Calculating Total Energy For The Diet And Setting Safe Weight Gain Targets

In our practice we calculate an individual's energy requirement using the pre-pregnancy weight to calculate resting energy expenditure, using Schofield's formula (61), and a physical activity ratio of 1.6. To this we add 200kcal for the energy requirements for the third trimester. If we wish to induce a mild degree of negative energy balance we subtract 500 kcal from this calculated daily energy requirement to provide the total energy for the diet.

The American Diabetic Association (ADA) have endorsed dietary guidelines for diabetes in pregnancy (62) that are based on pre-pregnancy weights, see Table 7.3.

As previously mentioned, current American guidelines recommend a minimum weight gain of 7.0 kg for all obese (BMI>29 kg/m2) women, both diabetic (63) and non-diabetic (24). No equivalent weight or daily calorie guidelines exist for the UK. Our own unit limits weight gains in diabetic pregnancies to the bottom rather than the top of those recommended for average, overweight and obese women. For Type 2 diabetic women and those with GDM if the BMI is >34 kg/m2 we set no minimum weight gain. Ideally we like to achieve no overall weight gain in the overweight woman post partum and weight loss in the morbidly obese woman.

Table 7.3

Pre-pregnancy weight (% ideal body weight)

Daily calorie intake (kcal/kg)

<90%

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