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Nutritional Guidelines and Energy Needs During Pregnancy and Lactation

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Abstract

From a nutritional point of view, pregnancy and lactation are the most demanding physiological situations in a woman’s life. Requirements for all nutrients increase and optimal energy, and nutrient intake during pregnancy and lactation are basic for the actual and future health of both mother and child. Because successful pregnancy depends upon previous nutritional status of the mother, all women of childbearing age should be encouraged to consume a variety of nutrient-dense foods and beverages within and among the basic food groups while choosing foods that limit the intake of saturated and trans fats, cholesterol, added sugars, salt, and alcohol. Special attention must be paid to intake of micronutrients such as folic acid, vitamin D, iron, and iodine. A deficit in folic acid intake during the first 8 weeks of conception may lead to malformations (neural tube defects) which can be prevented by daily intake of 600 μg of folates from diet, supplements, or nutrient-enriched foods. Vitamin D deficiency among pregnant women can result from inadequate cutaneous synthesis, limited dietary intake of vitamin D, or vitamin D pathway impairment, and can lead to osteoporosis in the mother and/or rickets, hypocalcemia, delayed ossification, and abnormal enamel formation in the children as well as immune dysfunction. The DRI for vitamin D, during pregnancy and lactation, is 600 IU (15 μg)/day. There are not many natural foods rich in vitamin D so, apart from cold water fish, fortified foods are the main sources of this vitamin. Iron and iodine are also problematical nutrients which deficiencies are prevalent during gestation and lactation and so the need for their supplementation must be carefully evaluated. About energy, during pregnancy, women should consume an additional 300 kcal per fetus; however, women who are active during their pregnancy may need extra calories for exercise, and ideally, this additional energy should come from added servings of carbohydrate because carbohydrate intake meets the growth needs of the fetus and provides energy for exercise.

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Author information

Authors and Affiliations

  1. Department of Health, Exercise, and Sports Sciences, Texas Tech University, Lubbock, TX, USA

    Jacalyn J. Robert-McComb Ph.D, FACSM, ACSM P.D. & Lesley Carraway M.S., ACSM H.F.S.

  2. Pharmaceutical and Health Sciences, University San Pablo-CEU, Urb. Montepríncipe; Ctra. Boadilla del Monte km 5.3, Alcorcón, Madrid, 28668, Spain

    Ángela García González M.D., Ph.D.

Authors
  1. Jacalyn J. Robert-McComb Ph.D, FACSM, ACSM P.D.
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  2. Ángela García González M.D., Ph.D.
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  3. Lesley Carraway M.S., ACSM H.F.S.
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Correspondence to Jacalyn J. Robert-McComb Ph.D, FACSM, ACSM P.D. .

Editor information

Editors and Affiliations

  1. Department of Health, Exercise and Sport Sciences, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA

    Jacalyn J. Robert-McComb Ph.D., F.A.C.S.M., A.C.S.M., P.D. (Professor of Exercise Physiology) (Professor of Exercise Physiology)

  2. Pharmacology and Neuroscience, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA

    Reid L. Norman Ph.D. (Professor and Chair) (Professor and Chair)

  3. Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA

    Mimi Zumwalt M.D. (Associate Professor Head of Sports Medicine) (Associate Professor Head of Sports Medicine)

Appendices

Appendix 1 Physical Activity Level Categories and Walking Equivalence

 

Walking equivalence (mi/day at 3–4 mph)

PAL category

PAL range

PAL

Lightweight individual (44 kg)

Middleweight individual (70 kg)

Heavyweight individual (120 kg)

Sedentary

1.0–1.39

1.25

~0

~0

~ 0

Low active

1.4–1.59

    

 Mean

 

1.5

 2.9

 2.2

 1.5

Active

1.6–1.89

    

 Minimum

 

1.6

 5.8

 4.4

 3.0

 Mean

 

1.75

 9.9

 7.3

 5.3

Very active

1.9–2.49

    

 Minimum

 

1.9

14.0

10.3

17.5

 Mean

 

2.2

22.5

16.7

12.3

 Maximum

 

2.5

31.0

23.0

17.0

  1. Adapted from the National Research Council. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). Washington, DC: The National Academies Press, 2005
  2. In addition to energy spent for the generally unscheduled activities that are part of a normal daily life, the low, middle, and high miles/day values apply to relatively heavyweight (120 kg), midweight (70 kg), and lightweight (44 kg) individuals, respectively

Appendix 2 Estimated Energy Expenditure* Prediction Equations at Four Physical Activity Levels

EER for infants and young children 0–3 years

TEE (kcal/day) = 89 (±3 [standard error]) × weight of the child (kg) − 100 (±56 [standard error])

EER = TEE + energy deposition

0–3 months (89 × weight of infant [kg] − 100) + 175 (kcal for energy deposition)

4–6 months (89 × weight of infant [kg] − 100) + 56 (kcal for energy deposition)

7–12 months (89 × weight of infant [kg] − 100) + 22 (kcal for energy deposition)

13–36 months (89 × weight of child [kg] − 100) + 20 (kcal for energy deposition)

Where PA = physical activity coefficient:

PA = 1.0 if PAL is estimated to be ≥ 1.0 < 1.4 (sedentary)

PA = 1.13 if PAL is estimated to be ≥ 1.4 < 1.6 (low active)

PA = 1.26 if PAL is estimated to be ≥ 1.6 < 1.9 (active)

PA = 1.42 if PAL is estimated to be ≥ 1.9 < 2.5 (very active)

EER for girls 3–8 years

TEE = see doubly labeled water data used to predict energy expenditure for standard error in the dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients) at http://www.nap.edu/openbook.php?isbn=0309085373

EER = TEE + energy deposition

EER = 135.3 − (30.8 × Age [years]) + PA × (10 × weight [kg] + 934 × height [m]) + 20 (kcal for energy deposition)

Where PA = physical activity coefficient:

PA = 1.0 if PAL is estimated to be ≥ 1.0 < 1.4 (sedentary)

PA = 1.16 if PAL is estimated to be ≥ 1.4 < 1.6 (low active)

PA = 1.31 if PAL is estimated to be ≥ 1.6 < 1.9 (active)

PA = 1.56 if PAL is estimated to be ≥ 1.9 < 2.5 (very active)

EER for girls 9–18 years

TEE = see doubly labeled water data used to predict energy expenditure for standard error in the dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients) at http://www.nap.edu/openbook.php?isbn=0309085373

EER = TEE + energy depositions

EER = 135.3 − (30.8 × age [years]) + PA × (19 × weight [kg] + 934c height [m]) + 25 (kcal for energy deposition)

Where PA = physical activity coefficient:

PA = 1.0 if PAL is estimated to be ≥ 1.0 < 1.4 (sedentary)

PA = 1.16 if PAL is estimated to be ≥ 1.4 < 1.6 (low active)

PA = 1.31 if PAL is estimated to be ≥ 1.6 < 1.9 (active)

PA = 1.56 if PAL is estimated to be ≥ 1.9 < 2.5 (very active)

EER for women 19 years and older

EER = 354 − (6.91 × age [years]) + PA × (9.36 × weight [kg] + 726 × height [m])

Where PA = physical activity coefficient:

PA = 1.0 if PAL is estimated to be ≥ 1.0 < 1.4 (sedentary)

PA = 1.12 if PAL is estimated to be ≥ 1.4 < 1.6 (low active)

PA = 1.27 if PAL is estimated to be ≥ 1.6 < 1.9 (active)

PA = 1.45 if PAL is estimated to be ≥ 1.9 < 2.5 (very active)

EER for pregnant women (14–18 years)

EER pregnant = adolescent EER nonpregnant + additional energy expended during pregnancy + energy deposition

First trimester = adolescent EER + 0 + 0

Second trimester = adolescent EER + 160 kcal (8 kcal/week × 20 week) + 180 kcal

Third trimester = adolescent EER + 272 kcal (8 kcal/week × 24 week) + 180 kcal

EER for pregnant women (19–50 years)

EER pregnant = adult EER nonpregnant + additional energy expanded during pregnancy + energy deposition

First trimester = adult EER + 0 + 0

Second trimester = adult EER + 160 kcal (8 kcal/week × 20 week) + 180 kcal

Third trimester = adult EER +272 kcal (8 kcal/week × 34 week) + 180 kcal

EER for lactating women (14–18 years)

EER lactation = adolescent EER prepregnancy + milk energy output − weight loss

First 6 months = adolescent EER + 500 − 170

Second 6 months = adolescent EER + 400 − 0

EER for lactating women (19–50 years)

EER lactation = adult EER prepregnancy + milk energy output − weight loss

First 6 months = adult EER + 500 − 170

Second 6 months = adult EER + 400 − 0

Weight maintenance TEE in overweight girls 3–18 years or at risk of a high

TEE = 389 − (41.2 × age [years]) + PA × (15.0 × weight [kg] + 701.6 × height [m])

Where PA = physical activity coefficient:

PA = 1.0 if PAL is estimated to be ≥ 1.0 < 1.4 (sedentary)

PA = 1.12 if PAL is estimated to be ≥ 1.4 < 1.6 (low active)

PA = 1.24 if PAL is estimated to be ≥ 1.6 < 1.9 (active)

PA = 1.45 if PAL is estimated to be ≥ 1.9 < 2.5 (very active)

Overweight and obese women 19 years and older

TEE = 448 − (7.95 × age [years]) + PA × (11.4 × weight [kg] + 619 × height [m])

Where PA is the physical activity coefficient:

PA = 1.0 if PAL is estimated to be ≥ 1.0 < 1.4 (sedentary)

PA = 1.16 if PAL is estimated to be ≥ 1.4 < 1.6 (low active)

PA = 1.27 if PAL is estimated to be ≥ 1.6 < 1.9 (active)

PA = 1.44 if PAL is estimated to be ≥ 1.9 < 2.5 (very active)

Normal and overweight or obese women 19 years and older

TEE = 387 − (7.31 × age [years]) + PA × (10.9 × weight [kg] + 600.7 × height [m])

Where PA is the physical activity coefficient:

PA = 1.0 if PAL is estimated to be ≥ 1.0 < 1.4 (sedentary)

PA = 1.14 if PAL is estimated to be ≥ 1.4 < 1.6 (low active)

PA = 1.27 if PAL is estimated to be ≥ 1.6 < 1.9 (active)

PA = 1.45 if PAL is estimated to be ≥ 1.9 < 2.5 (very active)

  1. Adapted from the National Research Council. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, DC: The National Academies Press, 200. See http://www.nap.edu/openbook.php?isbn=0309085373
  2. * Estimated energy expenditure (EER) is the average dietary energy intake that is predicted to maintain energy balance in a healthy adult of a defined age, gender, weight, height, and level of physical activity consistent with good health. In children and pregnant and lactating women, the EER includes the needs associated with the deposition of tissues or the secretion of milk at rates consistent with good health
  3. Physical activity level (PAL) is the physical activity level that is the ratio of the total energy expenditure to the basal energy expenditure
  4. Total energy expenditure (TEE) is the sum of the resting energy expenditure, energy expended in physical activity, and the thermic effect of food
  5. Body mass index (BMI) is determined by dividing the weight (in kilograms) by the square of the height (in meters)

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Robert-McComb, J.J., González, Á.G., Carraway, L. (2014). Nutritional Guidelines and Energy Needs During Pregnancy and Lactation. In: Robert-McComb, J.J., Norman, R.L., Zumwalt, M. (eds) The Active Female. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8884-2_31

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