. Most of the commonly eaten fish species in New Zealand can be eaten freely. However:

• Eat longer-lived and larger fish which can contain more mercury (eg, farmed salmon, snapper, uncanned albacore tuna and mackerel, as well as kahawai, red cod, orange roughy and ling) less than three to four times a week.
• Eat school shark, southern bluefin tuna, marlin, and trout from geothermal regions and Lake Rotomahana only once a week or fortnight.
• Bluff and Pacific oysters and queen scallops can have high cadmium concentrations so should be eaten no more than once a month. Cook all shellfish before eating.
• Take care when choosing foods containing brown seaweed. Brown seaweeds are typically sold dry and are used in soups and stewed dishes, kelp salt and seaweed salads. Brown seaweeds, such as kelp, kombu, wakame, contain naturally high and varying levels of iodine. It is recommended that you eat brown seaweed no more than once a week.
• Nori is a green seaweed which is also sold dried and used in many seaweed-containing products. Unlike brown seaweed, it contains safe levels of iodine so is not restricted to one serving a week.

Mercury levels in fish are actively monitored by New Zealand Food Safety. For the most up to date, more detailed information check the NZFS website mpi.govt.nz/food-safety-home/safe-levels-of-chemicals-in-food/ mercury-levels-fish/ or freephone 0800 00 83 33

Food safety at home

To keep food safe:

Cleaning

• Keep cooked and ready-to-eat foods separate from raw foods so that cross-contamination can’t occur.
• Wash your hands and utensils between preparing raw and ready to-eat foods, to avoid cross-contamination. Use separate chopping boards for raw and ready-to-eat foods.
• Use cooked, prepared, and canned food stored in the fridge within two days.
• Wash and dry whole raw fruits, vegetables and herbs thoroughly.

Cooking

• Defrost food in the fridge overnight or on the defrost setting in the microwave and make sure it’s defrosted right through before cooking.
• Preheat the oven so that food cooks as quickly as possible.
• Cook or reheat food thoroughly. Meat should be cooked until the juices run clear. Cook chicken, mince and sausages right through.
• Marinate food in the fridge and cook marinade before pouring it over cooked food.
• Eat cooked food while it is still hot – don’t leave it to stand at room temperature for more than two hours.
• Reheat leftovers until piping hot (over 70ºC) and do not reheat more than once.

Microwaving

• Stir food to avoid uneven cooking which leaves cold spots.
• Cover food as this allows it to cook or thaw more evenly.
• Leave food for the recommended standing time so it finishes cooking.

Chilling

• Fridges should be at or below 4ºC. If the fridge is overloaded or opened often, it will have difficulty staying cold.
• Freezers should be cold enough that the food is frozen solid.
• Cover food before putting in the fridge or leaving out for serving.
• Cover and store raw meat on the bottom shelf of the fridge so juices don’t drip on other food.
• Leftover hot food should be covered and put in the fridge as soon as it has stopped steaming; hot food will cool more quickly if put into a shallow covered dish in the bottom of the fridge where it is colder.
• Eat canned food immediately after opening the can or transfer the food immediately to a covered, non-metal container and refrigerate.
• Throw out leftovers after two days and never freeze uncooked food more than once.

To learn more: mpi.govt.nz/food-safety-home/

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Overseas travel

Some countries have extremely high rates of foodborne illness, and water supplies may not be safe.

• Take special care that food (especially meats, pre-prepared or ready-to-eat foods, and uncooked, peeled fruit and salads) and water (including ice) is safe to eat and drink.
• Seek advice from your doctor, a local public health unit or travel health clinic before travelling overseas.

Drinks

Drink plenty of fluids each day

Use your thirst as a guide. Aim for nine cups of fluid (water [best choice] or reduced - or low-fat milk) each day. Extra fluid may be needed during hot weather, after activity, or if you are vomiting or constipated.

Drinks containing caffeine

There is evidence that high caffeine intake may affect your baby’s growth during pregnancy. Caffeine is naturally occurring in tea, coffee and chocolate and is present in many cola-type drinks and some fermented drinks, such as kombucha. Limit your intake of caffeinated drinks while pregnant. Have no more than four cups of tea or instant coffee or one 'double' espresso-type coffee each day. Energy drinks and shots, which may contain high levels of caffeine, are not recommended during pregnancy and breastfeeding.

Teas, herbal teas

Avoid drinking tea with meals. The tannins in tea mean you will not absorb the iron in the meal as well as you could.

Some herbal teas may be harmful in pregnancy. Check teas for a pregnancy warning label or ask your midwife.

Herbal teas that can be consumed in moderation (no more than two to three cups per day) during pregnancy and breastfeeding include: ginger, citrus peel/orange peel, echinacea, lemon balm, linden flower, peppermint, red raspberry leaf (no more than one cup per day in the first three months of pregnancy) and rose hip.

Other drinks

Limit fizzy drinks, fruit drinks and cordials because these are low in nutrients and high in sugar.

Alcohol

Stop drinking alcohol if you could be pregnant or are pregnant. Alcohol crosses from your blood through the placenta and into the baby’s bloodstream. Babies exposed to alcohol before birth may develop Foetal Alcohol Spectrum Disorder, which can stop your unborn baby’s nervous system (including the brain) from developing properly. Even small amounts of alcohol may be linked to behavioural and learning difficulties. From 1 August 2023, all packaged drinks with more than 1.15% alcohol will be required to have a Pregnancy Warning Label. Fermented food and drinks, such as kombucha, may contain low levels of alcohol from the brewing process and should be avoided.

Eat well and keep active for a healthy weight gain

A healthy weight gain during pregnancy is best for you and your baby. Talk to your midwife/ LMC about what a healthy weight gain during pregnancy is for you.

It’s normal to gain some weight during pregnancy due to the growth of the baby, placenta, and amniotic fluid. Gaining too much extra weight can increase your chances of:

• high blood pressure in pregnancy (pre-eclampsia)
• diabetes during pregnancy (gestational diabetes)
• needing a caesarean section
• having a large baby. This increases their risk of becoming obese in childhood and early adult life.
• difficulty losing weight after your baby is born. This may increase your risk of developing diabetes, heart disease and some cancers later in life.

Not gaining enough weight during pregnancy can increase the chances of having a premature (preterm) birth, or a smaller than expected baby.

In the first 12 weeks of pregnancy, you don't need to eat any more food than you would usually eat when not pregnant, but it is important that you eat nutritious food. If you are of normal weight, the total amount of extra food you need each day after the twelfth week of your pregnancy is equivalent to a wholegrain cheese and tomato sandwich or a wholegrain peanut butter sandwich and a banana. If you were overweight before pregnancy then the extra energy you require is about one slice of wholegrain bread or two pieces of fruit per day.

Dieting is not recommended because it may result in a smaller and less healthy baby and it could also affect your health.

Keeping active is important

Being physically active each day can help you avoid putting on excess weight, strengthen your heart and lungs and give you the extra energy and strength needed for the birth. Unless your midwife advises otherwise (eg you have a serious health condition), aim for at least 21/2 hours of moderate intensity physical activity spread over at least 3 days per week (for example 30 minutes a days, 5 days a week).

Choose activities you enjoy that match your level of fitness. Suitable activities include brisk walking, swimming, aqua-jogging or any activity that is comfortable for you and leaves you with enough breath to hold a conversation.

Wear suitable clothes when being physically active, for example, a good support bra, loose clothing and supportive footwear. Take breaks for a drink, food or a rest if you need to.

Doing daily stretching and pelvic floor muscle training may help during pregnancy and after baby is born.

If you were usually very active pre-pregnancy, seek specialist medical advice about continuing or adapting your chosen sport or activity during pregnancy.

Avoid physical activity in extremely hot weather.

You may need more rest. Listen to your body. If you are tired, rest.

Snack ideas

• Sandwiches: Use a variety of fillings such as banana, yeast extract spread, hard cheese, baked beans, peanut butter. Try different bases, for example, wholegrain bread rolls, rēwena bread, crackers, rice cakes, crumpets, pita bread, muffins and baked bread fingers.
• Vegetable sticks: Keep these in the fridge. Serve with plain unsweetened yoghurt or peanut butter.
• Fruit: Try fresh, canned (unsweetened) or cooked frozen fruit, served whole, cut up with yoghurt.
• Cereals: Choose cereals that are low in sugar, for example, porridge, untoasted muesli, cornflakes, bran flakes and wheat biscuits.
• Popcorn: Pop using a little oil or margarine or use a microwave. Go easy on the salt.
• Reduced- or low-fat milk products: Try yoghurt, cubes of hard cheese, reduced or low-fat milk and milk puddings (eg, creamed rice). Remember to eat pre-packaged items within two days of opening.

Lunch ideas

Base your lunch on breads or cereals:
wholegrain bread/toast/roll	rice or pasta
wholegrain toasted sandwich	rēwena bread
pita, focaccia or Turkish bread	crackers
pizza base	panini
crumpets, muffins or fruit bread
Add a filling, topping or spread:
canned baked beans, corn or spaghetti	hard-boiled egg
hard cheese	banana
yeast extract spread, jam, honey or peanut butter	canned fish, such as tuna, sardines, salmon or mackerel (freshly opened)
Add an accompaniment:
soup, either home-made, canned or made from a mix	freshly made salad or stir-fried vegetables
yoghurt	vege sticks (eg, baby carrots)
glass of reduced- or low-fat milk
Finish with fruit:
fresh	cooked from frozen
canned

 

Buying your lunch

When buying your lunch, choose healthy and safe options, such as:

• hot soup and toast
• hot savoury foods, for example, pizza, baked potatoes, rice and pasta dishes. These foods should be heated until they are piping hot (ie, >70°C). 
• freshly made, hot toasted sandwiches
• a savoury muffin or scone
• yoghurt
• fruit.

Remember...

Avoid high-risk foods. Follow the food safety advice provided in the pullout section.

Supplements

The only supplements recommended during pregnancy are folic acid-only tablets and iodine-only tablets, which can be purchased from pharmacies (or at a lower cost with a prescription from your doctor or midwife).

Folic acid

Aim to take one 800 µg folic acid-only tablet daily for at least four weeks before pregnancy and until the end of the first 12 weeks of pregnancy. If your pregnancy was unplanned, start taking a daily folic acid tablet as soon as possible.

Iodine

Take a 150 µg iodine-only tablet daily from the start of pregnancy until you stop breastfeeding.

Other supplements

It is best to only take supplements when recommended by your midwife, doctor or a dietitian. If you are taking any additional vitamin, mineral or herbal supplements, always let your midwife know.

The following supplements may be recommended by your health practitioner during pregnancy if you are at risk of being low in these. Talk to your midwife or doctor if you think you are at risk of a nutrient deficiency.

Iron

You may need iron supplements during pregnancy if your iron levels are low.

Vitamin B12

If you follow a vegan diet, you will need to take a vitamin B12 supplement during pregnancy and when breastfeeding.

Vitamin D

If you have darker skin, completely avoid sun exposure, have liver or kidney disease, or are on certain medications (eg, anticonvulsants), then you are at higher risk of vitamin D deficiency. If you live south of Nelson-Marlborough in winter, you're also more likely to have low vitamin D levels in late winter or early spring.

Eat well to cope with pregnancy symptoms

Nausea and vomiting are common during early pregnancy. This is referred to as ‘morning sickness’, but it may occur at any time of the day or night, especially when you are tired or hungry.

Eat as well as you can. Your extra nutrition needs are small during early pregnancy, so nausea and vomiting rarely cause any nutritional problems. However, if your vomiting is severe and you are unable to keep any food or fluids down, seek advice from your midwife.

TIPS

• Eat regularly, choosing smaller meals or snacks.
• Have fewer high-fat and spicy foods.
• Try a carbohydrate snack (such as a slice of dry toast, a cracker or fruit) before getting out of bed in the morning.
• Drink small sips of flat lemonade or ginger ale.
• Try ginger or foods flavoured with ginger.
• Give yourself extra time in the morning. Rushing can make you feel worse.
• Try to rest more.

Indigestion and heartburn

These are common towards the end of pregnancy.

• Eat regularly, choosing smaller meals or snacks.
• Have fewer high-fat and spicy foods.
• Avoid drinking fluids with meals.
• If a certain food upsets you, leave it for the time being.
• Avoid lying down straight after a meal.
• Going for a walk may help.
• Raise the head of the bed or use extra pillows.
• Check with your midwife before taking antacids.

Constipation

Constipation (finding it hard to poo) can result from the pressure of the growing baby and from hormonal changes that cause your gut muscles to relax.

Choose wholegrain breads and cereals and vegetables and fruit (eg, bran muffins, kiwifruit, figs, corn and peas).

Drink plenty of fluids every day.

Go for a daily walk or be physically active in some other way.

For more information

You are entitled to free maternity care during your pregnancy. Care is provided by Lead Maternity Carers (LMCs). The booklet Your Pregnancy (code HE1420) gives you information on choosing an LMC. Once your baby is born, you and your infant are entitled to receive free Well Child care in accordance with the Well Child Tamariki Ora National Programme. This includes advice about and support with your own and your baby’s nutrition requirements. This programme is delivered by your LMC from conception until 2–6 weeks after the birth of your baby. From 2–6 weeks onwards, your Well Child provider (Plunket, public health service, Māori or Pacific provider) will provide this care.

Further information on foodborne illness can be found at mpi.govt.nz/ food-safety-home/food-poisoning-symptoms-causes/listeria-infectionsymptoms-advice/, health.govt.nz/your-health/conditions-andtreatments/diseases-and-illnesses/food-and-water-borne-diseases/ listeria and healthify.nz/health-a-z/t/toxoplasmosis/ For more information on weight gain during pregnancy see health.govt. nz/your-health/healthy-living/food-activity-and-sleep/healthy-weight-gain-during-pregnancy Talk to your LMC or Well Child provider about other information you want to know.

See List of safe food in pregnancy | NZ Government (mpi.govt.nz) or download the pdf for the pullout guide

Useful organisations

• Healthline 0800 611 116
• New Zealand College of Midwives midwife.org.nz
• La Leche League (for breastfeeding support and information) lalecheleague.org.nz
• Maternity Services Consumer Council maternity.org.nz
• Multiples New Zealand multiples.org.nz
• Parents Centre parentscentre.org.nz
• New Zealand Dietitian at local public health unit
• New Zealand Food Safety (for food safety and label reading advice) 0800 00 83 33 mpi.govt.nz/food-safety-home/
• Ministry of Health health.govt.nz/your-health/pregnancy-and-kids
• HealthEd resources healthed.govt.nz
• Healthify healthify.nz/
• Raising Children raisingchildren.org.nz

IMPORTANT DISCLAIMER

Every effort has been made to ensure this information is accurate. The Ministry of Health and New Zealand Food Safety does not accept any responsibility or liability whatsoever for any error of fact, omission, interpretation, or opinion that may be present, however it may have occurred. This information does not replace or substitute for advice given by an appropriate professional. If you suspect you have a food allergy, you should see an appropriate health professional.

ISBN 978-1-99-106741-8 (print) 978-1-99-106742 (online)