LB2882MaternalNutriti+ - Mead Johnson Nutrition

Preconception Care
In 2005, the WHO’s World Report 2005: Make Every Mother and Child Count detailed the importance of
preconception care and indicated that reproductive health is an essential element of the continuum of maternal and
child health. It called for reform of programs and interventions at the country and international level. 1 Since 2005, a
number of programs and guidelines have been revised or developed but they vary in scope and content due to a
number of factors including the type of health care system, level of economic support, political, cultural, and religious
beliefs of the locale. Despite the differences in the programs and guidelines, the concept of preconception care
remains a critical component of maternal and child health promotion globally. 57
The US Centers for Disease Control and Prevention has issued recommendations on preconception care for
women. 2,58 The recommendations include screening for health risks that could affect the outcome of a future
pregnancy. Many of those risks, such as obesity, poorly-controlled diabetes, and inadequate diet are amenable to
positive lifestyle changes. Women should be counseled regarding the benefits of physical activity, achieving a healthy
weight prior to pregnancy, avoiding food faddism, consuming adequate folic acid, and controlling preexisting medical
conditions, such as diabetes, along with other factors that influence pregnancy outcome. 2 Pregnancy preparedness
is wise even when a woman does not plan to conceive since many pregnancies are unintended. For example, in the
United States, an estimated 50% of pregnancies are unintended or mistimed. 59 During the first seven to eight weeks
of pregnancy, when women may not realize they are pregnant, a developing fetus is highly susceptible to congenital
anomalies and other adverse outcomes as a result of exposure to alcohol, tobacco and other drugs, workplace
hazards, and inadequate intake of essential nutrients, such as folic acid. 60
NUTRITION DURING PREGNANCY AND LACTATION
Pregnancy Weight Gain Guidelines
Starting pregnancy with a healthy weight and gaining appropriately during pregnancy typically translates into a lower
risk of complications for mother and child. 3 However, women who are attempting to lose weight prior to conception
should stop once pregnancy has occurred.
Weight-gain and weight-monitoring recommendations during pregnancy vary around the world. 4 Many countries
in Europe, for example, do not weigh pregnant women after their first antenatal visit, 4 while others have developed
population-specific pregnancy weight-gain curves based on research of weight gain and pregnancy outcomes in their
countries. 61,62 In 2004, the Report of a Joint FAO/WHO/UNU Expert Consultation on human energy requirements 6
stated,
“This consultation endorsed the WHO recommendation that healthy, well-nourished women should gain 10 to
14 kg [22 to 30.8 pounds] during pregnancy, with an average of 12 kg [26.4 pounds], in order to increase the
probability of delivering full-term infants with an average birth weight of 3.3 kg, and to reduce the risk of foetal
and maternal complications.”
According to the Expert Consultation, underweight women (with a BMI 25 may benefit with weight gains near the lower end of the range. 6
In 2009, the Institute of Medicine (IOM) in the United States updated its guidelines for weight gain during pregnancy
as a result of rising obesity rates in women, 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 2009 recommendations
are an attempt to balance the risks and benefits associated with gestational weight gain for both the mother and
child. The IOM stated that while the guidelines are intended for use in the United States, “They may be applicable to
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