Nutrition and Nutritional Supplementation

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Maternal nutrition is important to pregnancy outcome. Total weight gain as well as the pattern of weight gain affect newborn birth weight. Maternal weight gain begins in the first trimester and is most significant during the first half of pregnancy. Average total gain is 12.5 kg (28 lb). A balanced diet with sufficient caloric intake for appropriate weight gain supplies necessary vitamins. Routine supplementation with a multivitamin, therefore, is not necessary. 19 Vitamin supplementation may be necessary for women with special nutritional needs or those who follow a restricted diet (e.g., vegetarian). Since folic acid supplementation prepregnancy and during early pregnancy may prevent neural tube defects, the Centers for Disease Control recommends a regular daily folic acid intake of 400 pg for all fertile women. 20 As soon as pregnancy is established, this supplementation of 1 mg/day should be started. For women with a previous pregnancy affected by neural tube defect, the supplementation should be further increased to 4 mg/day.20 Appropriate use of vitamin preparations is not harmful (and often folic acid supplementation is provided by a multivitamin preparation) in any trimester of pregnancy, but excess intake of some vitamins (e.g., A, D, C, and B 6) may lead to congenital defects.19

With the exception of iron, minerals do not need to be supplemented during normal pregnancy if dietary intake is appropriate. Since most women of childbearing age have poor iron stores and normal dietary intake cannot meet the increased demand during pregnancy, iron supplementation is recommended. Gastrointestinal side effects can be reduced, while still providing iron during the period of greatest demand, by initiation of iron supplementation after the first trimester. Zinc deficiency may be associated with neural tube defects. Daily intake of zinc during pregnancy should be 15 mg. 2021

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