NUTRITION

DURING
PREGNANCY
Obstetrical Physical Exam
• Low pre-pregnancy weight and low
maternal weight gain are risk factors for:
• Intrauterine growth retardation
• Low birth weight baby
• Increased incidence of perinatal death

• Need to asses:
• Pre-pregnancy weight (BMI)
• Current weight (BMI)
• Weight gain from previous visit
Recommended Weight Gain
BMI Weight (kg) Weight Gain Weight Gain
Height (m2) (kg) (lbs)
Underweight
12.7-18.2 28-40
BMI < 18.5
Normal Weight
11.4-15.9 25-35
BMI 19-24.9
Overweight
6.8-11.4 15-25
BMI 25-29.9
Obese
6.8 <15
BMI > 30.0
Nutritional Needs
During Pregnancy
Energy (Calorie) Needs
Dietary Recommended Intake : 2500 kcal

-sustain an elevated metabolic rate from increased thyroid

function and increased workload from extra wt. she must
carry

Inadequate intake: Protein breakdown for energy,

depriving a fetus for essential protein may lead to
ketoacidosis
Obtain calories from complex carbohydrates (cereals and
grains) rather than simple carbohydrates (sugar and fruits)
because these are more slowly digested to help regulate
glucose and insulin levels.

A pregnant woman needs to add calories by eating foods rich

in protein, iron and other essential nutrients rather than eating
more fast-food, empty-calories foods (pretzels and
doughnuts).

Suggest preparing foods such as carrot sticks or cheese and

crackers early in the day

Source: Bread, Beans, Potato, Rice

 Protein Needs
DRI during pregnancy: 71 g/d

- amino acids from protein becomes the basic building blocks

of cells

Best supplied by meat, poultry, fish, yogurt, eggs, and milk

From complementary proteins: beans and rice, legumes and
rice or beans and wheat

Women with hypercholesterolemia: probably should not eat

more than 2-3 eggs per week because of high cholesterol
content of eggs
Encourage women to:

Eat lean meat, to cook with olive oil instead of butter

Remove skin from poultry to remove its fat content

Pregnant women should not eat bologna or salami because

their protein content may not be high but their fat content is
Milk is also a good source of protein  Yogurt or cheese
May be incorporated into custards, eggnogs, or cream
soups

Others cannot drink milk because they are Lactose

intolerant: Add lactase supplement, buy lactose-free milk, or
take a calcium supplement

Source: Cheese, Milk, Fish, Potato, Soya bean meat, eggs

and nuts
Vitamin Needs
Vitamin D: essential for calcium absorption

DRI: 5 g/d
When lacking, can begin to diminish both fetal and maternal
mineral bone density
If woman is housebound, be certain that she is taking a
prenatal vitamin containing vit. D

Source: salmon, mackerel, egg yolk and milk

Cheese, liver, and fortified margarine

The skin can synthesize vitamin D if exposed to enough

sunlight on a regular basis
Vitamin A
DRI: 750 g/d

Lack of vit. A results in tender gums and poor night vision.

Infection resistance and fat metabolism

Intake of excessive vit. A in the form of isotretinoin

(Accutane), a medication prescribed for acne, causes
congenital anomalies

Source: mango, salmon, carrot, spinach, broccoli, squash,

sweet potatoes, pumpkin, and in animal sources such as
liver, milk, butter, cheese, and whole eggs
•Caution women to avoid taking megadoses of vitamins

Maternal overdosage can cause fetal toxicity

Megadoses of vit. C may cause withdrawal scurvy in infant at

birth – stored in the body rather than excreted
Folic Acid B12
DRI: 600 g/d

Found in fresh fruits and vegetables

Grain products such as bread, rice, pasta are enriched with
folic acid

Necessary for red blood cell formation; prevents neural tube

defects

Without adequate folic acid, a megaloblastic anemia (large but

ineffective red blood cells) may develop

Should take prenatal vitamin that contains a folic acid

supplement of 0.4 to 1.0 mg
Mineral Needs
Calcium and Phosphorus

Both for bone formation

Pregnant women need to eat foods high in calcium and vit. D

(necessary for calcium to be absorbed form gastrointestinal tract and
to enter bones)

Calcium DRI: 1300 mg/d

If a woman cannot drink milk or milk products (cheese), she can be

prescribed a daily calcium supplement

Calcium sources: dairy products, broccoli, cabbage, tofu, sardines

Phosphorus

DRI: 700 mg/d

Phosphorus sources: milk, grains, lean meats

Most foods high in protein are also high in phosphorus

Inadequate calcium intake will result in diminished maternal

bone density

Adequate calcium intake during pregnancy: fetus will receive

needed calcium for growth and mineralization of the fetal
skeleton
Iodine
DRI: 220 g/d
Essential for the formation of thyroxine and, therefore for the
proper functioning of thyroid gland

If iodine deficiency occurs, can cause hypothyroidism and

thyroid enlargement (goiter) in women

In extreme cases, can cause the same symptoms in fetus

Thyroid enlargement in a fetus at birth is serious because the
increased pressure of the enlarged gland on the airway could
lead to early respiratory distress
If not discovered at birth, hypothyroidism may lead to the
infant’s being cognitively challenged

Maternal iodine deficiency has long been recognized as a

cause of neonatal cretinism

Seafood is the best source of iodine

It is also suggested that women use iodized salt rather than

plain salt to ensure a healthy iodine intake
Iron
DRI: 27g

A woman needs to build an increased red cell volume for

herself and to protect against iron lost in blood at birth

Maternal anemia, defined by a hematocrit of less than 32 %

and a haemoglobin level of less than 11 g/dl

A female with anemia poorly tolerates hemorrhage during

childbirth and is more prone to puerperal infection

Inadequate iron consumption leads to poor haemoglobin

production and resulting compromised oxygen delivery to
uterus, placenta, and developing fetus
Dietary supplementation with 15 mg iron per day helps ensure
that adequate iron is ingested and absorbed
–to supplement not to replace

Iron-rich foods: organ meats, eggs, green leafy vegetables,

whole grains, enriched breads, dried fruits, fish

Iron absorption increases in an acid environment, so eating

iron-rich foods or swallowing iron pills with ascorbic acid
(orange juice) may increase absorption
Oral iron compounds turn stools black or blackish green. The
compounds can be irritating to the stomach or cause
constipation in some women.

If this happens, urge women not to stop taking the iron

compound but to always take the iron pills with food and
increase fluid intake or fiber to relieve constipation

Some may need a prescribed stool softener such as docusate

sodium (Colace)
Fluloride
Aids in the formation of sound teeth, a pregnant woman
should drink fluoridated water

Supplemental fluoride may be recommended

Fluoride in large amounts causes brown-stained teeth, so a

woman should not take the supplement more often than
prescribed

DRI: 3 mg/d
Sodium
Major electrolyte that acts to maintain fluid in the body

When sodium is retained rather than excreted by the kidneys,

an equal or balancing amt. of fluid is also retained
retaining enough fluid during pregnancy allows optimal
exchange of nutrients across the placenta

Unless a woman is hypertensive or has heart disease with

required sodium restriction when she enters pregnancy, she
should continue to add salt to foods
Moderation – too much salt could result in retention of
excessive amounts of fluid, putting a strain on her heart as
blood volume doubles

Source: table salt, baking soda, monosodium glutamate

(MSG), meat, fish, poultry, dairy foods, eggs, smoked meats,
olives, and pickled foods
Zinc
DRI: 12 mg/d
Necessary for synthesis of DNA and RNA

Promotes cell growth, helps to enhance body immunity

Zinc deficiency may be associated with preterm birth

Most people who take in adequate protein also take in adequate

zinc because zinc is contained in foods such as meat, liver, eggs,
and seafood

Source: wheat, oysters

Fluid Needs
Extra amounts of water are needed to promote kidney
function because a woman must excrete waste products for
two

2-3 glasses of fluid daily over and above three servings of milk
recommended by the food pyramid

(a total of 6-8 glasses daily)

Fiber Needs
DRI: 28 g/d

Constipation can occur during pregnancy from slowed

peristalsis because of the pressure of the uterus on the
intestine

-natural way of preventing constipation because the bulk of the

fiber left in the intestine aids evacuation

Fiber also has the advantage of lowering cholesterol levels and

may remove carcinogenic contaminants from the intestine

Good source: broccoli, asparagus

apples, oranges, carrots, cauliflower, green beans, potatoes
FOODS TO AVOID OR
LIMIT IN PREGNANCY
Excess seafood
Women should eat up to 12 ounces (2 to 3 meals) of seafood
or shellfish a week for their omega-3 and iodine content

Fish – shark, swordfish, king mackerel, tilefish are high in

mercury contamination, must be avoided.

Low in mercury are shrimp, canned light tuna, salmon and

catfish
 Caffeine
It is a central nervous system stimulant capable of increasing
heart rate, urine production in the kidney, and secretion of acid
in the stomach

Daily intake of 2-3 cups of coffee has not associated with low
birth weight but drinking over three cups is associated with
early miscarriage

To limit it, women may need to limit the amount of coffee they
drink but also the other sources of caffeine—chocolate, soft
drinks, and tea
If she has difficulty omitting it, she still can reduce the caffeine
she ingests

A good example is the decaffeinated coffee, contains almost

no coffee

The longer the tea brews, the greater is the caffeine content.

Green tea has less caffeine than black tea

Encourage women to choose caffeine-free types

Artificial Sweeteners
-used to improve the taste and to limit the caloric content of
foods

The use of saccharine is not recommended—because it is

eliminated slowly from the fetal bloodstream

In any event, pregnant women need carbohydrates furnished

by sugar rather than by artificial sweeteners
Weight Loss Diets
Weight reduction is not healthy during pregnancy

Liquid reducing drugs are particularly contraindicated because

they may lead to fetal ketoacidosis and poor growth

They may have few nutritional stores and additional vitamin

supplementation may be necessary
Alcohol
Fetal Alcohol Syndrome

Drugs
Over-the-counter drugs

Tobacco
Cigarette smoking
Low birth weight, SGA,
Relief from Common
Discomforts During
Pregnancy
Nausea and Vomiting
- Associated with increased levels of HCG
Peaks at 12 weeks gestation

Strategies for managing morning sickness:

Eat small, frequent meals

Drink fluids between rather than with meals

Avoid fried and greasy foods

Dry toast or eat crackers early in the morning

Heartburn
Cause:

- In late pregnancy, when fetus rapidly grows in size, the

uterus pushes up against the stomach, which may cause a
feeling of fullness in the mother.

- Additionally, because of the progesterone (which may

cause relaxation of smooth muscles), a relaxation of
gastroesophageal sphincter may occur, resulting in some
reflux of gastric contents into the lower esophagus.
Strategies for managing heartburn:

Eating small, frequent meals

Avoiding foods high in fat

Drinking fluids between rather than with meals

Limiting spicy foods

Avoiding lying down for 1 or 2 hours after eating

Wearing loose-fitting clothing around the abdomen

Constipation
- During the first trimester, progesterone (which slows GI
motility) may be responsible

- In third trimester, the growing fetus crowds the other

internal organs, again possibly slowing GI motility

Strategies for managing constipation:

Intake of fiber (grain cereals, fresh fruits)

Moderate exercise such as daily walk