Total Energy Cost of Pregnancy

The total energy cost of pregnancy in well-nourished women has been estimated from the sum of BMR or TEE and energy deposited in laying down maternal and fetal tissues [14]. Gestational weight gain is a major determinant of the incremental energy needs during pregnancy because it reflects not only energy deposition, but also the increase in BMR and TEE resulting from the energy cost of metabolism and moving a larger body mass. Using the gestational weight gain recommended by IOM for pregnant women with normal BMI (mean value = 13.8 kg), the estimated total energy cost of pregnancy was about 88,850 kcal [14]. The incremental needs for energy are not equally distributed over pregnancy. For example, energy needs associated with protein deposition occur primarily in the second and third trimesters, while the distribution of energy deposited as fat, is about 11, 47, and 42% across trimesters. Thus, the increments in BMR and TEE are greater in the second half of pregnancy. Reflecting the deposition of new-weight tissue across pregnancy, the average distribution of energy was estimated at approximately 105, 330, and 535 kcal per day for the first, second, and third trimesters, respectively. Using the gestational weight gain recommended by the WHO Collaborative Study on Maternal Anthropometry and Pregnancy Outcomes (mean value = 12 kg), the total energy cost of pregnancy was estimated at about 77,147 kcal, distributed as 90, 286, and 465 kcal per day for the first, second, and third trimesters, respectively [14].

The 2004 Dietary Reference Intakes (DRI) recommendations for energy intake in pregnant women with a normal prepregnancy BMI are an additional 0, 340, and 452 kcal/day for the first, second, and third trimesters, respectively, over the nonpregnant state [34]. The 2005 USDA Dietary Guidelines for Americans [35] and the 2005 USDA MyPyramid [36] provide dietary guidance to meet the energy needs associated with pregnancy, as described and discussed in Chap. 1("Nutrient Recommendations and Dietary Guidelines for Pregnant Women").

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