Pediatric Nutrition in Practice

128 Malek  Makrides

Pregnant and lactating women can largely
meet their nutritional needs by following the gov-
ernment-endorsed dietary guidelines available in
most countries and adding some extra daily serv-
ings of some core food groups [3, 4]. An example
is provided in table 2.
The remainder of the chapter outlines the cas-
es of specific nutrients and special conditions in
pregnancy and lactation.

F o l i c A c i d

Periconceptional folic acid supplementation has
been shown to reduce the first-time occurrence of
neural tube defects (NTD) by up to 72% and reoc-
currence by 68% [5]. The critical window for in-
creasing folate intake for the prevention of NTDs
is before neural tube closure, which normally oc-
curs by day 28 after conception. Given it can take
3 weeks to increase serum folate towards adequa-
cy, supplementation should commence at least 1
month before conception and continue until at
least 1 month after conception, although up to 3
months is often advised. A daily folic acid dose of
400–500 μg is recommended for low-risk women
(i.e. no family history of NTDs, not on anticon-

vulsants) and 4,000–5,000 μg for women with a

personal or close family history of NTDs. See

table 3 for natural and fortified sources of folate.

Iodine

Iodine is required for the production of thyroid

hormones, which are essential for normal fetal

and infant growth and brain development. Major

fetal effects of severe iodine deficiency (ID) in-

clude abortions, stillbirths, congenital abnormal-

ities, increased perinatal and infant mortality and

cretinism [6]. In an effort to prevent ID, salt iodi-

sation has been implemented in nearly all coun-

tries worldwide, and in countries where <20% of

households have access to iodised salt, the WHO

and UNICEF recommend iodine supplementa-

tion for pregnant and lactating women.

Mild-to-moderate ID also occurs in many

countries. Although its functional consequences

are not well established, many countries recom-

mend a daily supplement containing 150 μg of io-

dine in preconception, pregnancy and lactation.

Iodine-fortified foods, including bread, are

available in some countries. While iodine is also

found naturally in certain foods ( table 3 ), the io-

Ta b l e 1. The 2009 Institute of Medicine gestational weight gain recommendations for singleton and twin pregnan-
cies [2]

Pre-pregnancy BMI category Singleton pregnancy Twin pregnancy
total weight
total weight gain mean rate (range) of weight gain in the second and third trimesters gain

Underweight (<18.5) 28 – 40 lb 1.0 (1.0 – 1.3) lb/week –
12.5 – 18 kg 0.51 (0.44 – 0.58) kg/week –
Normal weight (18.5 – 24.9) 25 – 35 lb 1.0 (0.8 – 1.0) lb/week 37 – 54 lb
11.5 – 16 kg 0.42 (0.35 – 0.50) kg/week 17 – 25 kg
Overweight (25.0 – 29.9) 15 – 25 lb 0.6 (0.5 – 0.7) lb/week 31 – 50 lb
7 – 11.5 kg 0.28 (0.23 – 0.33) kg/week 14 – 23 kg
Obese (≥30.0) 11 – 20 lb 0.5 (0.4 – 0.6) lb/week 25 – 42 lb
5 – 9 kg 0.22 (0.17 – 0.27) kg/week 11 – 19 kg

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 127–133

DOI: 10.1159/000367872