The Truth About First Trimester Nutrition: What Actually Matters vs. What Doesn't
By Nicole Roggow, Certified Pregnancy Nutrition Coach | Published: October 27, 2025
After seven years of providing personalized nutrition coaching to pregnant women, I've learned to separate the nutrition noise from what actually impacts pregnancy outcomes. So often i have clients come to me at just WEEKS pregnant (maybe not even experiencing symptoms yet!) with the perfect plans they have for their nutrition. These clients have often read blogs and books and listened to "pregnancy nutrition experts" talk about what best practices are and these clients have the best intentions. BUT - what they are not accounting for (and what the experts and books never told them) was that its very likely the reality of pregnancy is going to "get in the way" of their perfect plans and they are going to need to be more mentally flexible with how and what positive pregnancy nutrition actually looks like.
Here's what really matters in the first trimester.
What Actually Matters: The Non-Negotiables of Pregnancy Nutrition
1. Folic Acid/Folate (400–800 mcg daily)
WHY IT MATTERS: Prevents neural tube defects, which occur in the first 4–6 weeks of pregnancy (often before you know you're pregnant).
HOW TO GET IT: Prenatal vitamin, fortified cereals, leafy greens, beans, citrus fruits.
REALITY CHECK: If you're just starting prenatal vitamins at 8–10 weeks, that is completely fine. You are still helping with ongoing neural development and its likely you have gotten enough of what you need from fortefied foods.
2. Staying Hydrated
WHY IT MATTERS: Supports increased blood volume, helps with nausea, prevents constipation, supports placental development.
HOW MUCH: The gold standard is 100oz/day, and maybe even more depending on your activity level and time spent in the heat/how much you are sweating daily.
REALITY CHECK: We measure plain water and want enough of that but things like electrolytes, coconut water, herbal tea, soups, and even popsicles are also hydrating!.
3. Eating Something Every Few Hours
WHY IT MATTERS: Prevents blood sugar drops, provides consistent energy for early development, helps manage nausea, ensures you can get enough food in without having huge meals.
HOW OFTEN: Something every 2-3 hours, even if it's just crackers.
REALITY CHECK: “Something” doesn’t have to be a balanced meal. Sometimes crackers or a single piece of fruit is all your body needs.
4. Avoiding Major Risk Factors
THE BIG ONES: Alcohol, raw meat, raw fish, unpasteurized dairy, high-mercury fish, smoking.
REALITY CHECK: A glass of wine before you knew you were pregnant isn’t going to hurt your baby. We can only control from here on out and we are going to do the absolute best we can moving forward.
What Doesn't Matter As Much As You Think
1. Perfect Macro Balance
THE PRESSURE: “You need exactly X grams of protein, Y grams of carbs, Z grams of fat at every meal.”
REALITY CHECK: Your baby weighs less than an ounce for most of the first trimester. Your body’s existing nutrient stores are handling most of the work and we want to stay focused on our "best effort" nutrition at every opportunity throughout the day.
WHAT TO DO: Aim to get in some protein whenever you can and give as much attention to fruit as possible. Some days this is going to be easier than others but trust that your best effort is going to be enough!
2. Eating Organic
THE PRESSURE: “Pesticides will harm your baby! Everything must be organic!”
REALITY CHECK: While organic is nice if you can afford it, conventional produce is still packed with nutrients and incredibly beneficial for you and baby. The benefits of eating fruits and vegetables far outweigh the pesticide concerns.
WHAT TO DO: Wash your produce well. Focus the organic budget on the “dirty dozen” if you truly want to incorporate more organic foods.
3. Avoiding Sugar
THE PRESSURE: “Sugar is toxic during pregnancy!”
REALITY CHECK: Your body needs carbohydrates for energy, especially when dealing with pregnancy fatigue. Moderate amounts of sugar won’t harm your baby.
WHAT TO DO: Choose foods that sound appealing and provide energy. If that’s fruit, great. If it’s a cookie, that’s fine too. We want to think more about what we can ADD INTO our diet during pregnancy to improve nutrient intake, not be worried about avoiding something like sugar.
4. Taking a Handful of Supplements
THE PRESSURE: “You NEED to add in: iron, DHA, greens powder, protein powder, probiotics, vitamin D, calcium, magnesium, ginger, B6…”
REALITY CHECK: A good prenatal vitamin covers most of your bases. Additional supplements might be helpful if a deficiency was noted, but aren’t essential for most women.
WHAT TO DO: Start with a prenatal vitamin. Add others only if your doctor discovers a deficiency or you have specific needs that require additional supplemenation.
5. Eating Six Small Meals a Day
THE PRESSURE: “You must eat every 2–3 hours to maintain stable blood sugar!”
REALITY CHECK: Some women feel better eating frequently, others prefer fewer larger meals. Your baby doesn’t care about your meal timing and truly the best approach to an eating schedule is the one that keeps you comfortable throughout the day and allows you to get what you need in daily.
WHAT TO DO: Eat when you’re hungry and when food sounds appealing. Let your body guide you!
The Grey Area: Things That Help But Aren’t Essential
1. Extra Protein
HOW IT CAN HELP: Supports placental growth and helps with nausea for some women. Will also help maintain muscle mass in the mother, especially in fit women looking to continue to exercise throughout their pregnancy.
DONT STRESS IT: If you can’t stomach traditional protein sources, you are not alone. We want to do our best here and keep our mind open to other ways we can accumulate protein in our diet. Think cheese, nuts, yogurt, and even protein pasta: it all counts!
2. Limiting Caffeine
HOW IT CAN HELP: High caffeine intake is linked to miscarriage risk.
DONT STRESS IT: You can have a large cup of coffee most days. The ACOG reccomends keeping your caffine intake to about 200mg a day (about 1–2 cups of coffee) to be considered safe.
3. Taking DHA/Omega-3s
HOW IT CAN HELP: Supports brain development.
DONT STRESS IT: Sometimes it can be hard to find an Omega supplement that doesn’t make you nauseous. You can start this in the second trimester, or turn to foods such as nuts and seeds, avocado, eggs and milk if you can stomach them.
Other Factors That Can Impact First Trimester Outcomes
Stress Levels
Chronic stress and anxiety about nutrition can be more harmful than occasional less-than-perfect meals.
Consistency Over Perfection
Eating something regularly matters more than eating perfectly some of the time.
Avoiding Major Risks
Steering clear of alcohol, smoking/second hand smoke, and raw/unsafe foods has a bigger impact than stressing over sugar, organic foods or a macro breakdown
If you are feeling overwhelmed by first trimester nutrition rules, we are here to help! As a pregnancy nutrition coach for 7 years now, I can promise you: you don’t need perfection, you need perspective and knowledge! Get personalized pregnancy nutrition coaching that helps you focus on what REALLY matters.
