LB2882MaternalNutriti+ - Mead Johnson Nutrition

EXECUTIVE SUMMARY
A mother’s nutritional status, diet and lifestyle influence pregnancy and lactation outcomes and can have lasting
effects on her offspring’s health. This monograph reviews current nutrition and nutrition-related recommendations for
women during pregnancy and lactation. The goal in highlighting these recommendations is to increase familiarity with
nutrients and nutrition-related issues that can have an important impact during pregnancy, lactation, and beyond.
Experts around the world increasingly emphasize the importance of providing preconception health services that
include screening for health risks that could affect the outcome of a future pregnancy. 1,2 Women should be counseled
regarding the benefits of achieving a healthy weight prior to pregnancy, regular physical activity, consuming a
balanced diet with adequate folic acid, and controlling preexisting medical conditions, such as diabetes, along with
other factors that influence pregnancy outcome. 2
To help optimize conception and pregnancy outcomes, women should strive to enter pregnancy with a Body Mass
Index (BMI) within the normal range (18.5 to 24.9 kg/m 2 ). 3 Weight-gain and weight-monitoring recommendations
during pregnancy vary around the world 4 and women should follow recommendations endorsed by experts in their
countries. In 2009, the Institute of Medicine (IOM) in the United States updated its pregnancy weight gain guidelines
as a result of rising obesity rates, the large proportion of women with high gestational weight gain, and the strength
of the evidence linking gestational weight gain to certain adverse outcomes. 3 The recommended weight gain ranges
vary significantly according to a woman’s pre-pregnancy BMI. Women within the normal BMI range should gain
between 25 and 35 pounds. Overweight and obese women are encouraged to gain less (15 to 25 pounds for
overweight women; 11 to 20 pounds for obese women). 3
Recommended intakes for energy and the macronutrients, carbohydrate and protein, increase during pregnancy
and are easily achieved by most women who are eating a balanced diet. 5-7 Recommended intake for total fat, as a
percentage of energy, does not increase during pregnancy and lactation. 5,8 However, the importance of consuming
long chain polyunsaturated fatty acids (LCPUFA), particularly docosahexaenoic acid (DHA), during pregnancy and
lactation has received increased emphasis in recent years. Exact requirements for DHA during pregnancy and
lactation have not been determined but in 2010 three groups published recommendations on DHA intakes. The
minimum amount of DHA recommended during pregnancy and lactation by these groups is 200 mg per day. 8-10
Recommended intakes of several vitamins and minerals also increase during pregnancy and lactation and many of
these recommendations can be met with a balanced diet. While appropriate intake of all vitamins and minerals is
important, some deserve particular attention with pregnancy. For example, adequate folic acid intake prior to and
during the first few weeks of pregnancy is associated with a reduced risk of neural tube defects (NTDs) 11,12 and
observational studies suggest that adequate choline intake during early pregnancy may positively influence neural
tube closure, independent of folate. 13,14 Emerging evidence indicates that vitamin D may play an important role
in immunity and neurocognitive development in addition to its roles in calcium homeostasis and bone health. 15,16
Inadequate intakes of vitamin A, iron and iodine are associated with night-blindness, anemia, and brain damage,
respectively. 17-19 While adequate intakes of vitamins and minerals during pregnancy are essential, excessive intakes of
some can have negative consequences and should be avoided. For example, excessive intake of preformed vitamin
A (retinoids) during pregnancy increases the risk of birth defects. 20,21
Food guides can be used by women and their health care providers to design balanced eating plans before
pregnancy for achieving desirable weight, and to support a healthy pregnancy and lactation. Some countries around
the world have adopted food guides based on those developed in the US while others have developed their own
specific guides that are based on the country’s food supply, food consumption patterns, nutrition issues and nutrition
standards. 22 Women should use food guides that are adopted by the countries in which they live.
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