Nutrition in Pregnancy

Nutrition in pregnancy significantly affects maternal health and infant size and well-being. Pregnant women should have nutrition counseling early in prenatal care and access to supplementary food programs if necessary. Counseling should stress abstention from alcohol, smoking, and recreational drugs. Caffeine and artificial sweeteners should be used only in small amounts. "Empty calories" should be avoided, and the diet should contain the following foods: protein foods of animal and vegetable origin, milk and milk products, whole-grain cereals and breads, and fruits and vegetables - especially green leafy vegetables.

Weight gain in pregnancy should be 20-40 lb, which includes the added weight of the fetus, placenta, and amniotic fluid and of maternal reproductive tissues, fluid, blood, increased fat stores, and increased lean body mass. Maternal fat stores are a caloric reserve for pregnancy and lactation; weight restriction in pregnancy to avoid developing such fat stores may affect the development of other fetal and maternal tissues and is not advisable.

Obese women can have normal infants with less weight gain (15-20 lb) but should be encouraged to eat high-quality foods. Normally, a pregnant woman gains 2-5 lb in the first trimester and slightly less than 1 lb/wk thereafter. She needs approximately an extra 200-300 kcal/d (depending on energy output) and 30 g/d of additional protein for a total protein intake of about 75 g/d. Appropriate caloric intake in pregnancy helps prevent the problems associated with low birth weight.

Rigid salt restriction is not necessary. While consumption of highly salted snack foods and prepared foods is not desirable, 2-3 g/d of sodium is permissible. The increased calcium needs of pregnancy (1200 mg/d) can be met with milk, milk products, green vegetables, soybean products, corn tortillas, and calcium carbonate supplements.

The increased need for iron and folic acid should be met from foods as well as vitamin and mineral supplements. (See section on anemia in pregnancy.) Megavitamins should not be taken in pregnancy, as they may result in fetal malformation or disturbed metabolism. However, a balanced prenatal supplement containing 30-60 mg of elemental iron, 0.5-0.8 mg of folate, and the recommended daily allowances of various vitamins and minerals is widely used in the United States and is probably beneficial to many women with marginal diets. There is evidence that periconceptional folic acid supplements can decrease the risk of neural tube defects in the fetus. For this reason, the United States Public Health Service recommends the consumption of 0.4 mg of folic acid per day for all pregnant women (and thus all women capable of becoming pregnant). Women with a prior pregnancy complicated by neural tube defect may require higher supplemental doses as determined by their providers. Lactovegetarians and ovolactovegetarians do well in pregnancy; vegetarian women who eat neither eggs nor milk products should have their diets assessed for adequate calories and protein and should take oral vitamin B12 supplements during pregnancy and lactation.