Chapter 28 Nutritional Guidelines and Energy Needs During Pregnancy and Lactation

1. Chapter 28Nutritional Guidelines and Energy Needs During Pregnancy and Lactation Jacalyn J. Robert-McComb, PhD, Fellow of the American College of Sports Medicine

2. Learning Objectives Following this presentation, you should have an understanding of: • Energy requirements during pregnancy and lactation • Nutritional guidelines during pregnancy and lactation • Important nutrients, vitamins, and minerals for optimal pregnancy/ infancy outcomes • Importance of iron reserves prior to conception • Folic acid supplementation • Vitamin D deficiency in women with dark complexions and limited sun exposure

3. Energy Requirements During Pregnancy and Lactation • To estimate energy needs during pregnancy and lactation, energy needs in non-pregnant state must be computed using: • Age • Weight • Height gender • Level of physical activity • Doubly labeled water studies conducted

4. Energy Requirements During Pregnancy and Lactation Cont’ • Energy needs in pregnancy increase 17% (about 300 kcal/day) • Multiple gestations need an additional 300 kcal and 10 gram of protein per fetus

5. Total Weight Gain during Pregnancy

6. Nutritional Guidelines During Pregnancy and Lactation • Essential nutrients, minerals, and vitamins obtained in diet or supplementation • Protein 20% of diet • Fat 30 % of diet • Carbohydrates 50% of diet

7. Nutritional Guidelines During Pregnancy and Lactation Cont’ • Food pyramid: • 6-11 servings fruit • 3-5 servings vegetables • 2-4 servings meats, beans, or nuts • 1 serving of sweets • Average recommendation is 2,500 kcal/day • Extra 300 kcal and 10 gm protein per fetus • Extra calories needed for exercise • Supplementation may be needed

8. Healthy diet for pregnancy and lactation includes key recommendations • Variety of nutrient-dense foods and beverages • Balanced eating pattern • Eat foods high in heme-iron and/or iron-rich plant foods or iron-fortified foods with an enhancer of iron absorption, such as vitamin C-rich foods • Consume adequate synthetic folic acid daily

9. Importance of Iron Reserves Prior to Conception • Maternal anemia – hematocrit < 32% & hemoglobin level < 11g/dl • Representative data from U.S. indicate: • 5% non-pregnant women anemic • 17% increase of anemia among pregnant women • 33% pregnant women anemic in low socioeconomic groups

10. Importance of Iron Reserves Prior to Conception Cont’ • During gestation - 300 mg of iron needed reserves prior conception • Best outcome conditions when Hb between 95 and 125 g/L • Pregnant women – additional 700-800 mg iron

11. Folic Acid Supplementation • NTD not only lack of folate in diet, but genetically determined in uptake, metabolism, or both in maternal and , fetal cells • Folic acid (0.4- 0.8 mg) along with a multivitamin 1 month before and until 3 months conception reduce occurrence of NTD’s • Food fortification with folic acid and B vitamins helpful

12. Vitamin D Deficiency in Women with Dark Complexions and Limited Sun Exposure • Vitamin D Deficiency – inadequate cutaneouus synthesis, limited dietary intake of vitamin D, or vitamin D pathway impairment • Can lad to rickets, hypocalcemia, delayed ossification and abnormal enamel formation in children • Osteoporosis, osteomalacia and bone fractures in adults

13. Vitamin D Deficiency in Women with Dark Complexions and Limited Sun Exposure Cont’ • Lower limit of normal for 25(OH)D: • 15-25 mmol/L • Expectant mothers with dark complexion or limited sun exposure need to be routinely assessed for 25(OH)D levels during pregnancy