The Importance of Nutrition in Pregnancy and Lactation: Lifelong Consequences

Nicole E. Marshall, Barbara Abrams, Linda A. Barbour, Patrick Catalano, Parul Christian, Jacob E. Friedman, William W. Hay, Teri L. Hernandez, Nancy F. Krebs, Emily Oken, Jonathan Q Purnell, James M. Roberts, Hora Soltani, Jacqueline M Wallace, Kent L. Thornburg* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

60 Citations (Scopus)
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Most women in the United States do not meet the recommendations for healthful nutrition and weight before and during pregnancy. Women and providers often ask what a healthy diet for a pregnant woman should look like. The message should be "eat better, not more." This can be achieved by basing diet on a variety of nutrient-dense, whole foods, including fruits, vegetables, legumes, whole grains, healthy fats with omega-3 fatty acids that include nuts and seeds, and fish, in place of poorer quality highly processed foods. Such a diet embodies nutritional density and is less likely to be accompanied by excessive energy intake than the standard American diet consisting of increased intakes of processed foods, fatty red meat, and sweetened foods and beverages. Women who report "prudent" or "health-conscious" eating patterns before and/or during pregnancy may have fewer pregnancy complications and adverse child health outcomes. Comprehensive nutritional supplementation (multiple micronutrients plus balanced protein energy) among women with inadequate nutrition has been associated with improved birth outcomes, including decreased rates of low birthweight. A diet that severely restricts any macronutrient class should be avoided, specifically the ketogenic diet that lacks carbohydrates, the Paleo diet because of dairy restriction, and any diet characterized by excess saturated fats. User-friendly tools to facilitate a quick evaluation of dietary patterns with clear guidance on how to address dietary inadequacies and embedded support from trained healthcare providers are urgently needed. Recent evidence has shown that although excessive gestational weight gain predicts adverse perinatal outcomes among women with normal weight, the degree of prepregnancy obesity predicts adverse perinatal outcomes to a greater degree than gestational weight gain among women with obesity. Furthermore, low body mass index and insufficient gestational weight gain are associated with poor perinatal outcomes. Observational data have shown that first-trimester gain is the strongest predictor of adverse outcomes. Interventions beginning in early pregnancy or preconception are needed to prevent downstream complications for mothers and their children. For neonates, human milk provides personalized nutrition and is associated with short- and long-term health benefits for infants and mothers. Eating a healthy diet is a way for lactating mothers to support optimal health for themselves and their infants.

Original languageEnglish
Pages (from-to)607-632
Number of pages26
JournalAmerican Journal of Obstetrics and Gynecology
Issue number5
Early online date6 May 2022
Publication statusPublished - May 2022

Bibliographical note

We offer deep appreciation to the Vitamix Foundation and Bob’s Red Mill for the contribution toward a conference and to the experts who were speakers at the 2019 Nutrition in Pregnancy conference. Their contributions were important in the writing of this manuscript. The following experts involved in this review were as follows: Jennifer Barber, PhD, University of Michigan; Andrew Bremer, MD, PhD, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH); Romy Gaillard, PhD, Erasmus University, The Netherlands; Kelle Moley, MD, National March of Dimes; Kripa Raghavan, DrPH, MPH, MSc, US Department of Agriculture, Center for Nutrition Policy and Promotion; Daniel Raiten, PhD, NICHD, NIH; Usha Ramakrishnan, PhD, Emory University; Leanne Redman, PhD, FTOS, Pennington Biomedical Research Center; Roberto Romero, MD, NICHD, NIH; Kartik Shankar, PhD, DABT, Anshutz Medical Campus, University of Colorado; Diane Stadler, PhD, RD, Oregon Health & Science University; Alison Steiber, PhD, RDN, Academy of Nutrition and Dietetics; Chittaranjan Yajnik, MD, FRCP, King Edward Memorial Hospital Research Centre, India.


  • adolescent pregnancy
  • developmental origins of disease
  • fetal and neonatal nutrition
  • gestational diabetes
  • lactation
  • macronutrients
  • maternal nutrition
  • nutritional requirements
  • pregnancy
  • micronutrients
  • vitamin supplementation
  • Obesity
  • Vegetables
  • Gestational Weight Gain
  • Lactation
  • Humans
  • Male
  • Pregnancy
  • Diet
  • Female
  • Nutritional Status
  • Weight Gain


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