Not all the weight gained during pregnancy is lost during and immediately after delivery. Schauberger and coworkers (1992) studied prenatal and postpartum weights in 795 women. Their average weight gain was 28.6 Ib or 12.9 kg. As shown in Figure 9-4, most maternal weight loss was at deliveryapproximately 12 lb or 5.4 kg-and in the ensuing 2 weeksapproximately 9 Ib or 4 kg. An additional 5.5 lb or 2.5 kg was lost between 2 weeks and 6 months postpartum. Thus, average retained pregnancy weight was 2.1 Ib or 1 kg. Excessive weight gain is manifest by accrual of fat and may be partially retained as long-term fat (Berggren, 2016; Widen, 2015). Overall, the more weight that was gained during pregnancy, the more that was lost postpartum. Interestingly, there is no relationship between pre pregnancy BMI or prenatal weight gain and weight retention.
Periodically, the Institute of Medicine (2006, 2011) publishes recommended dietary allowances, including those for pregnant aRecommendations measured as adequate intake.
Calories are necessary for energy. Whenever caloric intake is inadequate, protein is metabolized rather than being spared for its vital role in fetal growth and development. Total physiologiWeeks of pregnancy cal requirements during pregnancy are not necessarily the sum or lactating women. The latest recommendations are summarized in Table 9-5. Certain prenatal vitamin-mineral supplements may lead to intakes well in excess of the recommended allowances. Moreover, the use of excessive supplements, which often are self-prescribed, has led to concern regarding nutrient toxicities during pregnancy. Those with potentialy toxic fects include iron, zinc, selenium, and vitamins A, B6, C, and D.
As shown in Figure 9-5, pregnancy requires an additional 80,000 kcal, mostly during the last 20 weeks. To meet this demand, a caloric increase of 100 to 300 kcal/d is recommended during pregnancy (American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, 2017). This greater intake, however, should not be divided equally during the course of pregnancy. The Institute ofMedicine (2006) recommends adding 0, 340, and 452 kcal/d to the estimated nonpregnantenergy requirements in the irst, second, and third trimesters, respectively. he addition of 1000 kcal/d or more results in fat accrual Qebeile, 2015).
From the Institute of Medicine, 2006, 2011.
pregnancy may be compensated in whole or in part by reduced physical activity (Hytten, 1991).
Protein requirements rise to meet the demands for growth and remodeling of the fetus, placenta, uterus, and breasts, and for 80,000 70,000 60,000 Maintenance ) 50,000 � 40,000 30,000 20,000 10,000
FIGURE 9-4 Cumulative weight loss from last antepartum visit to 6 months postpartum. *Significantly different from 2-week weight loss; **Significantly different from 6-week weight loss. (Redrawn from Schauberger CW, Rooney BL, Brimer LM: Factors that influence weight loss in the puerperium. Obstet Gynecol 79:424, 1992.)