Manual of Clinical Nutrition

Nutrition Management During Pregnancy and Lactation

Manual of Clinical Nutrition Management A- 15 Copyright © 2013 Compass Group, Inc.

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
Twin pregnancy
Normal BMI
Overweight
Obese
Triplet pregnancy

Individualized

Individualized

Individualized

Individualized

37 - 54 lb

31 - 50 lb

25 - 42 lb

45 - 55 lb (4)

The updated Institue of Medicine (IOM) guidelines are based on the World Health Organization (WHO) BMI

categories and formulated as a range of weight gain for each category of prepregnancy BMI (1). The recommended

weight gain ranges for short women and for racial or ethnic groups are the same as those for the whole population

(1). In addition, teenagers who are pregnant should use the adult BMI categories to determine their weight gain

range until more research is done to determine whether special categories are needed for them (1). Women who

are pregnant with twins are given provisional guidelines (1). Those in the normal weight range should aim to gain

37 to 54 lbs; overweight, 31 to 50 lbs; and obese, 25 to 42 lbs ( 1 ). For women pregnant with triplets, a weight gain of

45 - 55 lbs has been suggested (4). The newer guidelines include a specific and relatively narrow range of

recommended gain for obese women (1). For many women, this will mean gaining less weight, which may be

particularly challenging for women who are overweight or obese at conception (1).

Energy: The total energy needs during pregnancy range between 2, 200 and 2, 900 kcal/day for most women

(3,5). However, the mother’s age, prepregnancy BMI, rate of weight gain, and physiologic appetite must be

considered when determining individual needs (3). Based on a review of evidence, an average additional

intake of approximately 340 to 452 kcal/day is suggested in the second and third trimesters ( 6 ). For normal

weight and overweight women in developed countries, the additional energy need may actually be less than

300 kcal/day, especially in sedentary women (3). Appropriate weight gain and appetite are better indicators

of energy sufficiency than the amount of energy consumed (3). It has been suggested that an additional 500

kcal/day for a twin pregnancy is added to the calculated needs. There is no absolute recommendation in the

literature for the amount of additional energy needed for a multiple pregnancy. The indication is to add 500

kcal/day in the first trimester as soon as the multiple pregnancy is diagnosed, because these pregnancies

usually do not go to term and the goal is to maximize the early weight gain ( 4 ). Pregnant women should

consume a variety of foods according to the Dietary Guidelines to meet nutrient needs and gain the

recommended amounts of weight (3). MyPyramid guidelines include MyPyramid for Moms, which contains

food plans for pregnant women (3).

Protein: The 2002 DRIs list the recommended daily allowances for protein for all age groups during

pregnancy and lactation to be 1.1 g/kg per day or an additional 25 g/day in addition to the 0.8 g/kg per day

for a nonpregnant state ( 6 ). On average, this recommendation equates to approximately 71 g, but for women

with greater energy needs, the protein needs may need to be adjusted. For a twin pregnancy, an additional 5 0

g/day of protein above the recommended daily allowance of 0.8 g/kg per day for a nonpregnant state is

suggested during the second and third trimesters ( 6 ). Protein utilization depends on energy intake.

Therefore, adequate energy intake is important so that protein may be spared.

Vitamins and minerals: A multivitamin and mineral supplement is recommended in several circumstances

(1,3). Pregnant women who smoke or abuse alcohol or drugs should take a multivitamin and mineral

supplement (3). For women infected with the human immunodeficiency virus, especially women who receive

antiretroviral treatment, a supplement containing B-complex, vitamin E, and vitamin C may slow the

progression of disease and reduce complications (3). A multivitamin and mineral supplement is also

recommended for women with iron deficiency anemia or poor-quality diets and women who consume animal

products rarely or not at all (3). B 12 supplementation is recommended for persons who follow a vegetarian

diet pattern, including the lacto-ovo vegetarian diet pattern (3). Women carrying two or more fetuses are also

advised to consume a multivitamin and mineral supplement (3). Additional nutrients that may need to be

supplemented include folic acid, iron, zinc, copper, calcium, and vitamin D. The Food and Nutrition Board

recommends the use of supplements or fortified foods to obtain desirable amounts of some nutrients, such as

iron. The Food and Nutrition Board also recommends 400 g/day of synthetic folic acid from fortified foods,

supplements, or both for women who are trying to become pregnant and 600 g/day for women who are

pregnant (7).^

Iron: To meet the DRI of 27 mg/day of ferrous iron during pregnancy, a low-dose supplement is

recommended at the first prenatal visit (1,3,6). An iron supplement containing 150 mg of ferrous sulfate, 300