Nutrition during

pregnancy
Dr Rania Abd El Hamid Hussein
MBBSch
Master’s degree in Internal Medicine
Doctor in Nutrition and Public Health
Assistant Professor of Nutrition
Faculty of Applied Medical Sciences
KAU

Dr Rania Hussein
Physiologic changes of pregnancy

Dr Rania Hussein
• In first half of pregnancy →
meet metabolic demands of placenta and fetus

• In latter half of pregnancy →

meet increasing fetal requirements,
prepare for demands of labor and lactation.

Dr Rania Hussein
 Total weight gain
• Average weight gain in pregnancy is 12.5 Kg, and
amounts to an approximate 20% increase in body
weight.
• Most weight gain occurs during the last 20 weeks of
gestation.
• 1st trimester: 1-2 Kg
• 2nd trimester gain; 3-4 Kg
• 3rd trimester: 6-7 Kg

Dr Rania Hussein
 Analysis of weight gain in
pregnancy
30-40w 20-30w 10-20w Up to 10
w
4750 2530 720 55 Fetus,
placenta
1300 1170 765 170 Uterus,
breast
1250 1250 600 100 Blood
1200 - - - ECF
4000 3500 1915 325 Fat
12500 8500 4000
Dr Rania Hussein 650 Total gain
 Blood volume
• Hypervolemia + a smaller ↑ in red cell volume=
hemodilution

• Hemodilution means a decrease in concentration of

blood components as albumin, hemoglobin .

Dr Rania Hussein
 Cardiovascular changes
• ↑Cardiac output.

• ↓ Peripheral vascular resistance → ↓ diastolic blood

pressure.

Dr Rania Hussein
 Metabolism
• BMR increases due to increased secretion of
hormones.
• Late in the third trimester, the fetus
metabolizes glucose, protein , and fat.

Dr Rania Hussein
 Respiration
Respiratory rate increases due to:
• Increase in amount of oxygen utilized by the pregnant
mother
• To compensate for the reduced lung expansion
(Growing uterus presses upwards against the
diaphram).

Dr Rania Hussein
 Kidney function
• ↑ in blood flow through the kidneys →↑ in rate
of filtration of blood → ↑ loss of glucose, and
amino acids.
• ↓ ability to excrete water→ edema of legs and
ankles.
• Pregnant uterus displaces urinary bladder → ↑
frequency of micturition.

Dr Rania Hussein
 Gastrointestinal system
• ↑ in appetite.
• Nausea and vomiting.
• Relaxation of muscles → constipation, esophageal
regurgitation, and heart burn.
• Heart burn is exaggerated late in pregnancy (why).

Dr Rania Hussein
Nutritional requirements
during Pregnancy

Dr Rania Hussein
Strongest predictors of infant birth
weight
1. Prepregnant weight
2. Gestational weight
gain ( indicator of the
adequacy of maternal
diet).

Dr Rania Hussein
 Recommended weight gain during pregnancy
2nd and 3rd 1st Total Pre
trimester trimester weight pregnancy
weekly gain gain BMI
gain

0.49 2.3 12.5-18 Under

weight

0.44 1.6 11.5-16 Normal

0.3 0.9 7-11.5 Overweight
All in 3rd Dr Rania Hussein
6 obese
 Who should strive for weight gain at the
?upper end of the target range
1. Adolescents
2. Black women who tend to have small infants
3. Those carrying twins

Dr Rania Hussein
Feeding the pregnant female . . .
what to eat?

Proper diet Good health

Promotes
Proper
Fetal
growth
Dr Rania Hussein
 Energy
Daily caloric recommendations of an additional
300, and 450 Kcal, in the second and third
trimesters respectively are needed

Dr Rania Hussein
 Carbohydrates
• 135-175g/day is the quantity needed to:
• Provide enough calories
• Spare proteins needed for growth
• Maintain adequate glucose level to fetal brain

Dr Rania Hussein
 Protein
• An additional 10 g/day higher than non
pregnant woman.

Dr Rania Hussein
 Essential fatty acids
• Essential Long chain
polyunsaturated fatty acids
play important roles as
precursors of prostaglandins,
and as structural elements of
cell membranes.
• Linoleic acid: in vegetable oils
• Alpha-linolenic acid: in fish
and seed oils

Dr Rania Hussein
Iron requirements ↑ in pregnancy
Foods abundant in iron include: red meat (especially
liver), whole grains, dark green leafy vegetables,
shellfish and dried fruit.

Dr Rania Hussein
– Recommended routine iron
supplementation is 30 mg iron/day
during the second and third trimesters
for all pregnant females.
– If nutritional anemia is prevalent,
recommended dose of iron is 60 mg
elemental iron . When Hb level
returns to normal, shift to 30 mg
Iron/day.

Dr Rania Hussein
:WHO definition of severe anemia
• Hemoglobin < 7 g/dL
• Severe anemia is associated with:
– Low birth weight newborns
– Premature newborns
– Increased maternal mortality and morbidity

Dr Rania Hussein
 Anemia and Obstetrical
Hemorrhage
• Anemia does not cause obstetrical hemorrhage
(even severe anemia), but ↑ levels of
hemoglobin are beneficial.

Dr Rania Hussein
Zinc requirements ↑ in pregnancy
• Zinc plays a role in cell division
• Severe zinc deficiency can cause growth
retardation, teratogenic effect

Dr Rania Hussein
Folic Acid requirements in pregnancy
• Folic acid prevents neural tube defects.
• NTD =defect in closure of neural tube (between
day 15 and 28 after conception), long before most
women know they are pregnant.
• Also, prolonged inadequate intake of folic acid
may lead to megaloblastic anemia.

Dr Rania Hussein
 Folic acid sources
• Folic acid is found in
spinach, parsley, broccoli,
lettuce, beef liver, orange,
legumes.
• RDA for folate:
– 400 g/day: All women
in childbearing age
– 600 g/day: Pregnant
women

Dr Rania Hussein
Calcium requirements ↑ in pregnancy

Calcium has the following benefits:

– Maintaining bone strength and healthy teeth
– Proper muscle contraction
– Blood clotting
– ↓ risk of hypertension, pre-eclampsia

Dr Rania Hussein
• Needs of the fetus are met by:
-↑ maternal absorption of Calcium, or
- mobilization of calcium from the skeleton of
the mother.

Dr Rania Hussein
Foods abundant in calcium include: dairy
products, dark green vegetables, nuts, whole
grains and beans.

Dr Rania Hussein
 Iodine

• Iodine deficiency is a
preventable cause of mental
impairment (neonatal
cretinism).
• Iodized salt can provide
sufficient iodine for
pregnant females.

Dr Rania Hussein
 Vitamin A requirement is not
increased
• Vitamin A is required for growth , and
differentiation of epithelial tissues.
• Also it has a positive interaction with iron in
reducing anemia
• Retinal , (used to treat acne), before 7th week of
gestation is associated with birth defects:
craniofacial, central nervous system, cardiac.

Dr Rania Hussein
Vitamin A is present in food in
two forms:
– As pre-formed vitamin A in
foods from animals
– As pro-vitamin A in some
plant foods
• Vitamin A is found in foods
such as carrots, egg yolk, fish
oil, liver and broccoli

Dr Rania Hussein
 Water soluble vitamins requirements ↑
in pregnancy
• B1, B2, B7 → release of energy form carbohydrates,
fats, and proteins.

• Vitamin B6 → synthesis of the non essential amino

acids needed for growth,
Also megadoses of vitamin B6 may play a role in
treatment of nausea and vomiting during pregnancy.

Dr Rania Hussein
• Vitamin B12 supplements need to be given to
pregnant complete vegetarians.
• Vitamin C: A daily increase of 80 mg is
recommended.

Dr Rania Hussein
Nutrient supplementation in
pregnancy
to whom is given?

Dr Rania Hussein
 ,Except for iron
• Nutritional needs can be met by selection of a
wide variety of food.

Dr Rania Hussein
 Nutrient supplementation in
pregnancy
to whom is given?
1. General population:
a- 30 mg elemental iron in 2nd and 3rd
trimester
- Iron 60 mg daily if iron deficiency anemia is
diagnosed. Cu and Zn are added (iron
interferes with their absorption and
utilization)

Dr Rania Hussein
• To enhance Fe absorption, the supplement
must be taken between meals or at bed time,
with fluids other than milk, tea, coffee.
• Vitamin C does not enhance Fe supplement
absorption (it is already in the ferrous state).

Dr Rania Hussein
b- Folic acid

Dr Rania Hussein
2. If adolescent:
- Calcium

Dr Rania Hussein
3- Vit D: in females living in
northern latitudes in winter, and
those with low exposure to the
sun
4- Vit B12 : for complete
vegeterians (vegans)

Dr Rania Hussein
5. Malnourished women who remain resistant to
dietary changes should receive a multivitamin
and mineral supplement

Dr Rania Hussein
 References
• Brown JE, Isaacs J, Wooldridge N, Krinke B,
Murtaugh M. Nutrition through the lifecycle,
2007 . 3rd ed. Wadsworth publishing.
• Mahan LK, Escott- Stamp S. krause’s food,
and nutrition therapy 2008. 12 th ed. Saunders
Elsevier. Canada.

dr Rania Hussein