An adequate supply of nutrients is probably the single most important environmental factor affecting pregnancy outcome. Women with early or closely spaced pregnancies are at increased risk of entering a reproductive cycle with reduced reserves. Maternal nutrient depletion may contribute to the increased incidence of preterm births and fetal growth retardation among these women as well as the increased risk of maternal mortality and morbidity. In the past, it was assumed that the fetus functioned as a parasite and withdrew its nutritional needs from maternal tissues. Studies in both animals and humans demonstrate, however, that if the maternal nutrient supply is inadequate, the delicate balance between maternal and fetal needs is disturbed and a state of biological competition exists. Furthermore, maternal nutritional status at conception influences how nutrients are partitioned between the mother and fetal dyad. In severe deficiencies maternal nutrition is given preference; in a marginal state the fetal compartment is favored. Although the studies of nutrient partitioning have focused on energy and protein, the partitioning of micronutrients may also be influenced by the maternal nutritional status. Marginal intakes of iron and folic acid during the reproductive period induce a poor maternal status for these nutrients during the interpregnancy interval. Poor iron and folic acid status has also been linked to preterm births and fetal growth retardation. Supplementation with food and micronutrients during the interpregnancy period may improve pregnancy outcomes and maternal health among women with early or closely spaced pregnancies.

Zinc is essential for multiple aspects of metabolism. Physiologic signs of zinc depletion are linked with diverse biochemical functions rather than w

▪ Abstract About one third of all pregnant women in the United States are obese. Maternal obesity at conception alters gestational metabolic adjustments and affects placental, embryonic, and fetal growth and development. Neural tube defects and other developmental anomalies are more common in infants born to obese women; these defects have been linked to poor glycemic control. Preeclampsia, a gestational disorder occurring more frequently in obese women, appears to be due to a subclinical inflammatory state that impairs early placentation and development of its blood supply. Fetal growth and development during the last half of pregnancy depends on maternal metabolic adjustments dictated by placental hormones and the subsequent oxygen and nutrient supply. Maternal obesity affects these metabolic adjustments as well. Basal metabolic rates are significantly higher in obese women, and maternal fat gain is lower, possibly in response to altered leptin function. The usual increase in insulin resistance seen in late pregnancy is enhanced in obese mothers, causing marked postprandial increases in glucose, lipids, and amino acids and excessive fetal exposure to fuel sources, which in turn increases fetal size, fat stores, and risk for disease postnatally. Impaired glucose tolerance, gestational diabetes, and hyperlipidemia are more common among obese mothers. To date, little attention has been given to the role of diet among obese women in preventing these problems. However, studies of women with impaired glucose tolerance show that replacing refined carbohydrates and saturated fat with complex, low-glycemic carbohydrates and polyunsaturated fatty acids improves metabolic homeostasis and pregnancy outcomes. Thus, current dietary guidelines regarding the amount and type of carbohydrates and fat for nonpregnant women seem appropriate for pregnant women as well.

Nuts have been part of the diet for thousands of years. In 2003, a Qualified Health Claim was approved, stating that eating 1.5 oz (42 g) of nuts per day may reduce the risk of heart disease. Usual intakes fall short of this recommendation. About one-third of Americans report consuming nuts (tree nuts or peanuts) on any one day. Seven percent of Europeans report eating nuts, but the amount eaten by European nut consumers (31 g/d) is larger than that of Americans (21 g/d). Nuts are an excellent source of vitamin E and magnesium. Individuals consuming nuts also have higher intakes of folate, β-carotene, vitamin K, lutein+zeaxanthin, phosphorus, copper, selenium, potassium, and zinc per 1000 kcal. Regular nut consumption increases total energy intake by 250 kcal/d (1.05 MJ/d), but the body weight of nut consumers is not greater than that of nonconsumers. Nuts are an excellent source of phytochemicals (phyotsterols, phenolic acids, flavonoids, stilbenes, and carotenoids). The total phenolic constituents probably contribute to the total antioxidant capacity of nuts, which is comparable to broccoli and tomatoes. To improve guidance on the use of nuts in the diet, the position of nuts in typical food patterns needs to be addressed. The 2005 MyPyramid includes nuts in the meat and beans group. Yet, nuts are rarely consumed as meat substitutes. Because ∼60% of the nuts consumed in the U.S. are eaten as snacks, emphasizing their use as a healthy snack may be more effective than inclusion within a food group.

The white potato is a concentrated source of carbohydrate, dietary fiber, and resistant starch and continues to be the staple food of choice for many cultures. The white potato is also a concentrated source of vitamin C and potassium. Two of the nutrients in white potatoes, dietary fiber and potassium, have been designated as nutrients of concern in the 2010 Dietary Guidelines for Americans. Potatoes are often maligned in nutrition circles because of their suspected link to obesity, and popular potato foods often contain more fat calories than carbohydrate calories. Some food guides do not include potatoes in the vegetable group because of their association with high-fat diets. However, potatoes should be included in the vegetable group because they contribute critical nutrients. All white vegetables, including white potatoes, provide nutrients needed in the diet and deserve a prominent position in food guides.

Population, human, animal, tissue, and molecular studies show collectively and consistently that maternal nutrition in the pre- or periconception peri