Heather Elia

Nutrition and Lifestyle for a Healthy Pregnancy Outcome

It is the position of the Academy of Nutrition and Dietetics that women of
childbearing age should adopt a lifestyle enhancing health in order to reduce the risk of
and birth defects and chronic health problems. Many components of a healthy lifestyle
are defined within the position to prevent any risks of the mother or baby.
The categories were divided into: trends that impact pregnancy outcomes, obesity and
gestational diabetes, and optimizing pregnancy outcomes with healthy lifestyle choices.
The trends that impact pregnancy outcomes are: birth defects, low birth weight, and
viable birth trends. Birth defects affect about 3% of babies [1] and are the number one
cause of death of infants in the United States (2006). [2] Low birth is the second cause of
death in infants in the United States, with statistics showing approximately 8.1% (2010)
of babies compromised with low birth weight. [2]
It is very important to seek a registered dietitian for direction concerning ideal body
weight before, during, and post pregnancy because of the increasing number of
overweight and obese women of child bearing age. Nearly two thirds of women were
classified as overweight, and one third of women were identified as being obese [3].
Hypertension is more common in obese women and this can harm both the mother and
the fetus. Developing hypertension makes women16%-25% more vulnerable to
preeclampsia, verses the 3%-5% of the normal population. Gestational diabetes mellitus
is also expected to increase with 18% of all pregnancies affected and immediately
following pregnancy 5-10% of women are usually diagnosed with type 2 diabetes, and
35-60% of women showing the chance of developing diabetes 10 to 20 years later. [4]

Heather Elia
Nutrition and Lifestyle for a Healthy Pregnancy Outcome
Discussing optimal and healthy body weight throughout all phases of pregnancy with a
RND will help with unfavorable maternal and fetal outcomes.
Optimizing pregnancy outcomes with a healthy lifestyle choice is very important on the
long-term influence of offspring. The prominence of supplements like: iron, folic acid,
vitamin D, choline, calcium, and iodine are evaluated for maternal and fetal development.
Iron deficiency is the most prevalent micronutrient deficiency worldwide and primarily
affects pregnant (17.4%) or lactating women and their children which is why there is a
necessity of iron supplementation, especially during the first two trimesters of pregnancy
to prevent the risk of preterm labor, low body weight and infant mortality. [5] Folic acid
has preventative properties against neural tube defects, which is why it is important
before and during pregnancy. It is recommended to consume 400ug/day of folic acid
from fortified foods or dietary supplements before pregnancy and 600ug/day while
pregnant. [6] The need for vitamin D supplementation during pregnancy still remains
debated, although supplementation has been proposed as an intervention to protect
against adverse gestational outcomes like low birth weight. [7] The IOM recommends
600 IU/ day of vitamin D to meet North American needs. Choline is important because
of its high rate of transport from mother to fetus and a deficiency can interfere with
normal fetal brain development. The satisfactory intake for pregnant women is 450mg/
day. There is an increased efficiency in calcium absorption during pregnancy and
maternal bone mobilization so as long as intakes are greater than 500 mg/day, maternal
and fetal bone requirements are optimal. [8] Iodine is a growing concern because
pregnant and lactating women in the US have a mild to moderate inadequate dietary

Heather Elia
Nutrition and Lifestyle for a Healthy Pregnancy Outcome
iodine intake and iodine is recommended for normal brain development and growth. [9]
The IOM recommends 150mg/day of iodine before conception, and 220mg/day of iodine
during pregnancy. [10] Consulting with an RND for proper and timely nutrient
supplementation is vital for maternal and fetus protection. Nutrients are not the only
concern for pregnant women. Dietary issues, especially those of foodborne illnesses are
a concern during pregnancy because pregnant women and their fetuses are more
susceptible to developing and foodborne illness because of hormonal changes that lead to
a decreases immune system. Listeria monocytogenes, Toxoplasma gondii, Brucella
species, Sal- monella species, and Campylobacterjejuni are of greatest concern. Food
safety guidelines should be reviewed and practiced at all times. An RDN can help assist
with proper food handling and preparation. There are benefits and concerns regarding
fish and seafood consumption, the benefit of consuming at least 8oz of seafood a week is
associated with improved infant visual and cognitive development because of the n-3
fatty acids. [11] The concern with fish consumption is the mercury exposure because it
has been associated with a greater risk of attention-deficit hyperactivity disorder
behaviors. [12] RDNs can help women balance the benefits of eating fish while avoiding
mercury content of seafood. Consumption of liquids during pregnancy is also essential.
Water intake during pregnancy should be about 3 liters per day [13] Energy drinks and
alcohol should be avoided and research shows that there is no added benefit. Caffeine
half-life increases during pregnancy which is why it is advises that no more than 200 mg
of caffeine a day should be consumed during pregnancy, but there is no evidence
showing a risk of congenial malformations, miscarriage, preterm labor, or growth
retardation when consumed. [14] Sugar sweetened drinks should be reduced because of
3

Heather Elia
Nutrition and Lifestyle for a Healthy Pregnancy Outcome
calorie content but there is limited research showing the safety of non-nutritive
sweeteners on healthy pregnancy [15] Maternal return to healthy weight status
postpartum can prevent future overweight and obesity. Physical activity during
pregnancy is associated with a 48% lower risk of hyperglycemia, specifically among
women with pre-pregnancy BMI <25[16] and has been shown to reduce gestational
weight gain and decrease weight retention and 2 months post partum. [17] Diet quality,
dietary intake and overall nutritional status can affect the risk of post partum depression
[11] so it is important to have dietary intervention with a RDN before, during, and after
pregnancy can help promote optimal health of mother and fetus.
I agree with the position for the Nutrition and Lifestyle for a Healthy Pregnancy
Outcome by the Academy of Nutrition and Dietetics. There is sufficient evidence
showing the benefits and concerns of pregnancy outcomes. There are many components
to a healthy lifestyle throughout pregnancy for both the mother and their child;
nourishment to the body during pregnancy will affect the health of both. Women who eat
well, take necessary supplements, practice safe food handling, and exercise regularly are
less likely to have complications during pregnancy. An RDN would be able to assist with
balancing all of these components to have a successful pregnancy with the product of a
healthy baby.

Heather Elia
Nutrition and Lifestyle for a Healthy Pregnancy Outcome
References
[1] Centers for Disease Control and Prevention. Division of Birth Defects and Developmental Disabilities. Birth defects. http://www.cdc.gov/ncbddd/birthdefects/ index.html.
Accessed October 4, 2012.
[2] Centers for Disease Control and Prevention. FastStats: Births and natality. http://
www.cdc.gov/nchs/fastats/births.htm. Accessed October 4, 2012.
[3] Rasmussen KM, Yaktine AL, eds. Weight Gain During Pregnancy: Reexamining the
Guidelines. Washington, DC: National Academies Press; 2009. http://www.
nap.edu/openbook.php?record_id1412584 &page14R1. Accessed March 19, 2014.
[4] Centers for Disease Control and Prevention. 2011 National Diabetes fact sheet:
Gestational diabetes in the United States. http://www.cdc.gov/diabetes/pubs/estim
ates11.htm. Accessed November 11, 2012
[5] Gautam CS, Saha L, Sekhri K, Saha PK. Iron deficiency in pregnancy and the rationality of iron supplements prescribed during pregnancy. Medscape J Med.
2008;10(12):283-288. http://www.ncbi. nlm.nih.gov/pmc/articles/PMC264404/.
Accessed October 3, 2012.
[6] US Department of Agriculture, US Department of Health and Human Ser- vices.
Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC: US Gov- ernment
Printing Office; 2010.
[7] Thorne-Lyman A, Fawzi WW. Vitamin D during pregnancy and maternal, neonatal
and infant health outcomes: A systematic review and meta-analysis. Paediatr Peri- nat
Epidemiol. 2012;26(suppl 1):75-90.
[8] Hacker AN, Fung EB, King JC. Role of calcium during pregnancy: Maternal and fetal
needs. Nutr Rev. 2012;70(7):397-409.
[9] Stagnaro-Green A, Abalovich M, Alexander E, et al. Guidelines of the American
Thyroid Association for the diagnosis and management of thyroid disease during
pregnancy and post- partum. Thyroid. 2011;21(10):1081-1125.
[10] Swanson C, Zimmermann M, Skeaff S, et al. Summary of an NIH workshop to
identify research needs to improve the monitoring of iodine status in the United States
and to inform the DRI. J Nutr. 2012;142(6):1175S-1185S.
[11] McMillen IC, MacLaughlin SM, Muhlhausler BS, Gentili S, Duffield JL, Morrison
JL. Developmental origins of adult health and disease: The role of per- iconceptional and
foetal nutrition. Basic Clin Pharmacol Toxicol. 2008;102(2):82-89.
[12] Sagiv SK, Thurston SW, Bellinger DC, Amarasiriwardena C, Korrick SA. Prenatal
exposure to mercury and fish consump- tion during pregnancy and attention-

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Nutrition and Lifestyle for a Healthy Pregnancy Outcome
deficit/hyperactivity disorder-related behavior in children. Arch Pediatr Adolesc Med.
2012;166(12):1123-1131
[13] Institute of Medicine. Dietary reference intakes for water, potassium, sodium,
chloride, and sulfate. http://www.nap.edu/ openbook.php?record_id1410925&page14
151. Published 2005. Accessed October 21, 2012.
[14] Brent RL, Christian MS, Diener RM. Eval- uation of the reproductive and developmental risks of caffeine. Birth Defects Res (Part B). 2011;92(2):152-187.
[15] Academy of Nutrition and Dietetics Evi- dence Analysis Library. Pregnancy and
nutritionNon-nutritive sweeteners. http://andevidencelibrary.com/evidence.
cfm?evidence_summary_id14250587. Accessed December 3, 2013
[16] Deierlein AL, Siega-Riz AM, Evenson KR. Physical activity during pregnancy and
risk of hyperglycemia. J Womens Health. 2012;21(7):769-775.
[17] Ruchat SM, Davenport MH, Giroux I, et al. Nutrition and exercise reduce excessive
weight gain in normal-weight pregnant women. Med Sci Sports Exerc. 2012;44(8): 14191426.