Maternal Health
Trimester-by-trimester symptoms, nutrition with exact RDAs, IOM weight gain guidelines, exercise safety, food safety, and mental health screening.
Nutrition
Proper nutrition during pregnancy supports fetal development and maternal health. Caloric needs increase modestly: no extra calories in the first trimester, +340 kcal/day in the second, and +452 kcal/day in the third. Quality of nutrition matters more than quantity.
Key Nutrients
| Nutrient | RDA | Role | Sources |
|---|---|---|---|
| Folate/Folic Acid | 600 mcg DFE/day | Neural tube development (closure at 28 days). Prevents spina bifida and anencephaly. Supplementation should begin at least 1 month before conception. | Dark leafy greens, fortified cereals, legumes, citrus fruits, prenatal vitamins |
| Iron | 27 mg/day | Supports 40-50% increase in blood volume. Prevents iron-deficiency anemia (affects 15-25% of pregnancies). Required for fetal red blood cell production and brain development. | Red meat, poultry, beans, fortified cereals, spinach. Pair with vitamin C to enhance absorption. Avoid with calcium (inhibits absorption). |
| Calcium | 1,000 mg/day (1,300 for teens) | Fetal bone and teeth development. If maternal intake insufficient, calcium is mobilized from maternal bone (does not cause permanent bone loss if adequately repleted). | Dairy products, fortified plant milks, sardines with bones, tofu (calcium-set), almonds |
| DHA (Omega-3) | 200-300 mg/day | Fetal brain and retinal development. Third trimester is the period of maximal DHA accretion in the fetal brain. May reduce risk of preterm birth. | Low-mercury fish (salmon, sardines, anchovies), algae-based supplements for vegetarians/vegans |
| Vitamin D | 600 IU/day (many experts recommend 1,000-2,000 IU) | Calcium absorption, immune function, fetal bone development. Deficiency associated with preeclampsia, gestational diabetes, and preterm birth. | Fortified milk, fatty fish, sun exposure, supplements |
| Iodine | 220 mcg/day | Thyroid hormone synthesis (T3/T4). Critical for fetal brain development. Severe deficiency causes cretinism. Mild deficiency associated with lower IQ. | Iodized salt, dairy, seafood. Many prenatal vitamins contain 150 mcg. |
| Choline | 450 mg/day | Neural tube development, brain development, epigenetic regulation. Synergistic with folate. Most pregnant women do not meet adequate intake. | Eggs (1 egg = 147 mg), liver, soybeans, beef, chicken, fish |
Caloric Needs by Trimester
| Trimester | Extra Calories | Total | Note |
|---|---|---|---|
| First | 0 kcal/day | ~2,000 kcal/day (varies by activity) | No additional calories needed. Focus on nutrient density. |
| Second | +340 kcal/day | ~2,340 kcal/day | Equivalent to a small meal: apple + 2 tbsp peanut butter + glass of milk. |
| Third | +452 kcal/day | ~2,452 kcal/day | Fetal growth accelerates; protein needs increase to 71g/day. |
Food Safety
Foods to Avoid
- Raw/undercooked meat —
- Raw fish/sushi —
- High-mercury fish —
- Deli meats/hot dogs —
- Soft cheeses (unpasteurized) —
- Raw/undercooked eggs —
- Unpasteurized juice/milk —
- Raw sprouts —
- Alcohol —
- Excessive caffeine —
Safe Foods
- Pasteurized dairy —
- Cooked fish (low mercury) —
- Well-cooked meat and poultry —
- Eggs (cooked until firm) —
- Fruits and vegetables —
- Whole grains —
IOM Weight Gain Guidelines
| Pre-Pregnancy BMI | Recommended Gain | Rate (2nd/3rd Tri) |
|---|---|---|
| Underweight (<18.5) | ||
| Normal (18.5-24.9) | ||
| Overweight (25.0-29.9) | ||
| Obese (>=30.0) |
Exercise During Pregnancy
ACOG recommends 150 minutes of moderate-intensity aerobic exercise per week during uncomplicated pregnancies. Exercise reduces gestational diabetes risk by 25-40%, reduces preeclampsia risk, improves mood, reduces excessive weight gain, and may shorten labor.
Safe Exercises
- Walking — Safest and most accessible. No equipment needed. Low impact.
- Swimming/water aerobics — Buoyancy reduces joint stress. Water provides natural resistance. Reduces edema. Safe throughout pregnancy.
- Stationary cycling — Low impact, stable. Avoid outdoor cycling in late pregnancy due to balance changes and fall risk.
- Prenatal yoga — Improves flexibility, reduces back pain, teaches breathing techniques useful during labor. Avoid hot yoga (core temperature risk).
- Low-impact aerobics — Modified intensity. Keep one foot on ground. Heart rate conversation test: should be able to talk during exercise.
- Strength training — Moderate weights with higher reps. Avoid Valsalva maneuver (bearing down). Modify as pregnancy progresses.
- Pelvic floor exercises (Kegels) — Reduces urinary incontinence risk. 10 reps, 3 sets daily. Hold each contraction 10 seconds.
Exercises to Avoid
- Contact sports — Risk of abdominal trauma (soccer, basketball, hockey, boxing)
- High-altitude exercise (>6,000 ft) — Hypoxia risk. Acclimatization needed if living at altitude.
- Hot yoga/hot pilates — Core temperature >102.2F (39C) is potentially teratogenic, especially in first trimester.
- Scuba diving — Fetus cannot decompress — risk of fetal decompression sickness and gas embolism.
- Supine exercises after 20 weeks — Inferior vena cava compression reduces venous return. Use left lateral tilt or inclined position.
- Downhill skiing/surfing — Fall risk with altered center of gravity and ligament laxity.
- Heavy weightlifting/max effort — Valsalva maneuver increases intra-abdominal pressure. Risk of pelvic floor injury.
Mental Health
Perinatal mental health disorders (depression, anxiety) affect approximately 1 in 5 women during pregnancy and/or the first year postpartum. They are among the most common complications of pregnancy and are underdiagnosed. Screening is recommended at least once during pregnancy and postpartum.