Chapter 28
Nutritional Guidelines and Energy Needs
During Pregnancy and Lactation
Jacalyn J. Robert-McComb, PhD, Fellow
of the American College of Sports Medicine
Learning Objectives
Following this presentation, you should have an
understanding of:
 Energy requirements during pregnancy and lactation
 Nutritional guidelines during pregnancy and lactation
 Important nutrients, vitamins, and minerals for optimal
pregnancy/ infancy outcomes
 Importance of iron reserves prior to conception
 Folic acid supplementation
 Vitamin D deficiency in women with dark complexions
and limited sun exposure
Energy Requirements During
Pregnancy and Lactation

To estimate energy needs during pregnancy and
lactation, energy needs in non-pregnant state
must be computed using:
Age
 Weight
 Height gender
 Level of physical activity


Doubly labeled water studies conducted
Energy Requirements During
Pregnancy and Lactation Cont’


Energy needs in pregnancy increase 17% (about
300 kcal/day)
Multiple gestations need an additional 300 kcal
and 10 gram of protein per fetus
Total Weight Gain during Pregnancy
Normal
1st Trimester 2nd & 3rd
Total weight
Trimester
gain ranges
1.6 kg
0.44 kg/week 11-15 kg
Underweight 2.3 kg
0.49 kg/week 12.7 -18 kg
Overweight
0.30 kg/week 7-11 kg
0.9 kg
Nutritional Guidelines During
Pregnancy and Lactation

Essential nutrients, minerals, and vitamins
obtained in diet or supplementation
Protein 20% of diet
 Fat 30 % of diet
 Carbohydrates 50% of diet

Nutritional Guidelines During
Pregnancy and Lactation Cont’

Food pyramid:
6-11 servings fruit
 3-5 servings vegetables
 2-4 servings meats, beans, or nuts
 1 serving of sweets


Average recommendation is 2,500 kcal/day
Extra 300 kcal and 10 gm protein per fetus
 Extra calories needed for exercise


Supplementation may be needed
Healthy diet for pregnancy and lactation
includes key recommendations




Variety of nutrient-dense foods and beverages
Balanced eating pattern
Eat foods high in heme-iron and/or iron-rich
plant foods or iron-fortified foods with an
enhancer of iron absorption, such as vitamin Crich foods
Consume adequate synthetic folic acid daily
Importance of Iron Reserves Prior to Conception

Maternal anemia – hematocrit < 32% &
hemoglobin level < 11g/dl

Representative data from U.S. indicate:
5% non-pregnant women anemic
 17% increase of anemia among pregnant women
 33% pregnant women anemic in low socioeconomic
groups

Importance of Iron Reserves Prior to
Conception Cont’



During gestation - 300 mg of iron needed
reserves prior conception
Best outcome conditions when Hb between 95
and 125 g/L
Pregnant women – additional 700-800 mg iron
Folic Acid Supplementation



NTD not only lack of folate in diet, but
genetically determined in uptake, metabolism, or
both in maternal and , fetal cells
Folic acid (0.4- 0.8 mg) along with a
multivitamin 1 month before and until 3 months
conception reduce occurrence of NTD’s
Food fortification with folic acid and B vitamins
helpful
Vitamin D Deficiency in Women with Dark
Complexions and Limited Sun Exposure

Vitamin D Deficiency – inadequate cutaneouus
synthesis, limited dietary intake of vitamin D, or
vitamin D pathway impairment
Can lad to rickets, hypocalcemia, delayed ossification
and abnormal enamel formation in children
 Osteoporosis, osteomalacia and bone fractures in
adults

Vitamin D Deficiency in Women with Dark
Complexions and Limited Sun Exposure Cont’

Lower limit of normal for 25(OH)D:


15-25 mmol/L
Expectant mothers with dark complexion or
limited sun exposure need to be routinely
assessed for 25(OH)D levels during pregnancy