Adolescent Pregnancies and the Importance of Nutrition Education

Megan Hovey
The Sage Colleges

Introduction
Throughout a womans pregnancy nutrition is particularly important. Pregnant women

with poor nutritional status can have undesired outcomes such as prolonged labor, low birth
weight, and hemorrhage at delivery. If the developing fetus is unable to receive ideal nutrients
from its undernourished host the babys growth can be restricted (Mahan & Raymond, 2017).
Undernutrition is a great concern for women during their pregnancy, but is even more of a
concern for adolescent pregnancies.
In the United States the incidence of teen pregnancies has reduced due to public
health initiatives, yet still remains a concern today. In some low-income minority groups teen
pregnancies continue as a major problem. A few risk factors for poor outcomes in pregnant
adolescents are young maternal age, poor nutrition, obesity, poverty, lack of social support,
unstable housing, and lack of access to age-appropriate prenatal care (Mahan & Raymond,
2017).
Too often than not adolescents enter pregnancy with poor nutritional status, such as low
levels of calcium, folic acid and vitamin D. Studies also show that there are many undesirable
outcomes of obese and overweight adolescents that become pregnant. Adolescents that become
pregnant often gain excessive amounts of weight due to lack of knowledge and education on
nutrition (Mahan & Raymond, 2017). It is absolutely necessary to have improved dietary
practices for adolescents that are pregnant.
Vitamin D Metabolites in Adolescent Pregnancies
Vitamin D is essential in ones diet, especially during pregnancy. It is essential for
optimal calcium homeostasis, immune function, and growth and development. Reproductive
Sciences published a study that an estimated 21-50% of pregnancies are deficient in vitamin D
(Finkelstein, Pressman, Cooper, Kent, Bar & OBrien, 2015). In this study the role of vitamin D
was examined in metabolomic profiles in a group of 30 African American pregnant adolescents

(13-18 years old) at midgestation (12-30 weeks). The 30 participants were split into 2 groups
15 adolescents with 25-hydroxy vitamin D (25(OH)D)>20 ng/mL and 15 adolescents with
25(OH)D<20 ng/mL. Each subject in this study was prescribed prenatal supplements containing
27 mg of iron and 400 ug of folate as part of prenatal care. Vitamin D status was evaluated at
midgestation (about 27 weeks) based on serum concentrations of 25 (OH)D. The status for the
adolescents vitamin D levels were categorized as insufficient if 25 (OH)D was <20 ng/mL or
sufficient if 25 (OH)D was >20 ng/mL. All participants were found to be vitamin D deficient
and were provided with an additional 400 IU of vitamin D that was to be taken once per day
throughout the remainder of their pregnancy (Finkelstein et al., 2015).
Sixteen metabolites were different (P< .20) between the high and low vitamin D groups
11 of the 16 metabolites remained significantly different (P< .05). Vitamin D sufficiency was
associated with higher bilirubin (an antioxidant) and pyridoxate (an oxidase enzyme involved in
vitamin B6 metabolism). Participants with higher vitamin D status were also associated with
higher concentrations of cholate, which is involved in feedback regulation of bile acid synthesis.
Lastly xylose concentrations were higher in groups with higher vitamin D status xylose is
associated with gut microbiome metabolism (Finkelstein et al., 2015).
The study discovered that lower maternal vitamin D status at midgestation impacted
serum metabolic profiles in pregnant adolescents. Lower maternal vitamin D status (<20 ng/mL)
was associated with lower bilirubin, xylose, cholate and pyridoxate. Also, lower maternal
vitamin D status was linked with increased biochemical parameters related to inflammation,
oxidative stress, fatty acid oxidation, and altered gut microbiome. To conclude, this study found
that maternal 25(OH)D status significantly influenced serum metabolic profiles in a group of
pregnant adolescents. This study states that future work is needed to examine metabolic

pathways linked to potential alterations in metabolites for the benefit of identifying implications
for maternal and neonatal health outcomes (Finkelstein et al., 2015).
Sensible Eating in Pregnant Adolescents
As an adolescent there is less parental supervision on food choices and often times a
decrease in physical activity. With these factors combined, weight gain is often the result as
eating and activity behavior changes occur. Excess body fat during pregnancy can be a risk
factor for poor pregnancy outcomes. There are many interventions that are aimed at preventing
excess body fat in young women that can be a large factor in weight gain during pregnancy
(Todd, Street, Ziviani, Byrne & Hills, 2015). This article suggests many approaches to help with
pregnant adolescents that are at risk for obesity.
Food preparation and food choice are two key focuses on educating adolescents on
nutrition. Support, education, and opportunity at home and at school, are often associated with
the success of lifestyle interventions, and may enable adolescents to make positive choices, and
engage in health promoting behaviors during adolescence and childbearing years (Todd et al.,
2015, p. 2306). As published in International Journal of Environmental Research and Public
Health the authors state that there needs to be an understanding of the connection between
female adolescent development, weight gain, and undesirable pregnancy outcomes to improve
the health of future generations. Because adolescents are at higher risk for weight gain a lifestyle
intervention during the adolescent period can have a positive influence on lifelong health. The
adolescents risk of obesity would be modified by the education of sensible eating and physical
activity (Todd et al., 2015).
Adolescents, in most cases, are taking responsibility for their food choices as parental
supervision decreases. Greater control over dietary choice is the potential for changes in food

preference driven by lifestyle, hormonal, social or environmental alterations (Todd et al., 2015,
p.2310). Additionally, physical activity for female adolescents is decreased during this time.
Achieving physical activity through the childbearing years can decrease excess weight gain
(Todd et al., 2015).
Nurturing healthy behaviors during adolescent years can increase the potential for healthy
habits further along in life, including pregnancy. Sensible eating is encouraged for adolescents,
and dieting is discouraged as it aids in restraining specific foods. As an adolescents body
undergoes physical and metabolic changes, including a period of decreased insulin sensitivity,
healthy eating is paramount to ensure excess body fat does not accumulate, aggravate insulin
resistance, and predispose to a sub-optimal environment for fetal development, should the
woman become pregnant (Todd et al., 2015, p. 2316). Adopting a healthy eating lifestyle can
reduce obesity risk in adolescents.
Intervention to Improve Nutrition, Physical Activity & Knowledge
Ethnic minority youth have higher rates of adolescent pregnancy, and additionally
adolescent pregnancy rates remain higher in the United States compared to other industrialized
nations. African American adolescent pregnancies doubles that of Caucasian adolescents, and
triples for Hispanic adolescents. According to an article published by National Institute of
Health, adolescent mothers are more likely to gain an excessive amount of weight during
pregnancy compared to adult pregnancies (over 40 pounds). The authors further state that
adolescent mothers after delivery are still likely to gain weight without the proper education
(Davis, Gallagher, Taylor, Canter, Gillette, Wambach & Nelson, 2013). Literature does indicate
that the nutrition education programs can have an impact with regard to weight loss among lowincome adults mothers (Davis et al., 2013, p.2). Additionally, studies show that weight loss

interventions may help reduce perceived barriers to healthy eating for low-income mothers
(Davis et al., 2013).
In this study the participants were teen mothers that were receiving services from a
family support program, which was funded by various federal grants such as Head Start. The
program provided low-income families with direct services through partnerships with other local
agencies. Expecting adolescent mothers were offered to be a part of the one-year intervention
study. Both a knowledge assessment and health behavior survey were completed at the first
visit. Expecting mothers received 6 in home intervention sessions focused on physical activity
and nutrition over the span of 2 to 3 months (Davis et al., 2013).
Health information related to food (such as reading nutrition labels and preparing healthy
meals), exercise, and behavioral topics (such as social support and goal tracking) were some
topics taught by the educator. Health Knowledge was the first measure that was studied
expecting mothers completed a pre-intervention and post-intervention questionnaire. Health
Behaviors and Height and Weight were the remaining measures that were studied. As a result,
adolescent mothers demonstrated significant increases in knowledge about healthy nutrition and
physical activity practices (p< .01). Adolescent mothers reported a significant increase in the
amount of exercise throughout the intervention (p< .02). Lastly, the participants successfully
decreased their BMI, on average, from 27.36 to 26.98 (Davis et al., 2013).
Discussion
There is a commonality between these articles that there is a decrease in knowledge
between dietary intake and adolescent pregnancy. It is possible to tailor a diet and lifestyle
intervention or program that is targeted to adolescent pregnant women. These interventions can
provide adolescents with nutrition education and can help reduce weight in adolescents by

making lifestyle changes. Therefore, interventions that target healthy lifestyle behaviors in
adolescence hold promise for reducing the risk of pregnancy-related complications (Todd et al.,
2015, p.2318). According to the study published in National Institute of Health brief in-home
education focused interventions for pregnant adolescents prove to be successful (Davis et al.,
2013). A low-cost at-home intervention may be an outstanding way to improve nutrition and
physical activity knowledge among adolescents. The ideal management for pregnancy-related
health outcomes will be prevention.
There are various nutrient needs for a pregnant adolescent, and vitamin D is one of them.
Vitamin D is extremely important in the development of the fetal immune system.
Observational studies have linked low maternal vitamin D status with an increased risk of
health outcomes for the mother, fetus, and infant, including preterm birth, preeclampsia,
infection, gestational diabetes, and obstructed labor (F, 2015, p.685). Additionally, vitamin D
deficiency has been linked to stunting, deficits in neurocognitive development, asthma, and
infectious disease (Finkelstein et al., 2015). Part of the nutrition education for pregnant
adolescents can also educate mothers on correct amounts of vitamins and minerals to take, or
increase, throughout their pregnancy.
Medical Nutrition Therapy
According to Krauses Food and the Nutrition Care Process more energy is needed
throughout pregnancy to support the metabolic demands of pregnancy and fetal growth. Energy
needs increase 340 kcal/day during the second trimester and 452 kcal/day during the third
trimester. There are additional needs for protein intake to support the production of maternal and
fetal tissues, which increases throughout gestation. Requirements for protein increase in the
second half of pregnancy to 1.1 gm/kg/day. Poor fetal growth can be a result if there was a

protein deficit during pregnancy. Additionally, protein is used in the production of hormones and
neurotransmitters (Mahan & Raymond, 2017).
The RDA for dietary folate equivalents increases to support maternal erythropoiesis,
DNA synthesis, and fetal and placental growth (Mahan & Raymond, 2017, p.256). Preterm
birth, low birth weight, and miscarriages can be associated to low folate levels. Folic acid plays
an even larger role in adolescent pregnancies because more than half of all U.S. pregnancies are
unplanned. The neural tube closes by 28 days after conception this is before most women,
especially adolescents, realize they are pregnant. The DRI for pregnant women 18 years and
younger is 600 mcg/day of folic acid (Mahan & Raymond, 2017).
The DRI for calcium intake for adolescents that are pregnant is 1,300 mg/d due to
hormonal factors influencing calcium metabolism in pregnancy. Absorption of calcium across
the gut doubles throughout gestation. As the fetus grows, there is a continual need for calcium
retention in order to meet fetal skeletal demands for mineralization. Calcium plays many roles
such as blood clotting, regulating uterine contractions, intracellular proteolysis, and bone
formation (Mahan & Raymond, 2017). Weight gain for adolescent pregnancies is no different
than adult pregnancies. Individuals with a BMI that is considered underweight are
recommended to gain 28-40 lbs., normal weight to gain 25-35 lbs., overweight to gain 15-25 lbs.,
and lastly obese to gain 11-20 lbs. (Mahan & Raymond, 2017).
Krauses Food and the Nutrition Care Process states In counseling young mothers, the
nutrition professional must be aware of the teens psychosocial and literacy skills, her economic
status and level of independence, as well as her culture environment, all of which may influence
her food choices (Mahan & Raymond, 2017, p.265). Due to the risks of an undernourished
fetus, it is imperative to advise a pregnant adolescent the benefits of a healthy nutritious diet.

Medical Nutrition Therapy (MNT) has been successful in improving gestational weight gain,
reducing the risk of anemia in late pregnancy, lowering the risk of preterm babies, and most
importantly has been successful in improving the maternal diet. Pregnant adolescents are given
guidelines to appropriate weight gains as well as appropriate nutrient intakes (Mahan &
Raymond, 2017).
Conclusion
Birth rates for females 15-19 years of age have declined over the past decade or so, yet
adolescent pregnancy remains a public health issue. Because of adolescents increased nutrient
needs during pregnancy, they are at high risk for nutritional deficiencies. Pregnant adolescents
require additional iron, zinc, folic acid, calcium and vitamin D. It is imperative that adolescents
that are pregnant to have a full nutrition assessment done as early in the pregnancy as possible to
establish if there are any nutrient deficiencies and also to encourage healthy weight gain (Mahan
& Raymond, 2017). To conclude, health education and interventions targeting pregnant
adolescents are a necessity to protect both the mother and the fetus.

References
Davis, A.M., Gallagher, K., Taylor, M., Canter, K., Gillette, M.D., Wambach, K., & Nelson, E.
(2013). An in-home intervention to improve nutrition, physical activity and knowledge

among low-income teen mothers and their children; results from a pilot study. National
Institute of Public Health, 34(8), 1-13. doi:10.1097/DBP.0b013e3182a509df
Finkelstein, J.L., Pressman, E.K., Cooper, E.M., Kent, T.R., Bar, H.Y., & OBrien, K.O. (2015).
Vitamin D status affects serum metabolomic profiles in pregnant adolescents.
Reproductive Sciences, 22(6), 685-695.
Mahan, L. K. & Raymond, J. L. (2017). Krause's food & the nutrition care process (14th ed.). St.
Louis, MO: Elsevier.
Todd, A.S., Street, S.J., Ziviani, J., Byrne, N.M., & Hills, A.P. (2015). Overweight and obese
adolescent girls: the importance of promoting sensible eating and activity behaviors from
the start of adolescent period. International Journal of Environmental Research and
Public Health, 22, 2306-2329. www.mdpi.com/journal/ijerph

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