Energy and protein intake in pregnancy

  • Review
  • Intervention

Authors

  • Michael S Kramer,

    Corresponding author
    1. McGill University Faculty of Medicine, Departments of Pediatrics and Epidemiology, Biostatistics and Occupational Health, Montreal, Quebec, Canada
    • Michael S Kramer, Departments of Pediatrics and Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, 2300 Tupper Street, Les Tourelles, Montreal, Quebec, H3H 1P3, Canada. michael.kramer@mcgill.ca.

    Search for more papers by this author
  • Ritsuko Kakuma

    1. Centre for Addiction and Mental Health, Health Systems Research and Consulting Unit, Toronto, Ontario, Canada
    Search for more papers by this author

Abstract

Background

Gestational weight gain is positively associated with fetal growth, and observational studies of food supplementation in pregnancy have reported increases in gestational weight gain and fetal growth.

Objectives

To assess the effects of advice to increase or reduce energy or protein intake, or of actual energy or protein supplementation or restriction, during pregnancy on energy and protein intakes, gestational weight gain, and the outcome of pregnancy.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2009) and contacted researchers in the field.

Selection criteria

Acceptably controlled trials of dietary advice to increase or reduce energy or protein intake, or of actual energy or protein supplementation or restriction, during pregnancy.

Data collection and analysis

We extracted data from published reports, supplemented by additional information from the trialists we contacted.

Main results

In five trials (1135 women), nutritional advice to increase energy and protein intakes was successful in achieving those goals, but no consistent benefit was observed on pregnancy outcomes.

In 13 trials (4665 women), balanced energy/protein supplementation was associated with modest increases in maternal weight gain and in mean birthweight, and a substantial reduction in risk of small-for-gestational-age (SGA) birth. These effects did not appear greater in undernourished women. No significant effects were detected on preterm birth, but significantly reduced risks were observed for stillbirth and neonatal death.

In two trials (529 women), high-protein supplementation was associated with a small, non-significant increase in maternal weight gain but a non-significant reduction in mean birthweight, a significantly increased risk of SGA birth, and a non-significantly increased risk of neonatal death. In three trials, involving 966 women, isocaloric protein supplementation was also associated with an increased risk of SGA birth.

In four trials (457 women), energy/protein restriction of pregnant women who were overweight, or exhibited high weight gain, significantly reduced weekly maternal weight gain and mean birthweight but had no effect on pregnancy-induced hypertension or pre-eclampsia.

Authors' conclusions

Dietary advice appears effective in increasing pregnant women's energy and protein intakes but is unlikely to confer major benefits on infant or maternal health.

Balanced energy/protein supplementation improves fetal growth and may reduce the risk of fetal and neonatal death. High-protein or balanced-protein supplementation alone is not beneficial and may be harmful to the fetus.

Protein/energy restriction of pregnant women who are overweight, or exhibit high weight gain, is unlikely to be beneficial and may be harmful to the fetus.

Plain language summary

Energy and protein intake in pregnancy

A baby developing inside the womb receives all its nutrition from its mother. Thus, advising women on diet and providing food supplements in pregnancy may help babies to grow and thrive, particularly babies of undernourished mothers. The review of trials examined several aspects of this and found:
(1) nutritional advice: five trials involving 1135 women showed an increase in the mother's energy intake but no clear benefit for the developing baby;
(2) giving energy and protein balanced supplements, including to undernourished women: 13 trials involving 4665 women showed fewer small babies and fewer stillbirths, but the impact on long-term health of the baby is uncertain;
(3) high-protein supplementation: two trials involving 1076 women showed no benefit for babies or women;
(4) isocaloric protein supplements (i.e. without energy supplementation): three trials involving 966 women showed no benefit and potential harm;
(5) energy/protein restriction in women with overweight or high-weight gain: four trials involving 457 women found no benefit and potential harm to the developing baby.
The overall findings suggest nutritional advice to women and balanced energy/protein supplements may be beneficial but that high-protein supplements for pregnant women and energy/protein restriction for overweight pregnant women may both be harmful.

Ancillary