Nutrition During Pregnancy

Jean Cox, a registered dietician and Sharon Phelan, an obstetrician authored an excellent review article: “Nutrition During Pregnancy” (1) in the September edition of Obstetrics & Gynecology Clinics of North America. Nutritional concerns in pregnancy are gaining importance as we see increasing rates of obesity, poor nutrition and improper weight gain during pregnancy that can result in complications for both mom and her baby.

Prevention is always the best medicine. Preparing for pregnancy is no exception; this includes optimizing your health before pregnancy – including your weight. Research has shown that normal maternal weight before pregnancy and appropriate weight gain during pregnancy have been associated with better outcomes for both mom and baby. The converse is also true: obesity, poor nutrition and improper weight gain puts you and your baby at increased risk of developing complications both during and after pregnancy.

Risks associated with pre-pregnancy obesity:

• Mom during pregnancy: Increased miscarriage rate, gestational diabetes, high blood pressure, development of blood clots
• Mom during delivery: Cesarean section, stillbirths, hemorrhage, wound infections
• Mom postpartum: depression, difficulty breast feeding
• Fetus: Increased risk of birth defects including neural tube defects
• Newborn: Born either too large or too small
• Childhood: Childhood obesity

Risks associated with excessive weight gain:

• Mom: delivering a baby greater than 9 pounds, increased risk for cesarean section, failing to initiate breastfeeding or early termination of breastfeeding, postpartum weight retention
• Baby: respiratory distress, infection, low blood sugar, admission to ICU, longer hospital stay and childhood obesity.

The table below published by the Institute of Medicine shows the recommended weight gain given your pre-pregnancy BMI. Pregnancy weight gain goals were set by the Institute of Medicine (IOM) in 1990 (2). The goal at the time was to optimize pregnancy outcome (ie, full-term delivery of a healthy baby weighing 3 to 4 kg). An attempt was made to balance the needs of mother and baby. An updated report will be published soon by the IOM. For now, we know that following these recommendations improves your chances of a better outcome for both you and your baby.

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Table 1 -- Institute of Medicine prenatal weight gain goals

	Body mass index	Total weight gain (lb)	Total weight gain (kg)
Normal	19.8–26.0	25.0–35.0	11.5–16.0
Underweight	<19.8	28.0–40.0	12.5–18.0
Overweight	>26.0–29.0	15.0–25.0	7.0–11.5
Obese	>29.0	≥15.0	≥6.0
Twins	Ignore	35.0–45.0	16.0–20.5

The authors recommend nutritional counseling for all obese prenatals and women who have inappropriate weight gain (both too much and too little). Others who have a particular need for medical nutrition therapy include young teens, mothers with multiples, women who have poor dietary patterns, and women on restrictive diets (e.g. vegan). Those with previous bariatric surgery, other recent weight loss, some pre-existing (or current) medical conditions, and eating disorders will benefit from the more nutritionally focused care.

To obtain the best nutrients from your diet choose

• small frequent meals
• milk or yogurt - low fat, then skim later in pregnancy
• lower fat meats and red meats more than white
• minimize juice
• whole grains
• water instead of sports drinks
• fresh or frozen fruits and vegetables
• minimize juices
• avoid fried foods
• avoid added fats and sugars

Prenatal vitamins (multivitamin/multimineral) are recommended for those who have higher than average needs (women pregnant with multiples, women who have HIV, and women who smoke, drink alcohol, or take drugs) or those who eat little or no animal products. For others, they are used as insurance, not as a substitute for a good diet.

Resources:

1. MyPyramid for Pregnancy & Breastfeeding – discover your best nutritional options

2. How to calculate your BMI

3. Nutrition during Pregnancy - A Gift for Your Baby

References:

1. Cox JT, Phelan ST. Nutrition during pregnancy. Obstet Gynecol Clin North Am 2008:35 (3) 369-83, viii

2. IOM. (Institute of Medicine). Food and Nutrition Board. Nutrition During Pregnancy, Executive Summary. Report of the Subcommittee on Nutritional Status and Weight Gain During Pregnancy and the Subcommittee on Dietary Intake and Nutrient Supplements during Pregnancy. Washington, D.C.: National Academy Press, 1990