Early pregnancy presents a critical window where nutrition can significantly influence fetal development, pregnancy outcomes, and long-term health for both mother and child.^1,2 Health care providers can educate patients on meeting increased energy and nutrient needs, because following a healthy dietary pattern before and during pregnancy is associated with improved outcomes, including healthier birth weights and developmental markers.^1,2

Importantly, intentional nutrition and lifestyle habits before conception, by both the future mother and father, can also influence fertility, early fetal development, and even the baby’s long-term health.¹ Emerging research highlights how preconception health status, including nutrient status and dietary patterns, plays a role in conception and early pregnancy outcomes.³

Despite the importance of nutrition during pregnancy, adherence to dietary guidelines is often below target, with many individuals falling short on key nutrients in early pregnancy.¹ These gaps can contribute to preventable complications and long-term health concerns if not addressed. Health care providers should incorporate evidence-based prenatal care to better support patients from preconception through early pregnancy.⁴

Core Nutrition Priorities

Early attention to both macronutrients and micronutrients is critical in supporting fetal development, reducing the risk of birth defects, and promoting a healthy pregnancy trajectory. Nutrient needs shift significantly during pregnancy, and health care providers play a key role in helping patients understand and meet these evolving requirements.

According to the Dietary Guidelines for Americans, calorie needs begin to increase in the second trimester (+340 kcal/day) and rise further in the third trimester (+452 kcal/day).¹ Lactation also increases needs: +330 to +400 kcal/day for the first and second six months, respectively. Protein requirements also increase from 0.8g/kg/day to 1.1g/kg/day to support fetal tissue growth and maternal changes.^1,5 These needs may be even higher for very active or athletic individuals, and personalized adjustments provided by healthcare providers based on body size and type of activity are necessary.

For many people, meeting their nutritional needs is not always straightforward. In early pregnancy, many individuals experience nausea, food aversions, and gastric reflux, common barriers that interfere with consistent and adequate intake.⁶ These symptoms could lead to reduced intake, increasing the risk of micronutrient shortfalls during a critical window of fetal development.⁶ To support their patients, providers should offer practical strategies to maximize nutrition when intake is limited, such as focusing on nutrient-dense small meals, timing nutritional supplements around symptoms, and integrating gentle protein and calorie boosts, such as ready-to-drink protein beverages, throughout the day.

Promoting Growth and a Healthy Pregnancy
Protein, B12, and Iron 

Key nutrients like protein, vitamin B12, and iron are essential during pregnancy to support maternal tissue growth, fetal development, and the significant increase in blood volume. Some studies indicate that current protein requirements are too low, and pregnant people actually need 1.22-1.52 g/kg/d.⁷ Iron needs rise sharply, and deficiency is common (about 50%), so routine monitoring and early intervention are critical.^1,8,9 B12 is crucial for neural development and red blood cell formation, and supplementation is essential for individuals following plant-based or vegan diets.^1,10 Healthcare providers can individualize recommendations for their clients given their dietary patterns and activity levels; personalized expert advice is key. 

Updated guidelines support meeting these needs through a combination of food and supplementation.^1,11 Iron-rich foods such as lentils, fortified cereals, meat/poultry/seafood, and B12 sources, including animal products (meat/poultry/seafood, dairy, eggs) or supplements for plant-based diets, should be prioritized. Increased protein needs can be met with both plant and animal foods, such as eggs, dairy, legumes, soy foods, meat/poultry/seafood, and protein powders.

Brain and Neurological Health
Folate, Choline, Omega-3’s, Fiber

Folate, choline, and omega-3 fatty acids are essential in the early stages of pregnancy to support neural tube closure and ongoing fetal brain development.^1,10 Health care providers should counsel patients on obtaining these nutrients through food and supplementation if needed, especially in the first trimester when critical development occurs.¹⁰ All prenatal vitamins should contain folate, and high-quality varieties will contain choline, but omega 3s may need to be supplemented separately because the amount required often isn’t offered within a single multivitamin. 

Dietary sources of folate and choline include leafy greens, beans/lentils, and peas.¹ Choline is also found in egg yolks and meat/seafood.¹ Omega 3 fatty acids are found in fatty fish, walnuts, chia, hemp, and flaxseeds.¹²

Emerging evidence also highlights the role of dietary fiber in neurological outcomes. A 2023 Japanese cohort study (N=76,000 mother-child pairs) found that low maternal fiber intake during pregnancy was associated with an increased risk of developmental delays in communication, fine motor skills, problem-solving, and personal-social domains by age three.¹³ Studies like these highlight the importance of a varied, fiber-rich diet during pregnancy, not just for digestive health, but potentially for neurodevelopmental outcomes.

Bone Health
Vitamin D and Calcium

Vitamin D and calcium are critical during pregnancy to support fetal bone development and protect maternal bone density.¹ As the fetus draws calcium for skeletal growth, the mother’s body adapts to absorb and supply more, making adequate intake critical throughout pregnancy. Calcium needs remain at 1,000 mg/day, and vitamin D needs remain at 600 IU/day for pregnant adults, yet studies show that intake of both nutrients is often below recommended levels.^1,10

Testing vitamin D levels during pregnancy can be useful, particularly if a deficiency is suspected or risk factors such as obesity, history of gastric bypass, limited sun exposure, etc, are present.¹⁴ Supplementation may be required to reach optimal levels and should be based on blood tests for correct dosing.¹⁰ Health care providers can encourage sources of calcium, such as dairy foods, fortified plant-based milks, leafy greens, and tofu, and sources of vitamin D from fatty fish, egg yolks, and UV-exposed mushrooms.^1,14

Key Nutrition Targets During Pregnancy
General recommendations per the Dietary Guidelines for Americans for pregnant adults on a 2,000 calorie diet^1,10,12,14
*all recommendations stay the same across trimesters 1-3 unless specifically listed

Macronutrients
Nutrient	Purpose in Pregnancy	Recommended Intake
Carbohydrates	The primary energy source for mother and fetus	175 g/day (45-65% kcal)
Fiber	Supports digestion; may play other roles in fetal neurodevelopment	Trimester 1: 28 g/day Trimester 1: 34 g/day Trimester 1: 36 g/day
Protein	Builds maternal and fetal tissues	71 g/day (10–35% kcal)
Total Lipids	Necessary for fetal brain development and hormone production	25–35% of total calories
Omega 3’s (ALA)	Critical for fetal brain and eye development and supports maternal cardiovascular health	1.4g/day
Micronutrients
Nutrient	Purpose in Pregnancy	Recommended Intake
Calcium	Builds fetal bones and teeth; preserves maternal bone health	1,000 mg/day
Choline	Supports fetal brain and spinal cord development	450 mg/day
Folate	Crucial for neural tube development and cell division	600 mcg DFE/day
Iron	Supports increased blood volume and fetal oxygen delivery	27 mg/day
Vitamin B12	Supports neural development and red blood cell formation	2.6 mcg/day
Vitamin D	Supports calcium absorption and fetal bone development	600 IU (15 mcg/day)



Takeaways for Healthcare Providers

Early, proactive nutrition support sets the foundation for healthier pregnancies and long-term outcomes. Studies have shown that nutrition education provided by trained healthcare professionals can increase pregnancy-specific nutrition knowledge, improve maternal dietary intake, and positively influence clinical outcomes, including reduced rates of maternal anemia, healthier gestational weight gain, gestational diabetes, and improved birthweight.⁴ When critical development is underway, healthcare providers can encourage clients to focus on nutrient-dense foods and targeted supplementation to address key nutrients early. 

References:

1. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020.
2. De Vito M, Alameddine S, Capannolo G, Mappa I, Gualtieri P, Di Renzo L, De Lorenzo A, D’Antonio F, Rizzo G. Systematic review and critical evaluation of quality of clinical practice guidelines on nutrition in pregnancy. InHealthcare. 2022;10(12)2490. MDPI.
3. Marshall NE, Abrams B, Barbour LA, et al. The importance of nutrition in pregnancy and lactation: lifelong consequences. American journal of obstetrics and gynecology. 2022;226(5):607-32.
4. Killeen SL, Geraghty AA, O’Brien EC, O’Reilly SL, Yelverton CA, McAuliffe FM. Addressing the gaps in nutritional care before and during pregnancy. Proceedings of the Nutrition Society. 2022;81(1):87-98.
5. Faizan U, Rouster AS. Nutrition and hydration requirements in children and adults. InStatPearls [Internet] 2023. StatPearls Publishing.
6. Dunbar K, Yadlapati R, Konda V. Heartburn, nausea, and vomiting during pregnancy. Journal of the American College of Gastroenterology.. 2022;117(10S):10-5.
7. Stephens TV, Payne M, Ball RO, Pencharz PB, Elango R. Protein requirements of healthy pregnant women during early and late gestation are higher than current recommendations. The Journal of Nutrition. 2015;145(1):73-8.
8. Cantor AG, Holmes R, Bougatsos C, Atchison C, DeLoughery T, Chou R. Screening and supplementation for iron deficiency and iron deficiency anemia during pregnancy: updated evidence report and systematic review for the US Preventive Services Task Force. Jama. 2024;332(11):914-28.
9. Benson AE, Lo JO, Caughey AB. Iron Deficiency and Iron Deficiency Anemia During Pregnancy—Opportunities to Optimize Perinatal Health and Health Equity. JAMA Netw Open. 2024;7(8):e2429151.
10. Adams JB, Kirby JK, Sorensen JC, Pollard EL, Audhya T. Evidence based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients. Maternal Health, Neonatology and Perinatology. 2022;8(1):4.
11. Office of Disease Prevention and Health Promotion. Nutrition During Pregnancy: Support a Healthy Mom and Baby. Published February 16, 2022. Accessed May 8, 2025. https://odphp.health.gov/news/202202/nutrition-during-pregnancy-support-healthy-mom-and-baby
12. National Institutes of Health Office of Dietary Supplements. Omega-3 Fatty Acids – Health Professional Fact Sheet. Updated December 17, 2024. Accessed May 9, 2025. https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/
13. Miyake K, Horiuchi S, Shinohara R, et al Japan Environment Children’s Study Group. Maternal dietary fiber intake during pregnancy and child development: the Japan Environment and Children’s Study. Front Nutr. 2023;10:1203669.
14. National Institutes of Health Office of Dietary Supplements. Vitamin D – Health Professional Fact Sheet. Updated July 26, 2024. Accessed May 10, 2025. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/