Upping your energy during pregnancy what works for you baby. Women have known for decades that one-size-fits-all is a fallacy, and now a new study in the American Journal of Clinical Nutrition indicates that researchers suspect pregnant womens nutritional needs are not a generic, one-size-fits-all concept, either. The study followed healthy women from pre-conception through post-partum to see how they met the energy demands of pregnancy, and if current dietary recommendations typically given out during prenatal care were sufficient. A pregnant woman undeniably needs more energy for the growth of the fetus, placenta, uterus, and breasts, as well as for fat storage and for her metabolism to maintain all these new tissues. Thirty years ago, experts decided a woman needed an extra 250 to 300 calories a day to support all this growth. Recently, the National Academy of Sciences changed these recommendations to 150 calories in the first trimester and 350 in the second and third. Elizabeth Somer, M.A., R.D., author of Nutrition for a Healthy Pregnancy says that the key is not how much you gain as how you gain it. Weight gain in pregnancy should be a gradual process, she states. No spikes in the scale reading, but an even, steady gain, with minimal gain in the first trimester and a half a pound to a pound a week in the second and third trimesters.
The subjects included pregnant women booking for delivery at the Department of Obstetrics and Gynaecology, Aarhus University Hospital, from September 1989 to August 1996. The women completed two questionnaires before the first visit for routine care at about 16 weeks of gestation. The information from the first questionnaire was used to obtain data on medical and obstetric history, maternal age, smoking habits before pregnancy and during the first trimester, and alcohol intake during pregnancy. From the second questionnaire the researchers obtained information on intake of coffee, tea, drinking chocolate, and cola and marital status, education, and employment status. They asked about current intake of coffee, tea, drinking chocolate, and cola, and women could indicate any whole number of daily cups of coffee, tea, and drinking chocolate, or bottles of cola. Information about delivery was obtained from birth registration forms filled in by the attending midwife immediately after delivery. Before entering the data, all birth registration forms were manually checked and compared with the medical records by a research midwife. Information about stillbirths was obtained from the data that was collected at the department and from the Danish medical birth register through record linkage using the mothers personal identification number. Information about deaths during the first year of life was obtained from the registry of causes of death, administered by the Danish National Board of Health, and from the civil registration system. Deaths of four children who died according to data from the civil registration system were not registered in the registry of causes of death. The childrens medical records confirmed these deaths. The researchers defined stillbirth as delivery of a dead fetus at or after 28 completed weeks of gestation and infant death as death of a liveborn infant before the age of 1 year. The study population was restricted to singleton pregnancies among Danish speaking women who filled in the first questionnaire, who delivered after 28 completed weeks of gestation, and to those with valid information about coffee intake during pregnancy (n=18,478).
Two techniques used to measure body fat distribution are computed tomography (CT) and magnetic resonance imaging (MRI). However, they use radiation and strong magnetic fields, which are prohibited during pregnancy. Ultrasound is safe during pregnancy, portable, and noninvasive, and has been shown to be highly correlated to CT-derived measures of visceral adiposity. To develop a reliable technique for studying the effect of fat distribution in the body on insulin resistance, some researchers from Denver, Colorado compared the value of skinfold caliper and ultrasound measurements on the distribution of subcutaneous adipose tissue and ultrasound measurements of visceral adiposity (US-VAT) for insulin resistance in pregnant adolescents. In an adolescent maternity program 16 girls, aged 13 to 19 who enrolled before the 14th week of gestation were included in this study. There were two study visits: One at enrollment and a second visit early in the third trimester. The fasting insulin and glucose-to-insulin ration were used to quantify insulin resistance. The distribution of subcutaneous adipose tissue was measured first by using a skinfold caliber at three sites on the extremities (triceps, biceps, and thighs) and three on the trunk (subscapular, costal, and suprailiac) and ten by two experienced songoraphers. The girls gained weight at a rate of 0.5 kg/week during gestation and the study period and gave birth at 38 weeks gestation. Fasting insulin levels and glucose-to-insulin ratios increased significantly during the study period. At the second study visit, fasting insulin level and glucose-to-insulin ratio was significantly correlated with the rate of weight gain. Thus, during this visit, insulin resistance was significantly related to total, visceral, and subcutaneous fat. The skinfold caliper measurement of subcutaneous fat at the subscapular site and the US measurement of subcutaneous fat at the costal site were the best predictors of insulin resistance. BMI was not associated to either model of adiposity.
Nutrition During Pregnancy