pregnancy

Diet Planning Guide: Prenatal Considerations

Author: Lauren Thomas Berube, PhD, RDN
New York University Steinhardt Department of Nutrition and Food Studies, New York, NY

Citation: Berube LT. Diet planning guide: prenatal diet [Published online May 22, 2019]. Nutrition411.

 

Adequate nutrient intakes before and during pregnancy are important for optimal maternal and child health outcomes. While women who follow healthy eating patterns during the prenatal period can meet most nutrient needs through dietary sources, research indicates that many pregnant women in the United States have suboptimal dietary intakes.1,2 This presents an opportunity for registered dietitian nutritionists (RDNs) to counsel women who are pregnant or planning to become pregnant to adopt healthy eating patterns.

RDNs should also assess the status of certain nutrients considered particularly important during pregnancy and recommend appropriate nutrient supplementation when necessary.

  • Folate is an important nutrient to consume in adequate amounts before pregnancy to prevent neural tube defects. Before pregnancy, women should consume 400 mcg of dietary folate equivalents (DFE)/day from food sources, foods fortified with folic acid, or folic acid supplements. These needs increase to 600 mcg DFE per day during pregnancy.
  • Iron is another key nutrient needed in higher amounts during pregnancy to prevent iron-deficiency anemia. Iron needs increase to 27 mg per day during pregnancy, and, while RDNs should encourage pregnant women to consume iron-rich food sources, an iron supplement is typically recommended.
  • Calcium is another important nutrient for maternal and infant health. Although calcium needs are unchanged during pregnancy because absorption increases, RDNs should encourage women to achieve adequate calcium intake from calcium-rich or fortified dietary sources. Women with inadequate intake may need a calcium supplement.
     

Other nutrients thought to be important during pregnancy that may not be consumed in adequate amounts include vitamin D, choline, and omega-3 fatty acids. RDNs should educate pregnant women about food sources rich in each of these important nutrients and amounts needed to meet recommended intakes.

RDNs should also be aware that energy needs increase during pregnancy, but pregnant women do not need to “eat for two.” Energy needs only increase by approximately 340 kcal per day and 450 kcal per day in the second and third trimesters of pregnancy, respectively. RDNs should recommend appropriate portions of nutrient-dense foods to pregnant women to meet these increased needs. Using food models or giving specific food and meal examples may be helpful when RDNs are educating pregnant women about energy and nutrient intake.

Special Populations

Several populations may be at increased risk of suboptimal energy and/or nutrient intakes during pregnancy. These groups may require individualized dietary counseling or supplementation to meet their needs. RDNs may need to provide dietary counseling for pregnant women with excess or inadequate gestational weight gain; gestational diabetes or hypertensive disorders of pregnancy; severe nausea/vomiting; anemia; or multiple pregnancies.

In addition, pregnant women with certain dietary patterns, including vegetarians/vegans and women who avoid milk products, follow a specialized/restricted diet; have disordered eating or substance abuse; or experience food insecurity, may be at increased risk of inadequate consumption of important nutrients needed during pregnancy. RDNs should individualize dietary plans for at-risk women and recommend supplementation when necessary. In addition, RDNs should consider women’s cultural food preferences, food attitudes and beliefs, and cooking habits when providing dietary recommendations.

Next Page: Dietary Recommendations for Pregnant Women

Diet Planning Guide: Recommendations for Pregnant Women

In general, RDNs should recommend a variety of healthy foods that are nutrient-dense and provide rich sources of important nutrients needed for pregnancy, including folate, iron, calcium, etc. RDNs can recommend the same dietary patterns that nonpregnant women are encouraged to follow, such as the US Dietary Guidelines, the DASH Diet, and the Mediterranean Diet.3,4,5 Specific dietary patterns can be individualized by RDNs to meet patient needs. For example, RDNs may recommend that women with specialized/restricted diets consume fortified food products to meet their nutrient needs. RDNs can also provide counseling about healthier food choices for women who regularly consume energy-dense foods or experience unhealthy cravings.

Before pregnancy, RDNs should ensure that women consume adequate DFEs through folate-rich foods and/or folic acid fortified foods or supplements. During pregnancy, prenatal supplementation is often warranted, especially to meet iron needs, and RDNs should recommend a prenatal supplement that meets 100% of iron needs.

RDNs should be aware of the seafood and caffeine recommendations during pregnancy. While seafood is a great source of omega-3 fatty acids, women should only consume 8 to 12 oz per week of low mercury seafood sources. Consuming under 200 mg of caffeine per day is considered safe, but RDNs should help women determine all the sources of caffeine they consume daily. RDNs should also be aware of foods to avoid during pregnancy and caution pregnant women against alcoholic beverages, herbal supplements, raw foods, deli meats, or unpasteurized juices or milk products.

Key Takeaways

RDNs are incredibly important resources to help women who are pregnant or planning to become pregnant choose foods that allow for optimal dietary intakes. RDNs should screen pregnant women for energy and nutrient intakes, particularly in at-risk groups, and provide individualized dietary counseling as needed. Practicing motivational interviewing and self-monitoring may be effective strategies to improve dietary intakes before and during pregnancy for certain women. RDNs should also be familiar with the gestational weight gain guidelines published by the Institute of Medicine.6

I recommend that RDNs who are interested in pregnancy or counseling pregnant women read the practice and position papers published in the Journal of the Academy of Nutrition and Dietetics, which address proper nutrition and lifestyle for healthy pregnancy outcomes.7

References:

1. Blumfield ML, Hure AJ, Macdonald-Wicks L, Smith R, Collins CE. Systematic review and meta-analysis of energy and macronutrient intakes during pregnancy in developed countries. Nutr Rev. 2012;70(6):322-36. doi:10.1111/j.1753-4887.2012.00481.x.

2. Blumfield ML, Hure AJ, Macdonald-Wicks L, Smith R, Collins CE. A systematic review and meta-analysis of micronutrient intakes during pregnancy in developed countries. Nutr Rev. 2013;71(2):118-32. doi:10.1111/nure.12003.

3. 2015-2020 dietary guidelines for Americans, eighth edition. US Department of Agriculture. https://www.dietaryguidelines.gov/sites/default/files/2019-05/2015-2020_Dietary_Guidelines.pdf. December 2015. Accessed May 16, 2019.

4. DASH eating plan. National Heart, Lung, and Blood Institute. National Institutes of Health. https://www.nhlbi.nih.gov/health-topics/dash-eating-plan. Accessed May 16, 2019.

5. Mediterranean diet. American Heart Association. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/mediterranean-diet. Page last reviewed April 18, 2018. Accessed May 16, 2019.

6. Rasmussen KM, Yaktine AL, et al; Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight gain during pregnancy: reexamining the guidelines. Washington (DC): National Academies Press (US); 2009. https://www.ncbi.nlm.nih.gov/pubmed/20669500.

7. Procter SB, Campbell CG. Position of the Academy of Nutrition and Dietetics: nutrition and lifestyle for a healthy pregnancy outcome. J Am Acad Nutr Diet. 2014;114(7):1099-1103. https://doi.org/10.1016/j.jand.2014.05.005.

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