Position of the American Dietetic Association: Nutrition and Lifestyle for a Healthy Pregnancy Outcome


        It is the position of the American Dietetic Association that women of child-bearing ages should maintain good nutritional status through a lifestyle that optimizes maternal health and reduces the risk of birth defects, suboptimal fetal growth and development, and chronic health problems in their children. The key components of a health-promoting lifestyle during pregnancy include appropriate weight gain; appropriate physical activity; consumption of a variety of foods in accordance with the Dietary Guidelines for Americans 2005; appropriate and timely vitamin and mineral supplementation; avoidance of alcohol, tobacco, and other harmful substances; and safe food handling. Pregnant women with inappropriate weight gain, hyperemesis, poor dietary patterns, phenylketonuria, certain chronic health problems, or a history of substance abuse should be referred to a registered dietitian for medical nutrition therapy. Prenatal weight gain within the Institute of Medicine recommended ranges has been associated with better pregnancy outcomes. Most pregnant women need 2,200 to 2,900 kcal a day, but prepregnancy body mass index, rate of weight gain, maternal age, and appetite must be considered when tailoring this recommendation to the individual. The consumption of more food to meet energy needs, and the increased absorption and efficiency of nutrient utilization that occurs in pregnancy, are generally adequate to meet the needs for most nutrients. However, vitamin and mineral supplementation is appropriate for some nutrients and situations. This position paper also includes recommendations pertaining to use of alcohol, tobacco, caffeine, and illicit drugs.
        To read this article in full you will need to make a payment

        Purchase one-time access:

        Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
        One-time access price info
        • For academic or personal research use, select 'Academic and Personal'
        • For corporate R&D use, select 'Corporate R&D Professionals'


        Subscribe to Journal of the Academy of Nutrition and Dietetics
        Already a print subscriber? Claim online access
        Already an online subscriber? Sign in
        Institutional Access: Sign in to ScienceDirect


          • Thorsdottir I.
          • Torfadottir J.E.
          • Birgisdottir B.E.
          • Geirsson R.T.
          Weight gain in women of normal weight before pregnancy: Complications in pregnancy or delivery and birth outcome.
          Obstet Gynecol. 2002; 99: 799-806
          • Stotland N.E.
          • Hopkins L.M.
          • Caughey A.B.
          Gestational weight gain, macrosomia, and risk of cesarean birth in nondiabetic nulliparas.
          Obstet Gynecol. 2004; 104: 671-677
          • Ehrenberg H.M.
          • Dierker L.
          • Milluzzi C.
          • Mercer B.M.
          Low maternal weight, failure to thrive in pregnancy, and adverse pregnancy outcomes.
          Am J Obstet Gynecol. 2003; 189: 1726-1730
          • Butte N.F.
          • Ellis K.J.
          • Wong W.W.
          • Hopkinson J.M.
          • Smith E.O.
          Composition of gestational weight gain impacts maternal fat retention and infant birth weight.
          Am J Obstet Gynecol. 2003; 189: 1423-1432
          • Rosebloom T.
          • de Rooij S.
          • Painter R.
          The Dutch famine and its long-term consequences for adult health.
          Early Hum Dev. 2006; 82: 485-491
          • Fagerberg B.
          • Bondjers L.
          • Nilsson P.
          Low birth weight in combination with catch-up growth predicts the occurrence of the metabolic syndrome in men at late middle age: The Atherosclerosis and Insulin Resistance study.
          J Intern Med. 2004; 256: 254-259
          • King J.C.
          Maternal obesity, metabolism, and pregnancy outcomes.
          Annu Rev Nutr. 2006; 26: 271-291
          • American College of Obstetricians and Gynecologists
          ACOG Committee Opinion #315: Obesity in pregnancy.
          Obstet Gynecol. 2005; 106: 671-675
          • US Department of Agriculture
          What we eat in America, NHANES 2001-2002: Usual nutrient intakes from food compared to Dietary Reference Intakes.
          (Published September 2005. Accessed November 13, 2007)
          • Institute of Medicine
          WIC Food Packages Time for a Change.
          in: National Academies of Science, Washington, DC2005: 46-73
          • US Department of Health and Human Services, US Department of Agriculture
          Dietary Guidelines for Americans January 2005.
          (Accessed November 13, 2007)
          • Centers for Disease Control and Prevention
          Preconception Care.
          (Accessed November 13, 2007)
          • Butte N.F.
          • King J.C.
          Energy requirements during pregnancy and lactation.
          Public Health Nutr. 2005; 8: 1010-1027
          • Institute of Medicine
          Nutrition during Pregnancy: Part I Weight Gain and Part II Nutrient Supplements.
          in: National Academies Press, Washington, DC1990: 10-23
          • Nielsen J.N.
          • O’Brien K.O.
          • Witter F.R.
          • Chang S.C.
          • Mancini J.
          • Nathanson M.S.
          • Caulfield L.E.
          High gestational weight gain does not improve birth weight in a cohort of African American adolescents.
          Am J Clin Nutr. 2006; 84: 183-189
          • Oken E.
          • Taveras E.M.
          • Kleinman K.P.
          • Rich-Edwards J.W.
          • Gillman M.W.
          Gestational weight gain and child adiposity at age 3 years.
          Am J Obstet Gynecol. 2007; 196: 322.e1-322.e8
          • Stotland N.E.
          • Cheng Y.W.
          • Hopkins L.M.
          • Caughey A.B.
          Gestational weight gain and adverse neonatal outcome among term infants.
          Obstet Gynecol. 2006; 108: 635-643
          • Linne Y.
          • Dye L.
          • Barkeling B.
          • Rossner S.
          Long-term weight development in women: A 15-year follow-up of the effects of pregnancy.
          Obes Res. 2004; 12: 1166-1178
          • Casanueva E.
          • Rosello-Soberon M.E.
          • De-Regil L.M.
          • Arguelles Mdel C.
          • Cespedes M.I.
          Adolescents with adequate birth weight newborns diminish energy expenditure and cease growth.
          J Nutr. 2006; 136: 2498-2501
          • Gigante D.P.
          • Rasmussen K.M.
          • Victora C.G.
          Pregnancy increases BMI in adolescents of a population-based birth cohort.
          J Nutr. 2005; 135: 74-80
          • Luke B.
          Nutrition and multiple gestation.
          Semin Perinatol. 2005; 29: 349-354
          • Institute of Medicine
          Dietary Reference Intakes: The Essential Guide to Nutrient Requirements.
          National Academies Press, Washington, DC2006
          • US Department of Agriculture
          MyPyramid Web site.
          (Accessed September 5, 2007)
          • Scholl T.O.
          • Chen X.
          • Khoo C.S.
          • Lenders C.
          The dietary glycemic index during pregnancy: Influence on infant birth weight, fetal growth, and biomarkers of carbohydrate metabolism.
          Am J Epidemiol. 2004; 159: 467-474
          • Kind K.L.
          • Moore V.M.
          • Davies M.J.
          Diet around conception and during pregnancy—Effects on fetal and neonatal outcomes.
          Reprod Biomed Online. 2006; 12: 532-541
          • Chan G.M.
          • McElligott K.
          • McNaught T.
          • Gill G.
          Effects of dietary calcium intervention on adolescent mothers and newborns: A randomized controlled trial.
          Obstet Gynecol. 2006; 108: 565-571
          • Dempsey J.C.
          • Butler C.L.
          • Williams M.A.
          No need for a pregnant pause: Physical activity may reduce the occurrence of gestational diabetes mellitus and preeclampsia.
          Exerc Sport Sci Rev. 2005; 33: 141-149
          • American College of Obstetricians and Gynecologists
          ACOG Committee opinion.
          Obstet Gynecol. 2002; 99: 171-173
          • Centers for Disease Control and Prevention
          Folate status in women of childbearing age, by race/ethnicity—United States, 1999-2000, 2001-2002, and 2003-2004.
          MMWR. 2007; 55: 1377-1380
          • Centers for Disease Control and Prevention
          Use of dietary supplements containing folic acid among women of childbearing age—United States, 2005.
          MMWR. 2005; 54: 955-958
          • Bodnar L.M.
          • Cogswell M.E.
          • Scanlon K.S.
          Low income postpartum women are at risk of iron deficiency.
          J Nutr. 2002; 132: 2298-2302
        1. Maternal iron deficiency anemia affects postpartum emotions and cognition.
          J Nutr. 2005; 135: 267-272
          • Cogswell M.E.
          • Parvanta I.
          • Ickes L.
          • Yip R.
          • Brittenham G.M.
          Iron supplementation during pregnancy, anemia, and birth weight: A randomized controlled trial.
          Am J Clin Nutr. 2003; 78: 773-781
          • Specker B.
          Vitamin D requirements during pregnancy.
          Am J Clin Nutr. 2004; 80: 1740S-1747S
          • Fawzi W.W.
          • Msamanga G.I.
          • Urassa W.
          • Hertzmark E.
          • Petraro P.
          • Willett W.C.
          • Spiegelman D.
          Vitamins and perinatal outcomes among HIV-negative women in Tanzania.
          N Engl J Med. 2007; 356: 1423-1431
          • Fawzi W.W.
          • Msamanga G.I.
          • Spiegelman D.
          • Wei R.
          • Kapiga S.
          • Villamor E.
          • Mwakagile D.
          • Mugusi F.
          • Hertzmark E.
          • Essex M.
          • Hunter D.J.
          A randomized trial of multivitamin supplements and HIV disease progression and mortality.
          N Engl J Med. 2004; 351: 23-32
          • Greenfield S.F.
          • Manwani S.G.
          • Nargiso J.E.
          Epidemiology of substance use disorders in women.
          Obstet Gynecol Clin North Am. 2003; 30: 413-446
          • Williams J.H.
          • Ross L.
          Consequences of prenatal toxin exposure for mental health in children and adolescents : A systematic review.
          Eur Child Adolesc Psychiatry. 2007; 16: 243-253
          • US Department of Health and Human Services
          National survey on drug use and health; 2006.
          (Accessed November 13, 2007.C)
          • Frary C.D.
          • Johnson R.K.
          • Wang M.Q.
          Food sources and intakes of caffeine in the diets of persons in the United States.
          J Am Diet Assoc. 2005; 105: 110-113
          • Higdon J.V.
          • Frei B.
          Coffee and health: A review of recent human research.
          Crit Rev Food Sci Nutr. 2006; 46: 101-123
          • Bech B.H.
          • Obel C.
          • Henriksen T.B.
          • Olsen J.
          Effect of reducing caffeine intake on birth weight and length of gestation: Randomised controlled trial.
          BMJ. 2007; 334: 409
          • McCusker R.R.
          • Goldberger B.A.
          • Cone E.J.
          Caffeine content of specialty coffees.
          J Anal Toxicol. 2003; 27: 520-522
          • McCusker R.R.
          • Goldberger B.A.
          • Cone E.J.
          Caffeine content of energy drinks, carbonated sodas, and other beverages.
          J Anal Toxicol. 2006; 30: 112-114
          • Raatikainen K.
          • Huurinainen P.
          • Heinonen S.
          Smoking in early gestation or through pregnancy: A decision crucial to pregnancy outcome.
          Prev Med. 2007; 44: 59-63
          • Bolnick J.M.
          • Rayburn W.F.
          Substance use disorders in women: Special considerations during pregnancy.
          Obstet Gynecol Clin North Am. 2003; 30: 545-558
          • Duffy V.B.
          • Sigman-Grant M.
          Position of the American Dietetic Association: Use of nutritive and nonnutritive sweeteners.
          J Am Diet Assoc. 2004; 104: 255-275
          • American Diabetes Association
          Standards of medical care in diabetes—2007.
          Diabetes Care. 2007; 30: S4-S40
          • American Diabetes Association
          Nutrition recommendations and interventions for diabetes.
          Diabetes Care. 2007; 30: S48-S65
          • American College of Obstetricians and Gynecologists
          Clinical management guidelines for obstetrician–gynecologists.
          Obstet Gynecol. 2002; 99: 159-167
          • Newstead J.
          • von Dadelszen P.
          • Magee L.A.
          Preeclampsia and future cardiovascular risk.
          Expert Rev Cardiovasc Ther. 2007; 5: 283-294
          • Scholl T.O.
          • Leskiw M.
          • Chen X.
          • Sims M.
          • Stein T.P.
          Oxidative stress, diet, and the etiology of preeclampsia.
          Am J Clin Nutr. 2005; 81: 1390-1396
          • Hofmeyr G.J.
          • Atallah A.N.
          • Duley L.
          Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems.
          Cochrane Database Syst Rev. 2006; (CD001059)
          • Rumbold A.
          • Crowther C.A.
          Vitamin E supplementation in pregnancy.
          Cochrane Database Syst Rev. 2005; (CD004069)
          • Makrides M.
          • Duley L.
          • Olsen S.F.
          Marine oil, and other prostaglandin precursor, supplementation for pregnancy uncomplicated by pre-eclampsia or intrauterine growth restriction.
          Cochrane Database Syst Rev. 2006; (CD003402)
          • Kendall P.
          • Medeiros L.C.
          • Hillers V.
          • Chen G.
          • DiMascola S.
          Food handling behaviors of special importance for pregnant women, infants and young children, the elderly, and immune-compromised people.
          J Am Diet Assoc. 2003; 103: 1646-1649
          • US Department of Health and Human Services, US Environmental Protection Agency
          What you need to know about mercury in fish and shellfish.
          (Published March 2004. Accessed September 5, 2007)
          • James D.C.S.
          • Dobson B.
          Position of the American Dietetic Association: Promoting and supporting breastfeeding.
          J Am Diet Assoc. 2005; 105: 810-818
        2. Gestational diabetes mellitus.
          Diabetes Care. 2004; 27 (Jan): S88-S90
          • Borders A.E.
          • Grobman W.A.
          • Amsden L.B.
          • Holl J.L.
          Chronic stress and low birth weight neonates in a low-income population of women.
          Obstet Gynecol. 2007; 109: 331-338

        Linked Article

        • Erratum
          Journal of the American Dietetic AssociationVol. 109Issue 7
          • Preview
            In the “Position of the American Dietetic Association: Nutrition and Lifestyle for a Healthy Pregnancy Outcome” that appeared in the March 2008 Journal (pp 553-561), there is an error in Table 1 on page 554. The Dietary Reference Intakes for women listed for α-linolenic acid were incorrect. The correct values are listed here:
          • Full-Text
          • PDF
        • Erratum
          Journal of the American Dietetic AssociationVol. 110Issue 1
          • Preview
            In the “Position of the American Dietetic Association: Nutrition and Lifestyle for a Healthy Pregnancy Outcome” that appeared in the March 2008 Journal (pp 553-561), there is an error in Table 1 on page 554. The daily recommended intake of iron for adult women should be 18 mg, not 8 mg as published. The daily adequate intake for sodium is 1,500 mg for adult women, pregnancy, and lactation.
          • Full-Text
          • PDF