Pregnancy Nutrition

• Nutrient requirements for pregnancy and lactation


  • The infant's bones, muscles and organs are all made from maternal nutrient stores and diet
  • For most individuals, pregnancy and lactation is the time when their nutrient needs are the greatest
  • It is essential that adequate nutrition be provided

  
• Energy Needs

  • Kilocalorie needs increase in the second and third trimester
  • 340 kcal in 2nd trimester
  • 450 kcal in 3rd trimester
  • Teenagers, underweight and active individuals need more kilocalories
  • Represents only a 15-25% increase in kilocalories, but specific nutrient needs increase more, so additional calories should come from nutrient-dense foods
• Protein

  • An additional 25 grams (above RDA) is needed
  • Most individuals are already consuming adequate amounts of protein
  • Vegetarians can easily meet their protein needs by consuming foods such as legumes, whole grains, nuts and seeds
• Nutrients of Concern

  • Folate
  • Vitamin B12
  • Choline
  • Vitamin D
  • Calcium
  • Iron
  • Zinc
• Folate

  • Needed for blood production, cell growth and prevention of neural tube defects (NTD)
  • RDA for folate 1.5x higher during pregnancy: must be emphasized even prior to conception, one month before conception and through the first trimester to prevent NTD, by 6th week neural tube has closed, individuals of childbearing age who are capable of becoming pregnant should consume 400 mcg of folic acid per day, in addition to folate-rich foods
• Vitamin B12


  • Activates folate so increased consumption is needed
  • Synthesis of RBC
  • Vegans should consume from fortified soy milk or cereals
• Choline


  • Important for development of brain and spinal cord
  • Food sources: eggs, dairy products, legumes, meats & seafood
• Vitamin D and Calcium


  • Vitamin D: Used for bone development, sunlight and fortified milk are good sources
  • Calcium: Increased calcium intake helps conserve maternal bone while meeting fetal needs, increased absorption during pregnancy, absorption doubles, intake is especially important if person is younger than 25 years old because they are still depositing calcium in own bones, recommended intake: 1000-1300 mg/day, food sources
• Iron and Zinc

  • Iron: Menstruation cessation is helpful to increase iron levels, dramatic increase in absorption, absorption triples, increased intake needed to support increased blood volume and provide for placental and fetal needs, infant draws on maternal stores to develop own stores for first 4-6 months after birth, few individuals enter pregnancy with adequate stores, so a daily iron supplement is recommended, use tips for increasing iron absorption
  • Zinc: Needed for DNA and RNA synthesis, supplementation may be needed if also taking iron supplements - most prenatal vitamins contain both iron and zinc
• Vitamin and Mineral Supplementation

  Iron required, prenatal supplements may benefit individuals with inadequate dietary intake
• Food Safety Reminders


  • Protein Food Group: Avoid certain types of fish (swordfish, shark) and limit others to 12 oz/week
  • canned albacore tuna: 6 oz/week
  • avoid deli/luncheon meats & hot dogs unless heated until steaming, smoked fish
  • Dairy Food Group: Avoid brie, feta, blue cheese (unless made from pasteurized milk)
• Weight Gain

  • Infants birth weight is influenced by mother's weight gain during pregnancy, infant birth weight is most potent single indicator of infant's future health
  • Underweight (BMI<18.5): Increased risk for LBW infant, recommended weight gain 28-40 lbs
  • Normal weight (BMI 18.5-24.9): Recommended weight gain: 25-35 lbs
  • Overweight (BMI 25-29.9): Recommended weight gain: 15-25 lbs
  • Obese (BMI ≥ 30): Increased risk for complications such as GDM (gestational diabetes) and HTN (hypertension), 30-50% of individuals w/ GDM develop Type 2 diabetes later in life, increased risk for large baby (macrosomia), recommended weight gain: 11-20 lbs
  • Goal: achieve healthy weight prior to pregnancy and avoid excessive weight gain during pregnancy, never advise weight loss during pregnancy
  • Adolescents should strive for upper end of range, short stature individuals should strive for lower end of range
  • Recommended rate of weight gain: 2-4 lbs total during the first trimester (13-14 weeks), 1/2 – 1 lb per week during the second and third trimester (2-4 lbs/month)
• Critical Period


  Finite period during development, usually a period of cell division on a body organ, an adverse event experienced before or during critical period permanently impairs development, full recovery never occurs, all systems have critical periods: heart, brain, lungs
• Nausea


  Hormonal changes lead to sensitivity to the appearance, texture and smell of food, peaks at 9 weeks, suggestions for coping: eat small, frequent meals, avoid greasy or spicy foods and rich foods, get up slowly and have food such as crackers at the bedside, avoid cooking odors, eat a high protein snack before bed
• Constipation


  Hormones alter muscle tone and growing infant crowds internal organs, suggestions for coping (prevention is the key): drink plenty of liquids, eat high-fiber foods, eat prunes or drink prune juice
• Heartburn


  Growing infant puts pressure on stomach causing reflux to occur, suggestions for coping: relax and eat slowly, include small meals, do not overeat at any meal, avoid fluid with meals, watch carbonated beverages, avoid laying down immediately after eating, wear comfortable clothing, avoid fatty foods, peppermint, spearmint and chocolate
• A balanced diet that includes an extra cup or ounce from each food group can usually meet increased needs