Pocket ObGyn – Nutrition in Pregnancy
See Abbreviations
Weight Management
- Caloric intake: Encourage balanced
1st trimester: No additional caloric intake from baseline
2nd trimester: 340 kcal/d from baseline
3rd trimester: 452 kcal/d from baseline
| Recommended weight gain during pregnancy by BMI | ||
| Category | BMI | Weight gain |
| Underweight | <18.5 kg/m2 | 12.7–18 kg (28–40 lb) |
| Nml weight | 18.5–24.9 kg/m2 | 11.3–15.8 kg (25–35 lb) |
| Overweight | 25–29.9 kg/m2 | 6.8–11.3 kg (15–25 lb) |
| Obese | ³30 kg/m2 | 0.45–9.1 kg (11–20 lb) |
- Obesity in Preg: complications w/ Encourage preconception weight loss. Preg is high-risk period for excessive weight gain ® long-term obesity. Nutrition consultation: Encourage adherence to 0.45–9.1 kg (11–20 lb) weight gain. Pregnant women w/ BMI >30: rates of GHTN, preeclampsia, gestational diabetes, macrosomia, & cesarean deliv. Consider HbA1C or early GLT for pre-existing diabetes.
- Exercise in Preg: ACOG recommends ³30 min of mod daily exercise. Avoid activities w/ high risk for abdominal trauma (eg, horseback riding, skiing/ snowboarding), or Scuba Terminate exercise w/ bleeding, preterm labor, ¯ FM, LOF, chest pain, dizziness, dyspnea prior to exertion. Absolute contraindications to exercise: Heart or lung dzs, incompetent cervix, multi gest,VB, placenta previa, pregnancy-induced HTN, rupture of membranes (Int J Gynaecol Obstet 2002;77:79).
Food Warnings
- Methylmercury: High levels can cause CNS damage & mild dysfxn in Avoid: Shark, swordfish, king mackerel, or tilefish. Limit albacore tuna to 6 oz/w. Encourage 12 oz (~2 servings) of low mercury fish weekly.
- Caffeine: Mod consump safe (<200 mg/d). One 8 oz coffee = ~95 mg Mod (<200 mg/d) consump not a/w miscarriage (Am J Obstet Gynecol 2008;198:279). No clear evid for caffeine risk of IUGR (JAMA 1993;269:593).
- Vit A: Limit to 750 mg/d (Lancet 2010;375:1640). Deficiency common in developing Supplements improve night blindness & anemia w/o teratogenicity.
>3000 mg/d (10000 IU) ® fetal malformations.
- Food-borne illness: Encourage good hand hygiene & thorough cooking Listeriosis: Processed meats, soft cheeses, meat spreads, & pate. Brucellosis: Unpasteurized milk & cheese made from raw milk. Toxoplasmosis: Undercooked meats & contaminated vegetables > cat
- Pica: Consuming nonfood substances (J Am Diet Assoc 1991;91:34). More common in Avoid pica & screen for iron-deficiency anemia (unclear mech). Can ® lead tox or infectious dz (esp developing settings).
Nutrients in Pregnancy
| Macroand micronutrients in pregnancy | |||
| Nonpregnant | Pregnant | Comments | |
| Prot | 0.8 g/kg/d | 1.1 g/kg/d | Vegetarian women may be advised to supplement specific amino acids not found in vegetable prot sources |
| Carbs | 130 g/d | 175 g/d | |
| Iron | 15 mg/d | 30 mg/d | If anemic, need btw 30 & 120 mg daily |
| Calcium | 1000 mg/d | 1000 mg/d | Body mobilizes calcium stores in Preg so
intake generally not needed. |
| Folic
acid |
0.4 mg/d
preconception |
0.4–4 mg/d | See Folic acid below |
- Folic acid: ¯s NT forms during week 4 of gest ® start folate prior to Preg. Low-risk women, use 0.4 mg/d (common dose in prenatal vitamins). Women w/ h/o NTD in prior Preg ® 4 mg/d (72% ¯ in recurrence risk). If on antiepileptic drugs, also folate dose.
- Vit D: Deficiency common in Preg (newborn levels dependent on mat levels), esp vegetarians, limited sun exposure, & dark-skinned Deficiency = 25-OH-D
< 20. No routine screening for Vit D in Preg. Suppl w/ 1000–2000 IU/d (Obstet Gynecol
2011;118:197).