Good nutrition begins before conception. A woman's nutritional status at conception can have positive or negative impacts on her pregnancy outcome. For example, inadequate folic acid intake before pregnancy increases the risk of NTDs . Also, iron insufficiency at conception increases the risk for developing anemia during late pregnancy, when the iron demands are high. As previously mentioned, maternal iron deficiency increases preterm births and coincident low birth weights as well as the mother's ability to tolerate hemorrhage during delivery . Entering pregnancy with excessive amounts of body fat stores also increases the risk for metabolic complications during pregnancy such as glucose intolerance or preeclampsia . Implementing a healthy food pattern prior to conception may reduce the prevalence of these complications during pregnancy.
This analysis of the food patterns recommended for nonpregnant women of reproductive age in the United States shows that the same general food patterns can be followed throughout pregnancy, and that the recommended intake of all but two nutrients (iron and vitamin E) will be met. The only change necessary in the second or third trimester is to increase total energy intake by about 200 or400 kcal to cover the additional energy needed for tissue energy deposition and the metabolic costs of pregnancy. Thus, the food pattern for nonpregnant women only needs minor adjustments for pregnancy. This continuity makes it easier to provide guidance to women planning pregnancies. Furthermore, the general food pattern for pregnant women is appropriate for all family members as well as the mother after pregnancy. This means that dietary counseling provided to pregnant women is a great opportunity to promote good nutrition for everyone in the household. Pregnant women generally tend to have a heightened interest in food and nutrition making this period a very "teachable" time. Teaching a couple of concepts to the pregnant women should enable her to modify the food pattern for all family members. Those concepts are (1) choose diverse, nutrient-dense foods within and among the five food groups every day; (2) make fruits and vegetables part of every meal or snack, and (3) make at least half of grains consumed whole grains.
Surveys show that about only about 3-4% of all Americans follow all of the Dietary Guidelines . Although information about the principal sources of foods contributing to the nutrient intakes of pregnant women is scarce, one prospective study showed that low nutrient-dense foods were the major contributors of energy, fat, and carbohydrate whereas fortified foods were the primary sources of iron, folate, and vitamin C . This study was done in a population of black and white women living in North Carolina; over 50% of the women were <185% of the poverty level. Biscuits, muffins, French fries, whole milk, white bread, and soft drinks were the top five food sources of energy. Mayonnaise and salad dressings, cheese and cheese spreads, along with whole milk, French fries, and biscuits/muffins were the top five sources of fat. Whole milk, hamburgers, cheese and cheese spreads, beef steak and roasts, and fried chicken were the top protein sources. Soft drinks and fruit juices were the major sources of carbohydrates. These data suggest that the diets were not only high in total fat, but also high in saturated fat as illustrated by the frequent consumption of high-fat animal products. Soft drinks were often used in place of more nutrient-dense foods or beverages. These food patterns are similar to those reported for African-American adults , suggesting that lower income women do not change their food habits appreciably during pregnancy. This population could benefit from prenatal dietary guidance that emphasizes the importance of modifying the food pattern for the entire household.
The 2005 Dietary Guidelines makes two specific recommendations for women of reproductive age . The first focuses on the high prevalence of iron deficiency in this population. About 9-11% of adolescent girls and women of childbearing age have laboratory evidence of iron depletion . Consequently, it was recommended that women of childbearing age who may become pregnant should eat foods high in heme iron and/or consume iron-rich plant foods or iron-fortified foods, with an enhancer of iron absorption, such as vitamin C-rich foods. The second recommendation focused on reducing the risk of NTDs. Specifically, women of childbearing age who may become pregnant or those in the first trimester of pregnancy should consume adequate synthetic folic acid daily (from fortified foods or supplements) in addition to food forms of folate from a varied diet. The new folic acid fortification program may influence the need for obtaining folic acid from supplements. However, until further data are available confirming this trend, it seemed prudent to continue to recommend folic acid supplements for women of reproductive age.
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