Position of the Academy of Nutrition and Dietetics: Nutrition and Lifestyle for a Healthy Pregnancy Outcome
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FROM THE ACADEMY
Position Paper
Position of the Academy of Nutrition and Dietetics:
Nutrition and Lifestyle for a Healthy Pregnancy Outcome
ABSTRACT POSITION STATEMENT
It is the position of the Academy of Nutrition and Dietetics that women of childbearing It is the position of the Academy of Nutrition
age should adopt a lifestyle optimizing health and reducing risk of birth defects, sub- and Dietetics that women of childbearing
age should adopt a lifestyle optimizing
optimal fetal development, and chronic health problems in both mother and child. health and reducing risk of birth defects,
Components leading to a healthy pregnancy outcome include healthy prepregnancy suboptimal fetal development, and chronic
weight, appropriate weight gain and physical activity during pregnancy, consumption of health problems in both mother and child.
a wide variety of foods, appropriate vitamin and mineral supplementation, avoidance of Components leading to healthy pregnancy
outcome include healthy prepregnancy
alcohol and other harmful substances, and safe food handling. Pregnancy is a critical weight, appropriate weight gain and physical
period during which maternal nutrition and lifestyle choices are major influences on activity during pregnancy, consumption of a
mother and child health. Inadequate levels of key nutrients during crucial periods of wide variety of foods, appropriate vitamin
fetal development may lead to reprogramming within fetal tissues, predisposing the and mineral supplementation, avoidance of
alcohol and other harmful substances, and
infant to chronic conditions in later life. Improving the well-being of mothers, infants, safe food handling.
and children is key to the health of the next generation. This position paper and the
accompanying practice paper (www.eatright.org/members/practicepapers) on the same
topic provide registered dietitian nutritionists and dietetic technicians, registered; other
professional associations; government agencies; industry; and the public with the
Academy’s stance on factors determined to influence healthy pregnancy, as well as an
overview of best practices in nutrition and healthy lifestyles during pregnancy.
J Acad Nutr Diet. 2014;114:1099-1103.
25) and almost one third were obese
T
HIS POSITION PAPER PROVIDES choices are major influences on mother
Academy of Nutrition and Di- and child health. Improving the well- (BMI 30).4 Overconsumption/over-
etetics members, other profes- being of mothers, infants, and children weight throughout the reproductive
sional associations, government is key to the health of the next genera- cycle are related to short- and long-
agencies, industry, and the public with tion. One in 33 babies (approximately term maternal health risks, including
the Academy’s stance on factors deter- 3%) is born with a birth defect2; in 2010, obesity, diabetes, dyslipidemia, and
mined to influence healthy pregnancy, as low-birth-weight (LBW) infants cardiovascular disease. Caloric excess
well as emerging factors. Women with comprised 8.1% of US births.3 Birth de-
does not guarantee adequate intake or
inappropriate weight gain, hyperemesis, fects and LBW are ranked first and sec-
nutrient status critical to healthy
multiple gestations, poor dietary patterns ond, respectively, among the 10 leading
(eg, disordered eating), or chronic disease causes of death in US infants in 2006.3 A pregnancy outcomes.5
should be referred to a registered dieti- woman’s chance of having a healthy To improve maternal and child health
tian nutritionist (RDN) for medical nutri- baby improves when she adopts healthy outcomes, women should weigh within
tion therapy. For specific practice behaviors, including good nutrition; the normal BMI range when they
recommendations, refer to the Academy’s recommended supplementation; and conceive and strive to gain within
practice paper on “Nutrition and Lifestyle avoidance of smoking, alcohol, and illicit ranges recommended by the Institute of
for a Healthy Pregnancy Outcome.”1 drugs before becoming pregnant.2 Medicine (IOM) 2009 pregnancy weight
guidelines.4 High rates of overweight
and obesity are common in population
TRENDS IMPACTING OBESITY AND GESTATIONAL subgroups already at risk for poor
PREGNANCY OUTCOMES DIABETES maternal and child health outcomes,
Birth Defects, Low Birth Weight, Prepregnancy body mass index (BMI) is compounding the need for interven-
and Viable Birth Trends an independent predictor of many tion.4 In addition to health risks,
Pregnancy is a critical period during adverse outcomes of pregnancy. The gestational weight gain beyond the
which maternal nutrition and lifestyle prevalence of obesity in women 12 to recommendation substantially in-
44 years of age has more than doubled creases risk of excess weight retention
since 1976. In 1999 to 2004, nearly two in obese women at 1 year postpartum.6
2212-2672/$36.00
thirds of women of childbearing age More information on obesity and preg-
http://dx.doi.org/10.1016/j.jand.2014.05.005
were classified as overweight (BMI nancy outcomes can be found in the
ª 2014 by the Academy of Nutrition and Dietetics. JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 1099FROM THE ACADEMY
“Position of the Academy of Nutrition maternal metabolic conditions may be anemia in pregnant women in industri-
and Dietetics and American Society for associated with neurodevelopmental alized countries is 17.4%,19 with approx-
Nutrition: Obesity, Reproduction, and problems, including autism and devel- imately 9% of adolescent girls and
Pregnancy Outcomes.” 7 opmental delays in children.12 Inade- women of childbearing age in the United
New diagnostic criteria for gesta- quate levels of key nutrients during States having inadequate stores of body
tional diabetes mellitus (GDM) are ex- crucial periods of fetal development iron.20 The high incidence of iron defi-
pected to increase the proportion of may lead to reprogramming within ciency underscores the need for iron
women diagnosed with GDM, with fetal tissues, predisposing the infant to supplementation in pregnancy. During
potentially 18% of all pregnancies chronic conditions in later life. Those the first two trimesters of pregnancy,
affected.8 Immediately after pregnancy, conditions include obesity, cardiovas- iron-deficiency anemia increases the risk
5% to 10% of women with GDM are found cular disease, bone health, cognition, for preterm labor, LBW, and infant mor-
to have diabetes, usually type 2. Women immune function, and diabetes.13 tality.18 Maternal and fetal demand for
who have had GDM have a 35% to 60% Maternal weight gain during preg- iron increases during pregnancy; this
chance of developing diabetes in the nancy outside the recommended range increase cannot be met without iron
next 10 to 20 years.8 RDNs can provide is associated with increased risk to supplementation.18
valuable guidance to women seeking maternal and child health.4 Although
assistance regarding optimal weight physiological responses to prenatal Folic Acid. Folic acid is recognized as
and healthy food selection before, dur- overnutrition result in poor health important before and during pregnancy
ing, and post pregnancy. Additional in- outcomes that emerge in childhood because of its preventive properties
formation and guidance is available in and adolescence, fetal undernutrition against neural tube defects. All women,
the Academy’s GDM Evidence-Based responses range from fetal survival to including adolescents, who are capable
Nutrition Practice Guideline.9 poor health outcomes emerging later of becoming pregnant should consume
in the offspring’s adult life.14 The IOM 400 mg/day folic acid from fortified
Hypertension and Preeclampsia recommends that more US women foods and/or dietary supplements, in
achieve gestational weight gain within addition to eating food sources of
Prevalence of chronic hypertension in
the range identified for their prepreg- folate.21 Pregnant women are advised to
pregnancy in the United States is esti-
nant BMI.4 Pregnant women benefit consume 600 mg dietary folate equiva-
mated to be as high as 5%. This is pri-
from eating a variety of foods to meet lents daily from all food sources. Dietary
marily attributable to the increased
nutrient needs and consuming suffi- folate equivalents adjust for the differ-
prevalence of obesity, as well as delay in
cient calories to support recommended ence in bioavailability of food folate
childbearing to ages when chronic hy-
weight gain. Details regarding recom- compared with synthetic folic acid. One
pertension is more common.10 Hyper-
mended energy requirements and rec- dietary folate equivalent is equal to 1 mg
tension in pregnancy can harm both
ommended weight gain during food folate, which is equal to 0.6 mg folic
mother and fetus, and women with
pregnancy can be found in the related acid derived from supplements and
chronic hypertension are more likely to
practice paper.1 fortified foods taken with meals.14
experience preeclampsia (17% to 25% vs
Women who have had an infant with a
3% to 5% in the general population).10
Energy Expenditure neural tube defect should consult with
Age, preconception weight and health
their health care provider regarding
status, access to timely and appropriate Physical activity during pregnancy
the recommendation to take 4,000 mg
health care, and poverty are some of the benefits a woman’s overall health. In a
folic acid daily before and throughout
numerous factors affecting maternal low-risk pregnancy, moderately intense
the first trimester of pregnancy.22 An
health and the likelihood of a healthy activity does not increase risk of LBW,
association between the lack of peri-
pregnancy. Referral to the RDN and/or preterm delivery, or miscarriage.15 Rec-
conceptual use of vitamins or supple-
social worker may assure appropriate reational moderate and vigorous phys-
ments containing folic acid with an
care will be available, given the afore- ical activity during pregnancy is
excess risk for birth defects due to dia-
mentioned factors that can influence associated with a 48% lower risk of hy-
betes mellitus23 highlights ongoing
maternal and fetal outcomes. perglycemia, specifically among women
research.
with prepregnancy BMIFROM THE ACADEMY
research suggests higher levels of sup- jejuni.32 Pregnant women should closely containing caffeine do not increase
plementation are safe and effective for adhere to food-safety recommendations the risk of congenital malformations,
improving maternal and infant vitamin outlined in the 2010 Dietary Guidelines miscarriage, preterm birth, or growth
D status.24 for Americans.21 Updated food-safety retardation.36
guidelines can be reviewed on the Food
Choline. Choline is an essential and Drug Administration at www. Hydration and Water Needs. Ade-
nutrient during pregnancy because of fda.gov/Food/ResourcesForYou/Health quate hydration is essential to healthy
its high rate of transport from mother Educators/ucm083308.htm. pregnancy, as a woman accumulates 6
to fetus. Maternal deficiency of choline to 9 L of water during gestation. The
can interfere with normal fetal brain Benefits and Concerns Regarding total water Adequate Intake for preg-
development. Although choline is Fish and Seafood Consump- nancy (including drinking water, bev-
found in many foods, the majority of tion. The nutritional value of seafood erages and food) is 3 L/day. This
pregnant women are not achieving the is particularly important during fetal includes approximately 2.3 L (approxi-
Adequate Intake for pregnancy of 450 growth and development, as well as in mately 10 cups) as total beverages.37
mg choline per day.27 early infancy and childhood.14 Intake of
n-3 fatty acids, particularly docosahex- Energy Drinks. An energy drink is any
Calcium. The Dietary Reference Intake aenoic acid, from at least 8 oz of seafood beverage that contains some form of
for calcium in pregnancy is equal to that per week for pregnant women is as- legal stimulant and/or vitamins added
of nonpregnant women of the same age sociated with improved infant visual to provide a short-term boost in en-
because of increased efficiency in cal- and cognitive development.14 Although ergy. These drinks may contain sub-
cium absorption during pregnancy and prenatal mercury exposure (1 mg/g) stantial and varying amounts of sugar
maternal bone calcium mobilization.26 was found to be associated with a and caffeine, as well as taurine, carni-
Women with suboptimal intakes greater risk of attention-deficit hyper- tine, inositol, ginkgo, and milk thistle.
(FROM THE ACADEMY
intensive dietary intervention before 9. Academy of Nutrition and Dietetics Evi- www.cdc.gov/ncbddd/folicacid/recomme
dence Analysis Library. Gestational diabetes ndations.html. Accessed September 24,
and during pregnancy may be needed
evidence-based nutrition practice guide- 2012.
to promote optimal health.39 The risk line. http://andevidencelibrary.com/topic. 23. Correa A, Gilboa SM, Botto LD, et al. Lack
of maternal and infant mortality and cfm?cat¼3733. Accessed December 6, 2013. of periconceptional vitamins or supple-
pregnancy-related complications can 10. Seely EW, Ecker J. Chronic hypertension ments that contain folic acid and diabetes
be reduced with increased access to in pregnancy. N Engl J Med. 2011;365(5): mellitus-associated birth defects. Am J
439-446. Obstet Gynecol. 2012;206(3):218.e1-e13.
quality interconception care.
11. Tobias DK, Zhang C, Chavarro J, et al. 24. Hollis BW, Johnson D, Hulsey TC,
Prepregnancy adherence to dietary pat- Ebeling M, Wagner CL. Vitamin D sup-
terns and lower risk of gestational dia- plementation during pregnancy: Double-
CONCLUSIONS betes. Am J Clin Nutr. 2012;96(2):289-295. blind, randomized clinical trial of safety
Pregnancy has been regarded as a 12. Krakowiak P, Walker CK, Bremer AA, and effectiveness. J Bone Miner Res.
et al. Maternal metabolic conditions 2011;26(10):2341-2357.
maternal phase with requisite additional and risk for autism and other neuro-
nutritional requirements; mounting ev- 25. Thorne-Lyman A, Fawzi WW. Vitamin D
developmental disorders. Pediatrics.
during pregnancy and maternal, neonatal
idence suggests that the prenatal period 2012;129(5):e1121-e1128.
and infant health outcomes: A systematic
constitutes a critical convergence of 13. Hanley B, Dijane J, Fewtrell M, et al. review and meta-analysis. Paediatr Peri-
Metabolic imprinting, programming and
short- and long-term factors affecting nat Epidemiol. 2012;26(suppl 1):75-90.
epigenetics—A review of present prior-
the lifelong health of mother and child. ities and future opportunities. Br J Nutr. 26. Institute of Medicine. Dietary Reference
The aim of prenatal nutrition is to sup- 2010;104(suppl 1):S1-S25. Intakes for calcium and vitamin D. 2010.
http://www.iom.edu/Reports/2010/Diet
port a healthy uterine environment for 14. McMillen IC, MacLaughlin SM, ary-Reference-Intakes-for-Calcium-and-
optimal fetal development while sup- Muhlhausler BS, Gentili S, Duffield JL,
Vitamin-D.aspx. Published November 30,
Morrison JL. Developmental origins of
porting maternal health.5 The ideal pre- 2010. Accessed September 4, 2012.
adult health and disease: The role of per-
natal diet should limit overconsumption iconceptional and foetal nutrition. Basic 27. Caudill MA. Pre- and postnatal health:
for the mother and prevent undernutri- Clin Pharmacol Toxicol. 2008;102(2):82-89. Evidence of increased choline needs. J Am
Diet Assoc. 2010;110(8):1198-1206.
tion for the fetus5; a healthy lifestyle in- 15. US Department of Health and Human
Services. Physical activity for women 28. Hacker AN, Fung EB, King JC. Role of cal-
cludes regular physical activity and cium during pregnancy: Maternal and
during pregnancy and the postpartum
avoidance of harmful practices. period. In: 2008 Physical Activity Guide- fetal needs. Nutr Rev. 2012;70(7):397-409.
lines for Americans. Washington, DC: 29. Obican SG, Jahnke GD, Soldin OP,
Office of Disease Prevention & Health Scialli AR. Teratology public affairs com-
References Promotion; 2008:41-42. http://www. mittee position paper: Iodine deficiency
1. Academy of Nutrition and Dietetics. Prac- health.gov/paguidelines/guidelines/default. in pregnancy. Birth Defects Res.
tice Paper of the Academy of Nutrition and aspx. Accessed September 25, 2012. 2012;94(part A):677-682.
Dietetics: Nutrition and lifestyle for a
16. Deierlein AL, Siega-Riz AM, Evenson KR. 30. Stagnaro-Green A, Abalovich M,
healthy pregnancy outcome. http://www.
Physical activity during pregnancy and Alexander E, et al. Guidelines of the
eatright.org/members/practicepapers/.
risk of hyperglycemia. J Womens Health. American Thyroid Association for the
Published July 1, 2014. Accessed May 22,
2012;21(7):769-775. diagnosis and management of thyroid
2014.
17. Ruchat SM, Davenport MH, Giroux I, et al. disease during pregnancy and post-
2. Centers for Disease Control and Preven- partum. Thyroid. 2011;21(10):1081-1125.
Nutrition and exercise reduce excessive
tion. Division of Birth Defects and Devel-
weight gain in normal-weight pregnant 31. Swanson C, Zimmermann M, Skeaff S,
opmental Disabilities. Birth defects.
women. Med Sci Sports Exerc. 2012;44(8): et al. Summary of an NIH workshop to
http://www.cdc.gov/ncbddd/birthdefects/
1419-1426. identify research needs to improve the
index.html. Accessed October 4, 2012.
18. Gautam CS, Saha L, Sekhri K, Saha PK. Iron monitoring of iodine status in the United
3. Centers for Disease Control and Preven- States and to inform the DRI. J Nutr.
deficiency in pregnancy and the ratio-
tion. FastStats: Births and natality. http:// 2012;142(6):1175S-1185S.
nality of iron supplements prescribed
www.cdc.gov/nchs/fastats/births.htm.
during pregnancy. Medscape J Med. 32. Dean J, Kendall P. Food safety during preg-
Accessed October 4, 2012.
2008;10(12):283-288. http://www.ncbi. nancy. 2012;9.372. Colorado State Univer-
4. Rasmussen KM, Yaktine AL, eds. Weight nlm.nih.gov/pmc/articles/PMC264404/. sity Extension. Food and Nutrition Series.
Gain During Pregnancy: Reexamining Accessed October 3, 2012. http://www.ext.colostate.edu/pubs/food
the Guidelines. Washington, DC: National nut/09372.pdf. Accessed December 5, 2012.
19. Khalafallah AA, Dennis AE. Iron deficiency
Academies Press; 2009. http://www.
anaemia in pregnancy and postpartum: 33. Sagiv SK, Thurston SW, Bellinger DC,
nap.edu/openbook.php?record_id¼12584
Pathophysiology and effect of oral versus Amarasiriwardena C, Korrick SA. Prenatal
&page¼R1. Accessed March 19, 2014.
intravenous iron therapy [published on- exposure to mercury and fish consump-
5. Shapira N. Prenatal nutrition: A critical line June 26, 2012]. J Pregnancy. 2012; tion during pregnancy and attention-
window of opportunity for mother and 2012:630519. http://dx.doi.org/10.1155/ deficit/hyperactivity disorder-related
child. Womens Health. 2008;4(6):639-656. 2012/630519. behavior in children. Arch Pediatr Adolesc
6. Vesco KK, Dietz PM, Rizzo J, et al. Exces- 20. US Department of Agriculture, US Med. 2012;166(12):1123-1131.
sive gestational weight gain and post- Department of Health and Human Ser- 34. Academy of Nutrition and Dietetics Evi-
partum weight retention among obese vices. 2010 US Dietary Guidelines Advi- dence Analysis Library. Pregnancy and
women. Obstet Gynecol. 2009;114(5): sory Committee. Part D. Section 2: nutrition—Non-nutritive sweeteners.
1069-1075. Nutrient adequacy. In: Report of the Di- http://andevidencelibrary.com/evidence.
7. Academy of Nutrition and Dietetics. Po- etary Guidelines Advisory Committee on the cfm?evidence_summary_id¼250587.
sition of the Academy of Nutrition and Dietary Guidelines for Americans, 2010. Accessed December 3, 2013.
Dietetics and American Society for Nutri- 7th ed. Washington, DC: US Government 35. American College of Obstetrics and Gy-
tion: Obesity, reproduction, and preg- Printing Office; 2010: D2-38. necology. ACOG Committee opinion no.
nancy outcomes. J Am Diet Assoc. 21. US Department of Agriculture, US 462: Moderate caffeine consumption
2009;109(5):918-927. Department of Health and Human Ser- during pregnancy. Obstet Gynecol.
8. Centers for Disease Control and Preven- vices. Dietary Guidelines for Americans, 2010;116(2 Pt 1):467-468.
tion. 2011 National Diabetes fact sheet: 2010. 7th ed. Washington, DC: US Gov- 36. Brent RL, Christian MS, Diener RM. Eval-
Gestational diabetes in the United States. ernment Printing Office; 2010. uation of the reproductive and develop-
http://www.cdc.gov/diabetes/pubs/estim 22. Centers for Disease Control and Preven- mental risks of caffeine. Birth Defects Res
ates11.htm. Accessed November 11, 2012. tion. Folic acid: Recommendations. http:// (Part B). 2011;92(2):152-187.
1102 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS July 2014 Volume 114 Number 7FROM THE ACADEMY
37. Institute of Medicine. Dietary reference 38. Shapiro GD, Fraser WD, Séguin JR. 39. Fowles ER, Stang J, Bryant M, Kim SH.
intakes for water, potassium, sodium, Emerging risk factors for postpartum Stress, depression, social support, and
chloride, and sulfate. http://www.nap.edu/ depression: Serotonin transporter eating habits reduce diet quality in the
openbook.php?record_id¼10925&page¼ genotype and omega-3 fatty acid sta- first trimester in low-income women:
151. Published 2005. Accessed October 21, tus. Can J Psychiatry. 2012;57(11): A pilot study. J Acad Nutr Diet. 2012;
2012. 704-712. 112(10):1619-1625.
This Academy of Nutrition and Dietetics position was adopted by the House of Delegates Leadership Team on May 3, 2002 and reaffirmed on
June 11, 2006 and September 9, 2010. This position is in effect until December 31, 2018. Requests to use portions of the position or republish in
its entirety must be directed to the Academy at journal@eatright.org.
Authors: Sandra B. Procter, PhD, RD/LD, Kansas State University, Manhattan, KS; Christina G. Campbell, PhD, RD, Iowa State University, Ames, IA
(Lead Author).
Reviewers: Jeanne Blankenship, MS, RD (Academy Policy Initiatives & Advocacy, Washington, DC); Quality Management Committee (Melissa N.
Church, MS, RD, LD, Chickasaw Nutrition-Get Fresh! Program, Oklahoma City, OK); Sharon Denny, MS, RD (Academy Knowledge Center, Chicago,
IL); Public Health dietetics practice group (DPG) (Kathryn Hillstrom, EdD, RD, CDE, California State University, Los Angeles, CA); Vegetarian
Nutrition DPG (Reed Mangels, PhD, RD, LDN, FADA. University of Massachusetts, Amherst); Kathleen Pellechia, RD (US Department of Agriculture,
WIC Works Resource System, Beltsville, MD); Julie A. Reeder, PhD, MPH, CHES (State of Oregon WIC Program, Portland, OR); Tamara Schryver, PhD,
MS, RD (TJS, Communications LLC, Minneapolis, MN); Alison Steiber, PhD, RD (Academy Research & Strategic Business Development, Chicago, IL);
Women’s Health DPG (Laurie Tansman, MS, RD, CDN, Mount Sinai Medical Center, New York, NY).
Academy Positions Committee Workgroup: Cathy L. Fagen, MA, RD (Chair) (Long Beach Memorial Medical Center, Long Beach, CA); Ainsley M.
Malone, MS, RD, CNSC, LD (Mount Carmel West Hospital, Columbus, OH); Jamie Stang, PhD, MPH, RD, LN (Content Advisor) (University of
Minnesota, Minneapolis, MN).
We thank the reviewers for their many constructive comments and suggestions. The reviewers were not asked to endorse this position or the
supporting paper.
July 2014 Volume 114 Number 7 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 1103You can also read
