Manual of Clinical Nutrition Management A- 14 Copyright © 2013 Compass Group, Inc.NUTRITION MANAGEMENT DURING PREGNANCY AND LACTATION
Description
Diets for pregnant or lactating women include additional servings of food from the Regular Diet to meet the
increased requirement for nutrients during pregnancy and lactation.
Nutritional Adequacy
The food patterns will meet the Dietary Reference Intakes (DRIs) for pregnancy and lactation, as outlined in
Section IA: Statement on Nutritional Adequacy, except for the iron requirements in the second and third
trimesters of pregnancy. Factors that may increase nutritional requirements above the estimated demands of
pregnancy include: poor nutritional status; young maternal age; multiple pregnancy; closely spaced births;
breast-feeding during pregnancy; continued high level of physical activity; certain disease states; and the use
of cigarettes, alcohol, and legal or illegal drugs. Dietary intake of iron, folate, zinc, protein, and calcium should
be carefully assessed for adequacy (1). Supplementation is justified when evidence suggests that the
inadequate intake of specific nutrients can increase the risk of an adverse effect on the mother, fetus, or
pregnancy outcome. Vegetarians who exclude all animal products need 2 mg of vitamin B 12 daily (1). Also see
Section IA: Vegetarian Diets.
How to Order the Diet
Order as “Regular Diet – Pregnancy” or “Regular Diet – Lactation.” Any special instructions should be
indicated in the diet order.
Planning the Diet
Daily Food Group Guidelines (2)
No. of Servings
Food Group Pregnant Women Lactating Women
Grains, Breads, and Cereals nine six to eleven
Fruits three two to four
Vegetables four three to five
Low-fat Meat, Poultry, Fish, and Eggs two or more (6 oz) two or more (7-8 oz)
Low-fat Milk, Yogurt, Cheese three or four four or five
Fats, Oils, and Sweets As needed to provide energy
Specific Nutrient Requirements During Pregnancy
Weight gain: The National Academy of Sciences’ Food and Nutrition Board has stated that the optimal weight gain
during pregnancy depends on the mother’s weight at the beginning of pregnancy (1). The target range for weight
gain is associated with a full-term, healthy baby, weighing an average of 3.1 to 3.6 kg (6. 8 to 7. 9 lb) (3). The
optimum weight gain for a woman of normal prepregnancy weight for her height (body mass index (BMI), 19.8 to
26 kg/m^2 ) who is carrying a single fetus is 25 to 35 lbs; however, there are individual differences based on
maternal anthropometry and ethnic decent (3). The pattern of weight gain is more significant than the absolute
weight gain. The desired pattern of weight gain is approximately 3 to 8 lb in the first trimester and about 1
lb/week during the last two trimesters.The BMI, defined as weight divided by the height squared (kg/m^2 )^ (2), is a better indicator of maternal
nutritional status than is weight alone. Recommendations for weight gain during pregnancy should be
individualized according to the prepregnancy BMI (1,3). (See Section II: Body Mass Index.) To identify the BMI
categories and appropriate weight gain, use Table A- 1 (1).Table A-1: Guidelines for Weight Gain After the First Trimester of Pregnancy (1,3,4)
BMI (kg/m^2 ) Recommended Weight Gain Intervention Suggested Overall Weight Gain
<1 8. 5
(underweight)
1 lb/wk <2 lb/mo 28 - 40 lb- 5 - 2 4.9
(normal weight)
1 lb/wk <2 lb/mo, >6.5 lb/mo 25 - 35 lb
2 5 - 29 .9
(overweight)
0.6 lb/wk >3.5 lb/wk, <1 lb/wk 15 - 25 lb
30.0
(obese)
Individualized <l lb/wk, >2.5 lb/wk 11 - 20 lb