When it comes to prenatal care, nutrition is often reduced to a checklist: take a prenatal vitamin, avoid certain foods, and aim for steady weight gain. It’s pretty rare for conventional providers to approach prenatal nutrition from a proactive standpoint — one where prevention of pregnancy complications is front and center.

During pregnancy, nutrient demands shift dramatically to support fetal growth, placental development, and maternal physiological changes. Plus, many new symptoms can arise that affect food preferences and intake.

For these reasons (and more), nutritional assessment in pregnancy has some crucial differences when compared to assessments you apply to a non-pregnant population. If you’re a perinatal healthcare professional, I cannot overstate the importance of comprehensive nutritional assessment in pregnancy!

Unfortunately, many standard nutritional assessments fall short. They may overlook subtle deficiencies, fail to account for shifting physiological needs, not acknowledge different laboratory reference ranges (some can change by trimester), or sidestep important conversations about eating behaviors, mental health, and access to nutrient-dense foods.

A comprehensive prenatal nutrition assessment helps identify potential deficiencies early and guide targeted interventions, which ultimately may help reduce the risk of complications like preeclampsia, gestational diabetes, preterm birth, and potentially even postpartum mood disorders.

In this article, we’ll take a closer look at why nutritional assessment in pregnancy deserves more attention — and how a more individualized, thorough approach can improve outcomes for both mother and baby.

Why Nutritional Assessment in Pregnancy Deserves a Closer Look

Nutrient Needs Are Elevated and More Nuanced

Pregnancy isn’t just about “eating for two”; it’s about eating with intention to support fetal development, maternal tissue growth, and metabolic adaptations. The requirements of many key nutrients — like iron, folate, choline, vitamin D, vitamin B12, and iodine, just to name a few — increase during pregnancy. And the consequences of deficiency (or even suboptimal intake) can be significant.

A quality assessment goes beyond macronutrients and calories, or just telling your client to “take a prenatal.” It includes detailed questions about food quality, variety, supplementation, and dietary changes since conception. It also evaluates whether symptoms like food aversions, heartburn, nausea or vomiting are interfering with nutrient intake.

Weight Gain Requires a More Sensitive Approach

While pre-pregnancy BMI is still used to determine recommended gestational weight gain, we now know that weight is far from the full picture. Many pregnant people experience rapid or slow weight changes that don’t fit neatly into guideline boxes or prenatal weight gain grids. And for those with a history of weight stigma, disordered eating, or poor body image, weight monitoring can be triggering or even counterproductive.

A prenatal nutrition assessment needs to carefully approach the topic of expected weight changes over the course of gestation. Is the client comfortable with weigh-ins? Are they interested in discussing weight changes at all? How is their body image being impacted by pregnancy? These are important questions that help build trust and ensure recommendations are delivered with compassion. More on this topic here.

Biochemical Markers Must Be Interpreted in Context

Lab values shift during pregnancy due to hemodilution, increased nutrient demands, and hormonal changes. Just a few examples:

Ferritin levels naturally decline as plasma volume expands, but there is a point at which iron depletion needs to be considered. Multiple labs must be considered when determining whether a client is iron deficient or anemic (and which intervention is warranted).
Hemoglobin A1c becomes inaccurate beyond the first trimester due to hemodilution and more rapid turnover of red blood cells.
Standard reference ranges for some nutrients are not necessarily defined for different trimesters of pregnancy — and some research suggests they should be.
Thyroid function can fluctuate and requires trimester-specific reference ranges.

Relying on “normal” non-pregnant ranges — or skipping nutrient-related labs entirely — can lead to missed opportunities for early intervention.

Supplement Use Is Not Always Straightforward

Most pregnant clients take a prenatal vitamin, but that doesn’t guarantee they’re getting what they need. Some prenatals are poorly formulated or dosed. Others are missing key nutrients like choline and iodine. And in some cases, clients have discontinued or reduced their supplement use due to nausea, constipation, or taste aversions.

A thorough supplement assessment looks at what they’re taking, how much, how often, and for how long — and whether it’s truly meeting their needs. A comprehensive nutritional assessment would evaluate nutrient intake from food as well, so you’re targeting supplementation where they are falling short.

Lifestyle, Mental Health, and Food Access Matter More Than Ever

Stress, sleep, physical activity, mental health, and food security all play major roles in pregnancy outcomes — and each of these factors impacts nutritional status in direct and indirect ways. From elevated cortisol and emotional eating to difficulty affording nutrient-dense foods, these factors shape what and how women eat during pregnancy.

Yet they’re often left out of standard assessments, or clinicians simply don’t have the time within a conventional setting to dive into all of these areas.

Eating Behaviors and Relationship with Food Deserve Attention

Finally, it’s essential to explore a person’s relationship with food, both past and present. Disordered eating, history of dieting, cultural food beliefs, and trauma can all influence pregnancy eating habits and may affect how receptive someone is to nutritional counseling.

Asking the right questions (and creating a nonjudgmental environment for those answers) makes a world of difference.

Want a Clearer Framework for Nutrition Assessment During Pregnancy?

If you’ve made it this far, chances are this content resonates. Maybe you’re already working with pregnant clients — or you want to — and you’ve felt the gaps in your training. You’re not alone.

Even registered dietitians receive minimal education on pregnancy-specific nutritional assessment. That’s why additional, targeted training and professional mentorship can be so powerful.

To help bridge this gap, I’ve created a FREE on-demand webinar for healthcare professionals who want a clearer, more confident framework for prenatal nutrition assessment.

In this 90-minute webinar, you’ll learn:

How to adapt your nutrition assessment tools specifically for pregnancy
Which lab markers to prioritize — and key considerations when interpreting labs in pregnancy
The right questions to ask around diet, weight, supplements, and lifestyle
The most common nutrient gaps in pregnancy — and how to identify them
Why traditional assessment frameworks fall short in the prenatal setting

Whether you’re a dietitian, nurse, midwife, or another health practitioner, this training will give you actionable tools to enhance the care you provide. And for RDs, it’s pre-approved for 1.5 CEUs by the Commission on Dietetic Registration.

👉 Click here to access the free training — it’s 100% free and available on-demand, so you can watch it whenever it fits your schedule.

Ready to Deepen Your Expertise? Become a Specialist in Prenatal Nutrition

But a free webinar is just scratching the surface! If you’ve ever felt that your formal education didn’t fully prepare you to support pregnant clients nutritionally, you’re not alone.

Many practitioners, including registered dietitians, find that traditional training offers limited insight into the complexities of prenatal nutrition. Most of us (dietitians) only get 1-2 lectures in our entire undergraduate nutrition degree on prenatal nutrition. This gap can leave you feeling uncertain when addressing the unique needs of expecting mothers.

That’s exactly why I created the Institute for Prenatal Nutrition^® (IPN) — to bridge this gap. IPN offers a comprehensive mentorship program designed to elevate your clinical skills and confidence in prenatal nutrition.

IPN is ideal for healthcare professionals who:

Are currently working with — or aspire to work with — pregnant clients and seek to deepen their expertise
Want to specialize in pregnancy and postpartum nutrition
Feel their formal training didn’t equip them with the skills they need to assess, support, and nourish prenatal clients effectively
Are seeking a community of like-minded practitioners and ongoing mentorship

What sets IPN apart:

Evidence-Based Curriculum: Dive into current research that challenges conventional guidelines, focusing on nutrient-dense, real food approaches.
Comprehensive Topics: Explore subjects like pregnancy physiology, macronutrient and micronutrient requirements, management of pregnancy complications, lab assessments, supplementation, and more.
Interactive Learning: Engage in weekly live Q&A sessions, case studies, and assignments that promote practical application of the knowledge so you’re equipped to handle even the most complex cases.
Certification: Upon completion, earn the title of Specialist in Prenatal Nutrition (SPN), signaling your advanced expertise to clients and colleagues.

Inside IPN, we dive deep into the science and clinical application of prenatal nutrition, with a focus on real food, ancestral principles, and individualized care. It’s more than just knowledge — it’s about becoming the confident, trusted expert your clients need.

If you’re a health professional ready to specialize in this vital area and want structured mentorship along the way, learn more about IPN here. Make sure to join the waitlist to be notified of when we are accepting applications (enrollment opens once a year and space is limited).

Let me know in the comments if this article helped you think differently about nutritional assessment in pregnancy as well as whether you’ve noticed these gaps in your own training.

Until next time,
Lily

PS – If you’re looking for a practical deep dive into nutrient needs and foods to emphasize in pregnancy, Real Food for Pregnancy covers this in detail. It’s great whether you’re pregnant or if you’re a prenatal provider.

PPS – If you’re a Registered Dietitian looking for more CEU credits — I have two other opportunities that each can earn you a significant number of CEUs.

Two of my books are pre-approved by the Commission on Dietetic Registration. Earn 45.5 CEUs from Real Food for Pregnancy and 48.25 CEUs from Real Food for Fertility. Learn more HERE.

*Note: these activities expire in the spring of 2027, so take advantage now. I can’t guarantee CDR will continue to approve these activities (all self-study activities must be resubmitted every few years) or approve them for such a substantial number of CEUs in the future.