Nutrition and lifestyle factors can maximize health in pregnancy and lower future risk of disease for both mother and fetus. Education can make a big difference for patients in pregnancy outcomes, anxiety, and future health. Pregnancy is a time when attention to proper weight gain can reduce the risk of future obesity, diabetes, hyperlipidemia, and cardiovascular disease. There is mounting evidence that fetal “programming” for future risk of disease begins in utero and varies with nutritional exposures during different times of pregnancy, although the exact mechanisms remain to be elucidated. It is clear that a few simple precautions and enhancements of diet and lifestyle can prevent birth defects and perinatal infections and may reduce future health risks. Exercise in pregnancy is safe and should be encouraged for healthy women.
World Health Organization/Food and Agriculture Organization (WHO/FAO).Diet, Nutrition and the Prevention of Chronic Diseases. Geneva, Switzerland: WHO; 2003.
2.
World Health Organization (WHO).Programming of Chronic Disease by Impaired Fetal Nutrition: Evidence and Implication for Policy and Intervention StrategiesGeneva, Switzerland: WHO; 2002.
3.
Hanson M., Gluckman P., Bier D., et al. Report on the 2nd World Congress on Fetal Origins of Adult Disease . Pediatr Res.2004;55:894-897.
4.
Eriksson J., Forsen T., Tuomilehto J., et al. Size at birth, childhood growth and obesity in adult life. Int J Obes Relat Metab Disord. 2001;25:735-740.
5.
Galtier-Dereure F., Boegner C., Bringer J.Obesity and pregnancy: complications and cost . Am J Clin Nutr.2000;71:1242S-1248S.
6.
Kaiser LL, Allen L.Position of the American Dietetic Association: nutrition and lifestyle for a healthy pregnancy outcome. J Am Diet Assoc. 2002;102:1479-1490.
7.
National Research Council.Maternal Nutrition and the Course of Pregnancy. Report of the Committee on Maternal Nutrition, Food and Nutrition Board. Washington, DC: National Academy of Sciences; 1970.
8.
Institute of Medicine.Nutrition During Pregnancy, Weight Gain and Nutrient SupplementsReport of the Subcommittee on Nutritional Status and Weight Gain During Pregnancy, Subcommittee on Dietary Intake and Nutrient Supplements During Pregnancy, Committee on Nutritional Status During Pregnancy and Lactation, Food and Nutrition Board . Washington, DC: National Academy Press; 1990.
9.
American College of Obstetrician and Gynecologists.Nutrition during pregnancy. ACOG Tech Bull . April 1993:1-7, 179.
10.
Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999-2004 . JAMA. 2006;295:1549-1555.
11.
Feig D., Naylor C.Eating for two: are guidelines for weight gain during pregnancy too liberal ? Lancet. 1998;315:1054-1055.
12.
Smith DE, Lewis CE, Caveny JL, et al. Longitudinal changes in adiposity associated with pregnancy . JAMA. 1994;271:1747-1751.
13.
Stotland NE , Haas JS, Brawarsky P., et al. Body mass index, provider advice, and target gestational weight gain. Am J Obstet Gynecol. 2005;105:633-638.
14.
Cogswell ME , Scanlon KS, Fein SB, et al. Medically advised, mother's personal target, and actual weight gain during pregnancy. Obstet Gynecol . 1999;94:616-622.
15.
Scholl TO, Hediger ML, Schall JI, et al. Gestational weight gain, pregnancy outcome, and postpartum weight retention. Obstet Gynecol. 1995;86:423-427.
16.
Polley BA, Wing RR, Sims CJRandomized controlled trial to prevent excessive weight gain in pregnant women . Int J Obes Relat Metab Disord. 2002;26:1494-1502.
17.
Line Y., Barkeling B., Rossner S.Long-term weight development after pregnancy. Obes Rev. 2002;3:75-83.
18.
Keppel K., Taffel S.Implications of the 1990 Institute of Medicine guidelines on weight gain during pregnancy for postpartum weight retention. Am J Public Health . 1993;83:1100-1103.
19.
Ohlin A., Rossner S.Factors related to body weight changes during and after pregnancy: the Stockholm Pregnancy and Weight Development Study. Obes Res. 1996;4:271-276.
Ravelli AC, van der Meulen JH, Michels RP, et al. Glucose tolerance in adults after prenatal exposure to famine . Lancet. 1998;351:173-177.
22.
Roseboom TJ , van der Meulen JH, Osmond C., et al. Coronary heart disease after prenatal exposure to the Dutch famine, 1944-45. Heart. 2000;84:595-598.
23.
Shiell AW, Campbell-Brown M., Haselden S., et al. High-meat, low-carbohydrate diet in pregnancy: relation to adult blood pressure in the offspring. Hypertension. 2001;38:1282-1288.
24.
Roseboom TJ , van der Meulen JH, van Montfrans GA, et al. Maternal nutrition during gestation and blood pressure in later life. J Hypertens. 2001;19:29-34.
25.
Belizan JM, Villar J., Bergel E., et al. Long-term effect of calcium supplementation during pregnancy on the blood pressure of offspring: follow up of a randomized controlled trial . BMJ. 1997;315:281-285.
26.
Gillman MW, Rifas-Shiman SL, Kleinman KP, et al. Maternal calcium intake and offspring blood pressure. Circulation. 2004;110:1990-1995.
27.
US Department of Health and Human Service, Centers for Disease Control and Prevention.Folic Acid Available at: http://www.cdc.gov/ncbddd/folicacid/faqs.htm .
28.
US Department of Health and Human Services, Centers for Disease Control and Prevention.Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR Morb Mortal Wkly Rep.1992;41(No. RR-14).
29.
Food and Drug Administration.Food standards: amendment of standards of identity for enriched grain products to require addition of folic acid. Fed Reg.1996;61:8781-8797.
30.
Centers for Disease Control and Prevention.Spina bifida and anencephaly before and after folic acid mandate—United States, 1995-1996 and 1999-2000. MMWR Morb Mortal Wkly Rep.2004;53:362-365.
31.
Salmeron J., Manson JE, Stampfer MJ, et al. Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA. 1997;12:472-477.
32.
Hu FB, Willett WCOptimal diets for prevention of coronary heart disease. JAMA . 2002;288:2569-2578.
33.
Jovanovic-Peterson L., Peterson C., Reed G., et al. Maternal postprandial glucose levels and infant birth weight: the Diabetes in Early Pregnancy Study. Am J Obstet Gynecol. 1991;164:103-111.
34.
Moses RG, Luebecke M., Davis WS, et al. Effect of a low-glycemic-index diet during pregnancy on obstetric outcomes. Am J Clin Nutr. 2006;84:807-812.
35.
Al MD, Hornstra G., van der Schouw YT, Bulstra-Ramakers MT, Huisjes HJBiochemical EFA status of mothers and their neonates after normal pregnancy . Early Hum Dev. 1990;24:239-248.
36.
Helland IB, Smith L., Saarem K., et al. Maternal supplementation with very-long-chain n-3 fatty acids during pregnancy and lactation augments children's IQ at 4 years of age. Pediatrics. 2003;111:e39-e44.
37.
Helland IB, Saugstad OD, Saarem K., et al. Supplementation of n-3 fatty acids during pregnancy and lactation reduces maternal plasma lipid levels and provides DHA to the infants. J Matern Fetal Neonatal Med. 2006;19:397-406.
38.
Hellan IB, Saugstad OD, Smith L., et al. Similar effects on infants of n-3 and n-6 fatty acids supplementation to pregnant and lactating women. Pediatrics. 2001; 5:e82.
39.
Haider BA, Bhutta ZAMultiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev.2006;(4):CD004905.
40.
American Dietetic Association; Dietitians of Canada.Position of the American Dietetic Association and Dietitians of Canada: vegetarian diets. J Am Diet Assoc. 2003;103:748-765.
41.
O'Connell JM, Dibley MJ, Sierra J., et al. Growth of vegetarian children: the Farm study. Pediatrics. 1989;84:475-481.
42.
Lakin V., Haggarty P., Abramovich DRDietary intake and tissue concentrations of fatty acids in omnivore, vegetarian, and diabetic pregnancy. Prost Leuk Ess Fatty Acids. 1998;58:209-220.
43.
US Department of Health and Human Services, Centers for Disease Control and Prevention.Listeriosis Available at: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/listeriosis_g.htm.
44.
Ogunmodede F., Jones JL, Scheftel J., et al. Listeriosis prevention knowledge among pregnant women in the USA. Infect Dis Obstet Gynecol. 2005;13:11-15.
45.
Lopez A., Dietz VJ, Wilson M., et al. Preventing congenital toxoplasmosis. MMWR Morb Mortal Wkly Rep.2000;49(RR02):57-75.
46.
National Center for Health Statistics.Plan and Operation of the Third National Health and Nutrition Examination Survey, 1988-94Hyattsville, MD: US Department of Health and Human Services, Public Health Service, CDC; 1994.
47.
Agency for Toxic Substances and Disease Registry (ATSDR).Toxicological Profile for Mercury. Atlanta, GA: US Department of Health and Human Services, Public Health Service; 1999. Available at: http://www.atsdr.cdc.gov/toxprofiles/phs46.html.
48.
Kim EH, Kim IK, Kwon JY, et al. The effect of fish consumption on blood mercury levels of pregnant women. Yonsei Med J. 2006;47:626-633.
49.
US Environmental Protection Agency (EPA).Mercury Study Report to Congress: Volume I. Executive Summary Pub. EPA-452/R-97-03. Washington, DC: EPA; 1997.
50.
US Environment Protection Agency.Fish Advisories: What You Need to Know About Mercury in Fish and Shellfish. 2004 EPA and FDA Advice. Available at: www.epa.gov/waterscience/fishadvice/advice.html
51.
Hibbeln JR, David JM, Steer C., et al. Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. Lancet. 2007;369:578-585.
52.
Cnattingius S., Signorello, LB, Anneren G., et al. Caffeine intake and the risk of firsttrimester spontaneous abortions. N Engl J Med. 2000;343:1839-1845.
53.
Signorello LB, Nordmark A, Granath, et al. Caffeine metabolism and the risk of spontaneous abortion of normal karyotype fetuses. Obstet Gynecol.2001;98:1059-1066.
54.
Sayal K., Heron J., Golding J., et al. Prenatal alcohol exposure and gender differences in childhood mental health problems: a longitudinal population-based study. Pediatrics. 2007;119:e426-e434.
55.
American College of Sports Medicine.ACSM's Guidelines for Exercise Testing and Prescription. 6th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2000.
56.
ACOG Committee Opinion.Number 267, January 2002: exercise during pregnancy and the postpartum period . Obstet Gynecol.2002;99:171-173.
