What Nutrients Are Suggested for Each Stage of Pregnancy
Pregnancy is a joyous time, but it can also be a little confusing. Generally, you know to maintain a healthy diet and consider researching prenatal vitamins. But which nutrients are most important, and when and how much of each should you get?
For the most part, nutritional needs remain constant throughout each trimester of pregnancy. In some cases, however, different stages of pregnancy require tweaks to diet and additional nutrients to ensure optimum health for mother and fetus.
Nutrition across the trimesters
Calcium is essential to the fetus for building strong bones and teeth and muscle and nerve function. Current recommendations for calcium intake in pregnancy are 1,300 mg per day.1 You can get calcium from food sources like milk and other dairy products, broccoli, dark, leafy greens, or sardines. Those who are at higher risk of low dietary calcium intakes, like vegetarians and vegans, may require closer attention to diet.2
Choline plays a key role in cognitive function. High choline intake during pregnancy and early postnatal development has been linked with improved cognitive function in adulthood.3
The recommended intake of choline for pregnant women is 550 milligrams per day.1 Many foods contain choline, but animal-based products such as liver, poultry, dairy products, and eggs are particularly rich sources.4
Essential fatty acids (EPA and DHA)
“Dietary intake of essential fatty acids, particularly long-chain polyunsaturated fatty acids such as docosahexaenoic acid (DHA), are important during pregnancy… since DHA can influence the development of the brain and retina in the fetus.”5
“Over the course of pregnancy, maternal concentrations of essential fatty acids decrease by approximately 40%.”5 To maintain healthy levels of DHA and EPA, it is recommended that pregnant women eat at least two servings of oil-rich, low-mercury fish, such as salmon, per week.2
It’s widely understood that folate is an essential nutrient during pregnancy. However, studies have shown that women need to start taking folate supplements even before they decide to conceive if they are to reduce the odds of neural tube defects (NTDs).6 NTDs are the second-most common cause of serious birth defects and affect more than 2,500 US births annually.6
Evidence demonstrates that taking folate before conception as well as during the first trimester of pregnancy can reduce the risk of NTDs by up to 70%.6 For this reason, it is recommended that all women of childbearing age take 400 micrograms of folate daily.6
The need for folate significantly increases once a baby is conceived. Current dietary guidelines recommend that pregnant women get at least 600 micrograms of folate daily from all sources.6 Some studies even recommend as much as 800 micrograms for optimal development.7 Since it can be difficult to get that much folate from food alone, pregnant women should discuss options with their practitioners to determine if a daily folate supplement, alone or as part of a multivitamin, is suggested.
The fetus needs iodine for healthy brain development and growth.8 However, iodine deficiency is a growing concern worldwide, particularly for women of childbearing age. Recent surveys indicate there is a subset of pregnant and lactating US women who have mild to moderately inadequate dietary intake of iodine.8 To address this, the Institute of Medicine (IOM) recommends an iodine intake from dietary and supplement sources of 150 micrograms per day before conception and 220 micrograms per day during pregnancy.8
Good dietary sources of iodine include seaweed, dairy products, eggs, and iodized table salt. While seafood also contains iodine, pregnant women need to remember to avoid eating raw seafood and any fish containing high mercury levels for the duration of their pregnancy.
Iron is critical for the body’s red blood cells, which carry oxygen to organs and tissues. During pregnancy, women need about double the amount of iron in order to make more red blood cells that supply oxygen to the fetus.2 It is recommended that pregnant women get 27 milligrams of iron daily to achieve this.2
Iron-rich foods include lean red meat, poultry, fish that’s mercury-safe, dried beans and peas, iron-fortified cereals, and prune juice.9 Pregnant women should be sure to consume these iron-rich with foods rich in vitamin C, such as guava, bell peppers, citrus fruits, and tomatoes so that their bodies can absorb the iron more easily.2
Vitamin D works with calcium to help with the development of fetal bones and teeth, and it is also essential for healthy skin and eyesight.2 The recommended daily intake of vitamin D is 20 mcg for women, 15 mcg for pregnant and lactating women.2 This can be obtained from various foods such as milk fortified with vitamin D, fatty fish such as salmon, beef liver, cheese, and egg yolks.
Second and third-trimester shifts
Calcium absorption increases in pregnant women.11 Even though pregnant women experience increased efficiency in calcium absorption during pregnancy, some studies show a benefit in increasing calcium intake in the second and third trimesters of pregnancy.5,7 The World Health Organization recommends pregnant women obtain 1,500 to 2,000 milligrams of calcium per day.5 Remember dietary sources of calcium include dark leafy greens, dairy products, seaweed, nuts, and seeds.
During pregnancy, the diet has to provide enough energy to support the mother’s usual requirements as well as those of the growing fetus. During the first trimester, pregnant women do not need to get any more energy than nonpregnant women. However, at between 10 and 30 weeks of gestation there is an increase in the energy required by the expecting mother, who is growing new tissue for herself and her fetus.5
While caloric requirements during pregnancy may vary depending on the height, weight, age, and amount of physical activity, the Academy of Nutrition and Dietetics states that the extra energy need per day is 340 kcal for the second trimester and 452 kcal for the third trimester.9 This caloric increase may need to be adjusted by your healthcare practitioner, as there are many factors that influence caloric requirements in pregnancy such as prepregnancy BMI, weight gain in pregnancy, activity level, and carrying more than one child in utero.
While protein is an essential macronutrient throughout pregnancy, given its central role in fetal growth, it is especially necessary to obtain enough protein in the second and third trimesters. In early pregnancy, protein synthesis is at similar levels in pregnant and nonpregnant women. However, as fetal development progresses, protein turnover increases by 15% in the second trimester and 25% in the third trimester.5 Thus, it is recommended that pregnant women increase their intake of protein from 56 grams per day to 71 grams per day in the second half of pregnancy.5 Sources of protein include animal-based foods such as meat and dairy, as well as plant-based foods such as legumes, grains, and nuts. Vegetarians and vegans may need additional protein, as some plant-based protein may not convert as effectively into protein in the body as animal-based sources do.10 Research suggests that an individualized, practitioner supervised, and macro- and micronutrient focused vegetarian and vegan diet is safe in pregnancy for both mother and baby.10
Zinc can be found in the structure of numerous proteins and hormones.5 It also is a key player in a number of neurological and immune system functions, as well as wound healing and vision.5 Pregnant women are often deficient in zinc, and it is recommended that they raise their intake to 15 milligrams per day during the second and third trimesters of pregnancy.5
This content is not intended as a substitute for professional medical advice, diagnosis, or treatment. Individuals should always consult with their healthcare professional for advice on medical issues.
1. FDA frequently asked questions for industry on nutrition facts labeling requirements. https://www.fda.gov/media/99069/download. Accessed August 25, 2020.
2. Nutrition During Pregnancy, FAQ Pregnancy, February 2018, The American College of Obstetricians and Gynecologists. https://www.acog.org/patient-resources/faqs/pregnancy/nutrition-during-pregnancy. Accessed July 17, 2019.
3. Blusztajn J et al. Nutrients. 2017;9(8):815.
4. Choline Fact Sheet for Health Professionals. National Institutes of Health. Last updated July 9, 2019. https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/. Accessed July 23, 2019.
5. Mousa A et al. Nutrients. 2019;11(2):443.
6. Bixenstine P et al. Matern Child Health J. 2015;19(9):1974–1984.
7. Marangoni F et al. Nutrients. 2016;8(10):629.
8. Proctor S et al. J Acad Nutr Diet. 2014;114(7):1099–1103.
9. American Red Cross. redcrossblood.org/donate-blood/blood-donation-process/before-during-after/iron-blood-donation/iron-rich-foods.html. Accessed August 24, 2020.
10. Institute of Medicine. Dietary Reference Intakes for calcium and vitamin D. Washington, DC: The National Academies Press, 2011.
11. Kaiser LL et al. J Acad Nutr Diet. 2014;114(9):1447.
12. Sebastiani G et al. Nutrients. 2019;11(3):557.
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