Specific recommendations exist for different types of nutrients in pregnancy. They differ in some points according to both the eating tradition and nutrition status of the population. WHO antenatal standards paper provides 39 recommendations related to 5 types of interventions. The healthy eating and physically active style of life is promoted to prevent excessive gestational weight gain (GWG). In the undernourished population, balanced energy and protein intake are recommended to prevent LBW, SGA, and stillbirths. Doses of iron and folate supplementation are given with possible daily or intermittent routine. Supplementation of vitamin A is suggested to be restricted only to areas where vitamin A deficiency is a substantial public health problem. Recommendation of calcium supplementation is limited to population with low-calcium intake. Vitamin B6, zinc, multi-nutrient supplements and vitamin D supplementation are not advocated as routine procedure. Avoiding of caffeine is suggested for women with high consumption [
40]. Canadian consensus highlights the need of the uptake of nutrient-dense and energy-appropriate food with moderate increase of energy intake during pregnancy. Particular concern is given to GWG, adequate folate, iron, choline, omega-3 fatty acid and iodine input, as well as avoiding or limiting specific food which contains bacteria or methyl mercury and alcohol [
25]. German National Consensus is quite detailed in different aspects of diet in pregnancy. In the first paragraph, the difference between slightly increase of energy needs in comparison to a much greater increase of vitamin and minerals is highlighted. According to these requirements, nutrient-dense food eating, regular meals and regular exercises together with moderate GWG are recommended. The specific concerns exist for obese pregnant women for whom the standards of care and weight lose still are not well established, vegetarian nutrition with possible supplementation of iron and DHA and vegan where specific medical counselling is required due to diet deficiency of many nutrients [
16]. Italian Consensus differs a little in the points according to energy input and protein intake during pregnancy, where specific amounts are recommended in the particular periods. The emphasis is put on the protein and fat composition, iron supplementation, as well as iodine and calcium adequate provision [
17]. Standards of nutrition for Polish population, reflecting WHO and EFSA recommendations, contain tables for different groups according to age, sex and pregnancy status for both micro- and macronutrients together with energy requirements and expenditure [
7,
14]. Similar tables are published by Institute of Medicine [
13,
31]. Further in the text, the nutrient requirements during pregnancy are described in details and summarised in Table
1. Apart from the recommendations, there is substantial body of reviews concerning specific aspects of maternal nutrition. In the last 2 years, we identified important papers in the subject relating to diet and fertility, interventions for diabetic or obese pregnant women, metabolic consequences of excessive GWG, the impact of the diet rich in polyphenols, the use of probiotics and prebiotics, the maternal microbiome and the development of neonatal immune system, the benefits of Mediterranean diet and the epigenetic programming.
Table 1
Micro- and macronutrients intake during pregnancy—summary of the recommendations
Energy | No additional input I trimester 340 kcal/day II trimester 452 kcal/day III trimester [ 31] 69 kcal/day I trimester 266–360 kcal/day II trimester 437–496 kcal/day III trimester [ 17] 10% increase in late pregnancy—260 kcal/day [ 16] |
GWG | • BMI < 18.5 kg/m2
GWG 12.5–18 kg • BMI 18.5–24.9 kg/m2
GWG 11.5–16 kg • BMI 25–29.9 kg/m2
GWG 7–11.5 kg • BMI > 30 kg/m2
|
Protein | 10–35% of energy, 71 g/day [ 13] Additional 1 g/day I trimester 8 g/day II trimester 26 g/day III trimester [ 17] |
Carbohydrates | 45–65% of energy, 175 g/day |
Fat | Additional 8–14 g/d II trimester 11–18 g/day III trimester [ 14] |
n-6 | |
n-3 | EPA 250 mg/day DHA 100–200 mg/day [ 14, 16] DHA 600–1000 mg in risk groups [ 7] |
Fibre | |
Iron | Supplementation 30–60 mg/day [ 40] |
Iodine | Supplementation 100–150 mcg/day [ 16] Supplementation 200 mcg/day [ 7] None additional supplementation [ 40] |
Folate | Supplementation 0.4 mg/day [ 7, 16, 40] |
Calcium | Supplementation 1.5–2 g/day in risk population (low calcium intake) [ 40] |
Vitamin D | RDA 5 mcg (200 IU)/day [ 31] RDA 15 mcg (600 IU)/day [ 17] At least 600 IU/day RDA, 1500–2000 IU/day to maintain the level above 30 ng/ml [ 11] None additional supplementation in general [ 40] Additional supplementation in risk groups 2000 IU/day [ 7] |