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In Depth Tutorials and Information
Underweight mothers have an increased risk for a low-
birthweight baby, while overweight or obese mothers
have increased risk for gestational diabetes and hyper-
tension. Infants of overweight women are often larger
than normal, even if born prematurely.
In the first trimester, energy needs are not increased,
but do increase in the second and third trimesters. For
an overweight or obese woman, the goals of avoiding
excess weight gain while eating adequate kcalories may
require a specialized nutrition plan.
A pregnant woman needs to take in adequate car-
bohydrate to support fetal brain growth and spare the
protein needed to promote fetal growth. Protein needs
are increased as well; however, most women do not
need to increase their intake of protein from their pre-
pregnancy intake, as a typical western diet exceeds the
DRI for protein several-fold.
The essential fatty acids (omega 3 and omega 6 fatty
acids) are necessary for fetal brain development. Foods
rich in omega 6 fatty acids include leafy greens, seeds,
nuts, grains and vegetable oils. Foods rich in omega 3
fatty acids include canola and lax oil, walnuts, wheat
germ, soybeans and soy oil, and fatty cold water fishes
such as salmon, sardines and tuna. Women who are
pregnant or breastfeeding are recommended to avoid
eating fish that may be contaminated with mercury.
The highest levels are found in king mackerel, sword-
fish, tilefish and shark. Lists of fish that are likely to
contain low, moderate and high levels of mercury are
available.
28
Adequate intake of folate both before and during
pregnancy has been shown to decrease the risk of neu-
ral tube defects.
29
The need for iron is greatly increased
during pregnancy.
30
Meeting the increased need is dif-
ficult through food alone, so supplemental iron is gen-
erally needed. Most pregnant women benefit from
prenatal vitamins, but vitamins do not replace the need
to eat a nutritious diet.
Adequate intake of calcium is crucial, as the baby's
need for calcium during pregnancy and breastfeeding
may deplete the mother's bone density if her calcium
intake is insufficient.31
31
A woman should discuss with
her doctor whether calcium supplementation is needed.
mobility. Van Brussel et al. found that a physical train-
ing program for children with type I or IV OI signifi-
cantly improved the intervention group's peak oxygen
consumption; maximal workout capacity and muscle
force were improved after the 12-week program.
32
Individuals with OI may have significant barriers to
adequate physical activity. Muscle strength and exer-
cise tolerance may be reduced.
33
Bone pain may make
physical activity difficult. It is difficult for persons with
limited mobility and/or skeletal problems to participate
in aerobic or weight bearing activities. Accessibility
to gyms and pools may be difficult for persons using
assistive mobility devices. Overweight and obesity
can further limit mobility, and provide a psychological
deterrent to beginning an exercise program.
The OI Foundation has a fact sheet that addresses
exercise and activity
34
across the lifespan for individu-
als with OI. The key recommendations include physical
therapy starting in infancy to promote optimal align-
ment and positioning, as well as to improve delayed
motor skills and build strength and endurance.
Children and adults with OI benefit from swimming
and water play. Persons who are unable to walk on land
may be able to waterwalk, which provides resistance
and aerobic conditioning.
For persons with limited mobility, getting out of the
wheelchair and changing positions every 2 hours is
recommended to decrease stiffness and prevent skin
breakdown. High impact activities such as jumping or
contact sports should be avoided.
34
Persons with OI
may benefit from assistance from a physical therapist,
rehabilitation specialist or exercise specialist who is
familiar with adaptive exercise.
CONCLUSION
Although nutrition needs for persons with OI
have not been well studied, persons with OI will ben-
efit from eating an adequate, balanced and varied diet
based on nutrition recommendations for individuals
across the lifespan. As for all individuals, the nutrition
goals for persons with OI are to achieve optimal health
and participate fully in a physically and emotionally
satisfying life.
PHYSICAL ACTIVITY
References
[1] Chagas CA, et al. Do patients with osteogenesis imperfecta
need individualized nutrition support? Nutrition 2012;28(2):
138-42.
Exercise and physical activity are essential compo-
nents of energy balance and overall health. Persons
with OI are recommended to participate in physi-
cal activity as much as is safely possible. The benefits
of physical activity are numerous, including cardio-
vascular fitness, increased muscle tone and strength,
increased bone density, assistance achieving and main-
taining a healthy weight, and improving flexibility and
