Nutrition Prenatal Care Recommendation for weight gain

Recommended dietary allowance Pregnancy require an additional 80,000 kcal- most are accumulate in the last 20wk Caloric intake of an extra 100-300 kcal daily is sufficient for adequate maternal weight gain and fetal growth.

To prevent preterm birth, fetal growth restriction Obese lead to increase risk of gestational hypertension, preeclamsia, gestational diabetes, microsomia and cesarean delivery.

The practice of prenatal supplementation of vitamins and minerals is widespread, although many nutritionists believe it is unnecessary. Only the following two supplements are recommended in an adequately nourished female with a singleton pregnancy: 1. Iron, 30 mg/day, in the second and third trimester to meet the fetal demands for erythropoiesis. 2. Folic acid, 400 g/day, in the preconception period and during the first trimester for prevention of birth defects Protein used for growth and remodeling of fetus, placenta, uterus, and breasts as well increased maternal blood. During second half of pregnancy, approx 1000g protein deposited, amount to 5-6g per day. Preferably from animal source, such as meat, milk, eggs, cheese, poultry and fish because they furnish amino acid in optimal combination. Mineral Iron : appox 300mg iron transfer to fetus and placeta and 500mg into expanding maternal hemoglobin mass, nearly all used after midpregnancy. At least 27mg ferrous iron supplement daily. Not necessary during 1st 4 month. Calcium : pregnant women retain approx 30g of calcium, most of which is deposited in fetus late in pregnancy.

Zinc : deficiency cause hypogonadism and dwarfism. Supplement no benefit on development outcome Iodine : deficiency predispose to endemic cretism. Folic acid : prevent neural tube defect. 4mg folic acid one month prior to pregnancy and during 1st trimester. Vitamin A : deficiency associated with increased risk of anemia and preterm birth. Care must be taken to avoid toxicity of the fat-soluble vitamins, in particular vitamin A (retinol), where more is not necessarily better. Daily doses of retinol greater than 10,000 IU, approximately 3000 retinol equivalents (RE), have been associated with birth defects.

Pragmatic Nutritional Surveillance Although the science of nutrition continues in its perpetual struggle to identify the ideal amounts of protein, calories, vitamins, and minerals for the pregnant woman and her fetus, those directly responsible for their care may best discharge their duties as follows. 1. In general, advise the pregnant woman to eat what she wants in amounts she desires and salted to taste. 2. Make sure that there is ample food to eat in the case of socioeconomically deprived women. 3. Monitor weight gain, with a goal of about 25 to 35 pounds in women with a normal BMI. 4. Periodically explore food intake by dietary recall to discover the occasional nutritionally absurd diet. 5. Give tablets of simple iron salts that provide at least 27 mg of iron daily. Give folate supplementation before and in the early weeks of pregnancy. 6. Recheck the hematocrit or hemoglobin concentration at 28 to 32 weeks to detect any significant decrease.