Healthy pregnancy
Bethany is 29 years old, five foot seven, and reports a prepregnancy weight of 140 pounds (BMI = 22 kg/m2). She is in her first trimester of pregnancy at 11 weeks and is in good health. If Bethany were your friend, you would recommend she discuss these questions with a healthcare provider. However, as a way to review key concepts in this chapter, can you answer Bethany’s questions?
How much weight am I supposed to gain?
Is it okay that I’ve gained only two pounds so far?
What will compose the weight gain? How much will be fat?
How many kcal do I need?
How much protein do I need during pregnancy?
My doctor (or midwife) asked me if I am taking folic acid supplements. I told him only the amount in a regular multivitamin pill. Do I need extra amounts while I’m pregnant?
Do I need to take an iron supplement? If so, how much?
Before I was pregnant, I walked every day for 45 minutes. How much exercise should I get while pregnant?
I’m considering breastfeeding, but wonder if just using formula would be more convenient. What are the pros and cons of each?
Take It Further
Using Bethany’s information, visit http:/
| Daily recommendations from ChooseMyPlate.gov | Prepregnancy | Pregnant (second trimester) | Pregnant (third trimester) | Breastfeeding |
| kcal | 2,200 | 2,600 | 2,800 | |
| Grains/whole grains (1- |
7 | 9 | 10 | |
| Vegetables (cups) | 3 | 3 1/2 | 3 1/2 | |
| Fruits (cups) | 2 | 2 | 2 1/2 | |
| Dairy (cups) | 3 | 3 | 3 | |
| Protein (ounces) | 6 | 6 1/2 | 7 | |
| Oils (teaspoons) | 6 | 8 | 8 | |
| Discretionary kcal | ≤ 266 | ≤ 362 | ≤ 395 |
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During the 38 to 42 weeks of pregnancy, the developing fetus is supplied with nutrients and oxygen from the mother through the umbilical cord, connecting the fetus to the placenta, which is attached to the uterus.
A woman’s nutrient and energy needs change during pregnancy to support growth of the developing fetus and maternal support tissues.
A woman’s energy needs gradually increase as pregnancy advances, with an average increase of 15%. Nutrient needs increase by as much as 50% for some vitamins and minerals.
The Institute of Medicine provides guidelines for appropriate weight gain during pregnancy based on BMI at conception to reduce complications during pregnancy and at delivery, as well as to promote the birth of a healthy birth weight baby.
Birth weight is influenced by several factors. Infants who are born preterm or are small for gestational age have increased risk of death, complications, and certain medical conditions as adults.
Insufficient intake of essential nutrients can increase the risk of birth defects, particularly during critical periods of accelerated fetal development.
Folate plays an important role in the prevention of neural tube defects.
Iron needs are increased by 50% during pregnancy, which often warrants supplementation to prevent iron-
To reduce risks to the developing fetus, pregnant women are advised to avoid alcohol, limit their intake of certain fish because of potential mercury contamination, and avoid microbial-
The American Academy of Pediatrics recommends that mothers exclusively breastfeed their babies through six months of age, and then continue breastfeeding (ideally to one year or beyond), while also introducing complementary solid foods according to the infant’s developmental readiness.
Breastfeeding supplies the growing infant with essential nutrients in appropriate proportions, provides antibodies to strengthen immunity, and has many additional benefits for both the mother and baby.
Breast milk may not supply sufficient vitamin D, therefore supplementation for breastfed infants is recommended. Infants who are exclusively breastfed after six months of age may require iron supplementation.
Women who are breastfeeding have increased energy and nutrient needs for milk production, as well as to replenish nutrient stores.
Infants develop rapidly in the first year of life and require a consistent supply of energy and essential nutrients. Growth is an important indicator of adequate nutrition.
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Review Questions
1. Physiological changes associated with pregnancy include all of the following, EXCEPT:
decreased gastrointestinal motility.
decreased breathing rate.
increased blood volume.
increased calcium absorption.
increased cardiac output.
1. b
2. During pregnancy, there is a maternal adaptation to utilize ______ as primary fuel.
fat
glucose
glycogen
protein
2. a
3. Marilyn weighed 140 pounds prior to pregnancy and her BMI was 22. According to healthy weight-
150 to 160 pounds
155 to 165 pounds
160 to 170 pounds
165 to 175 pounds
170 to 180 pounds
3. d
4. Babies that are considered small for gestational age are defined as having a birth weight that is:
between one and three pounds.
less than 10% of maternal weight gain.
less than 10th percentile of gestational age.
less than 50th percentile of gestational age.
lower than 50% of average U.S. birth weight.
4. c
5. Typically, calorie needs during the first trimester of pregnancy:
do not increase over prepregnancy requirements.
increase by 30% over prepregnancy requirements.
increase by 340 kcal over prepregnancy requirements.
increase by 450 kcal over prepregnancy requirements.
are the highest compared with other trimesters because of rapid fetal development.
5. a
6. Which of the following about folate is NOT correct?
Adequate intake before and during pregnancy decreases the incidence of neural tube defects.
Between the ages of 15 and 45 years, all women should consume 400 micrograms through folate-
During pregnancy, the daily recommended intake is 600 micrograms.
Needs in pregnancy can be met without supplementation through diet and consumption of folate-
Supplementation is most critical during the second trimester when folate-
6. e
7. The only nutrient for which supplementation during pregnancy is universally recommended is:
calcium.
fluoride.
iron.
vitamin B12.
vitamin C.
7. c
8. Justin weighed 7 pounds, 3 ounces at birth and was 20 inches in length. What is his anticipated weight and height at one year?
14 pounds, 6 ounces; 30 inches
14 pounds, 6 ounces; 40 inches
21 pounds, 9 ounces; 30 inches
21 pounds, 9 ounces; 40 inches
8. c
9. The benefits of breastfeeding include:
reduced incidence of diarrhea and vomiting in infants.
reduced incidence of childhood leukemia and juvenile diabetes.
enhanced infant oral motor development and digestion.
increased mother–
all of the above.
9. e
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10. Nutritional recommendations for infants include all of the following, EXCEPT:
exclusive breastfeeding until at least six months of age.
vitamin B12 supplementation for all breastfed babies.
vitamin D supplementation for breastfed babies after the first few days of life.
iron supplementation if exclusively breastfed after four months.
solid foods can be introduced to complement breast milk after six months.
10. b
Take It Further
Describe developmental signs that an infant is ready for the introduction of solid foods.
Using SuperTracker to Understand Nutrition Requirements During Pregnancy
1. Log on to the United States Department of Agriculture (USDA) website at www.choosemyplate.gov. What two nutrients are discussed? Why are they so important?
2. In the left navigation bar select "Making Healthy Choices in Each Food Group." List the five food groups and provide two foods found in each of the food groups. What are two key nutrients found in each group?
3. Next select the “Nutritional Needs during Pregnancy” link.
List the major foods that are considered empty calories.
Explain the guidelines about alcohol consumption and pregnancy.
4. Next select the “Dietary Supplements” link. Click the “Why take a prenatal supplement?” link. What two nutrients are discussed? Why are they so important?
5. Finally, click on “Food Safety for Pregnant and Breastfeeding Women.”
Explain recommendations for fish intake.
What is listeriosis? Why is this pathogen dangerous during pregnancy?
Why is food safety especially important for pregnant women?