Nutrition and Weight Management in Pregnancy

Nutrition During Pregnancy (Part 2)

• General Outcome: Understand physiological changes during pregnancy and how they affect nutritional needs.

• Specific Outcomes:

  • Describe physiological changes during pregnancy.
  • Identify recommended weight gain ranges for different pre-pregnancy weights (underweight, normal weight, overweight, obese).
  • Identify relationships between nutritional status during pregnancy and long-term health outcomes in offspring.

Pregnancy Weight Gain

• Weight gain during pregnancy indicates plasma volume expansion, positive calorie balance, and dietary adequacy.

• Adequate weight gain improves newborn weight and health status.

• Women should not diet during pregnancy. Restricting weight gain can prevent the fetus from getting critical nutrients, leading to premature birth and low birth weight infants.

• Low birth weight infants can develop heart disease, diabetes, hypertension, and other chronic diseases later in life.

Pregnancy Weight Gain Recommendations

• Pre-pregnancy weight status influences the relationship between weight gain and birth weight.

• The higher the weight before pregnancy, the less weight gain is needed to produce healthy-sized infants.

• Underweight women need to gain more weight during pregnancy to ensure adequate fetal growth.

• Overweight/obese women need to gain less weight during pregnancy while still supporting fetal growth.

Recommended Weight Gains (Based on Pre-pregnancy BMI)

• BMI <18.5 (Underweight): 12.5-18 kg total weight gain.

• BMI 18.5-24.9 (Normal): 11.5-16 kg total weight gain.

• BMI 25-29.9 (Overweight): 7-11.5 kg total weight gain.

• BMI ≥30 (Obese): 5-9 kg total weight gain.

• Twin pregnancy weight gain: 11.4-24.5 kg.

Pregnancy Weight Gain Recommendations (Continued)

• Restricting pregnancy weight gain to levels below the recommended ranges is not recommended.

• Such restrictions do not decrease the risk of pregnancy-related hypertension.

• They can be associated with increased infant death and low birth weight.

• Excessive weight gain can lead to poorer offspring growth and development.

Rate of Pregnancy Weight Gain

• Low rates of weight gain in the first half of pregnancy can lead to slow fetal growth and low birth weight and thinness.

• Weight gain in the third trimester should be greater than 0.7 kg/week.

• High rates of weight gain can lead to increase postpartum weight retention.

Composition of Weight Gain in Pregnancy

• The fetus accounts for only half of the total weight gained during pregnancy.

• Most of the weight gained is due to increased maternal tissues (placenta, uterus, amniotic fluid, breasts, blood, etc.).

Body Fat Changes

• Pregnant women store body fat to meet their energy needs, supply nutrients to the fetus, and prepare for increased energy demands during lactation.

• Body fat stores increase most between weeks 10 and 20 and usually decrease near the end of pregnancy.

• Only 0.5 kg of the stored fat is deposited in the fetus.

Postpartum Weight Retention

• The average weight retained by women 1 year after delivery has increased over the past 30 years.

• Women tend to lose 6.4 kg within the first 6 weeks after delivery.

• The rate of weight loss beyond 6 weeks after delivery decreases.

• Weight loss is often difficult for women who gained more than 20 kg during pregnancy.

• Overweight/obese women are likely to gain weight between pregnancies.

Prevention of Excessive Body Weight After Delivery

• Gradual weight loss during post-partum is achievable by combining proper diet and exercise strategies.

• Weight loss of 0.5 to 1 kg per month is considered appropriate.

• Exclusive breastfeeding can facilitate weight loss in postpartum women.

Energy & Nutrient Needs During Pregnancy

• The requirement for all nutrients increases during pregnancy.

• Pregnant mothers should pay attention to macronutrients, micronutrients, and fluid intake.

Energy Requirements During pregnancy

• Energy requirements increase in pregnancy due to protein and fat synthesis in fetal and maternal tissues.

• The fetus accounts for 1.5% of increased energy needs.

• Calorie intake has implications for pregnancy weight gain and is used to assess adequacy of energy intake and maternal health.

Recommendations of additional energy needs for pregnant women in Malaysia (NCCFN 2017)

• Energy needs increase over the pregnancy stages.

Carbohydrate Requirements During Pregnancy

• Glucose is the preferred fuel for the fetus during early pregnancy.

• Insulin production increases early in pregnancy.

• Glucose is converted into glycogen and fat.

• Late in pregnancy, insulin resistance increases.

• Fats become a larger source of energy.

• Women should consume 45-65% of total energy intake from carbohydrates.

• 175 g Carbohydrates needed to meet fetal brain's glucose needs.

• Reduce added sugar and fat intake in pregnancy to better manage weight.

• Consumption of fiber-rich fruits, veggies and whole grains is important for maintaining health during pregnancy.

• Avoid artificial sweeteners during pregnancy as these have unknown effects on development.

• Limit or avoid alcohol consumption during pregnancy.

Protein Requirements During Pregnancy

• Protein requirements increase primarily because of protein tissue accretion during pregnancy.

• Protein is used less as energy.

• Additional protein is needed to maintain protein tissue development.

• Supplements are generally not necessary.

• Protein intake is only recommended for women who are undernourished.

Fat Requirements During Pregnancy

• Fats are crucial for fetal growth.

• Fats provide essential fatty acids needed for cell membranes of the developing fetus, especially in fetal brain and retina development.

• DHA is a major part of phospholipids in the central nervous system during pregnancy and the first year of life.

• The majority of DHA synthesis doesn't occur during gestation.

Micronutrients That Are Most Critical During Pregnancy

• Several micronutrients are important during pregnancy and increase in requirement due to placental and fetal growth, and increased volume of plasma and maternal tissues.

• Micronutrients include folate, iron, choline, sodium, water, iodine, and vitamins A & D and calcium.

Folate

• Important for DNA replication, gene expression, and metabolism.

• Critical for neural tube development during the first 28 days of pregnancy.

• Low folate levels can induce neural tube defects.

• Inadequate folate during pregnancy is related to anemia and reduced fetal growth.

• Consuming adequate folate from food sources (vegetables, fortified cereals).

• Supplements are a good source.

Choline

• Essential vitamin-like water-soluble nutrient.

• Precursor of intracellular messenger molecules to help with cell membrane structure.

• Found in eggs and meat.

Vitamin A

• Involved in cell differentiation.

• Deficiency can cause malformations in fetal lungs, urinary tract, and heart.

• High intake of retinoid-containing supplements in early pregnancy is to be avoided.

• Beta-carotene (provitamin A) is not associated with adverse outcomes.

Vitamin D

• Made in the skin via UV ray exposure.

• Crucial for fetal growth and calcium deposits in fetal bones.

• Deficiency impacts skeletal development in both mothers and fetuses.

• Obese women are prone to vitamin D deficiency.

Calcium

• Crucial for fetal skeletal mineralization and maternal bone health.

• 30 g calcium transfers from mother to baby.

• Optimal intake during third trimester is important.

• Found in dairy products and fortified foods.

Iron

• Needed for increasing maternal red blood cell mass and transferring needed nutrients to the fetus.

• Deficiency leads to weakness, fatigue, poor appetite, susceptibility to infection, and possibly anemia.

• Deficiency leads to preterm delivery, low birth weight and slower developmental milestones in infants later in life.

• Found in meat, fish, poultry, and fortified food products.

Iodine

• Required for thyroid function.

• Deficiency can lead to hypothyroidism in the offspring and impacts brain development.

• Sources include fish, seaweed, and certain types of tea.

• Should not exceed 1100 mcg daily.

Sodium

• Important for water balance.

• The need increases during pregnancy.

Water

• The need increases to 3 liters daily to support increased maternal blood volume, regulate body temperature, produce amniotic fluid, prevent urinary tract infections, and combat fluid retention.

• 8 – 12 glasses for optimal hydration.

• Ensure enough intake of sodium to prevent electrolyte imbalance during intense physical activity.

Nutrition-Related Concerns During Pregnancy

• Common concerns include nausea and vomiting, heartburn, constipation, craving and aversion, edema and leg cramps, gestational diabetes, and pregnancy-induced hypertension.

Management for common pregnancy complications.

• Providing management guidance for these problems or diseases can prevent more serious complications for the mother or fetus. This may include medical advice, supplementation, dietary or lifestyle changes.

Effects of Nutritional Status & Lifestyle on Pregnancy Outcome

• Various factors, including obesity, multifetal pregnancies, adolescents, HIV/AIDS, alcohol, vegetarian diets, dieting, caffeine, exercise, smoking, illegal drugs, food safety concerns can affect pregnancy outcome.

• These factors may have negative outcomes and can potentially cause more complications during or after pregnancy.

• Prevention or management strategies exist in many cases.