2 Nutrition of Healthy Infants, Children and Adolescents Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 127–133 DOI: 10.1159/000367872
2.8 Nutrition in Pregnancy and Lactation Lenka Malek Maria Makrides
Key Messages • Appropriate gestational weight gain is determined by the pre-pregnancy body mass index • Most nutritional requirements of most pregnant and lactating women can be met by consuming a variety of foods according to government-endorsed guidelines • There are almost universal recommendations for periconceptional folic acid supplementation to prevent neural tube defects. Supplementation with iodine during pregnancy and lactation, and with iron during pregnancy, is also recommended in different countries. Additional nutrient supplementation may be required for vegetarians, women having multifetal pregnancies and women diagnosed with deficiencies • High-listeria-risk foods and alcohol should be avoided during pregnancy, and caffeine intake © 2015 S. Karger AG, Basel should be limited
Introduction
Maternal nutrition from preconception through to lactation has both short- and long-term health effects on the offspring [1]. While requirements
for many nutrients increase in pregnancy and lactation, and some dietary changes are required, hormonal changes lead to physiological adaptations which help the body balance maternal and fetal demands, making ‘eating for two’ largely unnecessary. There is a negligible increase in energy requirements in the first trimester, followed by an average extra requirement of 1.4 MJ/day (335 kcal/day) in the second trimester, of 1.9 MJ/day (450 kcal/day) in the third trimester and of 2.0– 2.1 MJ/day (275–500 kcal/day) during lactation for women with a normal pre-pregnancy body mass index (BMI). Energy requirements vary according to the pre-pregnancy BMI, with lower requirements for overweight and obese women and higher requirements for underweight women. Healthy weight gain targets for pregnancy are also based on the pre-pregnancy BMI and are shown in table 1 [2]. Weight gain should be monitored throughout pregnancy to achieve the appropriate weight gain goal. Dieting to prevent weight gain or achieve weight loss is not recommended during pregnancy as it may result in inadequate intake of essential nutrients, which could adversely affect fetal growth and development. In the post-partum period, return to prepregnancy weight is faster in lactating women as fat stores laid down in pregnancy are mobilised to support lactation.
2
Downloaded by: UCONN Storrs 137.99.31.134 - 5/22/2015 3:25:06 AM
Key Words Pregnancy · Lactation · Gestational weight gain · Nutrient requirements, during pregnancy, lactation · Supplements
Table 1. The 2009 Institute of Medicine gestational weight gain recommendations for singleton and twin pregnan-
cies [2]
Underweight (
2.8 Nutrition in Pregnancy and Lactation Lenka Malek Maria Makrides
Key Messages • Appropriate gestational weight gain is determined by the pre-pregnancy body mass index • Most nutritional requirements of most pregnant and lactating women can be met by consuming a variety of foods according to government-endorsed guidelines • There are almost universal recommendations for periconceptional folic acid supplementation to prevent neural tube defects. Supplementation with iodine during pregnancy and lactation, and with iron during pregnancy, is also recommended in different countries. Additional nutrient supplementation may be required for vegetarians, women having multifetal pregnancies and women diagnosed with deficiencies • High-listeria-risk foods and alcohol should be avoided during pregnancy, and caffeine intake © 2015 S. Karger AG, Basel should be limited
Introduction
Maternal nutrition from preconception through to lactation has both short- and long-term health effects on the offspring [1]. While requirements
for many nutrients increase in pregnancy and lactation, and some dietary changes are required, hormonal changes lead to physiological adaptations which help the body balance maternal and fetal demands, making ‘eating for two’ largely unnecessary. There is a negligible increase in energy requirements in the first trimester, followed by an average extra requirement of 1.4 MJ/day (335 kcal/day) in the second trimester, of 1.9 MJ/day (450 kcal/day) in the third trimester and of 2.0– 2.1 MJ/day (275–500 kcal/day) during lactation for women with a normal pre-pregnancy body mass index (BMI). Energy requirements vary according to the pre-pregnancy BMI, with lower requirements for overweight and obese women and higher requirements for underweight women. Healthy weight gain targets for pregnancy are also based on the pre-pregnancy BMI and are shown in table 1 [2]. Weight gain should be monitored throughout pregnancy to achieve the appropriate weight gain goal. Dieting to prevent weight gain or achieve weight loss is not recommended during pregnancy as it may result in inadequate intake of essential nutrients, which could adversely affect fetal growth and development. In the post-partum period, return to prepregnancy weight is faster in lactating women as fat stores laid down in pregnancy are mobilised to support lactation.
2
Downloaded by: UCONN Storrs 137.99.31.134 - 5/22/2015 3:25:06 AM
Key Words Pregnancy · Lactation · Gestational weight gain · Nutrient requirements, during pregnancy, lactation · Supplements
Table 1. The 2009 Institute of Medicine gestational weight gain recommendations for singleton and twin pregnan-
cies [2]
Underweight (
