Nutrition during Pregnancy

Main Article Content

Chantakarn Thaisriwong
Vorapong Phupong

Abstract

Maternal nutrition is the only source of support fetal growth and has effects on offspring health. Nutrition management is important during pregnancy, and this should start from preconception. Women should have a normal prepregnancy BMI and optimal gestational weight gain to have favorable pregnancy outcomes. It is suggested that pregnant women have a healthy balanced diet with adequate calories. The proportion of total daily energy should consist of carbohydrate 45 - 65%, protein 10 - 15%, and fat 20 - 35% from various sources to ensure a sufficient intake of macronutrients and micronutrients. Because of increased demand during pregnancy, some supplements may be necessary. Folic acid and iron supplementation is generally recommended. Supplementation with iodine and calcium should be considered in pregnant women at risk of low dietary intake. Pregnant women should concern about food safety, foods to avoid during pregnancy, and beware of excessive vitamin A and iodine intake.  

Article Details

How to Cite
(1)
Thaisriwong, C. .; Phupong, V. Nutrition During Pregnancy. Thai J Obstet Gynaecol 2023, 31, 388-398.
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Special Article

References

Poore K, Hanson M, Faustman E, Neira M. Avoidable early life environmental exposures. Lancet Planetary Health 2017;1:e172-e173.

Cunningham FG, Leveno KJ, Dashe JS, Hoffman BL, Spong CY, Casey BM. Williams Obstetrics. 26th ed. New York: McGraw-Hill, 2022: 183-88.

Champion M, Harper L. Gestational weight gain: update on outcomes and interventions. Curr Diab Rep 2020;20:11.

Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines. Washington DC: The National Academies Press, 2009.

Phupong, V. Preconception care for obese women. Thai J Obstet Gynaecol 2022;30:294-301.

Huang X, Tan H, Cai M, Shi T, Mi C, Lei J. Gestational weight gain in Chinese women -- results from a retrospective cohort in Changsha, China. BMC Pregnancy Childbirth 2018;18:185.

Arora P, Tamber Aeri B. Gestational weight gain among healthy pregnant women from Asia in comparison with Institute of Medicine (IOM) guidelines-2009: A systematic review. J Pregnancy 2019;2019:3849596.

WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63.

Aoyama T, Li D, Bay J. Weight gain and nutrition during pregnancy: An analysis of clinical practice guidelines in the Asia-Pacific region. Nutrients 2022;14:1288.

Thai Dietetic Association. Dietary reference intake for Thais 2020. Nonthaburi: Bureau of Nutrition, Department of Health, Ministry of Public Health, 2020.

FAO, World Health Organization, United Nations University. Human energy requirements: report of a joint FAO/WHO/UNU expert consultation: Rome, 2001. Rome: FAO; 2004.

Trumbo P, Schlicker S, Yates A, Poos M. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J Am Diet Assoc 2002;102:1621-30.

Carbohydrate choice lists [Internet]. 2020. Available from: https://www.cdc.gov/diabetes/managing/eat-well/diabetes-and-carbs/carbohydrate-choice-lists.html

Palatnik A, Moosreiner A, Olivier-Van Stichelen S. Consumption of non-nutritive sweeteners during pregnancy. Am J Obstet Gynecol 2020;223:211-8.

Goran M, Plows J, Ventura E. Effects of consuming sugars and alternative sweeteners during pregnancy on maternal and child health: evidence for a secondhand sugar effect. Proc Nutr Soc 2018;78:262-71.

Clayton Z, Fusco E, Kern M. Egg consumption and heart health: A review. Nutrition 2017;37:79-85.

Achón M, Úbeda N, García-González Á, Partearroyo T, Varela-Moreiras G. Effects of milk and dairy product consumption on pregnancy and lactation outcomes: A systematic review. Adv Nutr 2019;10(suppl2):S74-S87.

Huang D, Wu Q, Xu X, Ji C, Xia Y, Zhao Z et al. Maternal consumption of milk or dairy products during pregnancy and birth outcomes: A systematic review and dose-response meta-analysis. Front Nutr 2022;9:900529.

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary guidelines for Americans, 2020-2025. 9th ed. 2020.

Donovan S, Dewey K, Novotny R, Stang J, Taveras E, Kleinman R, et al. Maternal diet during pregnancy and lactation and risk of child food allergies and atopic allergic diseases: A systematic review [Internet]. Alexandria (VA): USDA Nutrition Evidence Systematic Review; 2020

Middleton P, Gomersall J, Gould J, Shepherd E, Olsen S, Makrides M. Omega-3 fatty acid addition during pregnancy. Cochrane Database Syst Rev 2018;11:CD003402.

Makrides M, Best K, Yelland L, McPhee A, Zhou S, Quinlivan J et al. A randomized trial of prenatal n−3 fatty acid supplementation and preterm delivery. N Engl J Med 2019;381:1035-45.

Sass L, Bjarnadóttir E, Stokholm J, Chawes B, Vinding R, Mora‐Jensen A et al. Fish oil supplementation in pregnancy and neurodevelopment in childhood—a randomized clinical trial. Child Dev 2021;92:1624-35.

Bisgaard H, Stokholm J, Chawes BL, Vissing NH, Bjarnadóttir E, Schoos A-MM, et al. Fish oil–derived fatty acids in pregnancy and wheeze and asthma in offspring. N Engl J Med 2016;375:2530–9.

de Silva D, Halken S, Singh C, Muraro A, Angier E, Arasi S, et al. Preventing food allergy in infancy and childhood: Systematic review of randomised controlled trials. Pediatr Allergy Immunol 2020;31:813-26.

Institute of Medicine. Dietary reference intakes: the essential guide to nutrient requirements. Washington DC: The National Academies Press, 2006.

WHO recommendation: Calcium supplementation during pregnancy for the prevention of pre-eclampsia and its complications. Geneva: World Health Organization; 2018.

Sun X, Li H, He X, Li M, Yan P, Xun Y, et al. The association between calcium supplement and preeclampsia and gestational hypertension: a systematic review and meta-analysis of randomized trials. Hypertens Pregnancy 2019;38:129–39.

Brannon P, Taylor C. Iron supplementation during pregnancy and infancy: uncertainties and implications for research and policy. Nutrients 2017;9:1327.

Guideline: daily iron and folic acid supplementation in pregnant women. Geneva: World Health Organization; 2012.

Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 2017;27:315–89.

Nawapun K, Phupong V. Awareness of the benefits of folic acid and prevalence of the use of folic acid supplements to prevent neural tube defects among Thai women. Arch Gynecol Obstet 2007;276:53-7.

ACOG Practice Bulletin No. 187: Neural tube defects. Obstet Gynecol 2017;130:e279–90.

Wilson RD, O’Connor DL. Guideline No. 427: Folic acid and multivitamin supplementation for prevention of folic acid–sensitive congenital anomalies. J Obstet Gynaecol Can 2022;44:707-719.e1.

Dwyer ER, Filion KB, MacFarlane AJ, Platt RW, Mehrabadi A. Who should consume high-dose folic acid supplements before and during early pregnancy for the prevention of neural tube defects? BMJ 2022;377:e067728.

Hanson MA, Bardsley A, De-Regil LM, Moore SE, Oken E, Poston L, et al. The International Federation of Gynecology and Obstetrics (FIGO) recommendations on adolescent, preconception, and maternal nutrition: “Think Nutrition First”. Int J Gynaecol Obstet 2015;131 Suppl 4:S213-53.

Management of diabetes in pregnancy: standards of medical care in diabetes—2022. Diabetes Care 2022;45(Suppl1):S232–S243.

Rothman KJ, Moore LL, Singer MR, Nguyen U-SDT, Mannino S, Milunsky A. teratogenicity of high vitamin A intake. N Engl J Med 1995;333:1369–73.

EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA); Turck D, Bohn T, Castenmiller J, de Henauw S, Hirsch-Ernst KI, Knutsen HK, et al. Scientific opinion on the tolerable upper intake level for vitamin D, including the derivation of a conversion factor for calcidiol monohydrate. EFSA J 2023;21:e08145.

Institute of Medicine (US) Committee to review dietary reference intakes for vitamin D and calcium. Dietary reference intakes for calcium and vitamin D. National Academies Press: USA, 2011.

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911–30.

Tamblyn JA, Pilarski NSP, Markland AD, Marson EJ, Devall A, Hewison M, et al. Vitamin D and miscarriage: a systematic review and meta-analysis. Fertil Steril 2022;118:111-22.

Khaing W, Vallibhakara SA-O, Tantrakul V, Vallibhakara O, Rattanasiri S, McEvoy M, et al. Calcium and vitamin D supplementation for prevention of preeclampsia: A systematic review and network meta-analysis. Nutrients 2017;9:1141.

Fogacci S, Fogacci F, Banach M, Michos ED, Hernandez AV, Lip GYH, et al. Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials. Clin Nutr 2020;39:1742–52.

Santander Ballestín S, Giménez Campos MI, Ballestín Ballestín J, Luesma Bartolomé MJ. Is supplementation with micronutrients still necessary during pregnancy? A review. Nutrients 2021;13:3134.

Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM. Creasy and Resnik’s maternal-fetal medicine: principles and practice. 8th ed. Philadephia: Elsevier, 2019:181-9.