Maternal Nutrition
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Nutrition and pregnancy refers to the nutrient intake and dietary planning that is undertaken before, during, and after pregnancy. Nutrition of the fetus begins at conception. For this reason, the nutrition of the mother is important from before conception (probably several months before) as well as throughout pregnancy and breastfeeding. An ever-increasing number of studies have shown that the nutrition of the mother will have an effect on the child, up to and including the risk for
cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...
,
cardiovascular disease Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina, heart attack), heart failure, hypertensive heart disease, rheumati ...
,
hypertension Hypertension, also known as high blood pressure, is a Chronic condition, long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High blood pressure usually does not cause symptoms i ...
, and
diabetes Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...
throughout life. An inadequate or excessive amount of some nutrients may cause malformations or medical problems in the fetus, and neurological disorders and handicaps are a risk that is run by mothers who are malnourished. An estimated 24% of babies worldwide are born with lower than optimal weights at birth due to lack of proper nutrition. Personal habits such as consumption of alcohol or large amounts of caffeine can negatively and irreversibly affect the development of the baby, which happens in the early stages of pregnancy.
Caffeine Caffeine is a central nervous system (CNS) stimulant of the methylxanthine chemical classification, class and is the most commonly consumed Psychoactive drug, psychoactive substance globally. It is mainly used for its eugeroic (wakefulness pr ...
consumption during pregnancy is associated with an increased risk of pregnancy loss. The available research favors the notion that the benefits of fish consumption during pregnancy outweigh the risks; however, the type of fish is important. Folic acid, which is the synthetic form of the vitamin folate, is critical both in pre- and peri-conception.


Nutrition before pregnancy

As with most diets, there are chances of over-supplementing. However, as general advice, both state and medical recommendations are that mothers follow instructions listed on particular vitamin packaging as to the correct or recommended daily allowance (RDA). Daily prenatal use of iron substantially improves birth weight, potentially reducing the risk of
low birth weight Low birth weight (LBW) is defined by the World Health Organization as a birth weight of an infant of or less, regardless of gestational age. Infants born with LBW have added health risks which require close management, often in a neonatal inten ...
. *
Folic acid Folate, also known as vitamin B9 and folacin, is one of the B vitamins. Manufactured folic acid, which is converted into folate by the body, is used as a dietary supplement and in food fortification as it is more stable during processing and ...
supplementation is recommended before conception, to prevent the development of
spina bifida Spina bifida (SB; ; Latin for 'split spine') is a birth defect in which there is incomplete closing of the vertebral column, spine and the meninges, membranes around the spinal cord during embryonic development, early development in pregnancy. T ...
and other
neural tube defect Neural tube defects (NTDs) are a group of birth defects in which an opening in the spine or cranium remains from early in human development. In the third week of pregnancy called gastrulation, specialized cells on the dorsal side of the embryo ...
s. It should be taken as at least 0.4 mg/day throughout the first trimester of pregnancy, 0.6 mg/day throughout the pregnancy, and 0.5 mg/day while breastfeeding in addition to eating foods rich in folic acid such as green leafy vegetables. *
Iodine Iodine is a chemical element; it has symbol I and atomic number 53. The heaviest of the stable halogens, it exists at standard conditions as a semi-lustrous, non-metallic solid that melts to form a deep violet liquid at , and boils to a vi ...
levels are frequently too low in pregnant women, and iodine is necessary for normal thyroid function and mental development of the fetus, even cretinism. Pregnant women should take prenatal vitamins containing iodine. *
Vitamin D Vitamin D is a group of structurally related, fat-soluble compounds responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, along with numerous other biological functions. In humans, the most important compo ...
levels vary with exposure to sunlight. While it was assumed that supplementation was necessary only in areas of high latitudes, recent studies of Vitamin D levels throughout the United States and many other countries have shown a large number of women with low levels. For this reason, there is a growing movement to recommend supplementation with 1000 IU of Vitamin D daily throughout pregnancy. * A large number of pregnant women have been found to have low levels of
vitamin B12 Vitamin B12, also known as cobalamin, is a water-soluble vitamin involved in metabolism. One of eight B vitamins, it serves as a vital cofactor (biochemistry), cofactor in DNA synthesis and both fatty acid metabolism, fatty acid and amino a ...
, but supplementation has not yet been shown to improve pregnancy outcome or the health of the newborn. *Long-chain polyunsaturated fatty acids, specifically
docosahexaenoic acid Docosahexaenoic acid (DHA) is an omega−3 fatty acid that is an important component of the human brain, cerebral cortex, skin, and retina. It is given the fatty acid notation 22:6(''n''−3). It can be synthesized from alpha-linolenic acid or ...
(DHA) and
eicosapentaenoic acid Eicosapentaenoic acid (EPA; also icosapentaenoic acid) is an omega−3 fatty acid. In physiological literature, it is given the name 20:5(''n''−3). It also has the trivial name timnodonic acid. In chemical structure, EPA is a carboxylic acid wi ...
(EPA), are beneficial for fetal development. Several studies have shown a lower risk of preterm delivery and low birth weight in mothers with higher intakes. *
Iron Iron is a chemical element; it has symbol Fe () and atomic number 26. It is a metal that belongs to the first transition series and group 8 of the periodic table. It is, by mass, the most common element on Earth, forming much of Earth's o ...
is needed for the healthy growth of the fetus and placenta, especially during the second and third trimesters. It is recommended that the first and third trimesters retain concentrations greater than 11 grams/deciliter and that the second trimester has levels above 10.5 grams per deciliter. It is also essential before pregnancy for the production of hemoglobin. There is no evidence that a hemoglobin level of 7 grams/100 ml or higher is detrimental to pregnancy, but it must be acknowledged that maternal hemorrhage is a major source of maternal mortality worldwide, and a reserve capacity to carry oxygen is desirable. According to the Cochrane review conclusions iron supplementation reduces the risk of maternal anaemia and iron deficiency in pregnancy but the positive effect on other maternal and infant outcomes is less clear.


Nutrition during pregnancy

The United States and the European Union have established vitamin and mineral recommendations during pregnancy and lactation. The amounts in the table below are the higher of the two. The citations separately list recommendations for pregnancy and lactation. Recommendations (RDAs = Recommended Dietary Allowances and PRIs = Population Reference Intakes) are set higher than what has been determined to be average requirements so as to address women who have above-average needs. For some nutrients, there is not enough information to set a recommendation, so the term Adequate Intake (AI) is used based on what appears to be sufficient. *Adequate Intake
†Not established. The EU has not identified an AI for sodium or chloride, and does not consider chromium to be an essential mineral nutrient.


Vitamin and mineral supplements

Multiple micronutrient supplements taken with iron and folic acid may improve birth outcomes for women in low-income countries. These supplements reduce the number of low birth weight babies, small for gestational age babies, and stillbirths in women who may not have many micronutrients in their usual diets. Undernourished women can benefit from having dietary education sessions and balanced energy and protein supplements. A review showed that dietary education increased the mother's protein intake and helped the baby grow more inside the womb. The balanced protein and energy supplement lowered the risk of stillbirth in small babies and increased weight gain for both the mother and baby. Although more research is needed into the longer-term effects on the mothers' and infants' health, the short-term effects look promising. A review conducted in 2018 found that there was a slight benefit for lipid-based nutritional supplements (LNS) for newborn birth weight, length, small for gestational age, and stunting when compared with iron-folic acid (IFA). In the same study, IFA and multiple micronutrients (MMN) reduced maternal anemia better than LNS, but care is advised in interpreting and applying the results due to review limitations.
Prenatal vitamins Prenatal vitamins, also known as prenatal supplements, are vitamin and mineral supplements intended to be taken before and during pregnancy and during postnatal lactation. Although not intended to replace a healthy diet, prenatal vitamins provi ...
typically contain increased amounts of
folic acid Folate, also known as vitamin B9 and folacin, is one of the B vitamins. Manufactured folic acid, which is converted into folate by the body, is used as a dietary supplement and in food fortification as it is more stable during processing and ...
, iodine, iron, vitamin A, vitamin D, zinc, and calcium over the amounts found in standard multi-vitamins. Currently, there is insufficient evidence that zinc supplements during pregnancy result in improved neonatal or maternal outcomes. The World Health Organization does not routinely recommend zinc supplementation for all pregnant women. Approximately of calcium is accumulated during pregnancy, almost all of it in the fetal skeleton (25 g). For women with low calcium diets, there is low quality evidence to suggest that calcium supplementation during pregnancy may reduce the risk of preeclampsia. Low-quality evidence also suggests that calcium supplementation may reduce the risk of the mother having the baby before the 37th week of pregnancy (preterm birth). A mother's nutritional intake during pregnancy is believed to influence and possibly offer protective effects against the development of allergic diseases and asthma in children. Maternal intake of vitamin D, vitamin E, and zinc has all been associated with a lower likelihood of wheezing in childhood, suggesting a protective effect. Additionally, maternal intake of omega-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFAs) has been associated with a reduced risk of the development of eczema in childhood and reduced likelihood for infants to exhibit sensitivity to foods in the first year of life.


Folic acid

Folic acid, which is the synthetic form of the vitamin
folate Folate, also known as vitamin B9 and folacin, is one of the B vitamins. Manufactured folic acid, which is converted into folate by the body, is used as a dietary supplement and in food fortification as it is more stable during processing and ...
, is critical both in pre- and peri-conception. Deficiencies in folic acid may cause
neural tube defects Neural tube defects (NTDs) are a group of birth defects in which an opening in the spine or cranium remains from early in human development. In the third week of pregnancy called gastrulation, specialized cells on the dorsal side of the embry ...
(NTDs). Women who had 0.4 mg of folic acid in their systems due to supplementing 3 months before childbirth significantly reduced the risk of NTDs. More than 80 countries use fortification of certain foods with folic acid as a measure to decrease the rate of NTDs.


Vitamins C and E

The combination of
vitamin E Vitamin E is a group of eight compounds related in molecular structure that includes four tocopherols and four tocotrienols. The tocopherols function as fat-soluble antioxidants which may help protect cell membranes from reactive oxygen speci ...
and
vitamin C Vitamin C (also known as ascorbic acid and ascorbate) is a water-soluble vitamin found in citrus and other fruits, berries and vegetables. It is also a generic prescription medication and in some countries is sold as a non-prescription di ...
supplemented to pregnant women does not appear to be efficacious for reducing risk of
stillbirth Stillbirth is typically defined as fetus, fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without vital signs, signs of life. A stillbirth can often result in the feeling of guilt (emotio ...
, neonatal death,
preterm birth Preterm birth, also known as premature birth, is the Childbirth, birth of a baby at fewer than 37 weeks Gestational age (obstetrics), gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 ...
,
preeclampsia Pre-eclampsia is a multi-system disorder specific to pregnancy, characterized by the new onset of high blood pressure and often a significant amount of protein in the urine or by the new onset of high blood pressure along with significant end- ...
or any other maternal or infant outcomes, either in healthy women or those considered at risk for pregnancy complications. Antioxidant vitamins as dietary supplements have been proposed as having benefits if consumed during pregnancy. For the combination of vitamin E with vitamin C supplemented to pregnant women, a Cochrane review of 21 clinical trials concluded that the data do not support vitamin E supplementation – majority of trials alpha-tocopherol at 400 IU/day plus vitamin C at 1000 mg/day – as being efficacious for reducing risk of
stillbirth Stillbirth is typically defined as fetus, fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without vital signs, signs of life. A stillbirth can often result in the feeling of guilt (emotio ...
, neonatal death,
preterm birth Preterm birth, also known as premature birth, is the Childbirth, birth of a baby at fewer than 37 weeks Gestational age (obstetrics), gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 ...
,
preeclampsia Pre-eclampsia is a multi-system disorder specific to pregnancy, characterized by the new onset of high blood pressure and often a significant amount of protein in the urine or by the new onset of high blood pressure along with significant end- ...
or any other maternal or infant outcomes, either in healthy women or those considered at risk for pregnancy complications. The review identified only three small trials in which vitamin E was supplemented without co-supplementation with vitamin C. None of these trials reported any clinically meaningful information. A second Cochrane review of 29 trials, published same year, reported on the same combination trials but added analysis of trials with vitamin C alone. The conclusion was that the data do not support routine vitamin C supplementation alone or in combination with other supplements for the prevention of fetal or neonatal death, poor fetal growth, preterm birth, or preeclampsia.


Vitamin B12

For
vitamin B12 Vitamin B12, also known as cobalamin, is a water-soluble vitamin involved in metabolism. One of eight B vitamins, it serves as a vital cofactor (biochemistry), cofactor in DNA synthesis and both fatty acid metabolism, fatty acid and amino a ...
, the U.S. Recommended Dietary Allowance (RDA) for pregnancy is 2.6 μg/day, for lactation 2.8 μg/day. Determination of these values was based on an RDA of 2.4 μg/day for non-pregnant women, plus what will be transferred to the fetus during pregnancy and what will be delivered in breast milk. However, looking at the same scientific evidence, the
European Food Safety Authority The European Food Safety Authority (EFSA) is the agency of the European Union (EU) that provides independent scientific advice and communicates on existing and emerging risks associated with the food chain. EFSA was established in February 2002 ...
(EFSA) sets adequate intake (AI) at 4.5μg/day for pregnancy and 5.0 μg/day for lactation. Low maternal vitamin B12, defined as serum concentration less than 148 pmol/L, increases the risk of miscarriage, newborn low birth weight and preterm birth. During pregnancy the
placenta The placenta (: placentas or placentae) is a temporary embryonic and later fetal organ that begins developing from the blastocyst shortly after implantation. It plays critical roles in facilitating nutrient, gas, and waste exchange between ...
concentrates B12, so that newborn infants have a higher serum concentration than their mothers. What the mother-to-be consumes during the pregnancy is more important than her liver tissue stores, as it is recently absorbed vitamin content that more effectively reaches the placenta. Women who consume a small percentage of their diet from animal-sourced foods or who by choice consume a vegetarian or vegan diet are at higher risk than those consuming higher amounts of animal-sourced foods of becoming vitamin depleted during pregnancy, which can lead to anemia, and also an increased risk that their breastfed infants become vitamin deficient.


Food safety

Pregnant women are advised to pay attention to the foods they eat during pregnancy to reduce the risk of exposure to substances or bacteria that may be harmful to the developing fetus. This can include potentially harmful pathogens such as
listeria ''Listeria'' is a genus of bacteria that acts as an intracellular parasite in mammals. As of 2024, 28 species have been identified. The genus is named in honour of the British pioneer of sterile surgery Joseph Lister. ''Listeria'' species ...
,
toxoplasmosis Toxoplasmosis is a parasitic disease caused by ''Toxoplasma gondii'', an apicomplexan. Infections with toxoplasmosis are associated with a variety of neuropsychiatric and behavioral conditions. Occasionally, people may have a few weeks or month ...
, and
salmonella ''Salmonella'' is a genus of bacillus (shape), rod-shaped, (bacillus) Gram-negative bacteria of the family Enterobacteriaceae. The two known species of ''Salmonella'' are ''Salmonella enterica'' and ''Salmonella bongori''. ''S. enterica'' ...
. Intake of large amounts of retinol has been linked to birth defects and abnormalities.


Water

During pregnancy, a woman's mass increases by about 12 kg (26 lb).Water
Institute of Medicine Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: National Academies Press (2004).
The
European Food Safety Authority The European Food Safety Authority (EFSA) is the agency of the European Union (EU) that provides independent scientific advice and communicates on existing and emerging risks associated with the food chain. EFSA was established in February 2002 ...
recommends an increase of 300 mL per day compared to the normal intake for non-pregnant women, taking the total adequate water intake (from food and fluids) to 2,300 mL, or approximately 1,850 mL/ day from fluids alone.


Caffeine

Caffeine Caffeine is a central nervous system (CNS) stimulant of the methylxanthine chemical classification, class and is the most commonly consumed Psychoactive drug, psychoactive substance globally. It is mainly used for its eugeroic (wakefulness pr ...
consumption during pregnancy is associated with increased risk of pregnancy loss and increased risk of low birth weight, defined as below 2500 grams (5.5 pounds). The
European Food Safety Authority The European Food Safety Authority (EFSA) is the agency of the European Union (EU) that provides independent scientific advice and communicates on existing and emerging risks associated with the food chain. EFSA was established in February 2002 ...
and the American Congress of Obstetricians and Gynecologists concur that habitual caffeine consumption up to 200 mg per day by pregnant women does not give rise to safety concerns for the fetus. The United Kingdom Food Standards Agency had recommended that pregnant women should limit their caffeine intake to less than 300 mg of caffeine a day, but in 2009 revised that downward to less than 200 mg of caffeine a day. High doses of caffeine intake during pregnancy may increase the risk of miscarriage and some major negative pregnancy outcomes, such as stillbirth or low birth weight. A 2020 review called into question the safe levels proposed by the European Food Safety Authority, the American Congress of Obstetricians and Gynecologists, the
National Health Service The National Health Service (NHS) is the term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...
, and the Dietary Guidelines for Americans. It found that the current scientific evidence does not support moderate caffeine consumption during pregnancy as safe, and advised pregnant women and women contemplating pregnancy to avoid caffeine.


Alcohol

Fetal alcohol spectrum disorder Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person who is exposed to alcohol during gestation. FASD affects 1 in 20 Americans, but is highly misdiagnosed and underdiagnosed. The several forms of the ...
s are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. The most severe form of the condition is known as fetal alcohol syndrome. Problems may include an abnormal appearance, short height, low body weight, small head size, poor coordination, low intelligence, behavior problems, hearing loss, and vision problems. Those affected are more likely to have trouble in school, legal problems, participate in high-risk behaviors, and have trouble with alcohol and recreational drug use. Fetal alcohol syndrome usually occurs when a pregnant woman has more than four drinks per day. Milder symptoms have been found with two drinks per day during the early part of pregnancy. Evidence of harm from less than two drinks per day or 10 drinks per week is not clear. The American Academy of Pediatrics established a conservative set of recommendations in 2015: "During pregnancy: no amount of alcohol intake should be considered safe; there is no safe trimester to drink alcohol; all forms of alcohol, such as beer, wine, and liquor, pose similar risk; and binge drinking poses dose-related risk to the developing fetus." The
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations which coordinates responses to international public health issues and emergencies. It is headquartered in Gen ...
recommends that alcohol should be avoided entirely during pregnancy, given the relatively unknown effects of even small amounts of alcohol during pregnancy.


Fish and omega-3 fatty acids

Fish consumption during pregnancy is encouraged by European, Australian, and American guidelines. The reason given is that fat-containing fish such as salmon and tuna contain eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These are termed long chain,
omega-3 Omega−3 fatty acids, also called omega−3 oils, ω−3 fatty acids or ''n''−3 fatty acids, are polyunsaturated fatty acids (PUFAs) characterized by the presence of a double bond three atoms away from the terminal methyl group in their ...
,
polyunsaturated fatty acids In biochemistry and nutrition, a polyunsaturated fat is a fat that contains a polyunsaturated fatty acid (abbreviated PUFA), which is a subclass of fatty acid characterized by a backbone with two or more carbon–carbon double bonds. Some polyunsa ...
, and are considered important for fetal neurodevelopment. Additionally, fish are good sources of vitamins A, D, and B12, as well as the mineral iodine. Due to the risks of heavy-metal toxicity on fetal neurodevelopment, many mothers are concerned about eating fish during pregnancy. Overall, current research favors the notion that the benefits of fish consumption during pregnancy outweigh the risks; however, the type of fish is important. Current research suggests that 2-3 servings of low-
methylmercury Methylmercury is an organometallic cation with the formula . It is the simplest organomercury compound. Methylmercury is extremely toxic, and its derivatives are the major source of organic mercury for humans. It is a bioaccumulative environment ...
containing fish per week in pregnancy is both safe and beneficial. Mercury accumulates in fish through their own diet (
bioaccumulation Bioaccumulation is the gradual accumulation of substances, such as pesticides or other chemicals, in an organism. Bioaccumulation occurs when an organism absorbs a substance faster than it can be lost or eliminated by catabolism and excretion. T ...
). A general rule of thumb is that fish higher up on the food chain, and with longer life spans, will contain higher levels of mercury. Fish lower on the food chain and with shorter life spans will have lower metal content. However, it is important to note that the bioaccumulation of metals in fish is also dependent on geographical location, so it is hard to make global recommendations on specific fish species. An alternative to consuming fish is to use fish oil dietary supplements containing both EPA and DHA, or algae-derived DHA-only oils. The New York Times reported on a laboratory evaluation of 30 popular fish oil supplements. Some of those had less than the label claimed amounts of DHA. As for safety, "All of the products tested contained only very low levels of mercury, ranging from one to six parts per billion per serving. That range is far below the upper safety limit of 100 parts per billion set by the Global Organization for EPA and DHA Omega-3s, an industry trade group."


Nutrition after pregnancy

Proper nutrition is important after delivery to help the mother recover, and to provide enough food energy and nutrients for a woman to
breastfeed Breastfeeding, also known as nursing, is the process where breast milk is fed to a child. Infants may suck the milk directly from the breast, or milk may be extracted with a pump and then fed to the infant. The World Health Organization (WHO ...
her child. Women having serum
ferritin Ferritin is a universal intracellular and extracellular protein that stores iron and releases it in a controlled fashion. The protein is produced by almost all living organisms, including archaea, bacteria, algae, higher plants, and animals. ...
less than 70 μg/L may need
iron Iron is a chemical element; it has symbol Fe () and atomic number 26. It is a metal that belongs to the first transition series and group 8 of the periodic table. It is, by mass, the most common element on Earth, forming much of Earth's o ...
supplements to prevent iron deficiency anaemia during pregnancy and postpartum. During lactation, water intake may need to be increased. Human milk is made of 88% water, and the IOM recommends that breastfeeding women increase their water intake by about 300 mL/day to a total volume of 3000 mL/day (from food and drink), approximately 2,400 mL/day from fluids.


See also

*
Fetal alcohol spectrum disorder Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person who is exposed to alcohol during gestation. FASD affects 1 in 20 Americans, but is highly misdiagnosed and underdiagnosed. The several forms of the ...
* Prenatal nutrition *
Smoking and pregnancy Tobacco smoking during pregnancy causes many detrimental effects on health and reproduction, in addition to the general health effects of tobacco. A number of studies have shown that tobacco use is a significant factor in miscarriages among pregn ...


References


Further reading

* * Health Education Authority (1996) ''Folic acid - what all women should know (leaflet)'' London:HEA {{DEFAULTSORT:Nutrition And Pregnancy Nutrition Health issues in pregnancy