Nutrition Management During Pregnancy and LactationManual of Clinical Nutrition Management A- 17 Copyright © 2013 Compass Group, Inc.
consumption, while other studies have found an increase in stillbirths, spontaneous abortions, and fetal
malformations in pregnant women who consumed high levels of caffeine (>300 to 500 mg/day) (16, 17 ). A
more recent prospective study found that fetal growth restriction occurred at caffeine intakes greater than
100 mg/day ( 18 ). Until further evidence provides guidelines for setting a specific limit on caffeine intake,
women should be educated on the risks associated with caffeine consumption and the potential need to limit
caffeine based on predisposing risk factors (3,19).
Olestra: Studies of the fat substitute olestra conclude that pregnant or breast-feeding women should not
consume products containing olestra. Olestra causes gastrointestinal distress and diarrhea, which may lead
to the loss of the fat-soluble vitamins A, D, E, and K ( 20 ).
Nonnutritive Sweeteners: The FDA has approved seven nonnutritive sweeteners for general use:
aspartame, acesulfame-K, luo han guo extract, neotame, saccharin, sucralose, and stevia. All FDA-approved
nutritive and nonnutritive sweeteners approved for use by the general public, includes pregnant and lactating
women. The FDA and expert communities have concluded that these sweeteners are safe, based on studies of
the effects of these sweeteners on the fetus and the reproductive abilities of females and males ( 21 ). Thus,
consumption of acesulfame-K, aspartame, saccharin, sucralose, stevia, luo han guo, and neotame within the
acceptable daily intakes is safe during pregnancy ( 21 ). Research continues to indicate that aspartame is safe
during pregnancy, although women with phenylketonuria should exercise caution with this sweetener
because they need to closely monitor their intake of phenylalanine (3, 21 ). There is limited evidence that
saccharin can pass through the placenta and that it remains in fetal tissues; therefore, women should
moderate their intake of this sweetener (3). In a study in 2010, an association between intakes of nonnutritive
sweetened carbonated and noncarbonated soft drinks and preterm birth was found among Danish women
( 21 ). Women who consumed one or more nonnutritive sweetened soft drink per day were significantly more
likely to deliver preterm (21). The association was stronger for carbonated beverages with aspartame and
acesulfame-K compared to noncarbonated beverages. This finding has not been confirmed in other studies to
date (21).
Herbal and alternative therapies: Very few randomized clinical trials have examined the safety and efficacy
of alternative therapies during pregnancy (3). Several herbal and botanical supplements are harmful if used
during pregnancy (3). The American Academy of Pediatrics recommends that pregnant women limit their
consumption of herbal teas. Women who opt to consume herbal teas should limit their intake to two 8-oz
servings per day and choose herbal teas in filtered tea bags (3).
Fish: Due to the high levels of mercury in certain types of fish and mercury’s adverse effects on the fetus, the
US Department of Health and Human Services and the US Environmental Protection Agency suggest limiting
the type and amount of fish consumed during pregnancy (3). Pregnant women should avoid consuming shark,
swordfish, king mackerel, or tilefish. Twelve ounces or less per week of fish and shellfish lower in mercury,
such as shrimp, canned light tuna, salmon, pollock, and catfish, is safe (3). Consumption of albacore (“white”)
tuna should be limited to 6 oz/week, because this type of tuna contains more mercury than canned light tuna
(3). If no information regarding fish caught from local water sources is available, pregnant women should
limit their consumption of these fish to 6 oz/week and not consume any other fish during that week (3).
Foodborne Illness During Pregnancy
Pregnant women and their fetuses are at higher risk of developing foodborne illness (3). Pathogens such as
Listeria monocytogenes, Salmonella, and Toxoplasma gondii cause foodborne illness (3). Proper food storage
and preparation techniques should be reviewed to ensure safety (3). Unpasteurized foods and raw or
undercooked meat, poultry, or fish should be avoided to reduce the risk of exposure to pathogens (3). Careful
sanitation methods should be used, and pets should not be handled before or during food preparation (3).
Risk Factors During Pregnancy (1, 3 )
Women should be evaluated for factors that may put them at risk for adverse maternal and/or fetal outcomes
while they are pregnant. If any of the following risks are identified, appropriate medical and nutritional
monitoring should be provided throughout the pregnancy.