Pregnancy and Lactation 2Nutrition during pregnancy has a threefold goal: to provide for the mother’s nutritional needs, contribute to a healthy development and birth of the newborn, and prepare for an adequate lactation period. 1,2 Dietary recommendations around the world principally advocate an appropriate micronutrient intake and a balanced energy intake. On the food intake level, this translates to a high focus on nutrient-dense foods throughout pregnancy.

Balanced energy intakes

One of the aspects generally considered is a balanced energy intake. Worldwide, nutrition authorities recommend a modest increase in energy intake (on average around 275 kcal/day) throughout the pregnancy, sufficient for an optimal birth and maternal outcome (table 1).3-6 A significantly increased intake is recommended from the second half/third trimester of the pregnancy and onwards.

Table 1: Overview of additional energy intake recommendations during pregnancy, worldwide (FAO), in Europe (EFSA), the US (IOM) and Japan

Kcal/day FAO/WHO/UNU3 EFSA4 IOM5 Japan6
1st trimester 85 70 0 50
2nd trimester 285 260 340 250
3rd trimester 475 500 452 500


Weight gain guidelines

Additional energy needs during pregnancy are modest, and health care professionals recommend appropriate weight gain in their dietary advice. The latest US Institute of Medicine (IOM) re-examination of weight gain guidelines states that a pregnancy weight gain between 11.5-16 kg for normal weight women is ideal for optimal maternal and birth outcomes. Pre-pregnancy weight and multiple gestation influence the advice on weight gain (see table 2).7

Table 2: IOM-recommendations for total weight gain during pregnancy by pre-pregnancy BMI7

Pre-pregnancy BMI (kg/m2) Total weight gain range (kg) – single gestation Total weight gain range (kg) – twin gestation
Underweight (<18.5) 12.5-18 N/A
Normal weight (18.5-24.9) 11.5-16 17-24.5
Overweight (25.0-29.9) 7.0-11.5 14-22.5
Obese (>30.0) 5.0-9.0 11.5-19


Food based recommendations

Food based recommendations during pregnancy focus on providing an appropriate amount and variety of nutrient-dense foods from the basic food groups, such as fruits and vegetables, starchy foods, lean protein foods and dairy (table 3).8,9 These foods contribute to important nutrients such as folate and vitamin C (fruit and vegetables), fibre and various B-vitamins (whole grains), calcium and vitamin B12 (dairy products), iron and vitamin B12 (meat).1 As excessive weight gain should be avoided, foods providing mainly calories without nutrients (empty calories) should be discouraged. A variety of nutrient-dense foods provides the necessary nutrients during pregnancy and should therefore form an integral part of the recommended maternal diet.

A recent review of dietary guidelines for pregnancy concludes that these recommendations are adequate for healthy women with normal nutrient requirements, and should only be adapted for women with specific nutritional needs.2

Table 3: Overview of dietary recommendations during pregnancy for nutrient-dense foods at a global (WHO) as well as local (US, UK, Singapore) level

Portions/day United States1 United Kingdom8 Singapore9 WHO10
Grains and potatoes 8-9 Every meal 6-7 6-11
Fruit 2 >5 2 5
Vegetables 3 3
Dairy products 3 2-3  

3.5

3
Meat, fish, eggs, and protein alternatives 3 1-2 2


Foods to avoid

Food selection is important as recommendations often advise avoiding certain types of food, mainly to prevent adverse effects caused by bacteria, viruses or parasites. This includes avoiding raw milk and foods made from raw milk, raw, undercooked, or cold cured meat products and eggs, raw shellfish and fish, and unwashed fruits and vegetables. Health authorities also advise limiting or avoiding certain foods to safeguard the baby’s healthy development, including alcohol, vitamin A (liver products or liver oil supplements), and foods high in mercury (e.g. shark, swordfish and, to a lesser extent, tuna).1,8-10


References

  1. U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2010. Dietary Guidelines for Americans. U.S. Government Printing Office, Washington D.C., USA, 95pp.
  2. Jackson AA, Robinson SM. Dietary guidelines for pregnancy: a review of current evidence. Public Health Nutr. 2001 Apr;4(2B):625-30.
  3. FAO/WHO/UNU, 2004. Human energy requirements. Report of a Joint FAO/WHO/UNU Expert Consultation: Rome, 17–24 October 2001. FAO food and nutrition technical report series, 103 pp.
  4. EFSA Panel on Dietetic Products, Nutrition and Allergies. Scientific Opinion on Dietary Reference Values for energy. EFSA Journal 2013;11(1):3005.
  5. Institute of Medicine, 2005. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (Macronutrients). National Academies Press, Washington D.C., USA, 1357 pp.
  6. Sasaki S. Dietary Reference Intakes (DRIs) in Japan. Asia Pac J Clin Nutr 2008;17 Suppl 2:420-44.
  7. Institute of Medicine/National Research Council, 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. National Academies Press, Washington D.C., USA, 854 pp.
  8. National Health Service. A healthy diet in pregnancy. Webpage updated on 31 January 2013.
  9. Health Promotion Board. Pregnancy and diet. Webpage updated on 16 May 2013.
  10. World Health Organization Regional Office for Europe. Healthy Eating during Pregnancy and Breastfeeding. Booklet for mothers. 2001.