Introduction

Pregnancy is one of the most nutri-
tionally demanding periods of a
woman’s life. Gestation involves rapid
cell division and organ development.
An adequate supply of nutrients is
essential to support this tremendous
fetal growth.

The chart on the next page illus-

trates how the recommendation for
food energy (calories) and most nutri-
ents increase during pregnancy.
Energy needs increase only about 15
percent. Pregnant women need to
choose nutrient-dense foods to assure
an adequate nutrient intake without
overdoing on calories. For many
women this requires some change in
their current eating habits.

This brochure reviews the nutrition-

al needs of pregnant women, including
information on recommended weight
gain, protein needs, vitamin and min-
eral supplementation, and the overall
safety of their food choices. Prenatal
counseling should consider the variety
of psychosocial issues that affect opti-
mal nutrition during pregnancy.

A Message from the
March of Dimes

In the cycle of life, preg-
nancy marks a new
beginning that has
lifelong effects, for
both mother and
baby. Nutrition plays a
significant role in optimizing
the health of women and the growth of
babies. The March of Dimes is pleased
to work with the International Food
Information Council Foundation in
bringing Healthy Eating During
Pregnancy to nutritionists, health pro-
fessionals and writers for the benefit of
mothers and babies.

Jennifer L. Howse
President
March of Dimes

Weight Gain During
Pregnancy

Monitoring weight gain helps ensure a
healthy pregnancy outcome for both
mother and baby. A low gestational
weight gain often results in a low birth-
weight infant who may experience
delayed development. Low birthweight
infants (less than 5 pounds, 8 ounces
at birth) and particularly very
low birthweight infants (less
than 3 pounds, 5 ounces
at birth) have a statisti-
cally greater risk of dis-
ease development
and mortality during
the first month of life
than infants born
weighing at least 5

1

⁄

2

pounds, the cutoff
for low birthweight.

In addition to

weight gain associat-
ed with fetal growth,
pregnant women store
fat to prepare for lacta-
tion. Women below opti-
mal weight need especially
careful monitoring in preparation
for breastfeeding.

The chart, “Where Does Weight Gain

Go?” on page 2 shows how weight gain is
typically distributed during pregnancy.

Goals for Total Weight Gain

Goals for weight gain should be based on
pre-pregnancy weight, height, age, and
usual eating patterns. In 1990 the
National Academy of Sciences/Institute of
Medicine (NAS/IOM) issued recommen-
dations for weight gain during pregnancy.
Since every woman and every pregnancy
is unique, goals for weight gain are guide-
lines. Guidance from the woman’s health
care provider is essential.

A weight gain of 25 to 35 pounds is

considered desirable for healthy women
of normal weight (BMI 19.8 to 26).
Women who are below optimal weight
(BMI <19.8) when they conceive are
advised to gain about 28 to 40 pounds.
Overweight women (BMI 26 to 29)

should gain no more than 15 to 25
pounds. Very short women should set
goals for weight gain at the lower end of
the range. (For more information, go to
www.nhlbisupport.com/bmi/.)

Obese women with lower weight gains

can have successful pregnancies and
healthy babies. It is recommended that
their gestational gain be limited to no

more than 15 pounds. Obese women

require individual nutrition counsel-

ing to assure adequate nutrient

intake and regular physical

activity, and to discourage

them from inappropriate

attempts to lose weight

during pregnancy.

Young adolescents are

advised to gain at the

upper end of the recom-
mended ranges for their

BMI. Regardless of their

pre-pregnancy weight

and height, women carry-

ing twins should gain 35

to 45 pounds, and women

carrying triplets, 50 pounds.

Caloric restriction during

pregnancy has been associated

with reduced birthweights.

Regardless of pre-pregnancy weight,

height or age, appropriate weight gain is
important for a healthy outcome.

Pattern of Weight Gain

Patterns of weight gain are as important
as total weight gain. Besides setting goals
for total weight gain with the mother, her
progress needs to be carefully monitored,
using a standardized weight-gain grid in
the prenatal record. This should begin
with accurate measurement and record-
ing of height and weight on the initial pre-
natal visit and regular weigh-ins recorded
at each visit. Persistent deviations from
expected patterns of weight gain are sig-
nals for intervention and reassessment of
weight-gain goals.

Weight maintenance or slight weight

losses are normal during the first
trimester. However, during the first
trimester, usually 2 to 8 pounds of weight
gain is typical. Women with healthy

(continued on page 3)

March of Dimes

International Food Information Council Foundation

– January 2003 –

Energy .............................................19%

1

Carbohydrate ..................................35%
Fiber ................................................12%
Protein.............................................54%
Calcium ..............................................0%
Phosphorus........................................0%
Magnesium ........................................9%

2

Vitamin D ...........................................0%
Fluoride..............................................0%
Thiamin............................................27%

3

Riboflavin.........................................27%

3

Niacin ..............................................28%
Vitamin B6.......................................46%

3

Folate...............................................50%
Vitamin B12.......................................8%
Pantothenic acid..............................20%
Biotin .................................................0%

3

Choline...............................................6%

3

Vitamin C .........................................13%

3

Vitamin E............................................0%
Selenium ............................................9%
Vitamin A .........................................10%

4

Vitamin K ...........................................0%
Iron ..................................................50%

3

Zinc..................................................38%

4

Iodine ..............................................47%

1

This percent increase is for the 3rd
trimester compared to non-pregnant
women.

2

The percent increase for pregnant
women, age 18 and under and for
women 31 to 50 years is higher.

3

The percent increase for pregnant
women, age 18 and under is somewhat
higher.

4

The percent increase for pregnant
women, age 18 and under is somewhat
lower.

Source: Dietary Reference Intakes:
Recommended Intakes for Individuals,
National Research Council, National Academy of
Sciences, 1999, 2000, 2001, 2002

Percent Increase over

Non-pregnant Women

Recommended Nutrient Intake

During Pregnancy

Recommended Weight Gain for Pregnant

Women by Pre-pregnancy Body Mass

Index (BMI)*

WEIGHT-FOR-HEIGHT

RECOMMENDED

CATEGORY

TOTAL WEIGHT GAIN

Kilograms

Pounds

Underweight

12.5 – 18

28 – 40

(BMI < 19.8) or 90% wt/ht

Normal weight

11.5 – 16

25 – 35

(BMI 19.8 to 25) or 90-20% wt/ht

Overweight

7 – 11.5

15 – 25

(BMI 26 to 29.) or 120-135% wt/ht

Obese

7

No more

(BMI > 29) or 135% wt/ht

than 15

Twin Gestation

16 – 20

35 – 45

(any BMI)

Triplet Gestation

23

50

(any BMI)

Women at greater risk for delivering low birthweight babies,
including adolescents, African-American women, and others
should be monitored for optimal weight gain and dietary
quality throughout pregnancy.

*Body mass index, or BMI, is an indicator of nutritional status
based on two common measurements, height and weight.
Because it reflects body composition such as body fat and lean
body mass, BMI is considered a more accurate indicator than
height/weight tables.

BMI in this table is based on metric calculations, using the fol-
lowing formula:

BMI =

wt/ht

2

(metric) = body weight in kilograms/height in meters

2

A health care professional can help in calculating Body Mass
Index.

Sources:
Food and Nutrition Board, Institute of Medicine. Nutrition During
Pregnancy. Washington, DC: National Academy Press, 1990.

Brown, JE, Carlson, M. Nutrition and multifetal pregnancy.
J Am Diet Assoc, 2000; 100:343-348.

Where does the weight go

?

Approximate Weight

Gain (in pounds)

Baby

7

1

⁄

2

Placenta

1

1

⁄

2

Amniotic fluid

2

Mother

Breasts

2

Uterus

2

Body fluids

4

...Blood

4

Maternal stores of fat, protein,
and other nutrients

7

TOTAL

30 lbs.

Source: Planning Your Pregnancy and Birth, Third Edition, American College
of Obstetricians and Gynecologists (ACOG).

–

page

2

–

pre-pregnancy weights should gain an average of one pound a
week during the second and third trimesters. Women who are less
than optimal weight before conception should gain slightly more
than one pound per week. Those who were initially overweight
should gain at a slower rate (about

2

⁄

3

pound or 0.3 kg) per week.

Calories and Nutrients of
Concern

Calories
A pregnant woman needs about 300
calories a day more than she did pre-
pregnancy to support the rapid growth of
the fetus and her changing body. (Pre-
pregnancy needs are about 2,200 calo-
ries daily for most active women and
teenage girls and about 1,600 calories
for sedentary women.) This is approxi-
mately the same number of calories as
supplied by 2

1

⁄

2

cups of skim milk, or one

cup of ice cream, or a bagel with cream
cheese, or a tuna fish sandwich.

This additional calorie requirement

may seem small. However, it is enough to
supply the extra energy essential to sup-
port pregnancy. Some expectant moth-
ers may be tempted to “eat for two,” or
double the amount of food they normally
eat. This practice is likely to result in
excessive weight gain.

Protein
Both the expectant mother and developing fetus need increased
amounts of protein. In 1989, the Recommended Dietary
Allowance (RDA) for protein during pregnancy was significantly
reduced, based on revised estimates of the efficiency of protein
utilization in pregnant women. It is recommended that pregnant
women consume 60 grams of protein a day, or only 10 grams
more than nonpregnant women.

Ten grams of protein are roughly equivalent to the amount in

1

1

⁄

2

ounces of meat or 1

1

⁄

4

cups of milk. Since most Americans

regularly consume more protein than they require, most women
will not need to consciously increase their protein consumption
during pregnancy.

Lean meats, poultry, and fish are good sources of protein that

also supply other necessary nutrients, such as iron, B vitamins,
and trace minerals. Dried beans, lentils, nuts, eggs, and cheese
are other high-protein foods.

Since an adequate supply of protein is generally provided

through a balanced eating plan, there usually is no need to use
high-protein beverages, supplements, or powders.

Although protein needs can be met by a well-selected lacto-

ovo (milk and egg) vegetarian diet, pregnant vegans, who eat
only plant foods, should be referred to a registered dietitian for
diet counseling to assure an adequate intake of protein and
essential vitamins and minerals.

Calcium
The calcium recommendation during pregnancy is 1,000
mg/day for women 19 to 50 years of age, and 1,300 mg/day
for teens. Women who are not pregnant generally consume only
about 75 percent of the recommended amount of calcium, so
most pregnant women need to add calcium-rich foods to the
diet. Adequate calcium intake is very important for all women,

including pregnant women less than 25 years of age whose
bones are continuing to increase in density.

Milk, yogurt, and cheese are calcium-rich foods. Frozen

yogurt, ice cream, and ice milk supply significant amounts, too.
Non-fat and low-fat dairy products supply equal amounts of cal-
cium with fewer calories than their higher-fat counterparts. Some
green leafy vegetables, calcium-fortified tofu and soymilk, and
canned salmon (bones included) are other good sources of calci-
um. Calcium-fortified foods, such as some orange juice and
breakfast cereal, also provide significant amounts of calcium,

especially for women who do not eat
dairy products. Pregnant women should
consume at least two to three servings
of calcium-rich milk group foods a day.

Women with lactose intolerance or

milk allergies may need guidance from
their health professional.

Even if pregnant women consume

more dairy products, they may not
meet their calcium needs through food
sources alone. Calcium supplements are
advised for pregnant women and teens
if their calcium intake is inadequate.
Vegans and women under age 25 who
consume no milk products are advised
to take a supplement with 600 mg calci-
um per day. Supplements (bone meal,
oyster shell, dolomite) that may contain
contaminants should be avoided.
Calcium supplements are used best in
the body when taken with food.

Because vitamin D is important for

the absorption and use of calcium, vita-
min D intake should also be assessed
for adequacy.

Iron
The iron recommendation doubles, from 15 mg/day before preg-
nancy to 30 mg/day during pregnancy. Additional iron is needed
as a result of increased maternal blood volume. The fetus also
stores enough iron to last through the first few months of life.

Pregnant women need to know which foods are iron-rich and

encouraged to consume them regularly. Red meat is particularly
rich in iron. Fish and poultry are also good sources of iron.
Enriched and whole grain breads and cereals, green leafy veg-
etables, legumes, eggs, and dried fruits also provide iron.

The iron in eggs and in foods from plant sources is not

absorbed as efficiently as iron from meat, fish, and poultry.
Iron absorption from these nonflesh foods is enhanced when

(continued from page 1)

Pattern of Weight Gain

(continued on page 5)

See page 8
for the
Dietary Reference
Intakes:
Recommen de d
Intakes for
Pregnant Women

–

page

3

–

Food Guide Pyramid:

A Guide to Daily Food Choices for Pregnant Women

Food Group

Breads, Cereal, Rice, and Pasta
Group

— especially whole grain and refined
(enriched)

Recommended Servings

6 – 11 servings

What Counts as a Serving?

• 1 slice bread
•

1

⁄

2

hamburger bun or English muffin

• 3 – 4 small or 2 large crackers
•

1

⁄

2

cup cooked cereal, pasta, or rice

• About 1 cup ready-to-eat cereal

Fruit

2 – 4 servings

•

3

⁄

4

cup juice

• 1 medium apple, banana, orange, pear
•

1

⁄

2

cup chopped, cooked, or canned

fruit

Vegetable

(Eat dark-green leafy, yellow or orange
vegetables, and cooked dry beans and
peas often.)

3 – 5 servings

• 1 cup raw leafy vegetables
•

1

⁄

2

cup other vegetables — cooked or

raw

•

3

⁄

4

cup vegetable juice

Meat, Poultry, Fish, Dry Beans, Eggs,
and Nuts

— preferably lean or low fat

3 – 4 servings

• 2 – 3 ounces cooked lean meat,

poultry, fish

•

1

⁄

2

cup cooked, dry beans** or

1

⁄

2

cup

tofu counts as l ounce lean meat

• 2

1

⁄

2

-ounce soyburger or 1 egg counts

as 1 ounce lean meat

• 2 tablespoons peanut butter or

1

⁄

3

cup

nuts counts as 1 ounce meat

Milk, Yogurt, and Cheese

preferably fat free or low fat

3 – 4 servings *

• 1 cup milk
• 1 cup buttermilk
• 8 ounces yogurt
• 1

1

⁄

2

ounces natural cheese

• 2 ounces processed cheese
• 1 cup calcium-fortified soy milk

Use sparingly

• Limit fats and sweets

Fats and Sweets

*

*

During pregnancy and lactation, the recommended number of milk group servings is the same as for nonpregnant women. A soy-based
beverage with added calcium is an option for those who prefer a non-dairy source of calcium.

** Dry beans, peas, and lentils can be counted as servings in either the meat and beans group or the vegetable group. As a vegetable,

1

⁄

2

cup

cooked, dry beans counts as 1 serving. As a meat substitute, 1 cup cooked, dry beans counts as 1 serving (2 ounces meat).

Adapted from Eating for Two, 2001, March of Dimes and the Dietary Guidelines for Americans, Fifth Edition, 2000, U.S. Department of Agriculture and the U. S.
Department of Health and Human Services.

–

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4

–

Alcohol

Avoid

• Avoid alcoholic beverages altogether

consumed with foods high in vitamin C, such as orange juice,
or served with meat, fish, or poultry.

A well-balanced eating plan provides women with up to 12 to

14 mg of iron. To meet the added needs of pregnancy, maternal
iron stores are often tapped. Since many women enter pregnan-
cy with low iron reserves, they risk developing anemia.

The Centers for Disease Control and Prevention recommends

routine supplementation of low dose (30 mg/day) iron, starting
at the first prenatal visit. Most prenatal supplements supply this
dosage. In addition, prenatal counseling should recommend iron-
rich foods and foods that enhance iron absorption, as well as
screen for iron deficiency.

Iron supplements are absorbed best when taken between

meals, with water or juice, and not with other supplements.
Substances in coffee, tea, and milk inhibit iron absorption.
Taking iron supplements at bedtime often reduces problems of
gastric irritation.
Folic Acid *
Because of its important role in cell development and in the for-
mation of certain major fetal structures, all women of childbear-
ing age need adequate intake of folic acid. Recent research sug-
gests that taking folic acid before and during early pregnancy
can reduce the risk of spina bifida and other neural tube defects
(NTDs) in infants. This reduced risk has been observed both in
women with a previously NTD-affected pregnancy, who are con-
sidered at high risk for having a subsequent affected pregnancy,
as well as other women.

Most women do not consume adequate amounts of folate in

their diets in that important time before they know they are
pregnant. That is the time when the need for folate is the most

critical. For that reason, the March of Dimes, following recom-
mendations from the U.S. Public Health Service, offers this
advice: all women who can become pregnant should consume a
multivitamin containing 400 micrograms of folic acid daily, in
addition to eating foods that contain folate. Women with a previ-
ous NTD-affected pregnancy are advised to take a higher dose
of folic acid — 4 mg/day — before pregnancy.

To obtain recommended intakes of folic acid through the diet

requires careful selection of foods consistent with the U.S.
Dietary Guidelines and the Food Guide Pyramid. Good sources
of folate include leafy dark-green vegetables, legumes, citrus
fruits and juices, peanuts, whole grains, and some fortified
breakfast cereals. Since January 1998, grain products have
been fortified with 140 mcg/gram of folic acid. The Daily Value is
400 mcg; pregnant women need more (600-800 mcg/day).

(* Folate is the general term for this nutrient; folic acid is the syn-
thetic form used in supplements and in fortified grain products.)

A Special Diet for Phenylketonuria (PKU)

It is very important for women with this inherited error of body
chemistry to follow the special diet they followed in childhood in
order to prevent mental retardation and birth defects in their off-
spring. While some women with PKU have remained on this diet
all their lives, others discontinued the diet during the elementary
school years, as was sometimes advised a number of years ago.
Women with PKU who are not currently on the special diet must
resume the diet before becoming pregnant. All women with PKU
must follow the diet throughout pregnancy, and be monitored
frequently by their physicians to make sure that their blood lev-
els of the part of the protein (phenylalanine) that they cannot
metabolize do not rise to levels that will harm the baby.

Food Choices

Food requirements during pregnancy are not drasti-
cally different from a normal well-balanced
diet. Nutrient needs are higher, but the
general principles of sound nutrition-
variety, balance, and moderation-still
apply.

There are no “perfect” foods

that supply all the necessary
nutrients a pregnant woman
needs. Pregnant women need
to eat a variety of carefully
chosen foods over the
course of the day, or sever-
al days, to get the recom-
mended amount of calo-
ries, protein, vitamins,
and minerals needed
during pregnancy.

During pregnancy,

as throughout life,
eating should be
enjoyable. Expectant mothers can continue to enjoy their favorite
foods in moderation with some exceptions as addressed in the
paragraph on food safety on page 7. Attention to portion size
and frequency of consumption is the key to choosing occasional
treats while keeping total caloric intake under control.

The Food Guide Pyramid’s Guide to Daily Food Choices

from the U.S. Department of Agriculture outlines the

variety of foods and recommended amounts to

eat daily. Individual recommendations

vary depending on food energy (calo-

rie) needs. Pyramid guidelines help

women plan healthful meals and

snacks before, during, and after

pregnancy. Food variety within

the meat and beans group and

the milk group offer choices

for vegetarian women.

Additional servings and

larger portion sizes may be

advised for adolescents, women

who begin pregnancy under

normal weight, and women

who experience lower than

recommended weight gains.

Smaller portions of higher

calorie foods may be advised when the mother gains weight too

rapidly.

Pregnancy requires 8 to 12 cups of fluid per day to keep up

with the expanding blood supply. Milk, juice, water and other
beverages contribute to increased fluid intake.

(continued from page 3)

Calories and Nutrients of Concern

–

page

5

–

USE SPARINGLY

3-4 SERVINGS

3-4 SERVINGS

3-5 SERVINGS

2-4 SERVINGS

6-11 SERVINGS

Common Questions and Answers

Is it necessary to take a vitamin/mineral supplement during
pregnancy?
Though it’s possible to meet the requirements for most nutrients
through a balanced diet, most experts recommend pregnant
women take a daily vitamin/mineral supplement as a safeguard.
Supplementation should include 30 mg iron and 600 micro-
grams (mcg) folic acid daily. Vegans, women under age 25, and
those who choose to avoid milk products also are advised to
take calcium supplements (600 milligrams per day).

In addition, the U.S. Public Health Service and the March of

Dimes recommend that any woman of childbearing age who
might become pregnant should consume 400 micrograms
(mcg) of folic acid daily. This is the amount found in most
multivitamins.

Vitamin/mineral supplements are also recommended for

women who may be at nutritional risk. That includes women
who are strict vegetarians (vegans), breastfeeding, follow
restrictive diets, are heavy cigarette smokers, and/or abuse
alcohol, or are carrying twins or triplets. For strict vegetarians,
vitamin B12 supplements (and perhaps vitamin D and zinc) are
recommended.

Because excessive levels of vitamin A can be toxic to the fetus

and adequate levels are available through a balanced diet, vita-
min A supplementation is not recommended during pregnancy
except at low levels. There is no evidence that vitamin B6 sup-
plementation is an effective treatment for morning sickness.

No scientific evidence exists to justify recommendations for

herbal products. Some may have serious side effects.
Is it safe to consume low-calorie sweeteners during
pregnancy?
Low-calorie sweeteners can be used by pregnant women who
have diabetes, who need to control caloric intake, or who enjoy
the taste of products containing sweeteners. Since pregnancy is
a period of increased energy (calorie) demand for most women,
caloric restriction usually is discouraged.

In the United States, there are five low-calorie sweeteners

approved for use in foods and as tabletop sweeteners: aspar-
tame, saccharin, acesulfame K, sucralose, and neotame.

Aspartame consists of two amino acids, aspartic acid and

phenylalanine as the methyl ester, the basic building block of
protein. Aspartame has been extensively studied and all reports
indicate that aspartame is safe for the pregnant mother and
fetus, except for women who have phenylketonuria (PKU) and
must restrict their intake of phenylalanine from all sources.
Studies show that PKU heterozygote pregnant women (those
who carry the PKU gene but do not have the disease them-
selves) metabolize aspartame sufficiently to protect the fetus
from abnormal phenylalanine levels.

The Food and Drug Administration has approved aspartame

as a safe food ingredient for the general population, including
pregnant women. A task force of the American Academy of
Pediatrics Committee on Nutrition also concluded that aspar-
tame is safe for both the mother and developing baby.

Saccharin is not metabolized and passes through the diges-

tive tract unchanged. Although saccharin can cross the placenta,
there is no evidence that it is harmful to the fetus. Both the
American Dietetic Association and the American Diabetes
Association recommend saccharin can be used in moderation
during pregnancy. Saccharin is not a potential carcinogen,
according to the U.S. Department of Health and Human
Services.

Acesulfame K is not metabolized and is excreted unchanged

by the kidneys. Reproduction and teratology studies in animals
have shown no toxic effect due to acesulfame K.

CAFFEINE CONTENT OF

FOOD AND BEVERAGES

The table below shows the approximate caffeine content of

various foods and beverages:

MILLIGRAMS OF CAFFEINE

ITEM

TYPICAL

RANGE*

Coffee (8 fl. oz. cup)

Brewed, drip method ..........................85

65 - 120

Instant .................................................75

60 - 85

Decaffeinated........................................3

2 - 4

Espresso coffee (1 fl. oz. cup)..............40

30 - 50

Teas (8 fl. oz. cup)

Brewed major U.S. Brands..................40

20 - 90

Instant .................................................28

24 - 31

Iced (8 fl. oz. glass) .............................25

9 - 50

Some soft drinks (8 fl. oz.)...........................24

20 - 40

Cocoa beverage (8 fl. oz.) .............................6

3 - 32

Chocolate milk beverage (8 fl. oz.) ...............5

2 - 7

Milk chocolate (1 oz.) ...................................6

1 - 15

Dark chocolate, semi-sweet (1 oz.) .............20

5 - 35

Baker’s chocolate (1 oz.) .............................26

26

Chocolate-flavored syrup (1 fl. oz.)...............4

4

*Due to brewing method, plant variety, brand, etc.

Is caffeine consumption during pregnancy safe?

Studies have found that moderate
caffeine consumption has little
or no effect on the reported
time to conceive, however, high
caffeine consumption may
increase risks of delays in
conception. Major
studies over the last
decade have found no
association between
birth defects and caffeine
consumption. Even offspring
of the heaviest coffee drinkers were not
found to be at higher risk of birth defects.

Evidence from other human studies also supports the con-

clusion that low to moderate consumption of caffeine by
pregnant women probably does not predispose the mother
to miscarriage or preterm delivery. Some studies suggest
that drinking more than two or three cups of coffee daily
(approximately eight cups of tea or nine cans of caffeinated
soft drinks) increase the chances of low birthweight. Because
caffeine can cross the placenta and affect the fetus, pregnant
women should apply the principle of moderation to caffeine
consumption and discuss it with their personal physician.
Breast milk can also transfer caffeine from mother to baby.
Very high caffeine intake in nursing mothers may make
babies irritable. A reasonable guideline for daily intake of caf-
feine is up to 300 mg caffeine per day. The following chart
provides the approximate caffeine content of various foods
and beverages. A variety of caffeine-free beverages are avail-
able for women who wish to limit or avoid caffeine during
pregnancy.

(continued on page 7)

–

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6

–

Sucrolose, which is not well absorbed, is excreted basically

unchanged. Studies show no reproductive risk.

Neotame, the most recently approved low-calorie sweetener,

is rapidly metabolized, completely eliminated, and does not
accumulate in the body. Neotame is safe for use as a sweetener
and flavor enhancer by the general population including preg-
nant and lactating women, children, and people with diabetes.
Do food cravings indicate nutritional deficiency?
No. Food cravings and aversions to certain foods are common
during pregnancy. There is no evidence that food cravings are
the result of nutritional deficiencies, and their cause remains a
mystery. There is no harm in satisfying food cravings within rea-
son, especially when they make a nutritional contribution to the
diet.

Some pregnant women have the urge to eat nonfood sub-

stances, like laundry starch or clay. This is called pica. The con-
sumption of nonfood items is not safe and can be dangerous for
both mothers and babies. In some cases pica involves the con-
sumption of large amounts of nonfood items that displace foods
and interfere with adequate nutrient intake.
Should sodium intake be restricted during pregnancy?
No. In fact, sodium requirements increase during pregnancy. But
the sodium provided by the average diet is likely to be adequate
for expectant mothers. Use of additional salt is rarely warranted.

At one time, salt was routinely restricted during pregnancy in

an effort to reduce the incidence of toxemia (a condition charac-
terized by a combination of symptoms including hypertension,
fluid retention and protein in the urine). But there is no evidence
that sodium restriction prevents or alleviates toxemia.

Excessive sodium intake does contribute to high blood pres-

sure in some people. Women who have been advised to limit
sodium before becoming pregnant should continue this practice
until they discuss it with their doctors.
Can morning sickness and other forms of GI distress be
relieved?
Although some expectant mothers never experience it, morning
sickness is common and does not necessarily occur only in the
morning. Feelings of nausea may be relieved by eating low-fat,
easily digested carbohydrate foods, such as dry toast, plain
crackers, cereal, pasta, rice, or fruit.

For nausea and vomiting, small, frequent meals tend to be

tolerated better than large ones. Fried, gas-forming, or spicy
foods may cause discomfort. Fluids often are better tolerated
between meals rather than with them. A snack before getting up
or bedtime may help. If the problem persists or becomes severe,
the woman should seek advice from her health professional.

Constipation also can be a problem and may partially result

from decreased intestinal motility, characteristic of the second
and third trimesters. Foods high in insoluble fiber, such as fresh
fruits and vegetables and whole grain breads and cereal, can
help alleviate constipation. Liberal consumption of fluids and a
regular pattern of moderate physical activity also can help. Iron
supplements may promote constipation, especially if fiber intake
is low; check the dosage. Unless advised by a health care
provider, laxatives are best avoided.
Is it safe to have an occasional cocktail, beer, or glass of
wine?
No. Because the effects of even occasional alcohol consumption
on the developing baby during pregnancy are unknown, most
health care providers recommend not drinking any alcohol dur-
ing pregnancy.

There are no data to support a safe level of alcohol consump-

tion during pregnancy and the thresholds for fetal effects probably

vary. As a result, the consensus is to recommend abstinence.
Some women are concerned about having consumed moderate
amounts of alcohol soon after conception, before becoming
aware of their pregnancy. For most women, small amounts of
alcohol consumed during this time should not be a cause of con-
cern. Women should stop drinking alcohol as soon as they find
out they are pregnant, however.

Habitual alcohol consumption does affect the developing

infant. Studies show that pregnant women who drink one or two
drinks a day tend to give birth to smaller babies.

Women who use alcohol during pregnancy are at greater risk

of giving birth to babies with fetal alcohol effects (FAE) or the
more serious fetal alcohol syndrome (FAS). Characterized by
growth retardation, facial and heart abnormalities, small head
size and mental deficiency, FAS affects 30 to 40 percent of the
babies born to women who drink throughout pregnancy. FAE is
more common and variable, including growth retardation, mild
behavioral and intellectual impairments or learning disabilities,
and minor malformations.
Are there any food safety issues related to pregnancy?
Pregnant women are especially susceptible to foodborne and
waterborne hazards due to the physiological changes in preg-
nancy that may increase the exposure of the mother and fetus
to hazardous substances.

To reduce the risk for foodborne illnesses, pregnant women

need to follow general food safety guidelines: wash hands and
surfaces often, don’t cross-contaminate, refrigerate perishable
foods promptly, and cook food to proper temperatures.

Foodborne illness can be very harmful. For example, listeriosis

can cause miscarriage, stillbirth, or acute illness, and toxoplas-
mosis and E. coli can cause severe fetal infection. Pregnant
women should avoid raw fish and seafood, and any fish that may
be contaminated with methyl mercury and PCBs. The FDA rec-
ommends that pregnant women avoid swordfish, shark, king
mackerel and tilefish. Nutrition counseling during pregnancy
should address these food safety issues.

Conclusion

Because many pregnant women are particularly receptive,

pregnancy presents a good opportunity for nutrition educa-

tion. The basic principles of good nutrition — balance, variety

and moderation — should be encouraged during pregnancy

and as lifetime habits. Clients should be counseled to enjoy a

variety of nutrient-rich foods for their own good health and

the health of their unborn children.

(For additional information go to the Pregnancy and Newborn

Health Education Center at the March of Dimes.

Visit www.marchofdimes.com or call 1-888-MODIMES.)

(continued from page 6)

Common Questions and Answers

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American College of Obstetricians and Gynecologists.

Planning Your Pregnancy and Birth, Third Edition.
Washington, DC. 2000.

American Dietetic Association. American Dietetic

Association Diet Manual. Chicago IL, 2000.

American Dietetic Association: Position: Use of nutritive

and non-nutritive sweeteners. JADA, 98:580-587. 1998.

Barone, JJ and Roberts, H. Caffeine consumption. Food

and Chemical Toxicology, 34:119-129, 1996.

Brown, JE and Carlson, M. Nutrition and multifetal preg-

nancy. JADA, 100:343-348. 2000.

Centers for Disease Control and Prevention. Knowledge

and use of folic acid by women of childbearing age —
United States. MMWR: 46 (NO.310), 1997.

Centers for Disease Control and Prevention.

Recommendations to Prevent and Control Iron Deficiency in
the United States. MMWR: 47 (NO. RR-31), 1998.

Christian MS, Brent RL. Teratogen Update: Evaluation of

the Reproductive and Development Risks of Caffeine.
Teratology 64:51-78. 2001.

Cnattingus S, Haglund B, Kramn MS. Differences in late

fetal death rates in association with determinants of small
for gestational age fetuses: Population based cohort study.
BMJ 316:1483-1487. May 16, 1998.

Cnattingus S, Signorello LB, et al. Caffeine intake and risk

of first trimester spontaneous abortion. NEJM
(343)25:1839-1845. December 21, 2000.

Duyff, R. The American Dietetic Association’s Complete Food

and Nutrition Guide. New York: John Wiley and Co., 1998.

Food and Nutrition Board, Institute of Medicine. Dietary

Reference Intakes for Calcium, Phosphorus, Magnesium,
Vitamin D, and Fluoride. Washington, D.C. National
Academy Press. 1999.

Food and Nutrition Board, Institute of Medicine. Dietary

Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin
B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and
Choline. Washington, D.C. National Academy Press. 2000.

Food and Nutrition Board, Institute of Medicine. Dietary

Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron,
Chromium, Copper, Iodine, Iron, Manganese, Molybdenum,
Nickel, Silicon, Vanadium, and Zinc. Washington, D.C.
National Academy Press. 2001.

Food and Nutrition Board, Institute of Medicine. Dietary

Reference Intakes for Vitamin C, Vitamin E, Selenium, and
Beta Carotene and Other Carotenoids. Washington, D.C.
National Academy Press. 2000.

Klebanoff, MA, Levine, RJ, DerSimonian, et al. Maternal

serum parazanthine, a caffeine metabolite, and the risk of
spontaneous abortion. NEJM (341)1639-1644. 1999.

March of Dimes Birth Defects Foundation. Eating for Two.

09-219-00. August 2001.

March of Dimes. Nutrition Today Matters Tomorrow: A

Report from the March of Dimes Task Force on Nutrition and
Optimal Human Development. ISBN 0-86525-092-8. 2000.

Menard, MK. Vitamin and mineral supplement prior to and

during pregnancy. Obstet Gynecol Clin North America,
24;3:479. September, 1997.

National Institutes of Health, National Heart, Lung, and

Blood Institute Body Mass Index Table Aim for a Healthy
Weight. Washington, DC. http://www.nhlbi.nih.gov/actintime/
rhar/lew.htm.

Nehlig A. Debry G. Consequences on the newborn of chron-

ic maternal consumption of coffee during gestation and lac-
tation: a review. Jrnl Am Coll of Nutr 13(1):6-21. 1994.

U.S. Department of Agriculture, U.S. Department of Health

and Human Services, Nutrition and Your Health: Dietary
Guidelines for Americans, Fifth Edition. Home and Garden
Bulletin No. 232. Washington, D.C. U.S. Department of
Agriculture and U.S. Department of Health and Human
Services, 2000.

U.S. Public Health Service, 9

th

Report on Carcinogens

2000. Washington, D.C.: U.S. Department of Health and
Human Services, 2000.

Vegetarian Nutrition Practice Group. Vegetarian Diets

During Pregnancy. Leicester, MA: Vegetarian Nutrition, a
Practice Group of The American Dietetic Association; 1996.

Worthington-Roberts, BS and Williams, SR. Nutrition

During Pregnancy and Lactation, 6

th

Ed. Madison, WI:

Brown and Benchmark, 1997.

Dietary Reference Intakes: Recommended Intakes for Pregnant Women

2000 DRIs

Ca

P

Vit D

1

Fl

Thiamin

Riboflavin

Niacin

Vit B

6

Folate

VitB

12

Pantothenic Biotin

(mg/d)

(mg/d)

(µg/d)

(mg/d)

(mg/d)

(mg/d)

(mg/d)

(mg/d)

(µg/d)

(µg/d)

Acid (µg/d)

(µg/d)

<18 years

1,300 *

1,250

5 *

3 *

1.4

1.4

18

1.9

600

2.6

6 *

30 *

19-30 years

1,000 *

700

5 *

3 *

1.4

1.4

18

1.9

600

2.6

6 *

30 *

31-50 years

1,000 *

700

5 *

3 *

1.4

1.4

18

1.9

600

2.6

6 *

30 *

2000 DRIs

Choline (mg/d)

Vit C (mg/d)

Vit E (mg/d)

Se (µg/d)

Mg (mg/d)

Vit A (µg RE)

Vit K (µg)

Iron (mg)

Zinc (mg)

Iodine (µg)

<18 years

450 *

80

15

60

400

750

75*

27

12

220

19 –30 years 450 *

85

15

60

350

770

90*

27

11

220

31-50 years

450 *

85

15

60

360

770

90*

27

11

220

* The asterisk (*) indicates Adequate Intakes; all other nutrient amounts are Recommended Dietary Allowances (RDAs).

1

As cholecalciferol. 1 µg cholecalciferol = 40 IU vitamin D; and in the absence of exposure to sunlight.

DRIs for Pregnant Women

Kcal/day1

Carbohydrate (g/d)

Total Fiber (g/d)

Total Fat

Protein

14 to 18 Years Old

175

28*

ND

2

71

3

(1.1 g/kg/d)

1st Trimester .....................................2,368

2nd Trimester....................................2,708

3rd Trimester ....................................2,820

19 through 50 Years Old

175

28*

ND

2

71

3

(1.1 g/kg/d)

1st Trimester .....................................2,403

2nd Trimester....................................2,743

3rd Trimester ....................................2,855

1

These energy requirements assume an active lifestyle.

2

ND means Not Determined.

3

Protein requirement is based on a reference female: 5’4” tall, 119 lbs. (14 -18 years old) or 126 lbs. (19-30 years old).

References

For additional information, contact:

International Food Information Council Foundation

1100 Connecticut Avenue, N.W. • Suite 430

Washington, D.C. 20036

http://ific.org

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March of Dimes National Office

1275 Mamaroneck Avbenue

White Plains, NY 10605

www.marchofdimes.com