Nutrition for Pregnant and Lactating Women: The Latest Recommendations From the Dietary Guidelines for Americans 2020-2025 and Practice Implications

Monica Kazlausky Esquivel, PhD, RDN, CSSD, Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, 1955 East West Rd, Agricultural Sciences Building Room 216, Honolulu, HI 96822; e-mail: ude.iiawah@ekacinom.

Abstract

The influence of maternal nutrition and dietary intake is intergenerational. In recognizing that diet-related chronic conditions, such as obesity and diabetes, especially during conception and pregnancy, are associated with childhood obesity and diabetes risk, the latest Dietary Guidelines for Americans 2020-2025 includes an emphasis on lifespan nutrition. Research supports the need to achieve a healthy weight preconception, as women with a high body mass index before pregnancy are at risk for excessive gestational weight gain, gestational diabetes, hypertension, caesarian section delivery, and excessive postpartum weight retention, which sets the stage for subsequent risk in future pregnancies. The Dietary Guidelines committee emphasized that key components to healthy dietary patterns include higher consumption of vegetables, fruits, nuts, legumes, whole grains, lean meat and seafood, dairy, and unsaturated vegetable oils and lower consumption of processed meat, foods high in saturated fat and cholesterol, and foods and drinks with added sugar. The guidelines offer health care providers, individuals, and other stakeholders with a framework of strategies that can help individuals achieve optimal health. This framework can be utilized to develop individualized approaches for implementing culturally relevant interventions.

‘Diet-related chronic conditions, such as obesity and diabetes, especially during conception and pregnancy, are associated with childhood obesity and diabetes risk.’

The influence of maternal nutrition and dietary intake is intergenerational. Diet-related chronic conditions, such as obesity and diabetes, especially during conception and pregnancy, are associated with childhood obesity and diabetes risk. While pregnancy is a finite, 40-week period, the impacts of nutritional status on the outcomes of pregnancy are influenced by prepregnancy health status, as well as diet in the months following birth, during lactation. In recognizing this critical life period and the role of women’s diet and nutrition status on child health, the most recent Dietary Guidelines were published, and include a lifespan emphasis. This emphasis on dietary intake and patterns in distinct life phases is key to primary prevention of conditions such as childhood obesity, the trajectory for which is associated with maternal and prenatal health and dietary exposures.

The Dietary Guidelines provide research and science-based information on what individuals should eat and drink for health promotion and chronic disease reduction. The Dietary Guidelines are published every 5 years and have been since 1980 and are meant to provide policy makers, nutrition, and health professionals with the information to help individuals and families achieve a healthy diet. Foundational to the Dietary Guidelines is the Scientific Report of the 2020 Dietary Guidelines Advisory Committee. The Dietary Guidelines Advisory Committee is charged with reviewing current scientific and medical knowledge on the status of health, nutrition, and diet. As a result of the scientific inquiry, the committee publishes a report which in turn the US Department of Agriculture and Health and Human Services utilizes, along with public and agency comments, to write the Dietary Guidelines for Americans. Unique to the most recent Dietary Guidelines are first, ever, recommendations for dietary patterns across the lifespan, including specific recommendations for pregnant and lactating women.

The Dietary Guidelines committee’s scientific report outlines current evidence and gaps in literature around women’s health and diet. 1 This evidence, put into practice in the Dietary Guidelines, can help health practitioners and policy makers to develop appropriate interventions for the primary prevention of child health conditions, as well as secondary prevention of maternal health conditions.

Current Data on Health and Diet of Women: Dietary Guidelines Advisory Committee Scientific Report Highlights

Similar to other age and sex groups, women of childbearing age on average have low intake of key vitamins and minerals, 2 while approximately 50% of women 20 to 44 years of age have overweight or obesity. 3 Research supports the need to achieve a healthy weight preconception, as women with a high body mass index before pregnancy are at risk for excessive gestational weight gain, gestational diabetes, hypertension, caesarian section delivery, and excessive postpartum weight retention, which sets the stage for subsequent risk in future pregnancies. 4 -7 Children born from women who experience these risk factors carry a greater risk for obesity and metabolic syndrome. 8 Interventions to support attainment of a healthy body mass index for women may have significant impacts on disease trajectory of children.

Dietary patterns place an emphasis on the foods consumed by individuals instead of focusing on specific nutrients. The Dietary Guidelines committee emphasized that key components to healthy dietary patterns include higher consumption of vegetables, fruits, nuts, legumes, whole grains, lean meat and seafood, dairy, and unsaturated vegetable oils and lower consumption of processed meat, foods high in saturated fat and cholesterol, and foods and drinks with added sugar. 1 This dietary pattern is associated with a modest risk reduction in poor pregnancy outcomes, but low socioeconomic and minority groups are underrepresented in research studies, limiting generalizability of findings and ability to draw conclusions. 9 In addition to this healthful eating pattern, diet diversity is also emphasized in pregnancy and lactation. Diet diversity is defined as the number of different foods consumed, where greater diversity was found to be related to reduction in allergy outcomes and improved microbial diversity that is also influential on allergy outcomes of children. 10,11 Last, the Dietary Guidelines Committee emphasized some key food components that are of concern during pregnancy, including vitamin D, calcium, dietary fiber, potassium, sodium, saturated fat, and added sugar. Data suggest that low intake of iron and folate also continue to be of concern, and strong evidence links these 2 nutrients with outcomes such as neural tube defects and neurocognitive development in children. As a result of this research, the committee’s strategies for pregnant women (inclusive of women of reproductive age) are outlined in Table 1 .

Table 1.

Newly Identified Strategies for Optimizing Health and Nutritional Status of Women of Reproductive Age From the Scientific Report of the 2020 Dietary Guidelines Advisory Committee. 1

Putting the Scientific Report to Practice: Key Takeaways Included in the Dietary Guidelines for Americans 2020-2025

As a result of the Dietary Guidelines Advisory Committee’s report and other stakeholder input, the Dietary Guidelines for Americans 2020-2025 were written and published by the US Department of Agriculture and Health and Human Services. Unsurprisingly, the Dietary Guidelines for Americans 2020-2025 emphasize the following key points: (1) pregnant and lactating women should follow the core elements of a healthy diet pattern similar to other life stages (see Table 2 ); (2) consume adequate calories to accommodate needs during pregnancy from nutrient dense foods; (3) stick to weight gain recommendations ( Table 3 ); (4) consider supplemental folate, iron, iodine, and choline as needs are high and intake is often low, (5) consume 8 to 12 ounces of omega 3 fatty acid–rich seafood; (6) avoid alcohol; and (7) consume low to moderate amounts of caffeine. 12

Table 2.

Core Elements and Weekly Amounts From Food Groups in a Healthy, 2000 Calorie, Diet Pattern for Pregnant and Lactating Women From the Dietary Guidelines for Americans 2020-2025. 12

Table 3.

Institute of Medicine (IOM) Weight Gain During Pregnancy Recommendations. 13

Practice Applications for Lifestyle Medicine

The nutrition and diet recommendations for pregnant and lactating women in the 2020-2025 Dietary Guidelines for Americans offer practitioners and policy makers with a framework for evidenced-based interventions that aim to improve the health of both mother and baby. Foundational to these guidelines is the existing evidence that reinforces the relationship between maternal health and nutritional status, including overweight and obesity status, and child health. Strong correlations between the maternal obesity, excessive weight gain, and gestational diabetes and childhood risk for obesity and chronic disease exist. The moderate risk reduction achieved by the healthy dietary pattern among pregnant women led to the promotion of this diet pattern in the Dietary Guidelines, as adherence to the pattern is also conducive to weight control. Health care providers can reinforce these messages with their patients as well. The guidelines encourage a healthy dietary pattern mentioned above and emphasize the importance of customization of the pattern to meet the food preferences, culture, and budget of individuals. The nonprescriptive nature of the recommendations is meant to encourage choice and selection among individuals. Similarly, conversations between health care providers and patients around implementing these eating patterns can do the same. Rather than focusing on the specific types of foods, providers can discuss with patients the food groups and support patients in identifying the foods that they already enjoy that fit within the categories.

In the backdrop of population-level interventions, health care providers can also support policy-level changes that address access and availability of foods included in the healthy dietary patterns, specifically for women who are pregnant and lactating. Federal food programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP) present as potential solutions for increasing access to healthy foods for women at high risk for poor nutrition. By expanding enrollment eligibility for pregnant and lactating women, healthy food could become more accessible to a greater number of women. Programs that incentivize using WIC or SNAP benefits to purchase healthy foods may also improve availability and consumption of fruits and vegetables.

The 2020-2025 Dietary Guidelines for Americans provide updated, evidenced-based recommendations on what individuals can eat to promote health and reduce risk for disease. The guidelines offer health care providers, individuals, and other stakeholders with a framework of strategies that can help individuals achieve optimal health. This framework can be utilized to develop individualized approaches for implementing culturally relevant interventions as well as effective programs to target upstream influences on dietary intake and nutritional status.

Footnotes

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was supported by the United States Department of Agriculture Smith-Lever funds allocated from the State Extension Office through individual and state team Plans of Work.

Ethical Approval: Not applicable, because this article does not contain any studies with human or animal subjects.

Informed Consent: Not applicable, because this article does not contain any studies with human or animal subjects.

Trial Registration: Not applicable, because this article does not contain any clinical trials.

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