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– January 2003 –
– page 2–
Recommended Weight Gain for Pregnant
Women by Pre-pregnancy Body Mass
Index (BMI)* Recommended Nutrient Intake
WEIGHT-FOR-HEIGHT RECOMMENDED
CATEGORY TOTAL WEIGHT GAIN During Pregnancy
Kilograms Pounds
Underweight
(BMI < 19.8) or 90% wt/ht
12.5 – 18 28 – 40 Percent Increase over
Normal weight 11.5 – 16 25 – 35 Non-pregnant Women
(BMI 19.8 to 25) or 90-20% wt/ht
Overweight 7 – 11.5 15 – 25 Energy .............................................19% 1
(BMI 26 to 29.) or120-135% wt/ht Carbohydrate ..................................35%
Fiber ................................................12%
Obese 7 No more
(BMI > 29) or 135% wt/ht than 15 Protein.............................................54%
Calcium ..............................................0%
Twin Gestation 16 – 20 35 – 45
Phosphorus........................................0%
(any BMI)
Magnesium ........................................9% 2
Triplet Gestation 23 50 Vitamin D ...........................................0%
(any BMI)
Fluoride..............................................0%
Women at greater risk for delivering low birthweight babies, Thiamin............................................27% 3
including adolescents, African-American women, and others
Riboflavin.........................................27% 3
should be monitored for optimal weight gain and dietary
quality throughout pregnancy. Niacin ..............................................28%
*Body mass index, or BMI, is an indicator of nutritional status Vitamin B6.......................................46% 3
based on two common measurements, height and weight. Folate...............................................50%
Because it reflects body composition such as body fat and lean Vitamin B12.......................................8%
body mass, BMI is considered a more accurate indicator than
height/weight tables. Pantothenic acid..............................20%
BMI in this table is based on metric calculations, using the fol- Biotin .................................................0% 3
lowing formula: Choline...............................................6% 3
BMI = Vitamin C .........................................13% 3
wt/ht2 (metric) = body weight in kilograms/height in meters2
Vitamin E............................................0%
A health care professional can help in calculating Body Mass
Index. Selenium ............................................9%
Vitamin A .........................................10% 4
Sources:
Food and Nutrition Board, Institute of Medicine. Nutrition During Vitamin K ...........................................0%
Pregnancy. Washington, DC: National Academy Press, 1990. Iron ..................................................50% 3
Brown, JE, Carlson, M. Nutrition and multifetal pregnancy. Zinc..................................................38% 4
J Am Diet Assoc, 2000; 100:343-348.
Iodine ..............................................47%
Meat, Poultry, Fish, Dry Beans, Eggs, 3 – 4 servings • 2 – 3 ounces cooked lean meat,
and Nuts poultry, fish
— preferably lean or low fat • ⁄ 2 cup cooked, dry beans** or 1 ⁄ 2 cup
1
** During pregnancy and lactation, the recommended number of milk group servings is the same as for nonpregnant women. A soy-based
beverage with added calcium is an option for those who prefer a non-dairy source of calcium.
** Dry beans, peas, and lentils can be counted as servings in either the meat and beans group or the vegetable group. As a vegetable, 1⁄2 cup
cooked, dry beans counts as 1 serving. As a meat substitute, 1 cup cooked, dry beans counts as 1 serving (2 ounces meat).
Adapted from Eating for Two, 2001, March of Dimes and the Dietary Guidelines for Americans, Fifth Edition, 2000, U.S. Department of Agriculture and the U. S.
Department of Health and Human Services.
– page 5–
(continued from page 3)
Calories and Nutrients of Concern critical. For that reason, the March of Dimes, following recom-
mendations from the U.S. Public Health Service, offers this
consumed with foods high in vitamin C, such as orange juice,
advice: all women who can become pregnant should consume a
or served with meat, fish, or poultry.
multivitamin containing 400 micrograms of folic acid daily, in
A well-balanced eating plan provides women with up to 12 to
addition to eating foods that contain folate. Women with a previ-
14 mg of iron. To meet the added needs of pregnancy, maternal
ous NTD-affected pregnancy are advised to take a higher dose
iron stores are often tapped. Since many women enter pregnan-
of folic acid — 4 mg/day — before pregnancy.
cy with low iron reserves, they risk developing anemia.
To obtain recommended intakes of folic acid through the diet
The Centers for Disease Control and Prevention recommends
requires careful selection of foods consistent with the U.S.
routine supplementation of low dose (30 mg/day) iron, starting
Dietary Guidelines and the Food Guide Pyramid. Good sources
at the first prenatal visit. Most prenatal supplements supply this
of folate include leafy dark-green vegetables, legumes, citrus
dosage. In addition, prenatal counseling should recommend iron-
fruits and juices, peanuts, whole grains, and some fortified
rich foods and foods that enhance iron absorption, as well as
breakfast cereals. Since January 1998, grain products have
screen for iron deficiency.
been fortified with 140 mcg/gram of folic acid. The Daily Value is
Iron supplements are absorbed best when taken between
400 mcg; pregnant women need more (600-800 mcg/day).
meals, with water or juice, and not with other supplements.
Substances in coffee, tea, and milk inhibit iron absorption. (* Folate is the general term for this nutrient; folic acid is the syn-
thetic form used in supplements and in fortified grain products.)
Taking iron supplements at bedtime often reduces problems of
gastric irritation.
Folic Acid *
A Special Diet for Phenylketonuria (PKU)
It is very important for women with this inherited error of body
Because of its important role in cell development and in the for-
chemistry to follow the special diet they followed in childhood in
mation of certain major fetal structures, all women of childbear-
order to prevent mental retardation and birth defects in their off-
ing age need adequate intake of folic acid. Recent research sug-
spring. While some women with PKU have remained on this diet
gests that taking folic acid before and during early pregnancy
all their lives, others discontinued the diet during the elementary
can reduce the risk of spina bifida and other neural tube defects
school years, as was sometimes advised a number of years ago.
(NTDs) in infants. This reduced risk has been observed both in
Women with PKU who are not currently on the special diet must
women with a previously NTD-affected pregnancy, who are con-
resume the diet before becoming pregnant. All women with PKU
sidered at high risk for having a subsequent affected pregnancy,
must follow the diet throughout pregnancy, and be monitored
as well as other women.
frequently by their physicians to make sure that their blood lev-
Most women do not consume adequate amounts of folate in
els of the part of the protein (phenylalanine) that they cannot
their diets in that important time before they know they are
metabolize do not rise to levels that will harm the baby.
pregnant. That is the time when the need for folate is the most
Food Choices The Food Guide Pyramid’s Guide to Daily Food Choices
Food requirements during pregnancy are not drasti- from the U.S. Department of Agriculture outlines the
cally different from a normal well-balanced variety of foods and recommended amounts to
diet. Nutrient needs are higher, but the eat daily. Individual recommendations
general principles of sound nutrition- vary depending on food energy (calo-
variety, balance, and moderation-still USE SPARINGLY rie) needs. Pyramid guidelines help
apply. women plan healthful meals and
There are no “perfect” foods snacks before, during, and after
that supply all the necessary pregnancy. Food variety within
nutrients a pregnant woman the meat and beans group and
needs. Pregnant women need 3-4 SERVINGS 3-4 SERVINGS the milk group offer choices
to eat a variety of carefully
for vegetarian women.
chosen foods over the
course of the day, or sever- Additional servings and
al days, to get the recom- larger portion sizes may be
mended amount of calo- 3-5 SERVINGS 2-4 SERVINGS advised for adolescents, women
ries, protein, vitamins,
who begin pregnancy under
and minerals needed
during pregnancy. normal weight, and women
who experience lower than
During pregnancy,
as throughout life, recommended weight gains.
6-11 SERVINGS Smaller portions of higher
eating should be
enjoyable. Expectant mothers can continue to enjoy their favorite calorie foods may be advised when the mother gains weight too
foods in moderation with some exceptions as addressed in the rapidly.
paragraph on food safety on page 7. Attention to portion size Pregnancy requires 8 to 12 cups of fluid per day to keep up
and frequency of consumption is the key to choosing occasional with the expanding blood supply. Milk, juice, water and other
treats while keeping total caloric intake under control. beverages contribute to increased fluid intake.
– page 6–
Is caffeine consumption during pregnancy safe? Common Questions and Answers
Studies have found that moderate Is it necessary to take a vitamin/mineral supplement during
caffeine consumption has little pregnancy?
or no effect on the reported Though it’s possible to meet the requirements for most nutrients
time to conceive, however, high through a balanced diet, most experts recommend pregnant
caffeine consumption may women take a daily vitamin/mineral supplement as a safeguard.
increase risks of delays in Supplementation should include 30 mg iron and 600 micro-
conception. Major grams (mcg) folic acid daily. Vegans, women under age 25, and
studies over the last those who choose to avoid milk products also are advised to
take calcium supplements (600 milligrams per day).
decade have found no In addition, the U.S. Public Health Service and the March of
association between Dimes recommend that any woman of childbearing age who
birth defects and caffeine might become pregnant should consume 400 micrograms
consumption. Even offspring (mcg) of folic acid daily. This is the amount found in most
of the heaviest coffee drinkers were not multivitamins.
found to be at higher risk of birth defects. Vitamin/mineral supplements are also recommended for
Evidence from other human studies also supports the con- women who may be at nutritional risk. That includes women
who are strict vegetarians (vegans), breastfeeding, follow
clusion that low to moderate consumption of caffeine by
restrictive diets, are heavy cigarette smokers, and/or abuse
pregnant women probably does not predispose the mother alcohol, or are carrying twins or triplets. For strict vegetarians,
to miscarriage or preterm delivery. Some studies suggest vitamin B12 supplements (and perhaps vitamin D and zinc) are
that drinking more than two or three cups of coffee daily recommended.
(approximately eight cups of tea or nine cans of caffeinated Because excessive levels of vitamin A can be toxic to the fetus
soft drinks) increase the chances of low birthweight. Because and adequate levels are available through a balanced diet, vita-
caffeine can cross the placenta and affect the fetus, pregnant min A supplementation is not recommended during pregnancy
women should apply the principle of moderation to caffeine except at low levels. There is no evidence that vitamin B6 sup-
plementation is an effective treatment for morning sickness.
consumption and discuss it with their personal physician.
No scientific evidence exists to justify recommendations for
Breast milk can also transfer caffeine from mother to baby. herbal products. Some may have serious side effects.
Very high caffeine intake in nursing mothers may make
Is it safe to consume low-calorie sweeteners during
babies irritable. A reasonable guideline for daily intake of caf- pregnancy?
feine is up to 300 mg caffeine per day. The following chart
Low-calorie sweeteners can be used by pregnant women who
provides the approximate caffeine content of various foods have diabetes, who need to control caloric intake, or who enjoy
and beverages. A variety of caffeine-free beverages are avail- the taste of products containing sweeteners. Since pregnancy is
able for women who wish to limit or avoid caffeine during a period of increased energy (calorie) demand for most women,
pregnancy. caloric restriction usually is discouraged.
In the United States, there are five low-calorie sweeteners
approved for use in foods and as tabletop sweeteners: aspar-
CAFFEINE CONTENT OF tame, saccharin, acesulfame K, sucralose, and neotame.
FOOD AND BEVERAGES Aspartame consists of two amino acids, aspartic acid and
phenylalanine as the methyl ester, the basic building block of
The table below shows the approximate caffeine content of protein. Aspartame has been extensively studied and all reports
various foods and beverages: indicate that aspartame is safe for the pregnant mother and
MILLIGRAMS OF CAFFEINE fetus, except for women who have phenylketonuria (PKU) and
ITEM TYPICAL RANGE* must restrict their intake of phenylalanine from all sources.
Studies show that PKU heterozygote pregnant women (those
Coffee (8 fl. oz. cup) who carry the PKU gene but do not have the disease them-
Brewed, drip method ..........................85 65 - 120 selves) metabolize aspartame sufficiently to protect the fetus
Instant .................................................75 60 - 85 from abnormal phenylalanine levels.
Decaffeinated........................................3 2-4 The Food and Drug Administration has approved aspartame
Espresso coffee (1 fl. oz. cup)..............40 30 - 50 as a safe food ingredient for the general population, including
pregnant women. A task force of the American Academy of
Teas (8 fl. oz. cup) Pediatrics Committee on Nutrition also concluded that aspar-
Brewed major U.S. Brands..................40 20 - 90 tame is safe for both the mother and developing baby.
Instant .................................................28 24 - 31 Saccharin is not metabolized and passes through the diges-
Iced (8 fl. oz. glass) .............................25 9 - 50 tive tract unchanged. Although saccharin can cross the placenta,
Some soft drinks (8 fl. oz.)...........................24 20 - 40 there is no evidence that it is harmful to the fetus. Both the
American Dietetic Association and the American Diabetes
Cocoa beverage (8 fl. oz.) .............................6 3 - 32 Association recommend saccharin can be used in moderation
Chocolate milk beverage (8 fl. oz.) ...............5 2-7 during pregnancy. Saccharin is not a potential carcinogen,
Milk chocolate (1 oz.) ...................................6 1 - 15 according to the U.S. Department of Health and Human
Services.
Dark chocolate, semi-sweet (1 oz.) .............20 5 - 35
Acesulfame K is not metabolized and is excreted unchanged
Baker’s chocolate (1 oz.) .............................26 26 by the kidneys. Reproduction and teratology studies in animals
Chocolate-flavored syrup (1 fl. oz.)...............4 4 have shown no toxic effect due to acesulfame K.
*Due to brewing method, plant variety, brand, etc. (continued on page 7)
– page 7–
(continued from page 6) vary. As a result, the consensus is to recommend abstinence.
Common Questions and Answers Some women are concerned about having consumed moderate
amounts of alcohol soon after conception, before becoming
Sucrolose, which is not well absorbed, is excreted basically aware of their pregnancy. For most women, small amounts of
unchanged. Studies show no reproductive risk. alcohol consumed during this time should not be a cause of con-
Neotame, the most recently approved low-calorie sweetener, cern. Women should stop drinking alcohol as soon as they find
is rapidly metabolized, completely eliminated, and does not out they are pregnant, however.
accumulate in the body. Neotame is safe for use as a sweetener Habitual alcohol consumption does affect the developing
and flavor enhancer by the general population including preg- infant. Studies show that pregnant women who drink one or two
nant and lactating women, children, and people with diabetes. drinks a day tend to give birth to smaller babies.
Do food cravings indicate nutritional deficiency? Women who use alcohol during pregnancy are at greater risk
No. Food cravings and aversions to certain foods are common of giving birth to babies with fetal alcohol effects (FAE) or the
during pregnancy. There is no evidence that food cravings are more serious fetal alcohol syndrome (FAS). Characterized by
the result of nutritional deficiencies, and their cause remains a growth retardation, facial and heart abnormalities, small head
mystery. There is no harm in satisfying food cravings within rea- size and mental deficiency, FAS affects 30 to 40 percent of the
son, especially when they make a nutritional contribution to the babies born to women who drink throughout pregnancy. FAE is
diet. more common and variable, including growth retardation, mild
Some pregnant women have the urge to eat nonfood sub- behavioral and intellectual impairments or learning disabilities,
stances, like laundry starch or clay. This is called pica. The con- and minor malformations.
sumption of nonfood items is not safe and can be dangerous for Are there any food safety issues related to pregnancy?
both mothers and babies. In some cases pica involves the con- Pregnant women are especially susceptible to foodborne and
sumption of large amounts of nonfood items that displace foods waterborne hazards due to the physiological changes in preg-
and interfere with adequate nutrient intake. nancy that may increase the exposure of the mother and fetus
Should sodium intake be restricted during pregnancy? to hazardous substances.
No. In fact, sodium requirements increase during pregnancy. But To reduce the risk for foodborne illnesses, pregnant women
the sodium provided by the average diet is likely to be adequate need to follow general food safety guidelines: wash hands and
for expectant mothers. Use of additional salt is rarely warranted. surfaces often, don’t cross-contaminate, refrigerate perishable
At one time, salt was routinely restricted during pregnancy in foods promptly, and cook food to proper temperatures.
an effort to reduce the incidence of toxemia (a condition charac- Foodborne illness can be very harmful. For example, listeriosis
terized by a combination of symptoms including hypertension, can cause miscarriage, stillbirth, or acute illness, and toxoplas-
fluid retention and protein in the urine). But there is no evidence mosis and E. coli can cause severe fetal infection. Pregnant
that sodium restriction prevents or alleviates toxemia. women should avoid raw fish and seafood, and any fish that may
Excessive sodium intake does contribute to high blood pres- be contaminated with methyl mercury and PCBs. The FDA rec-
sure in some people. Women who have been advised to limit ommends that pregnant women avoid swordfish, shark, king
sodium before becoming pregnant should continue this practice mackerel and tilefish. Nutrition counseling during pregnancy
until they discuss it with their doctors. should address these food safety issues.
Can morning sickness and other forms of GI distress be Conclusion
relieved?
Because many pregnant women are particularly receptive,
Although some expectant mothers never experience it, morning
sickness is common and does not necessarily occur only in the pregnancy presents a good opportunity for nutrition educa-
morning. Feelings of nausea may be relieved by eating low-fat, tion. The basic principles of good nutrition — balance, variety
easily digested carbohydrate foods, such as dry toast, plain
crackers, cereal, pasta, rice, or fruit. and moderation — should be encouraged during pregnancy
For nausea and vomiting, small, frequent meals tend to be and as lifetime habits. Clients should be counseled to enjoy a
tolerated better than large ones. Fried, gas-forming, or spicy variety of nutrient-rich foods for their own good health and
foods may cause discomfort. Fluids often are better tolerated
between meals rather than with them. A snack before getting up the health of their unborn children.
or bedtime may help. If the problem persists or becomes severe, (For additional information go to the Pregnancy and Newborn
the woman should seek advice from her health professional. Health Education Center at the March of Dimes.
Constipation also can be a problem and may partially result
from decreased intestinal motility, characteristic of the second Visit www.marchofdimes.com or call 1-888-MODIMES.)
and third trimesters. Foods high in insoluble fiber, such as fresh
fruits and vegetables and whole grain breads and cereal, can
help alleviate constipation. Liberal consumption of fluids and a
regular pattern of moderate physical activity also can help. Iron
supplements may promote constipation, especially if fiber intake
is low; check the dosage. Unless advised by a health care
provider, laxatives are best avoided.
Is it safe to have an occasional cocktail, beer, or glass of
wine?
No. Because the effects of even occasional alcohol consumption
on the developing baby during pregnancy are unknown, most
health care providers recommend not drinking any alcohol dur-
ing pregnancy.
There are no data to support a safe level of alcohol consump-
tion during pregnancy and the thresholds for fetal effects probably
– page 8–
2000 DRIs Choline (mg/d) Vit C (mg/d) Vit E (mg/d) Se (µg/d) Mg (mg/d) Vit A (µg RE) Vit K (µg) Iron (mg) Zinc (mg) Iodine (µg)
<18 years 450 * 80 15 60 400 750 75* 27 12 220
19 –30 years 450 * 85 15 60 350 770 90* 27 11 220
31-50 years 450 * 85 15 60 360 770 90* 27 11 220
* The asterisk (*) indicates Adequate Intakes; all other nutrient amounts are Recommended Dietary Allowances (RDAs).
1
As cholecalciferol. 1 µg cholecalciferol = 40 IU vitamin D; and in the absence of exposure to sunlight.
References
American College of Obstetricians and Gynecologists. Duyff, R. The American Dietetic Association’s Complete Food Menard, MK. Vitamin and mineral supplement prior to and
Planning Your Pregnancy and Birth, Third Edition. and Nutrition Guide. New York: John Wiley and Co., 1998. during pregnancy. Obstet Gynecol Clin North America,
Washington, DC. 2000. Food and Nutrition Board, Institute of Medicine. Dietary 24;3:479. September, 1997.
American Dietetic Association. American Dietetic Reference Intakes for Calcium, Phosphorus, Magnesium, National Institutes of Health, National Heart, Lung, and
Association Diet Manual. Chicago IL, 2000. Vitamin D, and Fluoride. Washington, D.C. National Blood Institute Body Mass Index Table Aim for a Healthy
American Dietetic Association: Position: Use of nutritive Academy Press. 1999.
Weight. Washington, DC. http://www.nhlbi.nih.gov/actintime/
and non-nutritive sweeteners. JADA, 98:580-587. 1998. Food and Nutrition Board, Institute of Medicine. Dietary rhar/lew.htm.
Barone, JJ and Roberts, H. Caffeine consumption. Food Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin
B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Nehlig A. Debry G. Consequences on the newborn of chron-
and Chemical Toxicology, 34:119-129, 1996.
Choline. Washington, D.C. National Academy Press. 2000. ic maternal consumption of coffee during gestation and lac-
Brown, JE and Carlson, M. Nutrition and multifetal preg-
Food and Nutrition Board, Institute of Medicine. Dietary tation: a review. Jrnl Am Coll of Nutr 13(1):6-21. 1994.
nancy. JADA, 100:343-348. 2000.
Centers for Disease Control and Prevention. Knowledge Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, U.S. Department of Agriculture, U.S. Department of Health
and use of folic acid by women of childbearing age — Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, and Human Services, Nutrition and Your Health: Dietary
United States. MMWR: 46 (NO.310), 1997. Nickel, Silicon, Vanadium, and Zinc. Washington, D.C. Guidelines for Americans, Fifth Edition. Home and Garden
National Academy Press. 2001. Bulletin No. 232. Washington, D.C. U.S. Department of
Centers for Disease Control and Prevention.
Recommendations to Prevent and Control Iron Deficiency in Food and Nutrition Board, Institute of Medicine. Dietary Agriculture and U.S. Department of Health and Human
the United States. MMWR: 47 (NO. RR-31), 1998. Reference Intakes for Vitamin C, Vitamin E, Selenium, and Services, 2000.
Beta Carotene and Other Carotenoids. Washington, D.C.
Christian MS, Brent RL. Teratogen Update: Evaluation of U.S. Public Health Service, 9th Report on Carcinogens
the Reproductive and Development Risks of Caffeine. National Academy Press. 2000.
2000. Washington, D.C.: U.S. Department of Health and
Teratology 64:51-78. 2001. Klebanoff, MA, Levine, RJ, DerSimonian, et al. Maternal
Human Services, 2000.
Cnattingus S, Haglund B, Kramn MS. Differences in late serum parazanthine, a caffeine metabolite, and the risk of
spontaneous abortion. NEJM (341)1639-1644. 1999. Vegetarian Nutrition Practice Group. Vegetarian Diets
fetal death rates in association with determinants of small
March of Dimes Birth Defects Foundation. Eating for Two. During Pregnancy. Leicester, MA: Vegetarian Nutrition, a
for gestational age fetuses: Population based cohort study.
BMJ 316:1483-1487. May 16, 1998. 09-219-00. August 2001. Practice Group of The American Dietetic Association; 1996.
Cnattingus S, Signorello LB, et al. Caffeine intake and risk March of Dimes. Nutrition Today Matters Tomorrow: A Worthington-Roberts, BS and Williams, SR. Nutrition
of first trimester spontaneous abortion. NEJM Report from the March of Dimes Task Force on Nutrition and During Pregnancy and Lactation, 6th Ed. Madison, WI:
(343)25:1839-1845. December 21, 2000. Optimal Human Development. ISBN 0-86525-092-8. 2000. Brown and Benchmark, 1997.