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Nutrition Prenatal Care

Recommendation for weight gain

To prevent preterm birth, fetal growth restriction

Obese lead to increase risk of gestational

hypertension, preeclamsia, gestational diabetes,

microsomia and cesarean delivery.

Recommended dietary allowance

Pregnancy require an additional 80,000 kcal- most are

accumulate in the last 20wk

Caloric intake of an extra 100-300 kcal daily is

sufficient for adequate maternal weight gain and fetal

growth.

The practice of prenatal supplementation of vitamins

and minerals is widespread, although many

nutritionists believe it is unnecessary. Only the

following two supplements are recommended in an

adequately nourished female with a singleton

pregnancy:

1. Iron, 30 mg/day, in the second and third trimester

to meet the fetal demands for erythropoiesis.

2. Folic acid, 400μg/day, in the preconception period

and during the first trimester for prevention of birth

defects

Protein – used for growth and remodeling of fetus,

placenta, uterus, and breasts as well increased

maternal blood. During second half of pregnancy,

approx 1000g protein deposited, amount to 5-6g per

day. Preferably from animal source, such as meat,

milk, eggs, cheese, poultry and fish because they

furnish amino acid in optimal combination.

Mineral

  Iron : appox 300mg iron transfer to fetus and

placeta and 500mg into expanding maternal

hemoglobin mass, nearly all used after

midpregnancy. At least 27mg ferrous iron

supplement daily. Not necessary during 1st

4

month.

  Calcium : pregnant women retain approx 30g

of calcium, most of which is deposited in fetus

late in pregnancy.

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  Zinc : deficiency cause hypogonadism and

dwarfism. Supplement no benefit on

development outcome

  Iodine : deficiency predispose to endemic

cretism.

  Folic acid : prevent neural tube defect. 4mg

folic acid one month prior to pregnancy and

during 1st trimester.

  Vitamin A : deficiency associated with

increased risk of anemia and preterm birth.

  Care must be taken to avoid toxicity of the

fat-soluble vitamins, in particular vitamin A

(retinol), where“more” is not necessarily

better. Daily doses of retinol greater than

10,000 IU, approximately 3000 retinol

equivalents (RE), have been associated with

birth defects.

Pragmatic Nutritional Surveillance

Although the science of nutrition continues in its

perpetual struggle to identify the ideal amounts of 

protein, calories, vitamins, and minerals for the

pregnant woman and her fetus, those directly

responsible for their care may best discharge their

duties as follows.

1.  In general, advise the pregnant woman to eat

what she wants in amounts she desires and

salted to taste.

2.  Make sure that there is ample food to eat in

the case of socioeconomically deprived

women.

3.  Monitor weight gain, with a goal of about 25

to 35 pounds in women with a normal BMI.

4.  Periodically explore food intake by dietary

recall to discover the occasional nutritionally

absurd diet.

5.  Give tablets of simple iron salts that provide

at least 27 mg of iron daily. Give folate

supplementation before and in the early

weeks of pregnancy.

6.  Recheck the hematocrit or hemoglobin

concentration at 28 to 32 weeks to detect any

significant decrease.