Pregnancy and Nutrition

Pregnancy demands higher energy requirements across all BMI categories. High pre-
pregnancy BMI and excess weight gain during pregnancy may have a high risk of incidence
of Gestational diabetes mellitus, high BMI in later pregnancies, high risk of depression, risk
of severe Pre-eclampsia, and late-onset pre-eclampsia [2]. There are recommended additional
energy requirements recommended total weight gain for various categories during singleton
and twin pregnancies, adhering to this can help avoid complications.

Tackling ideal weight gain during pregnancy based on pre-pregnancy BMI                         

Weight gain of normal or obese women within the following recommendations [4] made by
the Institute of Medicine (IOM) in 2009 is observed to have a low risk of complications.

American Diabetes Association has reduced the BMI threshold of the normal weight category
in Asians from 25 kg/m2 to 23 kg/m2 due to different body compositions and in Japan, the
recommended weight gain is 7-10kg for 23 kg/m2 women. However, because of a lack of
scientific evidence on gestational weight gain and BMI thresholds in Asian women, IOM
recommendations are still followed [3].

Computing for calorific requirement based on BMI

Resting Metabolic Rate, physical activity, and tissue growth are the factors that influence
energy intake requirements during pregnancy. The requirements vary across pregnancy in
women of varied BMI.
Total Daily Energy Expenditure (TDEE) is the total of energy required to support [6] –
1. Resting Metabolic Rate (RMR) (60-80% of TDEE)
2. Diet induced thermogenesis (10% of TDEE)
3. Physical activity-related energy expenditure (variable)
It was observed that habitual exercise (moderate physical activity for 150 minutes a week as
recommended by various guidelines) can reduce the risk of complications such as Gestational
weight gain by 32%, GDM by 38%, hypertension by 39%, moderate depression by 67% and
macrosomia by 39% [6].

Institute of Medicine recommendations for Energy intake requirements (EIR) [6]

1. To support first trimester gain, in addition to pregravid energy levels, 100-200 kcal/day are
recommended in all women and 400 kcal/day in obese women.
2. Energy requirements during the second and third trimesters are 340 kcal/day and 452
kcal/day.

EIR in pregnant women with excess gestational weight gain as per Thomas et al. model [6]

1. 400-600 kcal/day for underweight and normal-weight women
2. 220-350 kcal/day for overweight or obese women

It was suggested that an additional energy intake is required among lactation mothers – 531
kcal/day for complete breastfeeding and 413 kcal/day for partial breastfeeding [5].

Conclusion

Pregnant women have recommended weight gain thresholds and the corresponding energy
intake requirements across various BMI categories. Excessive weight gain beyond
recommendation may predispose them to the risk of breastfeeding cessation, aggravating
pregnancy complications [1]. Recommended energy intakes based on BMI category,
moderate physical activity as recommended, and breastfeeding are three most important ways
to avoid such complications.

References

1. Martin, H., Thevenet-Morrison, K. & Dozier, A. Maternal pre-pregnancy body mass
index, gestational weight gain and breastfeeding outcomes: a cross-sectional analysis.
BMC Pregnancy Childbirth 20, 471 (2020). https://doi.org/10.1186/s12884-020-
03156-8 https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-
020-03156- 8#citeas

2. Shao Y, Qiu J, Huang H, Mao B, Dai W, He X, Cui H, Lin X, Lv L, Wang D, Tang Z,
Xu S, Zhao N, Zhou M, Xu X, Qiu W, Liu Q, Zhang Y. Pre-pregnancy BMI,
gestational weight gain and risk of preeclampsia: a birth cohort study in Lanzhou,
China. BMC Pregnancy Childbirth. 2017 Dec 1;17(1):400. DOI: 10.1186/s12884-
017-1567-2. PMID: 29191156; PMCID: PMC5709979.
https://pubmed.ncbi.nlm.nih.gov/29191156/

3. Morisaki N, Nagata C, Jwa SC, Sago H, Saito S, Oken E, Fujiwara T. Pre-pregnancy
BMI-specific optimal gestational weight gain for women in Japan. J Epidemiol. 2017
Oct;27(10):492-498. DOI: 10.1016/j.je.2016.09.013. Epub 2017 May 31. PMID:
28579106; PMCID: PMC5602799.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602799/

4. Kominiarek MA, Rajan P. Nutrition Recommendations in Pregnancy and Lactation.
Med Clin North Am. 2016 Nov;100(6):1199-1215. DOI:
10.1016/j.mcna.2016.06.004. PMID: 27745590; PMCID: PMC5104202.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5104202/

5. Nancy F Butte, William W Wong, Margarita S Treuth, Kenneth J Ellis, E O'Brian
Smith, Energy requirements during pregnancy based on total energy expenditure and
energy deposition, The American Journal of Clinical Nutrition, Volume 79, Issue 6,
June 2004, Pages 1078–1087, DOI:10.1093/ajcn/79.6.1078
https://academic.oup.com/ajcn/article/79/6/1078/4690222

6. Most J, Dervis S, Haman F, Adamo KB, Redman LM. Energy Intake Requirements in
Pregnancy. Nutrients. 2019 Aug 6;11(8):1812. DOI: 10.3390/nu11081812. PMID:
31390778; PMCID: PMC6723706.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723706