Nutritional management during pregnancy and lactation

Nutritional management during pregnancy and lactation

Diets for pregnant or lactating women include additional servings of food from the Regular Diet to meet the increased requirement for nutrients during pregnancy and lactation. Factors that may increase nutritional requirements above the estimated demands of pregnancy include: poor nutritional status; young maternal age; multiple pregnancy; closely spaced births; breast-feeding during pregnancy; continued high level of physical activity; certain disease states; and the use of cigarettes, alcohol, and legal or illegal drugs. Dietary intake of iron, folate, zinc, protein, and calcium should be carefully assessed for adequacy

Nutritional management during pregnancy and lactation

Supplementation is justified when evidence suggests that the inadequate intake of specific nutrients can increase the risk of an adverse effect on the mother, fetus, or pregnancy outcome. Vegetarians who exclude all animal products need 2 mg of vitamin B12 daily

How to Order the Diet

Order as “Regular Diet – Pregnancy” or “Regular Diet – Lactation.” Any special instructions should be indicated in the diet order.

Specific Nutrient Requirements during Pregnancy

Weight gain

The National Academy of Sciences’ Food and Nutrition Board has stated that the optimal weight gain during pregnancy depends on the mother’s weight at the beginning of pregnancy. The target range for weight gain is associated with a full-term, healthy baby, weighing an average of 3.1 to 3.6 kg (6.8 to 7.9 lb). The optimum weight gain for a woman of normal pre-pregnancy weight for her height (body mass index (BMI), 19.8 to 26 kg/m2) who is carrying a single fetus is 25 to 35 lbs; however, there are individual differences based on maternal anthropometry and ethnic decent. 

The pattern of weight gain is more significant than the absolute weight gain. The desired pattern of weight gain is approximately 3 to 8 lb in the first trimester and about 1 lb/week during the last two trimesters. The BMI, defined as weight divided by the height squared (kg/m2) (2), is a better indicator of maternal nutritional status than is weight alone. Recommendations for weight gain during pregnancy should be individualized according to the pre-pregnancy BMI



The total energy needs during pregnancy range between 2,200 and 2,900 kcal/day for most women. However, the mother’s age, pre-pregnancy BMI, rate of weight gain, and physiologic appetite must be considered when determining individual needs.

Based on a review of evidence, an average additional intake of approximately 340 to 452 kcal/day is suggested in the second and third trimesters. For normal weight and overweight women in developed countries, the additional energy need may actually be less than 300 kcal/day, especially in sedentary women

The 2002 DRIs list the recommended daily allowances for protein for all age groups during pregnancy and lactation to be 1.1 g/kg per day or an additional 25 g/day in addition to the 0.8 g/kg per day for a non-pregnant state.

On average, this recommendation equates to approximately 71 g, but for women with greater energy needs, the protein needs may need to be adjusted. For a twin pregnancy, an additional 50 g/day of protein above the recommended daily allowance of 0.8 g/kg per day for a non-pregnant state is suggested during the second and third trimesters
Vitamins and minerals

A multivitamin and mineral supplement is recommended in several circumstances. Pregnant women who smoke or abuse alcohol or drugs should take a multivitamin and mineral supplement.

A multivitamin and mineral supplement is also recommended for women with iron deficiency anemia or poor-quality diets and women who consume animal products rarely or not at all. B12 supplementation is recommended for persons who follow a vegetarian diet pattern, including the lacto-ovo vegetarian diet pattern.

To meet the DRI of 27 mg/day of ferrous iron during pregnancy, a low-dose supplement is recommended at the first prenatal visit. An iron supplement containing 150 mg of ferrous sulfate, 300 mg of ferrous gluconate, or 100 mg of ferrous fumarate can fulfill this additional need
Zinc and copper 

Iron can interfere with the absorption of other minerals. Therefore, women who take daily supplements with more than 30 mg of iron should add 15 mg of zinc and 2 mg of copper. These amounts of zinc and copper are routinely found in prenatal vitamins.

Ingestion of fiber is important to speed digestion and prevent constipation and hemorrhoids. The 2002 DRI for adequate intake of total fiber is 28 g/day for all age groups during pregnancy

Adequate fluid intake is extremely important. The recommended daily fluid intake for pregnant women is 8 to 10 cups or 35 to 40 mL/kg of pregravid weight

High doses of vitamin A during pregnancy have caused birth defects of the head, heart, brain, and spinal cord. The Food and Drug Administration (FDA) and the Institute of Medicine recommend that vitamin A intake be limited to the DRI of 5,000 IU during pregnancy


Sodium is required during pregnancy for the expanding maternal tissue and fluid compartments and to provide fetal needs. Routine sodium restriction is not recommended

Due to the increased efficiency of calcium absorption during pregnancy, calcium requirements for pregnant women are similar to the requirements for women who are not pregnant. A daily intake of 1,000 mg is recommended for pregnant and lactating women, older than 19 years

Due to the high levels of mercury in certain types of fish and mercury’s adverse effects on the fetus, the US Department of Health and Human Services and the US Environmental Protection Agency suggest limiting the type and amount of fish consumed during pregnancy.


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