Nutrition During Pregnancy Part I: Weight Gain, Part II: Nutrient Supplements (1990) / Chapter Skim
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7 Energy Requirements, Energy Intake, and Associated Weight Gain During Pregnancy
7 Energy Requirements, Energy Intake, and Associated Weight Gain During Pregnancy
Pages 137-175
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From page 137... ...
The subcommittee reviewed energy intakes in the context of gestational weight gain, the effectiveness of energy supplementation on weight gain, and net energy balance during pregnancy. Extra energy is required during pregnancy for the growth and maintenance of the fetus, placenta, and maternal tissues.
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From page 138... ...
RELATIONSHIP BETWEEN ENERGY INTAKE AND GESTATIONAL WEIGHT GAIN Tables 7-2A and 7-2B list studies in which the relationship between energy intake and gestational weight gain was described. Longitudinal studies of well-nourished pregnant women indicated a slight, although not always statistically significant and not universal, increase in energy intake during pregnancy.
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From page 140... ...
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From page 148... ...
Failure to detect significant trends in energy intake may be due to the substantial variability in food intake, the cross-sectional design of many studies, and measurement sensitivity and error. Results of energy intake studies in pregnant women subsisting on low energy intakes in developing countries are inconsistent.
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From page 149... ...
Some studies, particularly those conducted in nutritionally vulnerable populations, have shown that energy supplementation results in increased gestational weight gain and birth weight (Bhatnagar et al., 1983; Herrera et al., 198~, Iyenger, 1967; Kardjati et al., 1988; Tontisirin et al., 1986~. The compilation of studies in Tables 7-2A and 7-2B indicates that energy intakes by adult pregnant women living in industrialized countries are generally
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From page 150... ...
STUDIES OF ENERGY SUPPLEMENTATION DURING PREGNANCY Energy intake is one determinant of pregnancy outcome amenable to experimental intervention; studies that evaluated the effectiveness of energy supplementation on weight gain during pregnancy and on birth weight are summarized in Tables 7-3A and 7-3B. The subcommittee reviewed the findings and limitations of intervention studies conducted in both developing (Thble 7-3A)
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From page 151... ...
and the low energy intake group (<20,000 kcal) indicated that a net increment of 149 kcaVday was associated with an 111-g increase in birth weight and reductions in the incidence of low-birth-weight (LBW)
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From page 152... ...
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From page 158... ...
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From page 160... ...
Theories of adaptation have evolved to explain how these active pregnant women existed on energy intakes that barely exceeded estimated basal requirements. Subsequent studies on the energy expenditure of pregnant Gambian women, however, have cast doubt on the energy intake records of the earlier investigations (Lawrence et al., 1986~.
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From page 161... ...
on maternal nutritional status and birth weight were compared with those of a milkbased product fortified with minerals and vitamins (470 kcaVday) in a group of underweight pregnant women (Mardones-Santander et al., 1988~.
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From page 162... ...
In this study, WIC participation was associated with increased energy intake, normalization of weight gain that had been low in early pregnancy, and decreased triceps skinfold thickness late in pregnancy. There was no apparent relationship between WIC supplementation and birth weight.
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From page 163... ...
Also, the relationship between energy intake and gestational weight gain is confounded by several other intervening factors, such as physical activity and body size. Few supplementation trials confirmed the direct link between energy intake, weight gain, and birth weight.
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From page 164... ...
The potential for improvement in birth weight was greater in the undernourished populations, in which birth weight before intervention averaged approximately 2,900 g, in comparison with approximately 3,100 g in better-nourished populations, and the incremental increase in energy intake was higher. The proportion of LOW infants was effectively reduced by prenatal energy supplementation, especially in chronically malnourished populations (Table 7-3A)
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From page 165... ...
Thermogenesis The thermic effect of feeding refers to the increase in energy expenditure above basal metabolism following the ingestion of food. It is due mainly to the energy costs of digestion, absorption, transport, and storage and averages approximately 10% of the energy intake.
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From page 167... ...
The rates of weight gain in Ethiopian pregnant women who engaged in hard work were lower, and the birth weights of their children were compromised, compared with women with lighter work demands (safari et al., 1980~. Lower energy intake and lower weights during early pregnancy in the Ethiopian women may have been contributory factors.
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From page 168... ...
In absolute terms, the energy expended in sedentary activities such as sitting and standing was 15 to 30% higher in pregnant women, but was not different if standardized by body weight. The energy expenditure of weight-bearing activities such as walking was increased in proportion to gestational weight gain; however, the energy expenditure of treadmill walking expressed per unit of body mass did not differ between pregnant and nonpregnant women.
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From page 169... ...
In all countries, the estimation of the energy cost of pregnancy was subject to error, specifically in the estimation of maternal body fat and nonpregnant baseline values of BMR, but their estimates were all substantially lower than the theoretical estimates of Hytten (1980~. Increases in energy intake recorded for these populations did not approach the estimated energy costs of pregnancy, except for the Thai women.
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From page 170... ...
Prenatal energy supplementation may increase birth weight through greater rates of gestational weight gain. The impact of energy supplementation appears to be influenced by the nutritional vulnerability of pregnant women and the extent to which the supplement diminishes the deficit between usual energy intakes and requirements.
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From page 171... ...
· Gestational weight gain Is a function of energy intake, although the strength of the relationship Is confounded by intenen~ng factors. · Prenatal energy supplementation may increase birth weight through greater rates of gestational weight gain; however, the effectiveness Is conditional upon the nutritional vulnerability of the pregnant woman.
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From page 172... ...
1976b. Energy expenditure and consumption of mature, pregnant and lactating women.
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From page 173... ...
1987. Energy intake and physical activity during pregnancy in relation to maternal fat accretion and infant birthweight.
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From page 174... ...
1979. The quantitative effects of maternal dietary energy intake on pregnancy and lactation in rural Gambian women.
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From page 175... ...
1988. Energy intake during pregnancy.
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