Nutrition Recommendations for Pregnant Women

Essential Supplementation

The American College of Obstetricians and Gynecologists recommends that all pregnant women take 400 µg/day of folic acid (or 5 mg/day if obese or diabetic) starting before conception and continuing through at least the first trimester to prevent neural tube defects and congenital abnormalities 1, 2
Iron supplementation of 30 mg/day is required during the second and third trimesters to prevent maternal anemia and support increased blood volume, as recommended by the American College of Obstetricians and Gynecologists 3, 2
Zinc supplementation should be considered for women with low pre-pregnancy weight and low plasma zinc levels, as the average intake (11 mg/day) falls short of the RDA (15 mg/day), and supplementation leads to higher infant birth weight, according to the National Institutes of Health 1, 2

The National Academy of Sciences recommends protein needs of 1.2 g/kg/day during early pregnancy (~16 weeks) and 1.52 g/kg/day during late pregnancy (~36 weeks), which is significantly higher than older recommendations of 0.75 g/kg/day plus 10 g/day 4, 5

The American College of Obstetricians and Gynecologists recommends no additional calories in the first trimester unless the woman begins pregnancy with depleted body reserves, and an additional 300 kcal/day during the second and third trimesters to support maternal blood volume expansion, breast and uterine growth, placental development, fetal growth, and amniotic fluid 1, 3, 2

The Institute of Medicine recommends the following weight gain targets: underweight women (BMI <19.8) should gain up to 18 kg total, normal-weight women should gain 1.4-2.3 kg in the first trimester and 0.5-0.9 kg/week during the second and third trimesters, overweight women should gain at less than 50% of the normal-weight rate, and obese women (BMI >30) should limit total weight gain to 5.0-9.1 kg 2, 6

The American College of Obstetricians and Gynecologists recommends completely avoiding alcohol during pregnancy, as no amount is considered safe, and avoiding vitamin A in retinol form during the first 12 weeks due to teratogenic risk 1, 3
The Centers for Disease Control and Prevention recommend avoiding raw animal products and soft cheeses to prevent foodborne illness, and limiting caffeine to no more than 200 mg per day 1, 3

The American Diabetes Association recommends distributing carbohydrates throughout the day into three small-to-moderate meals and 2-4 snacks, with an evening snack usually necessary to decrease overnight hypoglycemia and fasting ketosis, particularly for insulin-treated women 7

The American College of Obstetricians and Gynecologists recommends never prescribing hypocaloric diets below 1,200 calories/day, as they result in ketonemia and ketonuria, which have been associated with lower intelligence scores in offspring at ages 2-5 years, and monitoring for ketones using daily food records, weekly weight checks, and ketone testing to ensure women are not under-eating to avoid insulin therapy 1, 2, 6

The Academy of Nutrition and Dietetics recommends emphasizing fruits, vegetables, legumes, whole grains, nuts, seeds, fish, and lean protein to provide adequate micronutrients naturally, and using FDA-approved nonnutritive sweeteners (saccharin, aspartame, acesulfame-K, and sucralose) in moderation 3, 2

The American College of Obstetricians and Gynecologists recommends that women post-bariatric surgery require nutritional screening every trimester, including ferritin, folate, vitamin B12, calcium, vitamin D, and vitamin A levels, with supplementation adjusted accordingly, and that vitamin B12 levels should be monitored every trimester with supplementation adjusted to maintain normal serum concentrations in at-risk populations 1

The American Diabetes Association recommends that pregnant women with diabetes eat consistent amounts of carbohydrates to match insulin dosage and avoid hyperglycemia or hypoglycemia, and evaluate carbohydrate quality carefully, as diets are often characterized by high-fat, low-fiber, and poor-quality carbohydrate intakes 8
Referral to a registered dietitian nutritionist is essential for pregnant women with diabetes to establish a food plan, insulin-to-carbohydrate ratio, and weight gain goals, according to the American Diabetes Association 8

The American College of Nutrition recommends avoiding diets that severely restrict any macronutrient class, such as ketogenic diet, paleo diet, or diets characterized by excess saturated fats, as they may be harmful to pregnant women 8