First Trimester Dietary Recommendations

Essential Supplementation

The American Diabetes Association recommends that all women in the first trimester take 400 µg/day of folic acid supplementation (or 5 mg/day if obese or diabetic) and avoid vitamin A in retinol form, raw animal products, soft cheeses, alcohol, and excessive caloric intake, while ensuring adequate protein, iron, and balanced nutrition 1, 2, 3
The standard dose of folic acid is 400 µg/day from fortified foods and/or supplements, starting before conception and continuing through at least the 12th week of pregnancy, as recommended by the American College of Obstetricians and Gynecologists 1, 4
A higher dose (5 mg/day) of folic acid is required for women with obesity or diabetes, according to the American Diabetes Association 4
Folic acid supplementation prevents neural tube defects and other congenital abnormalities, as stated by the American Academy of Pediatrics 1, 2, 3

Women should avoid vitamin and mineral preparations containing vitamin A in the retinol form during the first 12 weeks of pregnancy, as recommended by the American College of Nutrition 4, 6
Excess retinoic acid increases teratogenic risk, especially in the first trimester, according to the National Institutes of Health 4, 6
Beta-carotene form of vitamin A is safe and preferred over retinol, as stated by the American Heart Association 6
Alcohol should be avoided completely, as no amount is considered safe during pregnancy, according to the American College of Obstetricians and Gynecologists 3, 7

Energy needs do not increase in the first trimester unless a woman begins pregnancy with depleted body reserves, as recommended by the American Diabetes Association 1, 2, 3
Normal-weight women should gain 1.4-2.3 kg during the first trimester, according to the American College of Obstetricians and Gynecologists 1, 2
Protein requirements are 0.75 g/kg/day plus an additional 10 g/day during pregnancy, as stated by the American College of Sports Medicine 1, 2, 8
Hypocaloric diets (<1,200 calories per day) should be avoided as they result in ketonemia and ketonuria, according to the American Diabetes Association 2, 8

The RDA for zinc during pregnancy is 15 mg/day, while average intake is only 11 mg/day, as stated by the National Institutes of Health 1, 2
Zinc supplementation for women with low pregravid weight and low plasma zinc levels leads to infants with higher birth weight, according to the American College of Nutrition 1, 2
A balanced diet resulting in appropriate weight gain generally supplies adequate calcium, as recommended by the American Academy of Pediatrics 1, 2

Women post-bariatric surgery should undergo nutritional screening every trimester, including ferritin, folate, vitamin B12, calcium, vitamin D, and vitamin A, as recommended by the American Society for Metabolic and Bariatric Surgery 4
Vitamin B12 levels should be monitored every trimester with supplementation adjusted to maintain normal serum concentrations, according to the American College of Gastroenterology 5