Nutrition is a key modifiable factor that affects birth outcomes and has long-term effects on the
health of offspring.
Patient nutrition risk and habits should be assessed early in pregnancy. Completion of a self- administered dietary questionnaire prior to seeing the clinician can be helpful. Potential problems that require attention include:
- Use of supplements
- Food avoidances/special diets/skipping meals
- Eating disorders
- Lack of resources for adequate nutrition
- Low intake of nutrient-dense foods (fruits and vegetables)
- High intake of added sugars and fats (fried foods, processed foods, desserts)
- Overweight or obesity
- Medical history of bariatric surgery or other conditions that cause malabsorption
- Substance misuse
- Consultation with a trained specialist in maternal nutrition, such as a registered dietitian, is recommended for women with high nutrition risk.
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The incidence of pregnancy complications is higher at the upper and lower extremes of weight gain. The Institute of Medicine recommendations for weight gain during singleton pregnancy are:
- Body mass index (BMI) <18.5 kg/m2 (underweight) – weight gain 28 to 40 lbs (12.5 to 18.0 kg)
- BMI 18.5 to 24.9 kg/m2 (normal weight) – weight gain 25 to 35 lbs (11.5 to 16.0 kg)
- BMI ≥30.0 kg/m2 (obese) – weight gain 11 to 20 lbs (5 to 9.0 kg)
The Institute of Medicine and the Centers for Disease Control and Prevention recommend multiple-micronutrient (MMN) supplements (commonly called multivitamin supplements) for pregnant women who do not consume an adequate diet or may have malabsorption. Well- nourished women may not need MMN supplements, but in the absence of careful evaluation by a nutritionist, it is prudent to recommend them. At a minimum, the daily MMN supplement should contain key vitamins/minerals that are often not met by diet alone