In Part I of Nutrition During Pregnancy, the authors call for revisions in recommended weight gains for pregnant women. They explore relationships between weight gain during pregnancy and a variety of factors (e.g., the mother's weight for height before pregnancy) and places this in the context of the health of the infant and the mother. They present specific target ranges for weight gain during pregnancy and guidelines for proper measurement.

Part II addresses vitamin and mineral supplementation during pregnancy, examining the adequacy of diet in meeting nutrient needs during pregnancy and recommending specific amounts of supplements for special circumstances. It also covers the effects of caffeine, alcohol, cigarette, marijuana, and cocaine use and presents specific research recommendations.

Contents

• SUBCOMMITTEE ON NUTRITIONAL STATUS AND WEIGHT GAIN DURING PREGNANCY
• SUBCOMMITTEE ON DIETARY INTAKE AND NUTRIENT SUPPLEMENTS DURING PREGNANCY
• COMMITTEE ON NUTRITIONAL STATUS DURING PREGNANCY AND LACTATION
• FOOD AND NUTRITION BOARD
• PREFACE
• 1. Summary
  • Part I: Nutritional Status and Weight Gain
  • Part II Dietary Intake and Nutrient Supplements
• PART I. NUTRITIONAL STATUS AND WEIGHT GAIN
  • 2. Introduction
  • 3. Historical Trends in Clinical Practice, Maternal Nutritional Status, and the Course and Outcome of Pregnancy
    • Trends in Recommendations
    • Trends in Maternal Nutritional Status and Characteristics Associated with Outcome
    • Trends in Use of Prenatal Care and Food Supplementation Programs
    • Trends in Pregnancy Outcome
    • Trends in Gestational Weight Gain
    • Summary
    • References
  • 4. Assessment of Gestational Weight Gain
    • Methodological Issues Related to Data Collection in the Clinic
    • Interpretation of Research Involving Gestational Weight Gain
    • Uses of Gestational Weight Gain in Nutritional Surveillance
    • Summary
    • Clinical Implications
    • References
  • 5. Total Amount and Pattern of Weight Gain: Physiologic and Maternal Determinants
    • Norms for Total Gain, Rate of Gain, and Composition of Gain
    • Total Weight Gain and Pattern of Gain
    • Adjustments in Intake and Utilization of Energy Sources During Pregnancy
    • Maternal Determinants of the Pattern and Amount of Weight Gain
    • Conclusions and Recommendations
    • Clinical Implications
    • References
  • 6. Body Composition Changes During Pregnancy
    • Standard Methods
    • Skinfold Thickness Measurement
    • Direct Comparisons of Skinfold Thickness Measurements
    • Results of Studies
    • Summary
    • References
  • 7. Energy Requirements, Energy Intake, and Associated Weight Gain during Pregnancy
    • Relationship between Energy Intake and Gestational Weight Gain
    • Studies of Energy Supplementation during Pregnancy
    • Factors Influencing Energy Balance during Pregnancy
    • Summary
    • Clinical Applications
    • References
  • 8. Effects of Gestational Weight Gain on Outcome in Singleton Pregnancies
    • Fetal and Infant Outcomes
    • Maternal Outcomes
    • Summary
    • Clinical Implications
    • References
  • 9. Weight Gain in Twin Pregnancies
    • Mortality
    • Birth Weight
    • Gestation Length and Low Birth Weight
    • Maternal Factors
    • Summary
    • Clinical Implications
    • References
  • 10. Causality and Opportunities for Intervention
    • The Causal Paths
    • The Evidence
    • Implications
    • References
• PART II. DIETARY INTAKE AND NUTRIENT SUPPLEMENTS
  • 11. Introduction
    • Previous Recommendations from Professional Organizations
    • Usage Patterns
    • Scope of Report
    • Underlying Assumptions
    • Organization of the Report
    • References
  • 12. Assessment of Nutrient Needs
    • Nutrient Homeostasis
    • Assessment of Nutritional Status
    • Assessment of Nutrient Needs
    • Assessment of Dietary Adequacy
    • Recommended Dietary Allowances
    • Factors Influencing Nutrient Requirements and the Need for Supplementation
    • Nutrient-Nutrient Interactions
    • Nutrient Toxicities
    • Summary
    • Clinical Implications
    • References
  • 13. Dietary Intake During Pregnancy
    • Available Dietary Data
    • Limitations of the Data
    • Nutrient Intakes of Pregnant Women
    • Associations of Maternal Characteristics with Nutrient Intake During Pregnancy
    • Summary
    • References
  • 14. Iron Nutrition During Pregnancy
    • Importance of Iron During Pregnancy
    • Prevalence of Iron Deficiency
    • Special Groups at Risk
    • Iron Metabolism in Relation to Pregnancy
    • Iron Requirements for Pregnancy
    • Characteristics of Iron Deficiency during Pregnancy
    • Absorption of Iron Supplements
    • Clinical Applications
    • References
  • 15. Trace Elements
    • Zinc
    • Copper
    • Iodine
    • Selenium
    • Manganese
    • Chromium
    • Molybdenum
    • Fluoride
    • Summary
    • Clinical Implications
    • References
  • 16. Calcium, Vitamin D, and Magnesium
    • Calcium
    • Vitamin D
    • Magnesium
    • Summary
    • Clinical Implications
    • References
  • 17. Vitamins A, E, and K
    • Vitamin A
    • Vitamin E
    • Vitamin K
    • Clinical Implications
    • References
  • 18. Water-Soluble Vitamins
    • Vitamin B₆
    • Folate
    • Other Water-Soluble Vitamins
    • Clinical Implications
    • References
  • 19. Protein and Amino Acids
    • Importance
    • Amino Acid Utilization
    • Estimated Requirements
    • Usual Intakes
    • Criteria for Deficiency
    • Supplementation Studies
    • Recommendations Regarding Supplementation
    • Clinical Implications
    • References
  • 20. Substance Use and Abuse During Pregnancy
    • Cigarette Smoking
    • Alcohol
    • Caffeine
    • Marijuana
    • Cocaine
    • Summary and Recommendations for Future Research
    • Clinical Implications
    • References
  • 21. Periconceptional Vitamin Supplementation and Neural Tube Defects
    • Neural Tube Defects
    • Conclusion
    • References
• APPENDIXES
  • Appendix A Considerations in Constructing Gestational Weight Gain Charts
  • Appendix B Provisional Weight Gain Charts by Prepregnancy Body Mass Index (BMI).
  • Appendix C Table for Estimating Body Mass Index
  • Appendix D Biographical Sketches of Committee Members
• ACRONYMS
• GLOSSARY

This study was supported by project no. MCJ 116011 from the Maternal and Child Health Program (Title V, Social Security Act), Health Resources and Services Administration, U.S. Department of Health and Human Services.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Samuel O. Their is president of the Institute of Medicine.