Nutrition and pregnancy

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Pregnant woman eating fruit

Nutrition and pregnancy refers to the nutrient intake, and dietary planning that is undertaken before, during and after pregnancy. Nutrition of the fetus begins at conception. For this reason, the nutrition of the mother is important from before conception (probably several months before) as well as throughout pregnancy and breast feeding. An ever-increasing number of studies have shown that the nutrition of the mother will have an effect on the child, up to and including the risk for cancer, cardiovascular disease, hypertension and diabetes throughout life. [1] After pregnancy the child will need nutrients from their mother through breastfeeding and during their teenage years a good amount of vitamins for teens which are essential for normal growth, healthy skin and tissue repair.

Contents

An inadequate or excessive amount of some nutrients may cause malformations or medical problems in the fetus, and neurological disorders and handicaps are a risk that is run by mothers who are malnourished. [2] An estimated 24% of babies worldwide are born with lower than optimal weights at birth due to lack of proper nutrition. [3] Personal habits such as consumption of alcohol or large amounts of caffeine can negatively and irreversibly affect the development of the baby, which happens in the early stages of pregnancy. [4]

Caffeine consumption during pregnancy is associated with increased risk of pregnancy loss. [5] The available research favors the notion that the benefits of fish consumption during pregnancy outweigh the risks; however, the type of fish is important. [6] Folic acid, which is the synthetic form of the vitamin folate, is critical both in pre-and peri-conception. [7]

Nutrition before pregnancy

As with most diets, there are chances of over-supplementing, however, as general advice, both state and medical recommendations are that mothers follow instructions listed on particular vitamin packaging as to the correct or recommended daily allowance (RDA). Daily prenatal use of iron substantially improves birth weight, potentially reducing the risk of Low birth weight. [8]

Nutrition during pregnancy

The United States and the European Union have established vitamin and mineral recommendations for during pregnancy and lactation. The amounts in the table below are the higher of the two. The citations separately list recommendations for pregnancy and lactation. Recommendations (RDAs = Recommended Dietary Allowances and PRIs = Population Reference Intakes) are set higher than what has been determined to be average requirements so as to address women who have above average needs. For some nutrients there is not enough information to set a recommendation, so the term Adequate Intake (AI) is used based on what appears to be sufficient. [16] [17]

NutrientU.S. RDA or AI [16] EU PRI or AI [17] Unit
Vitamin A 9001300µg
Vitamin C 90155mg
Vitamin D 1515*µg
Vitamin K 120*70*µg
α-tocopherol (Vit E)1511*mg
Thiamin (Vit B1)1.21.0mg
Riboflavin (Vit B2)1.32.0mg
Niacin (Vit B3)1616mg
Pantothenic acid (Vit B5)5*7*mg
Vitamin B6 1.31.8mg
Biotin (Vit B7)30*45*µg
Folate (Vit B9)400600µg
Cyanocobalamin (Vit B12)2.45.0*µg
Choline 550*520*mg
Calcium 10001000mg
Chloride 2300*NE†mg
Chromium 35*NE†µg
Copper 9001500*µg
Fluoride 4*2.9*mg
Iodine 150200*µg
Iron 1816mg
Magnesium 420300*mg
Manganese 2.3*3.0*mg
Molybdenum 4565*µg
Phosphorus 700550*mg
Potassium 4700*4000*mg
Selenium 5585*µg
Sodium 1500*NE†mg
Zinc 1114.9mg

*Adequate Intake
†Not established. EU has not identified an AI for sodium or chloride, and does not consider chromium to be an essential mineral nutrient. [17]

Vitamin and mineral supplements

Multiple micronutrient supplements taken with iron and folic acid may improve birth outcomes for women in low income countries. [18] These supplements reduce numbers of low birth weight babies, small for gestational age babies and stillbirths in women who may not have many micronutrients in their usual diets. [18] Undernourished women can benefit from having dietary education sessions and, balanced energy and protein supplements. [19] A review showed that dietary education increased the mother’s protein intake and helped the baby grow more inside the womb. [19] The balanced protein and energy supplement lowered risk of stillbirth and small babies and increased weight gain for both the mother and baby. Although more research is needed into the longer term effects on the mothers’ and infants’ health, the short term effects look promising. [19] A review conducted in 2018 found that there was a slight benefit for lipid-based nutritional supplements (LNS) for newborn birth weight, length, small for gestational age and stunting when compared with iron-folic acid (IFA). In the same study IFA and multiple micro-nutrients (MMN) reduced maternal anemia better than LNS but care is advised in interpreting and applying the results due to review limitations. [20]

Prenatal vitamins typically contain increased amounts of folic acid, iodine, iron, vitamin A, vitamin D, zinc, and calcium over the amounts found in standard multi-vitamins. [4] Zinc supplements have reduced preterm births by around 14% mainly in low income countries where zinc deficiency is common. [21] However, the World Health Organization does not routinely recommend zinc supplementation for all pregnant women. [22]

Approximately 30 g of calcium is accumulated during pregnancy, almost all of it in the fetal skeleton (25 g). [23] For women with low calcium diets, there is low quality evidence to suggest that calcium supplementation during pregnancy may reduce the risk of preeclampsia. [24] Low-quality evidence also suggests that calcium supplementation may reduce the risk of the mother having the baby before 37th week of pregnancy (preterm birth). [24] The protective effect of calcium supplementation is not clear and there is not enough good quality to research to suggest best doses and timing of calcium supplementation. [25]

A mother's nutritional intake during pregnancy is believed to influence and possibly offer protective effects against the development of allergenic diseases and asthma in children. [26] Maternal intake of vitamin D, vitamin E, and zinc have all been associated with a lower likelihood of wheezing in childhood, suggesting a protective effect. [26] Additionally, maternal intake of omega-3 long chain polyunsaturated fatty acids (n-3 LC-PUFAs) has been associated with a reduced risk of development of eczema in childhood and reduced likelihood to for infants exhibit sensitivity to foods in the first year of life. [27]

Folic acid

Folic acid, which is the synthetic form of the vitamin folate, is critical both in pre-and peri-conception. [7] Deficiencies in folic acid may cause neural tube defects (NTDs). Women who had 0.4 mg of folic acid in their systems due to supplementing 3 months before childbirth significantly reduced the risk of NTDs. [28] More than 80 countries use fortification of certain foods with folic acid as a measure to decrease the rate of NTDs. [29]

Vitamins C and E

The combination of vitamin E and vitamin C supplemented to pregnant women does not appear to be efficacious for reducing risk of stillbirth, neonatal death, preterm birth, preeclampsia or any other maternal or infant outcomes, either in healthy women or those considered at risk for pregnancy complications. [30] Antioxidant vitamins as dietary supplements had been proposed as having benefits if consumed during pregnancy. For the combination of vitamin E with vitamin C supplemented to pregnant women, a Cochrane review of 21 clinical trials concluded that the data do not support vitamin E supplementation - majority of trials alpha-tocopherol at 400 IU/day plus vitamin C at 1000 mg/day - as being efficacious for reducing risk of stillbirth, neonatal death, preterm birth, preeclampsia or any other maternal or infant outcomes, either in healthy women or those considered at risk for pregnancy complications. [30] The review identified only three small trials in which vitamin E was supplemented without co-supplementation with vitamin C. None of these trials reported any clinically meaningful information. [30] A second Cochrane review of 29 trials, published same year, reported on the same combination trials but added analysis of trials with vitamin C alone. The conclusion was that the data do not support routine vitamin C supplementation alone or in combination with other supplements for the prevention of fetal or neonatal death, poor fetal growth, preterm birth or preeclampsia. [31]

Vitamin B12

For vitamin B12, the U.S. Recommended Dietary Allowance (RDA) for pregnancy is 2.6 µg/day, for lactation 2.8 µg/day. Determination of these values was based on RDA of 2.4 µg/day for non-pregnant women plus what will be transferred to the fetus during pregnancy and what will be delivered in breast milk. [32] [33] However, looking at the same scientific evidence, the European Food Safety Authority (EFSA) sets adequate intake (AI) at 4.5 μg/day for pregnancy and 5.0 μg/day for lactation. [34] Low maternal vitamin B12, defined as serum concentration less than 148 pmol/L, increases the risk of miscarriage, newborn low birth weight and preterm birth. [35] [33] During pregnancy the placenta concentrates B12, so that newborn infants have a higher serum concentration than their mothers. [32] What the mother-to-be consumes during the pregnancy is more important than her liver tissue stores, as it is recently absorbed vitamin content that more effectively reaches the placenta. [32] [36] Women who consume a small percentage of their diet from animal-sourced foods or who by choice consume a vegetarian or vegan diet are at higher risk than those consuming higher amounts of animal-sourced foods for becoming vitamin depleted during pregnancy, which can lead to anemia, and also an increased risk that their breastfed infants become vitamin deficient. [36] [33]

Food safety

Pregnant women are advised to pay attention to the foods they eat during pregnancy in order to reduce the risk of exposure to substances or bacteria that may be harmful to the developing fetus. This can include potentially harmful pathogens such as listeria, toxoplasmosis, and salmonella. [7] Intake of large amounts of retinol has been linked to birth defects and abnormalities. [37]

Water

During pregnancy, a woman's mass increases by about 12 kg (26 lb). [38] The European Food Safety Authority recommends an increase of 300 mL per day compared to the normal intake for non-pregnant women, taking the total adequate water intake (from food and fluids) to 2,300 mL, or approximately 1,850 mL/ day from fluids alone. [39]

Caffeine

Caffeine consumption during pregnancy is associated with increased risk of pregnancy loss [5] [40] and increased risk of low birth weight, defined as below 2500 grams (5.5 pounds). [41] [42] The European Food Safety Authority and the American Congress of Obstetricians and Gynecologists concur that habitual caffeine consumption up to 200 mg per day by pregnant women does not give rise to safety concerns for the fetus. [43] [44] The United Kingdom Food Standards Agency had recommended that pregnant women should limit their caffeine intake to less than 300 mg of caffeine a day, but in 2009 revised that downward to less than 200 mg of caffeine a day. [45] A 2020 review called into question the safe levels proposed by the European Food Safety Authority, the American Congress of Obstetricians and Gynecologists, the National Health Service, and the Dietary Guidelines for Americans. It found that the current scientific evidence does not support moderate caffeine consumption during pregnancy as safe and advised pregnant women and women contemplating pregnancy to avoid caffeine. [46]

Alcohol

Fetal alcohol spectrum disorders are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. The most severe form of the condition is known as fetal alcohol syndrome. Problems may include an abnormal appearance, short height, low body weight, small head size, poor coordination, low intelligence, behavior problems, hearing loss and vision problems. [47] Those affected are more likely to have trouble in school, legal problems, participate in high-risk behaviors, and have trouble with alcohol and recreational drug use. [48] Fetal alcohol syndrome usually occurs when a pregnant woman has more than four drinks per day. Milder symptoms have been found with two drinks per day during the early part of pregnancy. [49] [50] Evidence of harm from less than two drinks per day or 10 drinks per week is not clear. [49] [51]

The American Academy of Pediatrics established a conservative set of recommendations in 2015: "During pregnancy:no amount of alcohol intake should be considered safe; there is no safe trimester to drink alcohol; all forms of alcohol, such as beer, wine, and liquor, pose similar risk; and binge drinking poses dose-related risk to the developing fetus." [52] The World Health Organization recommends that alcohol should be avoided entirely during pregnancy, given the relatively unknown effects of even small amounts of alcohol during pregnancy. [53]

Fish and omega-3 fatty acids

Fish consumption during pregnancy is encouraged by European, [54] Australian, [55] and American guidelines. [56] The reason given is that fat-containing fish such as salmon and tuna contain eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These are termed long chain, omega-3, polyunsaturated fatty acids, and are considered as important for fetal neurodevelopment. [6] Additionally, fish are good sources of vitamins A, D, and B12, as well as the mineral iodine. [6]

Due to risks of heavy-metal toxicity on fetal neurodevelopment, many mothers are concerned about eating fish during pregnancy. Overall, current research favors the notion that the benefits of fish consumption during pregnancy outweigh the risks; however, the type of fish is important. [6] Current research suggests that 2-3 servings of low-methylmercury containing fish per week in pregnancy is both safe and beneficial. [6] Mercury accumulates in fish through their own diet (bioaccumulation). A general rule of thumb is that fish higher up on the food chain, and with longer life spans will contain higher levels of mercury. Fish lower on the food chain and with shorter life spans will have lower metal content. However, it is important to note that the bioaccumulation of metals in fish is also dependent on geographical location, so it is hard to make global recommendations on specific fish species. [57] An alternative to consuming fish is to use fish oil dietary supplements containing both EPA and DHA, or algae-derived DHA-only oils. The New York Times reported on a laboratory evaluation of 30 popular fish oil supplements. Some of those had less than the label claimed amounts of DHA. As for safety, "All of the products tested contained only very low levels of mercury, ranging from one to six parts per billion per serving. That range is far below the upper safety limit of 100 parts per billion set by the Global Organization for EPA and DHA Omega-3s, an industry trade group." [58]

Nutrition after pregnancy

Proper nutrition is important after delivery to help the mother recover, and to provide enough food energy and nutrients for a woman to breastfeed her child. Women having serum ferritin less than 70 µg/L may need iron supplements to prevent iron deficiency anaemia during pregnancy and postpartum. [59] [60]

During lactation, water intake may need to be increased. Human milk is made of 88% water, and the IOM recommends that breastfeeding women increase their water intake by about 300 mL/day to a total volume of 3000 mL/day (from food and drink); approximately 2,400 mL/day from fluids. [38]

See also

Related Research Articles

Riboflavin Vitamin and supplement

Riboflavin, also known as vitamin B2, is a vitamin found in food and used as a dietary supplement. It is required by the body for cellular respiration. Food sources include eggs, green vegetables, milk and other dairy product, meat, mushrooms, and almonds. Some countries require its addition to grains.

Vitamin Nutrients required by organisms in small amounts

A vitamin is an organic molecule (or a set of molecules closely related chemically, i.e. vitamers) that is an essential micronutrient which an organism needs in small quantities for the proper functioning of its metabolism. Essential nutrients cannot be synthesized in the organism, either at all or not in sufficient quantities, and therefore must be obtained through the diet. Vitamin C can be synthesized by some species but not by others; it is not a vitamin in the first instance but is in the second. The term vitamin does not include the three other groups of essential nutrients: minerals, essential fatty acids, and essential amino acids. Most vitamins are not single molecules, but groups of related molecules called vitamers. For example, there are eight vitamers of vitamin E: four tocopherols and four tocotrienols. Some sources list fourteen vitamins, by including choline, but major health organizations list thirteen: vitamin A (as all-trans-retinol, all-trans-retinyl-esters, as well as all-trans-beta-carotene and other provitamin A carotenoids), vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B5 (pantothenic acid), vitamin B6 (pyridoxine), vitamin B7 (biotin), vitamin B9 (folic acid or folate), vitamin B12 (cobalamins), vitamin C (ascorbic acid), vitamin D (calciferols), vitamin E (tocopherols and tocotrienols), and vitamin K (phylloquinone and menaquinones).

Pantothenic acid

Pantothenic acid, also called vitamin B5 is a water-soluble B vitamin and therefore an essential nutrient. All animals require pantothenic acid in order to synthesize coenzyme A (CoA) – essential for fatty acid metabolism – as well as to in general synthesize and metabolize proteins, carbohydrates, and fats.

Vitamin E Generic descriptor for all tocopherols and tocotrienols that exhibit alpha-tocopherol activity

Vitamin E is a group of eight fat soluble compounds that include four tocopherols and four tocotrienols. Vitamin E deficiency, which is rare and usually due to an underlying problem with digesting dietary fat rather than from a diet low in vitamin E, can cause nerve problems. Vitamin E is a fat-soluble antioxidant protecting cell membranes from reactive oxygen species.

Tocopherols are a class of organic chemical compounds, many of which have vitamin E activity. Because the vitamin activity was first identified in 1936 from a dietary fertility factor in rats, it was named "tocopherol", from the Greek τόκος tókos 'birth' and φέρειν phérein 'to bear or carry', that is "to carry a pregnancy," with the ending "-ol" signifying its status as a chemical alcohol.

Vitamin A nutrient

Vitamin A is a group of unsaturated nutritional organic compounds that includes retinol, retinal, and several provitamin A carotenoids. Vitamin A has multiple functions: it is important for growth and development, for the maintenance of the immune system, and for good vision. Vitamin A is needed by the retina of the eye in the form of retinal, which combines with protein opsin to form rhodopsin, the light-absorbing molecule necessary for both low-light and color vision. Vitamin A also functions in a very different role as retinoic acid, which is an important hormone-like growth factor for epithelial and other cells.

Retinol Chemical compound

Retinol, also known as vitamin A1-alcohol, is a vitamin in the vitamin A family found in food and used as a dietary supplement. As a supplement it is ingested to treat and prevent vitamin A deficiency, especially that which results in xerophthalmia. In regions where deficiency is common, a single large dose is recommended to those at high risk a couple of times a year. It is also used to reduce the risk of complications in those who have measles. It is used by mouth or injection into a muscle.

Folate Vitamin B9; nutrient essential for DNA synthesis

Folate, also known as vitamin B9 and folacin, is one of the B vitamins. Manufactured folic acid, which is converted into folate by the body, is used as a dietary supplement and in food fortification as it is more stable during processing and storage. Folate is required for the body to make DNA and RNA and metabolise amino acids necessary for cell division. As humans cannot make folate, it is required in the diet, making it an essential nutrient. It occurs naturally in many foods. The recommended adult daily intake of folate in the U.S. is 400 micrograms from foods or dietary supplements.

Vitamin deficiency is the condition of a long-term lack of a vitamin. When caused by not enough vitamin intake it is classified as a primary deficiency, whereas when due to an underlying disorder such as malabsorption it is called a secondary deficiency. An underlying disorder may be metabolic – as in a genetic defect for converting tryptophan to niacin – or from lifestyle choices that increase vitamin needs, such as smoking or drinking alcohol. Governments guidelines on vitamin deficiencies advise certain intakes for healthy people, with specific values for women, men, babies, the elderly, and during pregnancy or breastfeeding. Many countries have mandated vitamin food fortification programs to prevent commonly occurring vitamin deficiencies.

Dietary supplement Product that provides additional source of nutrients

A dietary supplement is a manufactured product intended to supplement one's diet by taking a pill, capsule, tablet, powder or liquid. A supplement can provide nutrients either extracted from food sources or that are synthetic in order to increase the quantity of their consumption. The class of nutrient compounds includes vitamins, minerals, fiber, fatty acids and amino acids. Dietary supplements can also contain substances that have not been confirmed as being essential to life, but are marketed as having a beneficial biological effect, such as plant pigments or polyphenols. Animals can also be a source of supplement ingredients, such as collagen from chickens or fish for example. These are also sold individually and in combination, and may be combined with nutrient ingredients. In the United States and Canada, dietary supplements are considered a subset of foods, and are regulated accordingly. The European Commission has also established harmonized rules to help insure that food supplements are safe and properly labeled.

Multivitamin

A multivitamin is a preparation intended to serve as a dietary supplement with vitamins, dietary minerals, and other nutritional elements. Such preparations are available in the form of tablets, capsules, pastilles, powders, liquids, or injectable formulations. Other than injectable formulations, which are only available and administered under medical supervision, multivitamins are recognized by the Codex Alimentarius Commission as a category of food.

Vegetarian nutrition

Vegetarian nutrition is the set of health-related challenges and advantages of vegetarian diets.

Pregnancy Time when children develop inside the mothers body before birth

Pregnancy, also known as gestation, is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but can occur through assisted reproductive technology procedures. A pregnancy may end in a live birth, a spontaneous miscarriage, an induced abortion, or a stillbirth. Childbirth typically occurs around 40 weeks from the start of the last menstrual period (LMP). This is just over nine months – where each month averages 31 days. When using fertilization age it is about 38 weeks. An embryo is the developing offspring during the first eight weeks following fertilization, after which, the term fetus is used until birth. Signs and symptoms of early pregnancy may include missed periods, tender breasts, nausea and vomiting, hunger, and frequent urination. Pregnancy may be confirmed with a pregnancy test.

Neural tube defect Group of birth defects of the brain or spinal cord

Neural tube defects (NTDs) are a group of birth defects in which an opening in the spine or cranium remains from early in human development. In the third week of pregnancy called gastrulation, specialized cells on the dorsal side of the embryo begin to change shape and form the neural tube. When the neural tube does not close completely, an NTD develops.

Folate deficiency Abnormally low level of folate (vitamin B9) in the body

Folate deficiency, also known as vitamin B9 deficiency, is a low level of folate and derivatives in the body. Signs of folate deficiency are often subtle. A low number of red blood cells (anemia) is a late finding in folate deficiency and folate deficiency anemia is the term given for this medical condition. It is characterized by the appearance of large-sized, abnormal red blood cells (megaloblasts), which form when there are inadequate stores of folic acid within the body.

Drugs and medications should be avoided while pregnant. Women should speak to their doctor or healthcare professional before starting or stopping any medications while pregnant. Tobacco, alcohol, marijuana, and illicit drug use while pregnant may be dangerous for the unborn baby and may lead to severe health problems and/or birth defects. Even small amounts of alcohol, tobacco, and marijuana have not been proven to be safe when taken while pregnant. In some cases, for example, if the mother has epilepsy or diabetes, the risk of stopping a medication may be worse than risks associated with taking the medication while pregnant. The mother's healthcare professional will help make these decisions about the safest way to protect the health of both the mother and unborn child. In addition to medications and substances, some dietary supplements are important for a healthy pregnancy, however, others may cause harm to the unborn child.

Vitamin D Group of chemical compounds

Vitamin D is a group of fat-soluble secosteroids responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and many other biological effects. In humans, the most important compounds in this group are vitamin D3 (also known as cholecalciferol) and vitamin D2 (ergocalciferol).

Nutriepigenomics is the study of food nutrients and their effects on human health through epigenetic modifications. There is now considerable evidence that nutritional imbalances during gestation and lactation are linked to non-communicable diseases, such as obesity, cardiovascular disease, diabetes, hypertension, and cancer. If metabolic disturbances occur during critical time windows of development, the resulting epigenetic alterations can lead to permanent changes in tissue and organ structure or function and predispose individuals to disease.

Vegan nutrition

Vegan nutrition refers to the nutritional and human health aspects of vegan diets. A well-planned, balanced vegan diet is suitable to meet all recommendations for nutrients in every stage of human life. Vegan diets tend to be higher in dietary fiber, magnesium, folic acid, vitamin C, vitamin E, iron, and phytochemicals; and lower in dietary energy, saturated fat, cholesterol, long-chain omega-3 fatty acids, vitamin D, calcium, zinc, and vitamin B12. Preliminary evidence from epidemiological research indicates that a vegan diet may lower the risk of cancer.

Relatively speaking, the brain consumes an immense amount of energy in comparison to the rest of the body. The mechanisms involved in the transfer of energy from foods to neurons are likely to be fundamental to the control of brain function. Human bodily processes, including the brain, all require both macronutrients, as well as micronutrients.

References

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