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Nutrition in Pregnancy
Aka: Nutrition in Pregnancy, Pregnancy Related Nutrition, Dietary Guidelines in Pregnant Women, Weight Gain in Pregnancy, Vitamin Supplementation in Pregnancy
- See Also
- First Trimester Education
- Second Trimester Education
- Third Trimester Education
- First Obstetric Visit
- Prenatal Visit
- 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
- 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]
- 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)
- 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
- Approach: Postpartum Weight Loss
- Plan for gradual weight loss
- Weight loss 0.36 - 0.45 kg (13 oz - 1 lb) per week
- Guidelines: National Research Council RDA Recommendations
- Myths
- 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 Women Example
- 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
- 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
- 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
- See Vitamin D
- Vitamin D 600 IU per day (PNV contains 200 to 600 IU)
- Guidelines: Specific Components and Additives
- Artificial Sweeteners
- Artificial Sweeteners are associated with Large for Gestational Age infants and Childhood Obesity
- Zhu (2017) Int J Epidemiol 46(5): 1499-508 [PubMed]
- 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)
- 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
- Deli meats or meat spreads
- Under cooked meats
- Bean Sprouts
- Left-overs
- Raw or Smoked seafood
- Salmonella risk
- Raw eggs
- Parasites and Norovirus
- Raw fish or shellfish
- References
- Cogswell (1999) Obstet Gynecol 94:616-22 [PubMed]
- Zolotor (2014) Am Fam Physician 89(3): 199-208 [PubMed]