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Nutrition- Key Message Revision

Beginnings Pregnancy Guide Update 2011-
Nutrition- Key Message Revision

Current Key Message: Do eat well. If you can do only one thing for your baby –this is it. Eat well.  You need extra energy to keep yourself healthy and grow a baby at the same time. Do not let your body run out of fuel. Eat at least every 4 hours. Snack on fruit and cheese, not donuts. Choose baked chicken and vegetables over burgers and fries.  Eat often and eat well.                                                                               Book 1; page 2 Keys to a Healthy Baby, Things to Do                 

Summary of Evidence Low birth weight, preterm birth, and intrauterine growth restriction (IUGR)--  these three adverse birth outcomes are the leading causes of neonatal death and both short- and long-term health problems including predisposition to chronic disease in adulthood.  Each has been extensively researched and found to be caused by or closely linked to maternal nutrition. The positive side is that these conditions are modifiable through eating patterns and supplementation.

Reviews of randomized controlled trials (RCT) are plentiful in the literature. However, most RCTs take into account a single nutrient and are limited to a short time frame (usually the 2 and 3 trimester of one pregnancy). Findings are far from consistent. So, it is important to consider RCT findings along with other available evidence. 

Undernutrition is most likely to occur in low-SES* populations in which diets are inadequate in nutrient-dense foods (e.g. meat, dairy) because of their expense.  The literature also reflects increasing concern over obesity and excess weight gain in pregnancy. It is possible to be overweight and undernourished.  Patterns of eating – what is eaten, how much and how often– remains an important part of adequate nutrition and pregnancy education.  Frequent intake is required to prevent the pregnancy fasting state termed “accelerated starvation” (Cunningham, 2005). Skipping meals and prolonged periods between food intake result in negative effects for both mother and fetus (Barger 2010; 505).

In light of current evidence, the Key Message “Eat well & eat often” will stand; as will the emphasis on frequent intake.  The sentence, “You need extra energy to keep yourself healthy and grow a baby at the same time” intends to counteract social pressure to be thin, and associated worries about “losing my figure” or becoming unattractive.  However, no extra calories are recommended in the first trimester and only 340-452 extra calories are recommended for the second and third trimester respectively.  In light of documented trends to pre-pregnancy obesity and excessive weight gain in pregnancy, for the 2011 update, the expanded Key Message on nutrition will be revised as follows:

Do eat well. If you can do only one thing for your baby –this is it. Eat the best food you can and plan to gain weight slowly. Do not let your body run out of fuel. Eat at least every 4 hours. Snack on fruit and cheese, not donuts. Choose baked chicken and vegetables over burgers and fries.  

Do you agree or disagree with this revision? Why?  Post a comment here.

Next:  Review of specific nutritional recommendations in the Beginnings Pregnancy Guide* SES = Socio-Economic Status.  SES describes social inequality; it includes measures of income, occupation, and/or educational attainment.  Educational attainment has been the strongest and most consistent SES predictor of health.

References Abu-Saad, K &  Fraser, D. (2010). Maternal Nutrition and Birth Outcomes. Epidemiological Reviews 32: 5-25. Barger, MK.
(2010) Maternal Nutrition and Perinatal Outcomes. Journal of Midwifery and Women’s Health 55: 502-511. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap L & Wenstrom KD.
(2005) Williams Obstetrics. 22 Ed. New York: McGraw Hill Widen, E & Siega-Riz, AM.
(2010). Prenatal Nutrition: A Practical Guide for Assessment and Counseling. Journal of Midwifery and Women’s Health 55: 540-549.  
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