Nutrition During Pregnancy:

 Nutrition Prior to Pregnancy

o Both a man’s and a woman’s nutrition may affect fertility and possibly the genetic
contributions they make to their children, but it is the woman’s nutrition that has the
most direct influence on the developing fetus.
o The woman’s body provides the environment for the growth and development of a new
human being.
o Because critical periods occur throughout pregnancy, a woman should continuously take
good care of her health. That care should include achieving and maintaining a healthy
body weight prior to pregnancy and gaining sufficient weight during pregnancy to
support a healthy infant.
 Considerations:
 Achieve and maintain a healthy body weight.
 Both underweight and overweight are associated with infertility
 Excess body fat in women disrupts menstrual regularity and ovarian hormone
production
 Mothers, both underweight and overweight, and their newborns faced increased
risks of complications.
 Weight Prior to Conceptions
o A woman’s weight prior to conception influences fetal growth.
o Underweight
 High risk of having a low-birthweight infant
 Higher rates of preterm births and infant deaths
 Weight gain during pregnancy
 All pregnant women must gain weight
 Maternal weight gain during pregnancy correlates closely
with infant birthweight, which is a strong predictor of the
health and subsequent development of the infant.
Pre-pregnancy Weight Recommended Weight Gain
BMI Pounds (lbs) Kilograms (kg)
Underweight <18.5 28-40 12.5-18.0
Healthy weight 18.5-24.9 25-35 11.5-16.0
Overweight 25-29.9 15-25 7.0-11.5
Obese >=30 15 minimum 6.8 minimum
Considerations:
 Adolescents should strive for gains at the upper end of the
target range
 Short women (5ft2in under) should strive for gains at the
lower end of the target range
 Women carrying twins should aim for a weight gain of 35-45
lbs.
 If a woman gains more than what is recommended early in
pregnancy, she should not restrict her energy intake later in
order to lose weight.
  A large weight gain over a short time may indicate excessive
fluid retention and may be the first sign of pre-eclampsia.
 Weight patterns:
o Weight gain ideally follows a pattern of 3 ½ pounds
during the first trimester, 1 lb per week thereafter
o Overweight an Obesity
 High risk of medical complications such as hypertension, gestational
diabetes, and postpartum infections.
 Higher risk for complications during labor and delivery, especially
since babies from overweight/obese women are likely to be large.
 Obesity may double the risk for neural tube defects.
 Greater risk of giving birth to infants with heart defects and other
abnormalities
 Weight loss during pregnancy
 Never advisable
 Try to achieve a healthy body weight before becoming
pregnant, avoid excessive weight gain during pregnancy,
and postpone weight loss until after child birth.
 Weight loss after pregnancy
 The typical woman does not return to her pre-pregnancy
 In general, the more weight a woman gains beyond the
needs of pregnancy, the more she retains.
 When the BMI increases by a unit or more, complications
such as diabetes and hypertension in future pregnancies as
well as chronic diseases in later life can increase, even for
women who are not overweight
 Choose an adequate and balanced diet
 Malnutrition reduces fertility and impairs the early development of an infant should
a woman become pregnant
 Be physically active
 Healthy pregnant women should incorporate 30 minutes or more of moderately
intense physical activity on most, if not all, days of the week and avoid activities
with a high risk of falling or abdominal trauma
 A woman who wants to be physically active when she is pregnant needs to become
physically active beforehand.
 An active, physically fit woman experiencing a normal pregnancy can continue to
exercise throughout pregnancy, adjusting the duration and intensity of activity as
the pregnancy progresses.
 Benefits of exercise – Improve fitness, prevent or manage gestational diabetes,
facilitate labor, and reduce stress.
 Participate in low-impact activities and avoid sports in which you may fall or be hit
by people or objects
Exercise Guidelines during Pregnancy
DO’s DON’T’s
  Begin exercise gradually
 Exercise regularly (most, if
not all, days of the week)
 Warm up with 5-10
minutes of light activity
 30 minutes or more of
moderate physical activity;
20-60 minutes of more
intense activity on 3-5 days
a week will provide greater
benefits
 Cool down with 5-10
minutes of slow activity
and gentle stretching.
 Rest adequately
 Exercise vigorously
after long periods of
inactivity
 Exercise in hot, humid
weather
 Exercise when sick with
fever
 Exercise while lying on
your back after the first
trimester of pregnancy
or stand motionless for
prolonged periods
 Exercise if experience
any pain, discomfort, or
fatigue
 Participate in activities
that may harm the
abdomen or involve
jerky, bouncy
movements.

 Receive regular medical care

 Regular health care visits can help ensure a healthy start to pregnancy.
 Manage chronic diseases
 Diseases such as diabetes, HIV/AIDs, PKU, and sexually transmitted diseases can
adversely affect a pregnancy and need close medical attention to help ensure a
healthy outcome.
 Avoid harmful influences
 Both maternal and paternal ingestion of harmful substances (such as cigarettes,
alcohol, drugs, or environmental contaminants) can cause abnormalities, alter genes
and their expression, and interfere with fertility

o Dietary Guidelines for the Pre-Pregnant

 Women of childbearing age who may become pregnant should eat foods high in heme-iron
and/or consume iron-rich plant foods or iron-fortified foods with an enhancer of iron
absorption, such as Vitamin-C rich foods
 Consume synthetic folate daily from fortified foods or supplements in addition to naturally
occurring folate from a variety of foods.
 Women in their first trimester of pregnancy should consume adequate synthetic folate daily
from fortified foods or supplements in addition to naturally occurring folate from a variety
of foods.
 Folate Supplementation – Folate supplements taken one month before conception
and continued throughout the first trimester can help support a healthy pregnancy,
prevent neural tube defects, and reduce the severity of those that do occur.
o 400 microgram (0.4 mg) or folate daily
 o Most over-the-counter multivitamin supplements contain 400 micograms of
folate. Pre-natal supplements usually contain at least 800 mg.

 Energy and Nutrient Needs During Pregnancy

Nutrient
Energy  Energy needs of a pregnant women are greater than those
of non-pregnant women
 Additional 300 kcal per day during the second trimester, and
500 kcal per day during the third trimester
 Choose nutrient dense selections (eg. Whole grain breads
and cereals, legumes, dark green vegetables, citrus fruits,
low-fat milk and milk products, lean meats, fish, poultry,
eggs)
 Ample carbohydrates (175 g or more per day) is necessary to
fuel the fetal brain
 Sufficient carbohydrate ensures that the protein needed for
growth will not be broken down and used to make glucose
Protein  +25 g per day
 Select meats, milk products, and protein-containing plant
foods such as legumes, whole grains, nuts and seeds.
 Avoid use of high-protein supplements during pregnancy as
it can be harmful to the infant’s development
Essential Fatty Acids  PUFA is particularly important to the growth and
development of the fetus
Folate  Best to obtain folate through a combination of supplements,
fortified foods, and a diet that includes fruits, juices,
vegetables, and whole grains.
B12 Vitamins  Modest amounts of meat, fish, eggs, or milk products
together with body stores easily meet
 Facilitates folate absorption
Iron  Support their enlarged blood volume and to provide for
placental and fetal needs.
 Few women enter pregnancy with adequate iron stores, so a
daily iron supplement is recommended during the second
and third trimesters for all pregnant women.
 To enhance iron absorption, the supplement should be
taken between meals or at bed-times and with liquids other
than milk, coffee, or tea which inhibit iron absorption.
Vitamin C  Vitamin C enhances absorption of iron in foods
 Helpful in preventing the premature rupture of amniotic
membranes
Zinc  Required for DNA and RNA synthesis, protein synthesis and
cell development.
 Routine supplementation is not advised
  Women taking iron supplements (more than 30 mg per day)
may need zinc supplementation because large doses of iron
can interfere with the body’s absorption and use of zinc.
Vitamin D  Plays a vital role in calcium absorption and utilization.
 Regular exposure to sunlight and consumption of Vitamin-D
fortified milk are usually sufficient to provide the
recommended amount of vitamin D during pregnancy
 Routine supplementation is not recommended because of
toxicity risk
Calcium  Calcium intakes for pregnant women typically fall below
recommendations.
 Pregnant women under age 25 who receive less than 600
mg of dietary calcium daily need to increase their intake of
milk, cheese, yoghurt, and other calcium-rich foods.

Nutrient Supplementation
o Pregnant women who make wise food choices can meet most of their nutrient needs,
with the possible exception of iron.
o Pre-natal supplements, which physicians mostly prescribed, contain greater amounts of
folate, iron, and calcium then regular vitamin-mineral supplements.
o Supplements are beneficial for women who do not eat adequately and for those in high-
risk groups (those carrying multiple fetuses, cigarette smokers, alcohol and drug abuse)
o Helps reduce the risk of preterm delivery, low infant birthweights, and birth defects.

Strategies to Alleviate Maternal Discomforts:

o To alleviate the Nausea of Pregnancy
 Eat dry toast or crackers
 Chew gum or suck hard candies
 Eat small frequent meals
 Avoid foods with offensive odors
 When nauseated, drink carbonated beverages instead of citrus juices, water,
milk, coffee or tea
o To prevent or alleviate constipation
 Eat foods high in fiber (fruits, vegetables, and whole-grain cereals)
 Exercise regularly
 Drink at least 8 glasses of liquids a day
 Respond promptly to the urge to defacate
 Use laxatives only as prescribed by a phsycian
o To prevent or relieve heartburn
 Relax and eat slowly
 Chew food thoroughly
 Eat small frequent meals
 Drink liquids between meals
 Avoid spicy or greasy foods
 Sit up while eating, elevate the head while sleeping
  Wait an hour after eating before lying down
 Wait two hours after eating before exercising

Foods to Avoid
o Alcohol
o Medicinal Drugs
o Herbal Supplements
o Smoking
o Environmental contaminants (inc. mercury)
 Avoid shark, swordfish, king makarel, and tilefish
 Limit average weekly consumption to 12 ounces (cooked or canned) of seafood
or to 6 ounces (cooked or can) of white (albacore) tuna
 Supplements of fish oils are not recommended because they may contain
concentrated toxins and because their effects on pregnancy remain unknown