Energy expenditure during pregnancy: a systematic review.

Context: Contrary to nutritional guidelines, accumulating evidence shows that pregnant women's energy intakes remain stable throughout trimesters. Although pregnant women may eat below their needs or underreport their energy intakes, it is also relevant to question how energy requirements - estimated through measurements of energy expenditure (EE) - change throughout pregnancy.

Objective: This review examined prospective studies that measured EE during pregnancy, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data Sources: PubMed/MEDLINE, Web of Science, Embase, and CINAHL databases were searched to identify relevant publications up to November 14, 2019.

Study Selection: All studies that measured EE prospectively and objectively during pregnancy were included in this systematic review. Two authors independently screened 4852 references. A total of 32 studies were included in the final analysis.

Data Extraction: One author extracted data and assessed the risk of bias and a second author did so for a random sample of studies (n = 7; 22%).

Data Analysis: Increases in resting EE ranged from 0.5% to 18.3% (8-239 kcal), from 3.0% to 24.1% (45-327 kcal), and from 6.4% to 29.6% (93-416 kcal) between early and mid-, mid- and late, and early and late pregnancy, respectively. Increases in total EE ranged from 4.0% to 17.7% (84-363 kcal), from 0.2% to 30.2% (5-694 kcal), and from 7.9% to 33.2% (179-682 kcal) between early and mid-, mid- and late, and early and late pregnancy, respectively. Participants were mainly of normal weight, although many studies did not report important covariates such as prepregnancy body mass index and gestational weight gain adequacy.

Conclusions: Additional high-quality longitudinal studies (ie, with multiple objective measurements of EE in all periods of pregnancy while considering important confounding variables, like gestational weight gain) are required.