Weight gain in pregnancy:

Weight gain in pregnancy should be 20-40 lb (pounds).

The total weight gain ,includes the weight of the fetus, placenta, amniotic fluid,maternal reproductive tissues,fluid,increased fat stores, blood and increased lean body mass.

Weight restriction/ weight loss in pregnancy should be avoided ,  because it may affect the development of the other fetal and maternal tissues.

Weight gain in obese pregnant women:

Obese women can have less weight gain such (eg 15-20 lb) and normal infants. They should also be encouraged to eat high quality foods.

Weight gain by Trimesters:

Weight gain in the first trimester of pregnancy is about 2-5 lb.

In the second and third trimesters the weight gain is slightly less than 1 lb per week

Nutrition in Pregnancy:

Nutrition directly affects the maternal health and infant size.

Nutrition counseling should be started early in prenatal care .

Pregnant women should also be given access to supplementary food programs ,if necessary.

General counseling should also stress the need for abstention from alcohol, smoking and recreational drugs.

Caffeine and artificial sweeteners should be used  only in small amounts.

Pregnant women should be encouraged to take the following foods: Protein foods of animal and vegetable origin, milk and milk products, whole-grain cereals and breads, and fats and vegetables- especially green leafy vegetables.

Rigid salt restriction is not necessary in pregnancy. However consumption of highly salted snacks and prepared foods should be avoided. About 2-3 g/day of  sodium is permissible.

Supplements in Pregnancy:

There is an increased requirement for iron and folic acid in pregnancy. This should be met with foods as well as vitamin and mineral supplements.

Megavitamins (and multivitamins) should generally be avoided in pregnancy. It can result in fetal malformations and abnormal metabolism.

However a balanced prenatal supplement containing the daily recommended allowances of various vitamins and minerals is widely used in the USA.

This supplement should contain 30-60mg of elemental iron, 0.5-0.8mg of folate.

It is now well established that periconceptional folic acid supplements can decrease the risk of neural tube defects in the fetus, therefore the United States Public Health Service now recommends 0.4mg of folic acid per day for all pregnant women (and all women capable of becoming pregnant). However pregnant women who have a history of pregnancy complicated by neural tube defects , should take a much higher dose of folate.

Vegetarians should be encouraged to take vitamin B12 supplements during pregnancy and lactation. Vegetarians should take a lot of milk and eggs during pregnancy and lactation.

Energy requirements in Pregnancy:

A pregnant lady needs an extra 200-300 kcal/day and 30g/day of additional protein intake, raising the total protein intake to about 75g/day.

Low calorie intake can result in low birth weight.

References:

Page 766, Chapter 18 Obstetrics. CMDT 2006 -Current Medical Diagnosis and Treatment. Edited by Lawrence M. Tierney, Jr. ,Stephen J. McPhee, Maxine A. Papadakis 45th edition Lange Publications.Mc Graw Hill

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