Recommended food patterns for pregnancy

Specific food patterns are available for pregnant women at the MyPyramid.gov website. The woman is asked to specify her age, due date, height, weight, and physical activity level. She will then receive a menu plan for the first, second, and third trimesters. The amounts of food increase slightly with advancing pregnancy to meet increased energy and nutrient needs in late gestation. We compared the nutrients provided in each of the food intake patterns between 2,000 and 3,000 kcal/d for non-pregnant women to the recommended nutrient intakes for pregnancy and found that the amount of macronutrients, vitamins, and minerals in the patterns for non-pregnant women meet pregnancy standards except for three nutrients—iron, vitamin E, and, to a lesser extent, potassium (Table 1.4). Thus, one could continue to base dietary guidance for pregnant women on the MyPyramid food patterns recommended for non-pregnant women. As mentioned above, the iron DRI during pregnancy, 27 mg/day, is higher than the amount that can be met from foods. At the first prenatal visit, all women are advised, therefore, to take a 30 mg iron supplement daily [44]. The food patterns only provide about 60-80% of the pregnancy vitamin E recommendation. The patterns are also insufficient in vitamin E for nonpregnant adults, providing only 50-70% of the requirement. The Dietary Guidelines Advisory Committee found that it was very difficult to develop food patterns meeting the vitamin E RDAs that also remained within the guidelines for dietary fat since vegetable oils are a primary source of vitamin E. Nuts are also a good source of vitamin E, and the Committee considered making nuts a subgroup of the meat group in order to emphasize their importance in the diet. But, since evidence of health problems among Americans due to insufficient intakes of vitamin E was lacking, the Committee decided to allow the vitamin E intakes to fall short of the RDAs. The vitamin E DRI can be met, however, by selecting vitamin E fortified ready-to-eat cereals, almonds, sunflower seeds, avocados, and certain oils (i.e., sunflower and cottonseed). Potassium intakes in the 2,000-, 2,200-, and 2,400-kcal patterns range from 85 to 95%, the pregnancy DRI. This potassium intake is likely within an acceptable range, but the amount in the diet can be enhanced by increasing milk, white potato, tomato, or orange juice intakes.

The amounts of protein, carbohydrate, fat, and types of fat in the six food patterns are shown in Table 1.5. The percent of energy as protein is about 18%, as carbohydrate about 55%, and as fat about 27%. Saturated fat makes up about 7.4% of the energy, monounsaturated fat about 10%, and polyunsaturated fat about 8%. The recommended

Table 1.4

Nutrient content of 2,000-, 2,200-, 2,400-, 2,600-, 2,800-, and 3,000-kcal food patterns expressed as a percentage of the pregnancy DRI

%DRI

Table 1.4

Nutrient content of 2,000-, 2,200-, 2,400-, 2,600-, 2,800-, and 3,000-kcal food patterns expressed as a percentage of the pregnancy DRI

%DRI

Nutrient

Pregnancy DRI

2,000kcal

2,200kcal

2,400 kcal

2,600kcal

2,800kcal

3,000kcal

Protein (g/day)

71

128

139

148

154

163

111

Carbohydrate (g/day)

175

155

175

191

211

231

247

Fiber (g/day)

28

111

125

132

146

157

164

Vitamins

A (meg/day)

770

137

141

146

161

166

111

E (mg/day)

15

63

67

71

77

82

87

C (mg/day)

85

182

192

192

200

231

267

Thiamin (mg/day)

1.4

143

164

171

186

207

214

Riboflavin (mg/day)

1.4

200

207

221

229

243

243

Niacin (mg/day)

18

122

139

152

163

111

187

B6 (mg/day)

1.9

126

147

153

163

179

184

Folate (meg/day)

600

116

128

137

151

164

142

B12 (meg/day)

2.6

319

338

354

362

381

362

Minerals

Calcium (mg/day)

1,100

120

123

126

131

135

138

Phosphorus (mg/day)

700

249

267

280

295

310

316

Magnesium (mg/day)

350

109

119

126

135

145

152

Iron (mg/day)

27

65

73

80

88

96

95

Zinc (mg/day)

11

130

142

152

160

171

169

Copper (mg/day)

1

150

170

180

200

210

220

Sodium (g/day)

1.5

119

133

140

153

167

180

Potassium (g/day)

4.7

86

94

96

102

109

117

Content of the food patterns is described in Table 1.6. Nutrient values of the food patterns from [42]

Content of the food patterns is described in Table 1.6. Nutrient values of the food patterns from [42]

Table 1.5

Amounts of Protein, Carbohydrate, Total Fat, and Types of Fat in the Six Food Patterns for Pregnant Women [35]

Table 1.5

Amounts of Protein, Carbohydrate, Total Fat, and Types of Fat in the Six Food Patterns for Pregnant Women [35]

Calorie levels

2,000

2,200

2,400

2,600

2,800

3,000

Protein (% kcal)

19

19

18

18

17

16

Carbohydrate (% kcal)

56

56

57

57

58

58

Fat (% kcal)

27

28

27

27

27

28

Saturated fat (% kcal)

7.4

7.4

7.4

7.3

7.1

7.4

Monounsaturated fat (% kcal)

10

10

10

10

10

10

Polyunsaturated fat (% kcal)

8

8

8

8

8

9

Linoleic acid

(g)

16.2

18.2

19.4

21.2

22.6

25.9

(% kcal)

7.3

7.4

7.2

7.4

7.3

7.8

a-Linolenic acid

(g)

1.6

1.8

1.9

2.1

2.2

2.5

(% kcal)

0.7

0.7

0.7

0.7

0.7

0.8

AI for linoleic acid is 13 g/day during pregnancy and the AI for a-linolenic acid is 1.4 g/day [4]. All six of these food patterns exceed the AI for the polyunsaturated fatty acids, with the linoleic acid intakes ranging from 125 to 199% of the AI, and the a-linolenic acid intakes ranging from 114 to 179%.

The six specific food patterns that can be recommended for individual pregnant women are shown in Table 1.6. The energy levels of the food patterns range from 2,000 to 3,000 kcal/day in 200-kcal increments. This range of energy intakes should cover the energy needs of most pregnant women with BMIs between 18.5 and 25 who have sedentary, moderate, or active lifestyles (see Table 1.2). The 2,200-kcal pattern would be appropriate for a sedentary woman weighing about 60 kg and 15.5 m tall. That pattern includes 2 cups of fruits, 3 cups of vegetables, 200-g (7 oz) equivalents of grains with at least half as whole grains, 171-g (6 oz) equivalents of meat or beans, 3 cups of milk, and 27 g (or about 75 ml) of oils. It is important to remember that the nutrient and energy contributions from each food group are calculated using the most nutrient-dense forms (e.g., lean meats and fat-free milk). Selection of foods with higher fat content will increase the intakes of energy and saturated fat. A small allowance for selecting some foods higher in fat and/or with added sugars is included at each calorie level. Examples of these are a choice of 2% milk, 80% lean ground beef, or cereal with added sugars. In Table 1.6, this allowance is noted as the "discretionary calorie allowance." Selection of foods or beverages with added sugars and with more fat forms should be limited to this allowance.

The standard of care for pregnant women generally involves recommending a prenatal vitamin-mineral supplement. The nutrient analysis of these food patterns shows that there is only a short-fall between the DRIs and nutrient levels in the food patterns for two nutrients—iron and vitamin E. Although a 30 mg/day iron supplement is recommended for all pregnant women, a multivitamin-mineral supplement that provides at least 10 mg iron daily is probably sufficient for women who are adhering to these dietary patterns.

Table 1.6

Amounts of food from each food group in food patterns, with energy levels ranging from 2,000 to 3,000 kcal/day

Energy level (kcal/day)

Table 1.6

Amounts of food from each food group in food patterns, with energy levels ranging from 2,000 to 3,000 kcal/day

Food group

2,000

2,200

2,400

2,600

2,800

3,000

Fruits3

2 cups:lh

2 cups

2 cups

2 cups

2.5 cups

2.5 cups

Vegetables

2.5 cups

3 cups

3 cups

3.5 cups

3.5 cups

4 cups

Dark green

3 cups/week

3 cups/week

3 cups/week

3 cups/week

3 cups/week

3 cups/week

Orange

2 cups/week

2 cups/week

2 cups/week

2.5 cups/week

2.5 cups/week

2.5 cups/week

Legumes

3 cups/week

3 cups/week

3 cups/week

3.5 cups/week

3.5 cups/week

3.5 cups/week

Starchy

3 cups/week

6 cups/week

6 cups/week

7 cups/week

7 cups/week

9 cups/week

Other

6.5 cups/week

7 cups/week

7 cups/week

8.5 cups/week

8.5 cups/week

10 cups/week

Grains

6-oz. eq.

7-oz. eq.

8-oz. eq.

9-oz. eq.

10-oz. eq.

10-oz. eq.

Whole

3

3.5

4

4.5

5

5

Enriched

3

3.5

4

4.5

5

5

Meat and Beans

5.5-oz. eq.

6-oz. eq.

6.5-oz. eq.

6.5-oz. eq.

7-oz. eq.

7-oz. eq.

Milk

3 cups

3 cups

3 cups

3 cups

3 cups

3 cups

Oils

27 g

29 g

31g

34 g

36 g

44 g

Discretionary calorie allowance0

267 kcal

290 kcal

362 kcal

410 kcal

426 kcal

512 kcal

For details regarding the types of food items included in each group and subgroup, see [42] "Amounts are per day unless otherwise indicated bThe following each count as one cup or oz. equivalent in their respective food groups:

Grains (oz eq): 1/2 cup cooked rice, pasta, or cooked cereal; 1 oz. dry pasta or rice, 1 slice bread; 1 small muffin; 1 cup ready-to-eat cereal flakes Fruits and vegetables (cup eq.): 1 cup cut-up raw or cooked fruit or vegetable, 1 cup fruit or vegetable juice, 2 cups leafy salad greens Meat and beans (oz eq.): 1 oz. lean meat, poultry, or fish; 1 egg; 1/4 cup cooked dry beans or tofu; 1 tbsp. peanut butter; 1/2oz. nuts or seeds Milk (cup eq): 1 cup milk or yogurt, 1 1/2oz. natural cheese such as Cheddar cheese or 2 oz. process cheese. Note that discretionary calories must be counted for all choices, except fat-free milk cThe discretionary calorie allowance is the amount of calories remaining in each food pattern after selecting the specified number of nutrient-dense forms of foods in each food group. The number of discretionary calories assumes that food items in each food group are selected in nutrient-dense forms (e.g., forms that are fat free or low fat and that contain no added sugars). Solid fat and sugar calories always need to be counted as discretionary calories, as in the following examples:

  • The fat in low-fat, reduced-fat, or whole milk, or milk products or cheese and the sugar and fat in chocolate milk, ice cream, pudding, etc.
  • The fat in higher fat meats (e.g., ground beef with more than 5% fat by weight, poultry with skin, higher-fat luncheon meats, sausages)
  • The sugars added to fruits and fruit juices with added sugars or fruits canned in syrup
  • The added fat and/or sugars in vegetables prepared with added fat or sugars
  • The added fats and/or sugars in grain products containing higher levels of fats and/or sugars (e.g., sweetened cereals, higher-fat crackers, pies and other pastries, cakes, cookies)

Also, a supplement providing at least 9 mg of vitamin E will bring the total intake up to the DRI recommendation for pregnancy. When prenatal vitamin-mineral supplements are given, it should be emphasized that those supplements do not replace a healthy diet composed of a variety of nutrient-dense foods because an array of other compounds, such as phytochemicals and antioxidants that may benefit health, are present in foods.

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