Guide to Diet, Nutrition and Exercise in Pregnancy
The American College of Obstetricans and Gynecologists (2011) FAQ: Exercise During Pregnancy. Retrieved from http://www.acog.org/Patients/FAQs/Exercise-During-Pregnancy
The American College of Obstetricians and Gynecologists (2013) Weight Gain During Pregnancy. Committee Opinion, 548, 1-3.
The American College of Obstetricans and Gynecologists (2015) FAQ: Nutrition During Pregnancy. Retrieved from http://www.acog.org/Patients/FAQs/Nutrition-During-Pregnancy
Bautista-Castaño, I, Henriquez-Sanchez, P, Alemán-Perez, N, Garcia-Salvador, JJ, Gonzalez-Quesada, A, García-Hernández, JA., Serra-Majem, L (2013) PLoS ONE, 8(11)1-6.
Graham, L.E., Brunner Huber, L.R., Thompson, M.E., Ersek, J.L. (2014) Does Amount of Weight Gain During Pregnancy Modify the Association Between Obesity and Cesarean Section Delivery? Birth: Issues in Prenatal Care, 41(1) 93-99
National Institutes of Health (2013) Calcium: Diet Supplement Fact Sheet. Retrieved from http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/#h3
Many patients are confused by all the literature available on what is best for their pregnancy and developing baby. How much should they eat? What vitamins do they need? Can they exercise? How much exercise? How many calories?
This guide is intended to be an overview of that information. Some basic guidelines will be provided here as a resource to reference. As always, if you have any questions regarding if the recommendations are right for you, discuss your questions with your physician.
Nutrition during pregnancy covers two areas. First, what calories are indicated to intake daily, and second, what nutrients should a pregnant woman consume?
For average weight women pregnant with a single fetus the general recommendation is to add 400 calories daily to their diet. For women pregnant with twins or higher multiples the daily recommendation may increase to 800 calories a day or more.
The Institute of Medicine (IOM) guidelines recommend weight gain during pregnancy based on a woman’s body mass index (BMI) prior to becoming pregnant. For women with a normal BMI prior to pregnancy (18.5-24.9) the recommended weight gain is 25-35 pounds. This usually averages out to ½ pound to 1 pound per week. For a women who is overweight (BMI 25-29.9) the recommended weight gain is 15-25 pounds. Obese women (BMI 30 or greater) should only gain 11-20 pounds. On the other hand, women who are underweight with a BMI less than 18.4 should have a higher weight gain of 28-40 pounds. (ACOG,2013)
Weight is recorded at every prenatal visit and you should review with your physician if you are gaining too much or too little.
Risks of excess weight gain include macrosomia (a larger than average fetus), gestational diabetes, gestational hypertension, intrauterine fetal demise, preeclampsia, thromboembolism, and perinatal mortality (Bautista-Castaño et al, 2013). Also, obese women have almost twice the risk of a cesarean section as women with a normal BMI (Graham et al, 2014).
- Folic acid is recommended at the time of conception and during pregnancy to prevent the formation of neural tube defects or spina bifida. Prior to conception 400 micrograms daily is recommended. Six hundred micrograms daily is recommended during pregnancy. Most women’s multivitamins contain at least 400 micrograms and most prescription prenatal vitamins contain 1 milligram of folic acid. Higher doses of folic acid are recommended in women with pre-pregnancy diabetes, seizure disorder and with certain medications that affect folic acid metabolism.For the majority of pregnant women an over the counter prenatal daily is fine to obtain the folic acid requirements. Many of the prescription prenatal vitamins contain vitamins that are structured in a way to have better absorption of better bioavailability. Pregnant women should ask their doctor if they have a condition that would require a higher or more bioavailable source of folic acid to be administered.
- Vitamin D supplementation is also recommended in pregnancy at least 600 IU daily. Most prenatal vitamins contain Vitamin D, check the label and add additional Vitamin D if needed. Sometimes obstetricians will check Vitamin D levels in the first trimester and if a patient is noted to have a lower level of Vitamin D they will recommend additional supplementation. Natural sources of Vitamin D include sunlight and animal products. Vitamin D is not found to any degree naturally in fruits and vegetables; if a patient is vegetarian she will definitely want to speak with her physician about ways
- Calcium should be supplemented at 1000 mg per day. Natural sources of calcium include most dairy products, salmon, tofu, and leafy greens including kale and turnip greens, bok choy and broccoli.
- Iron is included in most prenatal vitamins. Your physician will check for anemia in the first trimester and again at 26-28 weeks, if anemia is diagnosed than additional supplementation is usually recommended. Natural sources of iron include red meat; however, for vegetarians beans and dark green leafy vegetables are good sources. Iron can also be found in dark chocolate and sunflower seeds as well as some fortified foods.
- Omega 3 fatty acids (DHA/EPA) are often added to prenatal vitamin formulations. Although the research is conflicting on benefits for pregnancy such as a reduction in preterm birth and preeclampsia, there are proven cardiovascular benefits from the intake of omega 3s. Taking a prenatal vitamin with added DHA may have maternal and fetal benefits.
Exercise has known cardiovascular benefits as well as benefits on improving mood and sleep patterns. Exercise through the pregnancy may help protect against excessive maternal weight gain. Exercises that are low impact are generally considered best, such as walking, swimming, cycling, low impact aerobics and yoga, however, running and jogging may be safe for moms who have participated in those activities prior to pregnancy (ACOG,2011). Any activity that could result in trauma through a fall or blow to the abdomen should be avoided, examples include skiing and soccer. Scuba diving should also be avoided during pregnancy.
Any exercise that causes significant abdominal discomfort, bleeding or contractions should be discontinued immediately. Patient should call their doctors if they experience significant pain or bleeding.