Nutrient Requirements during Pregnancy and Lactation

Gestational Weight Gain (GWG)

A woman with a normal weight (body mass index (BMI) between 19 and 24 kg/m2)

Gestational Weight Gain (GWG) should be between 11 and 16 kg.

Human Chorionic Gonadotropin (hCG).

Recommended dietary allowance (RDA)

• Recommended dietary allowance (RDA): the average daily dietary intake level that is sufficient to meet
the nutrient requirement of nearly all healthy individuals in a group.
• Adequate intake (AI): a value based on observed or experimentally determined approximations of
nutrient intake by a group (or groups) of healthy people—used when an RDA cannot be determined.
• Tolerable upper intake level (UL): the highest level of daily nutrient intake that is likely to pose no risk
of adverse health effects to almost all individuals in the general population. As intake increases above the
UL, the risk of adverse effects increases.
• Estimated average requirement (EAR): a nutrient intake value that is estimated to meet the requirement
of half the healthy individuals in a group.

Iron and Vitamin B9

Iron plays an important role in the production of haemoglobin and for the transport of oxygen.

The iron requirements of pregnant women are markedly increased (22–27 mg/day).

Vitamin C can help with the intestinal absorption of iron, but that tea and coffee can decrease it (due to the
presence of polyphenols).

Anaemia is considered moderate and severe when haemoglobin (Hb) levels are between 7 and 9 g/dL and less
than 7 g/dL, respectively.

A diagnosis of iron deficiency anaemia can be made when the threshold values are as follows:

• Hb level <11 g/dL in the first and third trimesters;

• Hb level <10.5 g/dL in the second trimester;

• ferritin level <30 µg/L: insufficient iron reserve.

Postpartum haemoglobin level less than 9 g/dL is a factor associated with a higher risk of post-traumatic stress
disorder.

Maternal iron intakes decrease the risk of having a low birth weight or a premature baby and increase the average
birth weight of infants.
Vitamin B9 (natural food folate), also known as folic acid (the synthetic form), is metabolically inactive.

Enzymatic reductions enable the conversion of folic acid to DiHydroFolate (DHF), and then TetraHydroFolate
(THF).

Folate deficiency can be responsible for some pregnancy complications, such as primarily Neural Tube Defects
(NTD), including spina bifida and anencephaly.

Vitamin B9 requirements for pregnant women are 400 µg/day.

High folic acid intake may, under certain conditions, promote cancer, interact with medications, and impair foetal
development, epilepsy and liver damage.

WHO recommendation is a daily oral iron supplementation with 30 mg to 60 mg of elemental iron in order to
prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth.

WHO recommendations indicate that all women in the periconceptional period (eight weeks before and eight
weeks after conception) should take a folic acid supplement (400 µg folic acid daily) to reduce the risk of neural
tube defects.

Folic acid supplementation in the periconceptional period, either alone or in combination with other vitamins and
minerals, can prevent neural tube defects.

Daily oral iron and folic acid supplementation with 30 to 60 mg of elemental iron (60 mg of elemental iron
equivalent to 300 mg of ferrous sulphate heptahydrate, 180 mg of ferrous fumarate, or 500 mg of ferrous
gluconate) and 400 µg of folic acid is recommended for pregnant women to prevent maternal anaemia, puerperal
sepsis, low birth weight, and premature deliveries.

Intermittent oral iron and folic acid supplementation with 120 mg of elemental iron (120 mg of elemental iron
equivalent to 600 mg of ferrous sulphate heptahydrate, 360 mg of ferrous fumarate, or 1000 mg of ferrous
gluconate) and 2800 µg of folic acid once a week is recommended for pregnant women to improve the outcomes
of pregnancy for both mothers and newborns if daily iron intake is not acceptable due to side effects and in
populations where the prevalence of anaemia in pregnant women is less than 20%.

CALCIUM

Calcium participates in the mineralization of the foetal skeleton, especially during the third trimester.

The skeleton of a full-term baby contains approximately 30 g of calcium.

Maternal calcium needs to increase, especially from the third trimester (the need for calcium varies from 1000 to
1200 mg/day).

Low calcium intake can worsen the severity of last-trimester bone loss and the risk of developing pre-eclampsia.

Calcium can be used for the relief of pregnant women’s leg cramps.

The vitamin D supplementation recommended in the seventh month of pregnancy promotes intestinal absorption
of calcium.
In populations with low calcium intake, daily supplementation (1.5–2.0 g of elemental calcium) is recommended
for pregnant women to reduce the risk of pre-eclampsia.

WHO recommends using calcium to relieve cramps in the lower extremities during pregnancy.

MAGNESIUM

During pregnancy, serum magnesium levels gradually decrease, reaching low values during the last trimester and
increasing after childbirth.

The concentration of magnesium in the blood of the umbilical cord is higher than maternal Magnesium levels,
which means that active transport occurs through the placenta.

The magnesium requirements of pregnant women are difficult to define (around 350 mg/day).

Magnesium deficiency causes hypertensive disorders, gestational diabetes mellitus, preterm labor, and
intrauterine growth restriction.

WHO recommends the use of magnesium to relieve cramps in the lower extremities during pregnancy.

IODINE

Thyroid homeostasis, especially in pregnant women and foetuses, is essential for the development of brain tissue,
the acquisition of intelligence, and learning.

The main sources of iodine in the diet come from foods like fish, seafood, and dairy products.

Pregnant women avoid certain types of fish and seafood during pregnancy because they have a high risk of
contamination with parasites, germs, or toxins.

During pregnancy, iodine requirements are increased by approximately 50% due to maternal thyroid stimulation
(by hCG), an increase in renal iodine clearance and iodine transfer to the foetus for the synthesis of foetal thyroid
hormones from the second trimester.

WHO recommendation for iodine intake during pregnancy is 220–250 µg/day.

Pregnant women with high risk of deficiency: living in a particularly deficient area, smoking, having pregnancies
that are too close together, consuming a specific diet (e.g., veganism); and suffering nausea and vomiting, thereby
reducing food intake.

ZINC

Zinc is essential for example, cell division, protein synthesis and growth, and nucleic acid metabolism.

Deficiencies may lead to congenital malformations, low birth weight, intrauterine growth retardation, and preterm
delivery.

The zinc requirements of pregnant women are slightly increased (11 mg/day).

Zinc is mainly present in meat, fish, and seafood.

More iron consumption decreases zinc absorption.

Vitamin D

Vitamin D is available in two forms: D2 and D3.

Vitamin D2 (ergocalciferol) is the form found in plant-based sources.

Vitamin D3 (cholecalciferol) is the form found in dietary animal sources.

Vitamin D is converted into 25-hydroxyvitamin D (25-OH-D) by the liver.

Pregnant women have a vitamin D deficiency at the end of pregnancy because of low sun exposure.

The recommended daily intake of vitamin D for pregnant and breastfeeding women is 600 international units
(IU). Most prenatal vitamins contain 400 IU of vitamin D per tablet.

Vitamin D deficiency is common in pregnant women (5-50%) and breastfed infants (10-56%).

Vitamin D deficiency can lead to adverse health outcomes such as preeclampsia, low birthweight, and poor
postnatal growth.

Good sources of vitamin D include fortified low-fat or fat-free milk, fortified orange juice, egg yolks, and salmon.

If you're taking a vitamin D supplement, you should give your infant a daily vitamin D supplement of at least 400
IU to meet pediatric nutritional guidelines.

Most experts agree that supplemental vitamin D is safe in dosages up to 4,000 IU per day during pregnancy or
lactation. However, if you've been prescribed a very high dose of vitamin D (over 6,000 IU a day), your baby may
need extra blood tests

Vitamin D supplementation is not recommended by the WHO for pregnant women.

According to the WHO, for pregnant women with a suspected vitamin D deficiency, vitamin D supplements may
be given at the current recommended nutrient intake of 200 IU (5 µg) per day.

Vitamin A

The recommended daily intake of vitamin A during pregnancy is 750–770 mcg. The fetus depends on the mother's
supply of vitamin A, as the fetal liver stores only a small amount

The recommended daily intake of vitamin A during lactation is 1,200–1,300 mcg. Vitamin A is a normal
component of breast milk and is important for mammary gland development and milk production.

The recommended daily intake of vitamin A for infants aged 6 months or less is 400 mcg.

WHO recommends vitamin A supplementation during pregnancy or lactation in areas with endemic vitamin A
deficiency.

Vitamin A can be obtained from preformed retinoids or carotenoids, which are found in vegetables like carrots
and dark-green leafy vegetables.

The body absorbs between 70–90% of preformed vitamin A, but only 20–50% of carotenoids.
The liver stores most vitamin A reserves as retinyl esters, while carotenoids are deposited in fatty tissues
throughout the body.

The concentration of vitamin A in breast milk is influenced by the mother's diet and the intertissue flux of nutrients
in the gland during lactation.

B vitamins

• B1 (Thiamine): Supports brain development

• B2 (Riboflavin): Supports healthy eyes and skin

• B3 (Niacin): Can help with morning sickness and digestion

• B5 (Pantothenic Acid): Helps reduce leg cramps and produce pregnancy hormones

• B6 (Pyridoxine): Supports brain and nervous system development. When breastfeeding, it's likely safe to
take 2 mg per day, but higher amounts are not recommended.

• B7 (Biotin): Deficiency is common during pregnancy, so increased consumption is recommended.

• B9 (Folic Acid): Helps reduce the risk of birth defects, especially neural tube defects. The US
recommends that all women who could become pregnant take supplemental folic acid.

• B12 (Cobalamin): Supports nervous system development.

Some good sources of B vitamins include red meat, fish, beans, and cow milk. However, the composition of B
vitamins in human milk can vary widely, and inadequate intake could negatively impact infant growth and
development.

Omega-3 fatty acids

Omega-3s are essential for the development of the brain and eyes, and can help improve neurocognitive and visual
development in infants.

Omega-3s may reduce the risk of preterm birth, which can lead to death, disability, and other poor outcomes for
babies.

Omega-3s may reduce the risk of postpartum depression.

Omega-3s can help lower the risk of asthma and other allergic conditions in babies.

Omega-3s may help prevent heart disease, improve cognitive function, and regulate inflammation.

Omega-3s are essential for life and can be obtained from dietary sources, such as seafood, or from supplements,
such as fish oil.

The FDA recommends that pregnant, breastfeeding, or planning-to-be-pregnant women eat 8 to 12 ounces (2 to
3 servings) of fish low in mercury per week.

It can be difficult to get enough omega-3s from diet alone, especially during pregnancy. For this reason,
supplements are often recommended.
The recommended dosage of omega-3s is 1 g per day, with 500 mg per day of DHA.

Taking higher doses may not provide any additional benefit, and may even be harmful.