Dietary Supplements


Dietary ingredients in dietary supplements, including vitamins, minerals, herbs or other botanicals, and amino acids, are not subject to the premarket safety evaluations required of food ingredients and medi- cations. Because of this, the efficacy and safety of these products during pregnancy is questionable, and, thus, their use is discouraged unless specifically recommended by a health care provider for pregnancy health. Ingredients found in dietary supplements reach the fetus primarily by crossing the placenta. Expo- sure during pregnancy to some ingredients and substances in dietary supplements can indirectly impact the fetus by initiating uterine contractions and premature labor or by lowering maternal blood pressure, which, in turn, may reduce blood flow to the placenta and the consequent supply of oxygen and nutrients to the fetus, increasing the risk of the child being born at a low birth weight.187


Exposure during pregnancy


to some ingredients found in dietary supplements may also directly cause damage, abnormal development, and death of the fetus.188


WEIGHT GAIN RECOMMENDATIONS


Over the years, there has been considerable discussion regarding the optimal quantity of weight gain in pregnancy for both maternal and fetal health. Currently, the Institute of Medicine (IOM) and the Ameri- can College of Obstetricians and Gynecologists recommend a total weight gain of 25 to 35 lb for singleton pregnancies in women with a healthy BMI (18.5 to 24.9).121,122


for singleton pregnancies is recommended for female athletes who enter pregnancy underweight (BMI < 18.5).119,120


Women who are


overweight (BMI = 25 to 29.9) are encouraged to minimize pregnancy weight gain to 15 to 25 lb for singleton pregnancies.121,122


For twin pregnancies, the IOM Women who


are obese (BMI > 30) should minimize pregnancy weight gain to 11 to 20 lbs for singleton pregnancies.120,121


recommends a total gestational weight gain of 37 to 54 lb for women of normal weight, 31 to 50 lbs for women who are overweight, and 25 to 42 lb for women who are obese.121 Singleton pregnancy-associated weight gain during the first trimes-


ter of 1.1 to 4.4 lb can be attributed to the expanding uterus, growing breasts, and increased blood volume. It makes up only a small per- centage of total recommended pregnancy weight gain. Slightly more weight gain is attributed to the same causes for twin pregnancies. During the second and third trimesters, when fetal growth increases dramatically, a weekly weight gain of approximately 1 lb for single- ton pregnancies and 1.5 lb for twin pregnancies is recommended for women with underweight and healthy prepregnancy BMIs. Te rec- ommended weekly weight gain for women who are overweight and obese during the second and third trimester is 0.6 and 0.5 lb, re- spectively,


pregnancies.121


for singleton pregnancies and slightly higher for twin Some experts speculate that if adequate fetal growth is


occurring, even lower rates of pregnancy weight gain in women who are overweight and obese may be war- ranted to help optimize the long-term health of the child.123,124


Maintaining a healthy rate of weight gain in


pregnancy has been shown to decrease risk for several adverse maternal and neonatal outcomes, including gestational diabetes, hypertension, cesarean birth, fetal macrosomia, preterm birth, stillbirth, small or large for gestational age, and low birth weight.121-124,189,190 Especially relevant for female athletes interested in making a postpartum athletic comeback is the find- ing that staying within IOM weight-gain guidelines during pregnancy helps reduce the risk of retaining


CHAPTER 17: NUTRITION AND EXERCISE GUIDANCE FOR THE PREGNANT ATHLETE 373 A slightly greater weight gain of 28 to 40 lb


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