Adolescent Pregnancy and
Nutritional Risks
CFS 453
Nicole Azurin, Babak Maknoon, Nicole Karetov, &
Yanira Velazquez
March 17, 2014
Instructor: Kathrin Spoeck
Abstract
Pregnant adolescents are at a higher nutritional risk than the average pregnant
woman. A literature review was conducted that discussed various nutrition risks
associated with adolescent pregnancy. Topics that were reviewed included energy,
protein, calcium, iron and sugar intake and its relation to adolescent pregnancy. Through
this research, it was found that there is an increased need in energy, protein, calcium, and
iron intake. It was also found that adolescents consume a significant amount of sugar per
day. Recommendations include increased intake of energy, protein, calcium and iron, as
well as decreased consumption of sugar. Nutrition education should focus on motivating
the mother to make a dietary behavioral change for her and her baby.
Introduction
In 2011, a total of 329,797 babies were born in the United States to pregnant
adolescents aged 15 to 19 (Martin, Hamilton, Ventura, Osterman, & Matthews, 2013).
Pregnant adolescents are a population at high nutritional risk and require distinctive care
from clinicians. Physiologically, the fetus’ nutritional needs become secondary to the
growing mother. This can result in several negative pregnancy outcomes such as low
birthweight, cephalopelvic disproportion, and delayed educational achievement (Brown
& Isaacs, 2011). Maintaining proper nutritional status throughout pregnancy can reduce
negative pregnancy outcomes and promote overall health for both the adolescent and
fetus.
While the majority of nutrition recommendations are similar for pregnant
adolescents and adults, several nutritional concerns differ in the pregnant adolescent
population. Pregnant adolescents require an increased energy intake to support both their
own growth and fetus’ growth. Paying proper attention to the composition of their calorie
intake is crucial to prevent the deficiency of any essential nutrients. Pregnant adolescents
require increase intake of calcium to promote fetal and adolescent bone mineralization
and increased iron intake to support blood volume expansion. These requirements may be
more difficult for certain adolescents to achieve depending on their socioeconomic status.
Female adolescents in the United States generally consume high amounts of protein, and
may not need to consume additional sources during their pregnancy. Adolescents may
consume higher amounts of simple sugars during pregnancy and monitoring sugar intake
can help to prevent negative fetal outcomes like neural tube defects.
Review of Literature
Pregnant adolescents require additional energy to support their own growth, in
addition to supporting the growth of the fetus (Brown & Isaacs, 2011). However, the
nutrient composition of their diet is more important to ensure favorable fetal outcomes. A
study by Lee, et al. (2014) examined dietary intake of 156 pregnant adolescents under 18
years old. This study found that over 70% of subjects consumed suboptimal levels of
magnesium, iron, vitamin D, and vitamin E, despite the fact that they all consumed
adequate or excessive energy. This indicates that subjects may have been consuming a
calorically dense diet. Several factors may play a role in pregnant adolescents choosing
calorically dense foods instead of nutrient dense foods, such as taste cravings,
convenience, and food insecurity. Promoting a nutrient-dense diet may also help to
prevent excessive weight gain during pregnancy.
Protein needs generally increase with all pregnancies to support fetal growth.
However, the average protein intake for a non-pregnant adolescent in the United States is
nearly double the recommended intake (Stang, Story, & Feldman, 2005). Therefore,
consuming adequate protein is not as high of a nutritional concern.
Daily calcium needs are about 300 mg higher in adolescent pregnancies than adult
pregnancies (Brown and Isaacs, 2011). Extra calcium is required to support both the
teen’s and fetus’s bone formation. An estimated 25g to 30g of calcium is transferred to
the fetus during pregnancy (Lee, et al., 2014). Although calcium is found in a variety of
foods, consuming dairy products specifically may provide additional support in fetal
health. A study by Chan, McElligott, McNaught and Gill (2006) found that pregnant
adolescents consuming dairy products had higher serum Vitamin D levels, increased fetal
bone mineralization, and higher fetal weight than those consuming calcium from fortified
orange juice and vegetables. These subjects also had higher serum folate levels than the
fortified orange juice and vegetable group. Dairy products may support overall fetal and
teen bone development because they are also fortified with Vitamin D. Maintaining
proper calcium and Vitamin D status during pregnancy may also help prevent
hypertensive disorders such as preeclampsia (Brown and Isaacs, 2011).
Maintaining proper iron status is crucial to support the increased volume of blood
that accompanies pregnancy. Pregnant adolescents are at greater risk for developing iron
deficiency anemia due to several factors. Iron deficiency is a standard nutritional concern
in adolescents that are not pregnant. According to NHANES III Data, 9% of nonpregnant 12-25 year old girls had iron deficiency, with an additional 2-3% having irondeficiency anemia (Stang, Story, & Feldman, 2005). If pregnant, consuming adequate
iron through supplementation and dietary intake is needed to support fetal growth, blood
volume expansion, and the needs of the adolescent mother. The differing socioeconomic
statuses of adolescent mothers may also place them at higher risk for iron deficiency.
Rates of iron deficiency are highest in the third trimester, averaging 27.5% for the general
population and 34% for the low-income population served by WIC (Brown and Isaacs,
2011). Generally, a pregnant adolescent may have a lower income than a pregnant adult,
placing her at higher risk for iron deficiency.
Monitoring sugar consumption is of high nutritional concern in all pregnancies
due to the risk of developing gestational diabetes and other negative fetal outcomes. For
example, a study by Shaw, et al. (2004) found that consuming a high amount of simple
sugars and high glycemic foods was associated with a 2-fold increase in the chance of
neural tube defects, even with proper folate status. In addition, this risk increased to 4fold if the mother’s BMI was greater than 29. This relates to adolescent pregnancies, as
adolescents in general may have a higher consumption of simple sugars through sugar
sweetened beverages. In a study for the Center for Disease Control, researchers found
that females aged 12-19 years consumed 171 kilocalories per day from sugar drinks
(Ogden, Kit, Carroll, & Park, 2011). Pregnant adolescents may need additional
counseling on sugar intake to reduce the risks of developing these negative fetal
outcomes.
Discussion
From the review of literature it was found that compared to a pregnant adult,
pregnant adolescents have certain needs that are required in a nutrition intervention.
Pregnant adolescents have an increased energy needs to support fetal growth and their
own biological immaturity. The clinician should emphasize the importance of consuming
nutrient-dense foods as opposed to calorically-dense foods. If a pregnant adolescent is
consuming a calorically-dense diet, she may have an excessive energy intake while still
being deficient in essential nutrients that will impact fetal outcome. Convenience, food
access, and cravings may play a role in a pregnant adolescent choosing to eat caloricallydense foods. Education regarding convenient, affordable nutrient-dense foods can be
provided by the clinician. Similarly, education regarding adequate protein intake may not
be as high of a priority during nutritional counseling, as most adolescents consume higher
than adequate amounts. Sugar intake is a high priority nutritional problem in adolescent
pregnancy, to manage blood glucose levels and prevent any fetal damage that may result
from a lack of management.
Education regarding micronutrient intake and supplementation is required in the
intervention. Calcium needs are significantly increased to support bone formation of the
fetus and mother and findings have shown that calcium sources from dairy products (as
opposed to calcium-fortified sources) increase Vitamin D levels, which also support
positive fetal outcome. Due to the differing rates of iron deficiency between low income
and middle income pregnant mothers, socioeconomic status can play a role in the access
to supplementation and education.
Recommendations
Adequate weight gain and sufficient nutrient intake is essential for adolescent
pregnant mothers to reduce the risk of preterm delivery, low birth weight and infant
mortality. All of these associated risks occur more frequently in teens than in older adult
pregnant women. The recommended weight gain for pregnant teenage mothers is similar
to the recommendations for older adult pregnant women, which is based on the body
mass index (BMI) of the individual. Pregravid weight is used to assess the BMI of the
individual. For underweight teens with a BMI less than 18, at least 5 pounds should be
gained during the first trimester with an additional 0.5- 1.75 pounds per week gained in
the second and third trimester. The total recommended weight gain is 28-40 pounds for
underweight teens. For those with a normal BMI of 18.5-24.9, 2 to 4 pounds should be
gained in the first trimester, with an additional 0.5-1.5 pounds per week gained in the
second and third trimester. In total, a weight gain of 25 to 35 pounds is recommended for
pregnant adolescents with a normal BMI. For overweight teens with a BMI of 25-29.9, a
two pound weight gain is recommended during the first trimester, and 0.5-1.0 pounds per
week in the second and third. By the end of their pregnancy, a total of 15 to 25 pounds
gained is best. Lastly, for obese teens with a BMI greater than 30, at least 1.5 pounds
during the first trimester should be gained with an additional 0.5 or more per week in the
second and third trimesters. A total of 11-20 pounds is recommended for pregnant obese
teens (Stang, Story, and Feldman, 2005). Appropriate rate of weight gain during
pregnancy is important for the adolescent mother to achieve for the optimum health of the
baby.
Energy needs are increased during pregnancy due to the formation of new tissues
and because the cardiovascular, respiratory and renal systems of the mother become more
actively involved. Calorie needs for pregnant teens are similar to older pregnant women,
but may be slightly higher to support both the growth of the baby as well as themselves
(Brown & Isaacs, 2011, p. 161). During the first twenty-two weeks of pregnancy, a
relatively small increase of 100-350 calories per day is sufficient (Stang, Story, and
Feldman, 2005). Towards the second trimester, an increase of 340 calories per day should
be consumed, and in the third trimester, an additional 452 calories per day should be
consumed. These recommendations reflect the dietary reference intake (DRI) for
pregnant women, which is used as a general guideline. The energy needs between
different pregnant women vary, and in the case of pregnant adolescents, additional energy
consumption should be slightly higher. Consuming a nutrient-dense diet is particularly
helpful to meet these increased energy needs, as well as help the teenage mother achieve
an appropriate weight gain.
In addition to an increased need for energy, protein needs are increased during
pregnancy as well. It is recommended that pregnant women, including adolescent
females, consume an additional 25 g of protein per day. However, prior to an
intervention, a diet analysis should be performed to determine whether the adolescent is
consuming adequate protein to support their pregnancy. Intake of other nutrients needs to
be monitored for a pregnant adolescent mother also. Calcium intake increases to 300 mg
per day to ensure healthy bone formation in both the fetus and in the mother, which can
be met by consuming four servings of milk or milk products daily in addition to a regular,
balanced diet (Brown & Isaacs, 2011). Furthermore, iron intake must be monitored
during pregnancy to reduce the risk of becoming iron deficient or developing iron
deficiency anemia. The recommended increase of daily iron intake is 27 mg per day for
pregnant teens (“Iron”, 2014). Supplementation of iron in addition to dietary intake may
be required for some adolescents to ensure they are meeting the minimum
recommendations.
Generally, teenagers consume a greater amount of added sugars in the diet,
primarily through consumption of sugar sweetened beverages. Pregnant teens should be
cautious of their sugar intake to prevent the risk for developing gestational diabetes or
other health risks such as neural tube defects. Nutrition education and counseling may be
required to teach about the limitation of sugar sweetened beverages and monitoring of
daily sugar intake.
Another recommendation would be to encourage adolescent mothers to enroll or
participate in a support program--there are various resources for adolescent mothers who
lack proper prenatal care. The federal program Women, Infants, and Children (WIC)
provides a Special Supplemental Nutrition Program for mothers who need nutrient-dense
foods in their diets. Programs like these are under-utilized, especially by those of low,
socioeconomic background. Therefore, there should be an increased awareness and
promotion of these programs, in order to increase positive health outcomes of teen
mothers and their infants. In particular, these programs may reduce the risk for lowbirthweight babies, preterm delivery, and infant mortality rates. In a pilot study
conducted by Flynn, Budd, and Modelski, Teen Parenting Partnership (TPP) program
was developed--the goal of this program was to increase pregnant adolescents’ use of
resources to ultimately increase their overall health and reduce risk (Flynn, Budd, &
Modelski, 2008). Researchers concluded that the TPP program effectively motivated
pregnant adolescents to utilize their resources for prenatal care. In addition to WIC and
TPP, there are a vast array of resources, especially in the city of San Francisco--programs
like Teenage Pregnancy and Parenting Program are targeted towards young
adolescent parents and provide health, educational, and social services (“Children,
Youth, and Family Services,” 2014). Taking all of these factors into consideration will
provide optimal health for the mother, as well as a safe delivery of a healthy baby.
References
Brown, J. E., & Isaacs, J. S. (2011). Nutrition through the life cycle (4th ed.). Belmont,
CA:
Wadsworth, CENGAGE Learning.
Chan, G. M., McElligott, K., McNaught, T., & Gill, G. (2006). Effects of dietary calcium
intervention on adolescent mothers and newborns: a randomized controlled trial.
Obstetrics & Gynecology, 108(3, Part 1), 565-571.
“Children, youth, and family services.” (2014). Retrieved March 16, 2014, from https://
www.fsasf.org/svc_childrenyouthfamily.html.
Flynn, L., Budd, M., & Modelski, J. (2008). Enhancing resource utilization among
pregnant
adolescents. Public Health Nursing, 25(2), 140-148.
"Iron." (2014). Dietary Supplement Fact Sheet: — Health Professional Fact Sheet.
Retrieved March 16, 2014 from http://ods.od.nih.gov/factsheets/IronHealthProfessional/#h7.
Ogden, C.L., Kit, B.K., Carroll, M.D., & Park, S. (2011). Consumption of sugar drinks in
the
united states, 2005-2008. National Center for Health Statistics. Retrieved from
http://www.cdc.gov/nchs/data/databriefs/db71.htm
Stang, J. , Story, M. , & Feldman, S. (2005). Nutrition in adolescent pregnancy.
International
Journal of Childbirth Education, 20(2), 4.
Shaw, G. M., Quach, T., Nelson, V., Carmichael, S. L., Schaffer, D. M., Selvin, S., &
Yang, W.
(2003). Neural tube defects associated with maternal periconceptional dietary
intake of
simple sugars and glycemic index. The American Journal of Clinical Nutrition,
78(5),
972-978.