Nutrition in Pregnancy

1. See Also
   1. First Trimester Education
   2. Second Trimester Education
   3. Third Trimester Education
   4. First Obstetric Visit
   5. Prenatal Visit
2. Physiology: Adequate Weight Gain in Pregnancy
   1. Prevents Intrauterine Growth Retardation (IUGR)
      1. Especially in third trimester
   2. Weight gain distribution over multiple components
      1. Fetus
      2. Placenta, amnion, and Uterus
      3. Edema and Increased Blood Volume
      4. Breast engorgement
3. Approach: Weight Gain in Pregnancy
   1. Normal conception weight (BMI = 19.8 - 26)
      1. Total weight gain: 11.25 - 15.75 kg (25 - 35 lb)
      2. Gain 1st trimester: 1.35-2.25 kg (3-5 lb) per month
      3. Gain 2nd/3rd: 0.45-0.90 kg (1-2 lb) per week
   2. Overweight at conception (BMI 27-29)
      1. Total weight gain: 6.75 - 11.25 kg (15 - 25 lb)
      2. Gain 1st trimester: 0.90-1.80 kg (2-4 lb) per month
      3. Gain 2nd/3rd: 0.45 kg (1 lb) per week
   3. Morbidly Overweight at conception (BMI >29)
      1. Total weight gain: 6.8 kg (15 lb)
   4. Low weight at conception (BMI < 15)
      1. Total gain: 15.75 - 18 kg (35 - 40 lb)
4. Indications: Intensive Nutrition Counseling
   1. Weight gain <0.90 kg (2 lb) per month
   2. Weight gain >2.92 kg (6 lb 8 oz) per month
   3. Weight gain < 4.5 kg (10 lb) by mid-pregnancy
5. Approach: Postpartum Weight Loss (Gradual!)
   1. Weight loss 0.36 - 0.45 kg (13 oz - 1 lb) per week
6. Guidelines: National Research Council RDA Recommendations
   1. Non-Pregnant Women Example
      1. Daily Caloric Intake: 2200 KCals
      2. Daily Protein intake: 55 grams
   2. Pregnant Women: First Trimester Example
      1. Daily Caloric Intake 2300 KCals (100 additional calories per day)
      2. Equivalent of 100 additional calories/day
         1. One and one half slices of bread per day
         2. One Cup of milk or fruit juice
         3. One Banana
   3. Pregnant Women (Second and third trimester) Example
      1. Daily Caloric Intake: 2500 KCals (300 additional calories/day)
      2. Daily Protein intake: 60 grams
   4. Lactating Women Example
      1. Daily Caloric Intake: 2600 KCals (400 additional calories/day)
      2. Daily Protein intake: 65 grams
7. Guidelines: Specific Components and Additives
   1. See Folic Acid Supplementation in Pregnancy
   2. Artificial Sweeteners
      1. Avoid Saccharin (crosses placenta and may deposit in fetal tissue)
      2. Sucralose and Acesulfame-K are likely safe in pregnancy
      3. Aspartame is likely safe in pregnancy but has the theoretical risk of exposing an undiagnosed fetus with PKU to phenylalanine
   3. Caffeine
      1. Limit Caffeine to <150-300 mg/day (due to association with low birth weight and Spontaneous Abortion)
   4. Herbal teas
      1. Avoid chamomile, licorice, peppermint, raspberry leaf (risk or Preterm Labor, Spontaneous Abortion)
   5. Vitamin A Toxicity
      1. Avoid liver products
   6. Toxins
      1. See Mercury Content in Fish
      2. Various pollutants in farmed salmon (polychlorinated biphenyls, dioxins)
8. Guidelines: Foodborne Illness Prevention
   1. Listeria and Toxoplasosis risk
      1. Unpasteurized dairy and soft cheeses (e.g. Feta, Brie, Caembert, Blue cheese)
      2. Unwashed fruits and vegetables
   2. Listeria risk
      1. Deli meats or meat spreads
      2. Under cooked meats
      3. Left-overs
      4. Smoked seafood
   3. Salmonella risk
      1. Raw eggs
   4. Parasites and Norovirus
      1. Raw fish or shellfish
9. References
   1. Cogswell (1999) Obstet Gynecol 94:616-22 [PubMed]
   2. Zolotor (2014) Am Fam Physician 89(3): 199-208 [PubMed]