Nutrition in Pregnancy

Basics & Energy Needs - Fueling for Two

• Pregnancy ↑ Basal Metabolic Rate (BMR) & overall energy demands.
• Primary drivers: Fetal growth, placental development, maternal tissue expansion.
• Additional Caloric Intake (ICMR Recommendations):
  • 1st Trimester: No extra kcal; focus on nutrient-dense foods.
  • 2nd Trimester: +350 kcal/day.
  • 3rd Trimester: +450 kcal/day.
• Energy sources: Prioritize complex carbohydrates, adequate protein, healthy fats.
• Consequences of imbalance:
  • Deficiency: Risk of Low Birth Weight (LBW), Intrauterine Growth Restriction (IUGR).
  • Excess: Risk of Gestational Diabetes (GDM), macrosomia, excessive maternal weight gain.

⭐ The cumulative energy cost of a full-term pregnancy is estimated to be around 77,000 kcal above non-pregnant requirements.

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Macronutrients - Building Blocks

• Carbohydrates (CHO):
  • Primary energy source (~50-60% total calories).
  • Focus: Complex CHOs (whole grains, fruits, vegetables).
  • Fiber: Prevents constipation; RDA 25-30 g/day.
• Proteins:
  • Crucial for fetal/placental growth, maternal tissues.
  • RDA: Additional +25 g/day (approx. 1.1 g/kg/day or ~71 g/day total).
  • Sources: Dairy, pulses, eggs, meat.
  • ⭐ > Additional protein requirement during pregnancy is approximately +25 g/day to support fetal and maternal tissue synthesis.
• Fats:
  • Energy, fat-soluble vitamin absorption.
  • Essential Fatty Acids (EFAs):
    • Omega-3 (DHA, EPA) & Omega-6 (LA, AA).
    • DHA: Critical for fetal brain & retinal development.
  • Intake: ~20-30% total calories; prioritize unsaturated fats.

Vitamins - Vital Vitamins

• Folic Acid (B9):
  • RDA: 400 mcg (preconception), 600-800 mcg (pregnancy).
  • Prevents Neural Tube Defects (NTDs). Critical peri-conceptionally.
  • Sources: Leafy greens, legumes, fortified grains.

  ⭐ Deficiency: NTDs (spina bifida, anencephaly), megaloblastic anemia.

• Vitamin D (Calciferol):
  • RDA: 600 IU/day (ICMR: 400 IU).
  • For Ca/P absorption, fetal bone/teeth.
  • Deficiency: Maternal osteomalacia, neonatal rickets. ↑ risk GDM, preeclampsia.
  • Sources: Sunlight, fortified dairy.
• Vitamin B12 (Cobalamin):
  • RDA: 2.6 mcg/day.
  • DNA synthesis, erythropoiesis, fetal neurodevelopment.
  • Deficiency: Megaloblastic anemia, infant neurological damage. Common in vegetarians.
• Vitamin A:
  • RDA: 800-900 mcg RAE/day.
  • Vision, cell differentiation, immunity.
  • ⚠️ Excess preformed Vit A (>10,000 IU/day) teratogenic. Beta-carotene safe.
• Vitamin C (Ascorbic Acid):
  • RDA: 80-85 mg/day.
  • Antioxidant, collagen synthesis, ↑ iron absorption.

Minerals - Essential Elements

• Iron (Fe)
  • RDA: 35 mg/day (ICMR).
  • Prevents anemia; fetal neurodevelopment.
  • Deficiency: Anemia, preterm birth, LBW.
  • Supplement: 60 mg elemental Fe + 500 µg Folic Acid (from 2nd trimester).

  ⭐ Iron absorption ↑ with Vit C; ↓ with Ca, phytates, tannins.

• Calcium (Ca)
  • RDA: 1200 mg/day (ICMR).
  • Fetal skeleton; maternal bone health.
  • Deficiency: Maternal bone loss; ?preeclampsia risk.
• Iodine (I)
  • RDA: 250 µg/day (ICMR).
  • Fetal brain; thyroid function.
  • Deficiency: Cretinism, goiter. Source: Iodized salt.
• Zinc (Zn)
  • RDA: 14.5 mg/day (ICMR).
  • DNA synthesis; cell division; immunity.
  • Deficiency: Malformations, LBW, preterm.
• Magnesium (Mg)
  • RDA: 350-400 mg/day.
  • Enzyme, muscle, nerve function.
  • Used in preeclampsia/eclampsia management.
• Selenium (Se)
  • RDA: 60 µg/day.
  • Antioxidant; thyroid hormone metabolism. oka

High‑Yield Points - ⚡ Biggest Takeaways

• Folic acid (400 mcg/day, ideally 1 month preconception to 12 weeks gestation) prevents NTDs.
• Iron (27 mg/day RDA) for ↑ RBC mass & fetal needs; screen for anemia.
• Calcium (1000-1300 mg/day) for fetal skeletal development & maternal stores.
• Weight gain targets by pre-pregnancy BMI: Underweight 12.5-18 kg; Normal 11.5-16 kg; Overweight 7-11.5 kg; Obese 5-9 kg.
• Avoid excess Vitamin A (>10,000 IU/day) due to teratogenicity; limit liver.
• Additional calories: +300 kcal/day (2nd trimester), +450 kcal/day (3rd trimester).