Additional protein is necessary to support the synthesis of maternal and fetal tissue, with greatest demands during the second and third trimesters when requirements are 20-28 g per day more than nonpregnant requirements. Women in industrialized countries generally consume more than the recommended intake of protein during pregnancy. Studies of protein deficiency during pregnancy are limited in number and often confounded by low energy intakes. However, the few studies that provided either extra energy or energy plus protein to undernourished women suggest that limited energy intakes are more unfavorable for pregnancy outcome than limited protein intakes. High-protein supplements are not recommended during pregnancy because they have been associated with lower birth weight and increased mortality and prematurity. However, when supplements provide protein-to-energy ratios comparable to those found in usual diets, higher rates of prematurity are not observed. Vegetarian women can substitute meat, poultry, fish, and eggs by additional servings of beans, tofu, nuts, and soymilk (preferably fortified with calcium and vitamin D). Vitamin B12 will also need to be consumed as supplements to achieve the recommended intake of 2.6 mg/day.

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