Activity level, age, height, and weight prior to pregnancy are all factors that are considered when determining an individual's energy requirements. Although energy requirements vary from woman to woman, most women's energy needs range from approximately 2,500 to 2,700 kcal daily [4]. Caloric requirements during the second and third trimesters of pregnancy are estimated to be 300 kcal/day (500 kcal/day for adolescents <14 years of age) above caloric requirements prior to pregnancy. The prepregnancy energy requirements used as a basis for this caloric estimation during pregnancy should account for age, activity level, and prepregnancy weight [4]. The Dietary Reference Intakes (DRIs) for pregnancy take into account increasing needs in support of fetal growth and appropriate maternal weight gain [5-7]. Butte and King [8] estimated energy costs of pregnancy using respiratory calorimetry throughout pregnancy and found that the daily cost of pregnancy increased by trimester. Weight gain during pregnancy should be individualized relative to prepregnancy BMI such that pregnancy outcome is improved, postpartum weight retention is minimized, and risk for adult chronic disease is reduced in the child [1]. In special situations such as adolescent pregnancy in which additional calories are necessary for the adolescent's own growth energy, requirements may be higher to maintain weight gain goals [2]. Pregnant adolescents less than 14 years of age require an additional 500 kcal/day [4, 9]. Likewise, women carrying twins need to consume 500 calories daily above energy needs for pregnancy as outlined above [7, 10]. Conversely, women who are overweight or obese prior to pregnancy will require fewer calories due to the availability of stored energy. In any case, it is important that positive energy balance (energy in vs. energy out) exists such that a pregnant woman is in an anabolic state (energy in > energy out). The degree of positive energy balance should be determined relative to an individual woman's prepregnancy body weight (Tables 13.1, 13.2). Theoretically, an overweight woman may eat fewer calories when she becomes pregnant but still achieve an anabolic state because the degree of positive energy balance (calorie intake in excess of energy expended), while less than that prior to the pregnancy will generally be sufficient to support fetal growth and development.

Once energy needs are established, it is important that the pregnant woman understands how to translate her calorie needs into appropriate food choices to support a healthy pregnancy. Requirements for some nutrients, such as protein, iron, and calcium, are increased during pregnancy. Therefore, pregnant women should focus on nutrient dense foods [foods that provide a lot of nutrients relative to the number of calories]. For example, one egg will contribute high-quality protein, essential fat, as well as a variety of vitamins and minerals, for approximately 75 calories. Too often patients are given calorie levels that may be specific to their needs without adequate instruction on how to incorporate these guidelines into their daily routines. Twenty-four-hour diet recalls conducted and evaluated by a registered dietitian, in combination with appropriate nutrition education materials, can be very useful in assisting the individual in translating their usual diet into meal plans that are consistent with recommendations for appropriate and healthy weight gain throughout pregnancy.

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