Working with Athletic Pregnant women

When assessing the dietary needs of any pregnant women, you must analyze each woman individually.  However, I have discovered along the way that very athletic pregnant women have different needs than the average active person.  Healthy, slim, athletes have very efficient metabolisms, especially runners. They can eat quite a bit of food and not gain any weight due to their activity level. So while we have been advising all pregnant women to eat a whole, healthy, higher protein diet, this advice may not be enough for athletic women.

 Very athletic women need additional complex carbohydrates and protein. Essentially their bodies tend to burn any extra protein for energy, and it is unavailable to the liver for synthesis of albumin.  Albumin is a blood protein that helps keep water in circulation, and supplies the expanding blood volume of a pregnant woman.  Her blood volume will increase by 40- 60% during pregnancy, to supply not only her body, and the baby, but also so that she has an extra supply in the event of hemorrhage.  Hypovolumia , or low blood volume, is a major factor in the serious illness of pregnancy, pre-eclampsia.  Pre-Eclampsia puts both mother and baby at risk, so prevention is important.

By increasing calories in the form of complex carbohydrates (whole Grains), the athletes body has enough to burn for energy. Remember, a whole, balanced diet is one that contains real food, as close to its original state as is possible, from all food groups.  Protein bars are not real food, nor are powdered protein supplements.  They are processed differently by the body, and are not as bio-available.

Fad diets are becoming increasingly problematic. While they have always existed, the newest ones promote low carbohydrate/high protein diets that actually place women at higher risk for pregnancy complications by depleting their nutritional stores. Recent studies have shown that high protein diets without sufficient complex carbohydrates can cause women to lose weight when they should be gaining in order to build a baby. However, these studies are misinterpreted as indicating that too much protein is bad for women. A study by the Colorado Centre for Reproductive Medicine revealed poor implantation of embryos in mice fed supplemental high protein diets, resulting in complications contributing to miscarriage or premature birth.

The major problem with both the human and animal studies was that the researchers used powdered protein supplements, not dietary-food sources, and left out complex carbohydrates, fruits, vegetables, dairy, nuts, beans, seeds, salt, etc. It was not a complete diet. What the studies really told us is that protein supplements don’t work. In order to supply the pregnant body with what it needs, dietary protein, along with complex carbohydrates and all the other nutrients need to come from real food. Protein supplements are only advisable for moms who are pregnant with multiples, and then the supplements should be used in addition to the whole-food Brewer diet.

On the other end of the spectrum, Americans as a whole tend to be overweight and eat a great deal of poor quality, non-nutritious foods. I never cease to be amazed at what the average American thinks is a healthy diet. Based mostly on simple carbohydrates, sugar and fats and totally devoid of whole fruits, vegetables, complex carbohydrates and single-source proteins (i.e. beef, rather than bologna, sausage, etc.), it is no wonder many of us are obese. An overweight woman is not necessarily well fed. Conversely, eating a vegetarian or vegan diet does not guarantee proper nutrition, either. These women need to take extra care to obtain nutrition from a variety of vegetarian sources.

Weight Gain


Weight gain during pregnancy is another hotly debated issue (Kramer 2003a). Traditionally, women were told to limit weight gain to as little as 10 pounds based on the assumption that because sudden weight gain (along with other symptoms) is one of the major signs of toxemia, gaining too much was a cause of the problem. Then low birth weight became a problem, and doctors upped the amount to gains of 20-35 pounds. How much should a woman really gain during pregnancy? Well, that depends on the woman and her prepregnancy weight and health status. Dr. Brewer found that weight gain was not the real issue. On his diet, most women gained an average of 35 pounds, or if they were heavy to begin with, they lost while eating a superior diet with adequate calories.


When discussing recommendations on how much to eat doctors will often just say to add an extra 300 calories to their normal diet, but say nothing of  what types of foods they should or shouldn’t be eating.  A woman needs 2000-3000 calories per day to sustain a healthy pregnancy.  But how do you know where you fall in the scheme of things? Well, that depends upon your general size.  A woman who is 5 ft. tall might do well on 2000 calories per day.  But a woman who is 5ft. 10 would be more likely to need 3000 calories per day.


Portion size is also a consideration.  Not sure what that looks like? Well, look at your fist.  Your fist is generally a portion size for you.  So if you have a plate of food at each meal it should contain a fist sized portion each of a protein source, a complex carbohydrate of some sort (whole grain), and vegetable. Add a glass of milk or soy milk and you have a complete meal.  Exceptions would be cheese and nuts – those you would restrict to one oz. per serving. An ounce of cheese is about a 1 inch cube, and an ounce of nuts is a small fist full.   A snack might be a protein and a fruit, such as carrots and hummus, or cheese/peanut butter and apple slices, an ounce of nuts and a bunch of grapes, in addition to 3 well balanced meals a day.  Keep a daily food diary for about 12 weeks to help you see what you might be missing or pinpoint where you might be going overboard. How much women gain should not be the issue, but rather the quality of what they are eating, and how much exercise they are getting.


Examples/case studies:


High activity: Another woman also experienced problems assumed to be the beginnings of preeclampsia. When her case was analyzed, it was discovered that, while she ate what appeared to be a superior diet, she was lacking in whole grains (complex carbohydrates) and green leafy vegetables and was walking four miles a day. She was burning her extra protein for energy, and there was not enough available to supply her liver for the production of albumin. By adding more complex carbohydrates and green veggies and cutting her walking to one – two miles a day, she resolved the high blood pressure issues. Interestingly, when she asked her care provider if improving her nutrition would make a difference, the care provider said no. The woman was told she might have to be induced early, creating the potential for a premature baby. However, she decided to make these minor changes in diet and lifestyle and shocked her care provider by ceasing to show evidence of budding preeclampsia. (Her care provider still thinks it was a fluke.)


Non-food nutrition sources: This vegetarian athlete refused to increase her food intake, relying on nutrition bars and protein shakes. No matter what I said about eating a variety of real foods and sufficient complex carbohydrates, fruits and vegetables, in addition to adequate dietary protein, she refused to alter her eating habits. She also received conflicting advice from her medical care providers as to diet and weight gain. As a result, she developed one of the few cases of true preeclampsia I have seen in 18 years of teaching and had to be induced early.

So remember: Quality over Quantity, and moderate exercise. For more information on problems for healthy, active woman during pregnancy (i.e. runners), refer to Anne Frye’s Holistic Midwifery or her Midwifery Today article on “Turning Toxemia Around.”


Haas, A. V.; “Nutrition During Pregnancy”; Having a Baby Today, Issue #5, Midwifery Today, Eugene Oregon; 2002.

Brewer, Gail Sforza, and Brewer , Tom, MD;  What  Every Pregnant Woman Should Know: The Truth About Diet and Drugs in Pregnancy; Penguin Books; New York; 1985.


Frye, Anne, BA Holistic Midwifery; Understanding Diagnostic Testing in the Childbearing Year; 5th Ed.; Labrys Press; Portland, OR; 1993


Frye, Anne, BA Holistic Midwifery; “Unraveling Toxemia”; Midwifery Today, #34, Summer 1995, p. 22 -24.


Frye, Anne, BA Holistic Midwifery; Holistic Midwifery, vol. 1; Labrys Press, Portland, OR; 1995.


The Brewer Pregnancy Hotline by Gail Sforza Krebs  and Dr. Tom Brewer


Haas, A. V.; “Preventing Problems in Pregnancy with Nutrition”; Midwifery Today, #67; Eugene, Oregon; 2003.


Brewer, Tom and Brewer, Cornelia. (2003). The New Genetics in Global Maternal-Fetal Medicine Perinatology. Pre-Eclampsia Society Newsletter 43 (Spring): 28-30.


Kramer, M.S. (2003A). Energy/Protein Restriction for High Weight-for-height or Weight Gain During Pregnancy. (Cochrane Review) In: The Cochrane Library, Issue 2. Oxford: Update Software.


Kramer, M.S. (2003B). Balanced Protein/Energy Supplementation in Pregnancy. (Cochrane Review) In: The Cochrane Library, Issue 2. Oxford: Update Software.


Kramer, M.S. (2003C). High Protein Supplementation in Pregnancy. (Cochrane Review) The Cochrane Library Issue 2. Oxford: Update Software.


Kramer, M.S. (2003D). Isocaloric Balanced Protein Supplementation in Pregnancy. (Cochrane Review) The Cochrane Library Issue 2. Oxford: Update Software.


Boseley, S. (2004, Jun 29). “Atkins diet may cut chance of pregnancy, study shows.” Guardian Unlimited.


Amy V. Haas©2013