II. Physiology
- Weight gain distribution over multiple components
- Fetus
- Placenta, amnion, and Uterus
- Edema and Increased Blood Volume
- Breast engorgement
- Adequate Weight Gain in Pregnancy
- Prevents Intrauterine Growth Retardation (IUGR)
- Especially in third trimester
- Prevents Intrauterine Growth Retardation (IUGR)
-
Obesity in pregnancy associated risks (BMI 30 compared with BMI 20)
- Fetal death (RR 1.3)
- Stillbirth (RR 1.5)
- Perinatal death (RR 1.3)
- Johansson (2014) BMJ 349:g6572 [PubMed]
III. Approach: Weight Gain in Pregnancy
- Normal conception weight (BMI = 19.8 - 26)
- Total weight gain: 11.25 - 15.75 kg (25 - 35 lb)
- Gain 1st trimester: 1.35-2.25 kg (3-5 lb) per month
- Gain 2nd/3rd: 0.45-0.90 kg (1-2 lb) per week
- Low weight at conception (BMI < 18.5)
- Total gain: 12.7 - 18 kg (28 to 40 lb)
-
Overweight at conception (BMI 27-29)
- Total weight gain: 6.75 - 11.25 kg (15 - 25 lb)
- Gain 1st trimester: 0.90-1.80 kg (2-4 lb) per month
- Gain 2nd/3rd: 0.45 kg (1 lb) per week
- Morbidly Overweight at conception (BMI >=30)
- Total weight gain: 5.0 to 9.1 kg (11 to 20 lb)
IV. Indications: Intensive Nutrition Counseling
- Weight gain <0.90 kg (2 lb) per month
- Weight gain >2.92 kg (6 lb 8 oz) per month
- Weight gain < 4.5 kg (10 lb) by mid-pregnancy
V. Approach: Postpartum Weight Loss
- Plan for gradual weight loss
- Weight loss 0.36 - 0.45 kg (13 oz - 1 lb) per week
VI. Guidelines: National Research Council RDA Recommendations
- Dispelling the myth of very high calorie intake
- Women should NOT double their Caloric Intake in pregnancy
- Daily Caloric Intakes are estimates for a moderately active woman
- Individualize Caloric Intake for body habitus and activity level
- Non-Pregnant Woman Example
- See Nutrition Guidelines
- Daily Caloric Intake: 2200 KCals for moderately active woman (range 1800-2400 calories/day)
- Daily Protein intake: 55 grams
- Pregnant Women: First Trimester Example
- Daily Caloric Intake 2300 KCals (100 additional calories per day)
- Equivalent of 100 additional calories/day
- One and one half slices of bread per day
- One Cup of milk or fruit juice
- One Banana
- Pregnant Women (Second and third trimester) Example
- Daily Caloric Intake: 2500 KCals (300-400 additional calories/day)
- Daily Protein intake: 60 grams (5 to 7 oz/day)
- Vegetables: 2.5 to 3.5 cups/day
- Fruits: 1.5 to 2.5 cups/day
- Grains: 6 to 10 oz/day
- Oils: 24 to 36 g/day
- Equivalent of 300-400 additional calories/day
- Two slices of bread and one half avocado per day
- 1 cup blueberries and 2 hard boiled eggs
- Lactating Women Example
- Daily Caloric Intake: 2600 KCals (400 additional calories/day)
- Daily Protein intake: 65 grams
VII. Guidelines: Vitamin Supplementation in Pregnancy
- See Prenatal Vitamins (PNV)
- See Folic Acid Supplementation in Pregnancy
-
Vegetarian or Vegan diet
- Consider Vitamin B12 Supplementation
- Consider Vitamin D Supplementation
-
Calcium Supplementation
- See Dietary Calcium
- Calcium 1000 mg per day (PNV contains 200-300 mg Calcium)
- Elemental Iron
- See Dietary Iron
- Elemental Iron 30 mg per day (PNV contains 27 mg Elemental Iron)
-
Folic Acid
- See Folic Acid Supplementation in Pregnancy
- Folic Acid 400 to 1000 mcg per day (PNV contains 600 mcg)
- Up to 4000 mcg Folic Acid recommended daily if increased risk for Neural Tube Defect
-
Omega-3 Fatty Acids
- See Omega-3 Fatty Acid Supplement (use safe preparations without Mercury Poisoning risk)
- Omega-3 Fatty Acid 650 mg per day (PNV contains variable amounts up to 450 mg)
- Roughly Half of Omega-3 Fatty Acid should be Docosahexaenoic Acid
- Vitamin D
VIII. Guidelines: Specific Components and Additives
-
Artificial Sweeteners
- Artificial Sweeteners are associated with Large for Gestational Age infants and Childhood Obesity
- Specific sweeteners
- Avoid Saccharin (crosses placenta and may deposit in fetal tissue)
- Sucralose and Acesulfame-K are likely safe in pregnancy
- Aspartame is likely safe in pregnancy
- Theoretical risk of exposing an undiagnosed fetus with PKU to Phenylalanine
-
Caffeine
- Association with Spontaneous Abortion, preterm delivery and low birth weight with Caffeine >350 mg/day
- Limit Caffeine to <200 mg/day (2 small cups of coffee)
- Herbal teas
- Avoid chamomile, licorice, peppermint, raspberry leaf (risk or Preterm Labor, Spontaneous Abortion)
-
Vitamin A Toxicity
- Avoid liver products
- Toxins
- See Mercury Content in Fish
- Various pollutants in farmed salmon (polychlorinated biphenyls, dioxins)
IX. Guidelines: Foodborne Illness Prevention
- Toxoplasosis risk
- Unpasteurized dairy and soft cheeses (e.g. Feta, Brie, Caembert, Blue cheese)
- Unwashed fruits and vegetables
- Listeria risk (Listeriosis risk in 18 fold higher in pregnancy; fetal mortality approaches 35%)
- Unpasteurized dairy and soft cheeses (e.g. Feta, Brie, Caembert, Blue cheese)
- Unwashed fruits and vegetables
- Unpasteurized raw juice or milk
- Deli meats, hot dogs or meat spreads (unless steaming hot, >165 F or >74 C)
- Under cooked meats
- Bean Sprouts
- Left-overs
- Raw or Smoked seafood
-
Salmonella risk
- Raw eggs
-
Parasites and Norovirus
- Raw fish or shellfish