Nutrition Management During Pregnancy and Lactation
Manual of Clinical Nutrition Management A- 18 Copyright © 2013 Compass Group, Inc.
Risk factors at the onset of pregnancy:
Adolescence: younger than 15 years old at
time of conception or less than 3 years since
the onset of menses
Older than 35 years of age
Three or more pregnancies within 2 years
History of poor obstetric or fetal performance
Low income Unusual dietary practices
Smoking
Excessive alcohol intake
Recreational drug usea
Chronic systemic disease
Obesity
Prepregnancy BMI < 18. 5 kg/m^2 or > 29 .9
kg/m^2
Multiple gestation
aRecreational drugs or over-the-counter medications or dietary supplements that have adverse effects (eg, laxatives, antacids, or herbal
remedies containing teratogens)Risk factors during pregnancy (1, 3 ):
Hemoglobin level <11 g/dL (first and third trimesters), <10.5 g/dL (second trimester);
or hematocrit <33% (first and third trimesters), <32% (second trimester)
Inadequate weight gain: <1 lb/month for very overweight women
<2 lb/month for normal or slightly overweight women
<4 to 8 lb/month for women with multiple gestation and underweight women
Excessive weight gain (>6.6 lb/month after first trimester), possibly associated with fluid retention
Ferritin level < 20 g/dL ( 22 )
Serum folate level <3 mg/dL
Serum albumin level <2.5 g/dL
Total serum protein level <5.5 g/dL
Vitamin B 12 level <80 pg/mL
Nausea and Vomiting of Pregnancy
Nausea and vomiting are the most common symptoms experienced in early pregnancy, with nausea affecting
70% to 80 % of women ( 23 - 25 ). Dry, salty foods are traditionally recommended for resolving nausea or
vomiting; however, these foods do not always relieve symptoms ( 24 ). Foods with the following characteristics
are well tolerated: cold, warm, sour, creamy, crunchy, soft, wet, salty, and chocolaty (25). Increased olfactory
senses often are a leading cause of nausea during early pregnancy; thus, strong odors and sensitive
unpleasant odors should be avoided ( 24 ,25). Individualization in meal planning is necessary. Other
management techniques include the following recommendations (25):
Eat small, frequent meals and snacks.
Eat low-fat protein foods and easily digested carbohydrate foods.
Eat dry crackers before rising in the morning.
Avoid spicy foods and gas-forming fruits and vegetables.
Drink fluids between meals (milk is often not well tolerated).
Avoid drinks that contain caffeine or alcohol.
Hyperemesis gravidarum: Hyperemesis gravidarum is a condition characterized by severe, persistent
nausea and vomiting that causes dehydration, fluid and electrolyte abnormalities, acid-base disturbances,
ketonuria, and weight loss (ie, a 5% decrease from pregravid weight) ( 26 ). Hyperemesis gravidarum occurs in
approximately 2 % to 5 % of pregnant women ( 25 ). Nausea and vomiting of pregnancy and hyperemesis
gravidarum begin in the first trimester, usually between weeks 6 and 12, and symptoms often peak between
weeks 15 and 17. Symptoms often begin to decrease by week 20 (25). The pathogenesis of hyperemesis
gravidarum is not well understood. Nausea and vomiting of pregnancy and hyperemesis gravidarum are
thought to be related to increased secretion of human chorionic gonadotrophin and increased estrogen levels
(25). Other potential causes that have been implicated but not proven include thyroid changes, such as
hyperthyroidism, and bacterial infections, such as an underlying Helicobacter pylori infection (25,26).
Complications of hyperemesis gravidarum include dehydration, hyponatremia, inadequate weight gain, and
Mallory-Weiss tears (26). Another complication, Wernicke’s encephalopathy, is a result of insufficient thiamin
levels that are related to vomiting or the result of glucose administration without the addition of thiamin (25).