Energy expenditure during pregnancy: a systematic review (original) (raw)
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Longitudinal assessment of energy balance in well-nourished, pregnant women
The American journal of clinical nutrition, 1999
Clinicians often recommend an additional energy intake of 1250 kJ/d to their pregnant patients. Previous studies have shown considerable variation in the metabolic response to pregnancy and thus in the additional energy required to support a pregnancy. The purpose of this study was to assess how well-nourished women meet the energy demands of pregnancy and to identify factors that predict an individual's metabolic response. Resting metabolic rate (RMR), diet-induced thermogenesis (DIT), total energy expenditure (TEE), activity energy expenditure (AEE), energy intake (EI), and body fat mass (FM) were measured longitudinally in 10 women preconception; at 8-10, 24-26, and 34-36 wk of gestation; and 4-6 wk postpartum. Compared with preconception values, individual RMRs increased from 456 to 3389 kJ/d by late pregnancy. DIT varied from -266 to 110 kJ/meal, TEE from -105 to 3421 kJ/d, AEE from -2301 to 2929 kJ/d, EI from -259 to 2176 kJ/d, and FM from a 0.6-kg loss to a 10.6-kg gain. ...
Energy requirements during pregnancy based on total energy expenditure and energy deposition
The American Journal of Clinical Nutrition, 2004
Background: Energy requirements during pregnancy remain controversial because of uncertainties regarding maternal fat deposition and reductions in physical activity. Objective: This study was designed to estimate the energy requirements of healthy underweight, normal-weight, and overweight pregnant women and to explore energetic adaptations to pregnancy. Design: The energy requirements of 63 women [17 with a low body mass index (BMI; in kg/m 2), 34 with a normal BMI, and 12 with a high BMI] were estimated at 0, 9, 22, and 36 wk of pregnancy and at 27 wk postpartum. Basal metabolic rate (BMR) was measured by calorimetry, total energy expenditure (TEE) by doubly labeled water, and activity energy expenditure (AEE) as TEE Ҁ BMR. Energy deposition was calculated from changes in body protein and fat. Energy requirements equaled the sum of TEE and energy deposition. Results: BMR increased gradually throughout pregnancy at a mean (ȀSD) rate of 10.7 Ȁ 5.4 kcal/gestational week, whereas TEE increased by 5.2 Ȁ 12.8 kcal/gestational week, which indicated a slight decrease in AEE. Energy costs of pregnancy depended on BMI group. Although total protein deposition did not differ significantly by BMI group (mean for the 3 groups: 611 g protein), FM deposition did (5.3, 4.6, and 8.4 kg FM in the low-, normal-, and high-BMI groups; P ҃ 0.02). Thus, energy costs differed significantly by BMI group (P ҃ 0.02). In the normal-BMI group, energy requirements increased negligibly in the first trimester, by 350 kcal/d in the second trimester, and by 500 kcal/d in the third trimester. Conclusion: Extra energy intake is required by healthy pregnant women to support adequate gestational weight gain and increases in BMR, which are not totally offset by reductions in AEE.
Longitudinal assessment of energy expenditure in pregnancy by the doubly labeled water method
The American journal of clinical nutrition, 1993
Twelve women were studied before pregnancy and at 6-wk intervals from 6 to 36 wk gestation. Total energy expenditure (TEE) by the doubly labeled water method, basal metabolic rate (BMR), energy intake, and body composition were assessed on each occasion. There was substantial interindividual variation in the response to pregnancy. Mean total energy costs were as follows: delta BMR 112 +/- 104 MJ (range -53 to 273), delta TEE 243 +/- 279 MJ (range -61 to 869 MJ), and fat deposition 132 +/- 127 MJ (range -99 to 280 MJ). The mean total cost of pregnancy (cumulative TEE above baseline+energy deposited as fat and as products of conception) was 418 +/- 348 MJ (range 34-1192 MJ). This was much higher than current recommendations for incremental energy intakes. Self-recorded incremental intakes (208 +/- 272 MJ) seriously underestimated the additional costs. The variability in response emphasizes the problems in making prescriptive recommendations for individual women, because there is no wa...
The Impact of Maternal Nutrition on the Offspring, 2005
Energy requirements as defined in the 1985 FAO/WHO/UNU report on Energy and Protein Requirements [1] should support a body size and composition and level of energy expenditure (EE) consistent with good health, and allow for economically necessary and socially desirable physical activity. In pregnancy, extra energy is needed to cover the costs of maternal and fetal tissue accretion, and the rise in EE attributable to basal metabolism and physical activity. Because of uncertainties regarding desirable gestational weight gain (GWG), maternal fat deposition, putative reductions in physical activity and energetic adaptations to pregnancy, controversy remains regarding energy requirements during pregnancy [2]. Dietary energy studies imply that the incremental needs of pregnancy are relatively low. Calorimetric studies have demonstrated energetic adaptations to pregnancy via suppression of basal metabolism and reduction in physical activity. Energy requirements during pregnancy have been based on immediate infant and maternal outcomes; the long-term consequences of inadequate and excess maternal energy intake on fetal growth and development are just now being recognized. The objectives of this chapter are to review: (1) energy requirements during pregnancy; (2) energetic adaptations to pregnancy, and (3) consequences of deviations from maternal energy requirement on fetal outcome.
Current developments in nutrition, 2019
Objectives: Resting energy expenditure (REE) comprises 60% of total energy expenditure and variations may be associated with gestational weight gain (GWG). There is a paucity of research investigating the relationship between REE and GWG. We investigated variations in REE and dietary composition throughout the second trimester and their association with GWG. Methods: In this controlled trial, pregnant women (N = 16, mean age of 29.9 ± 4.3 years) with a gestational age < 17 weeks used the Breezing TM device for 13 weeks. This device is a real-time metabolism tracker that measures REE via indirect calorimetry. Height, weight, REE, and dietary intake via 24-hr recall were assessed every 2 weeks. Rate of GWG was calculated as weight gain divided by number of study weeks. Early (EC, GA wks 14-21), late (LC, GA wks 21-28), and overall (OC, GA wks 14-28) changes in macronutrient composition, REE, and GWG were used to evaluate time-specific associations.
Energy requirements during pregnancy and lactation
Public Health Nutrition, 2005
ObjectiveTo estimate the energy requirements of pregnant and lactating women consistent with optimal pregnancy outcome and adequate milk production.DesignTotal energy cost of pregnancy was estimated using the factorial approach from pregnancy-induced increments in basal metabolic rate measured by respiratory calorimetry or from increments in total energy expenditure measured by the doubly labelled water method, plus energy deposition attributed to protein and fat accretion during pregnancy.SettingDatabase on changes in basal metabolic rate and total energy expenditure during pregnancy, and increments in protein based on measurements of total body potassium, and fat derived from multi-compartment body composition models was compiled. Energy requirements during lactation were derived from rates of milk production, energy density of human milk, and energy mobilisation from tissues.SubjectsHealthy pregnant and lactating women.ResultsThe estimated total cost of pregnancy for women with a...
Body composition and energy metabolism in pregnancy
The Australian and New Zealand Journal of Obstetrics and Gynaecology, 2001
The objective of the study was to measure energy metabolism and body composition during pregnancy and postpartum, compared to non-pregnant women, using non-invasive techniques. A longitudinal study of eight normotensive pregnant women was carried out at 19 k 1 and 36 k 1 weeks gestation, and postpartum. A cross-sectional study was also performed comparing postpartum to 12 nonpregnant women. Indirect calorimetry was performed while fasting to measure basal metabolic rate (BMR) and postprandially to measure diet-induced thermogenesis (DIT). Body composition consists of fat mass, lean body mass (LBM), and total body water (TBW) and was measured by bio-electrical impedance. Insulin resistance was indirectly assessed by glucose and insulin concentration and DIT. Weight gain in pregnancy was predominantly fat mass (p < O.Ol), but LBM and TBW also increased (p < 0.01). Weight loss postpartum was comprised of fat mass, LBM and TBW (p < 0.01). BMR, glucose and insulin increased in pregnancy and decreased postpartum (p < 0.05), but DIT was unchanged. The BMR was not correlated with weight gain. Apart from fat mass, postpartum and non-pregnant women were similar. The insulin resistance increased insulin and glucose levels but not DIT. Fat mass was the major component of weight gain during pregnancy and there was an increase in BMR, glucose and insulin but no change in DIT. BMR decreased to normal but fat mass remained elevated 16 weeks post-partum.
The American Journal of Clinical Nutrition, 1994
To investigate changes in energy metabolism during pregnancy, complete 8-d energy balances were measured before pregnancy and at 12, 23, and 34 wk gestation in I 2 healthy Dutch women. While for each individual woman experimental diets were kept constant throughout the study with average intakes of 8.76 ± 0.92 MI/d (before pregnancy), 8.72 ± 1 .08 Mit d (week 12), 8.85 ± 0.93 MItd (week 23), and 8.72 ± 1.12 MIt d (week 34), neither the digestibility nor the metabolizability of the supplied diets showed significant changes from before pregnancy (92.8% and 88.6%, respectively) throughout pregnancy (92.7% and 88.2%, respectively). Twenty-four-hour energy cxpenditure (24-h EE) increased significantly from 8.63 ± 0.80 Mit d (before pregnancy) to 8.73 ± 1. I 5, 9.08 ± I .08, and 9.94 ± 0.94 Mltd in weeks 12, 23, and 34 of gestation, to the extent predictable from changes in resting metabolic rate so that in an experimental setting with physical activity and energy intake standardized there seems little scope for other adaptive mechanisms.