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An Update on Water Needs during Pregnancy and Beyond
Kristen S. Montgomery, PhD, RN
Adequate water intake is essential to maintaining life.
is a postdoctoral research fellow
Pregnant and breastfeeding women should be encour-
in the School of Nursing at the University of Michigan in
aged to increase their intake of water and other fluids to
Ann Arbor, Michigan.
meet their bodies’ needs. Infants do not need additional
water; breast milk or formula contributes adequate
amounts of water to their diet.
Journal of Perinatal Education, 11(3), 40–42; preg-
nancy, nutrition, water.
An essential element of life, water constitutes 55%–65%
of a person’s body weight, making it the most common
element in the body (Winson, 2001). Water needs to be
taken in throughout the day because the body cannot
produce enough on its own (Dudek, 2001). Intake of
fluids should approximately equal output. Adults lose
between 1450 to 2800 ml each day from insensible (im-
measurable) and sensible (measurable) losses (Dudek,
2001). Insensible water losses include evaporation from
the skin and exhalation. Sensible water losses include
urine and stool excretions. Water losses are approxi-
mately equal between insensible and sensible.
Water needs can be calculated based on food con-
sumption. Individuals generally need 1–1.5 ml of water
for each calorie consumed (e.g., a person eating a 2000-
Water needs to be taken in throughout the day because
the body cannot produce enough on its own.
40 The Journal of Perinatal Education Vol. 11, No. 3, 2002
calorie diet would need 2000–3000 ml of fluid each day) cerns about water safety and possible contamination can
be addressed via the Environmental Protection Agency(Dudek, 2001). Most pregnant women are advised to
increase their caloric consumption by about 300 calories, safe drinking water hotline at 1-800-426-4791.
Contamination can be avoided with the use of bottledbeginning in the second trimester (Dudek, 2001). There-
fore, they would need at least 300 ml of additional fluid water. Currently, about 700 different brands of bottled
water are available in the United States. Bottled waterintake.
The small intestine absorbs 85%–90% of water intake is regulated by the Food and Drug Administration for
water quality and accurate labeling (Dudek, 2001). Dif-(Wardlaw, 2000). Most of the remaining water is ab-
sorbed in the large intestine. Adequate water intake is ferent types of bottled water are identified in the Table.
necessary for optimal absorption of water-soluble vita-
mins, which include ascorbic acid, nicotinic acid, ribofla-
(thiamine), and B
General fluid needs increase during pregnancy in order
to support fetal circulation, amniotic fluid, and a higher
blood volume. The current recommendation for water
Adequate water intake is necessary for optimal
intake is drinking 8–10 glasses of water each day. In
absorption of water-soluble vitamins.
addition to maintaining fluid volume needs, most mun-
icipal water contains fluoride, which can aid the de-
velopment of teeth and bones in the growing fetus
Water carries out several additional functions within
(Henderson & Lenders, 1999). However, pregnant
the body: It provides shape and structure to cells; regu-
women must be cautioned that some water is tainted
lates body temperature; aids digestion and the absorp-
with lead, which can result in spontaneous abortion,
tion of nutrients; transports nutrients and oxygen to
decreased stature, and deficiency in the neurodevelop-
cells; acts as a solvent for vitamins, minerals, glucose,
ment of the growing fetus (Henderson & Lenders, 1999).
and amino acids; provides a foundation for chemical
Water contamination can be of particular concern in the
reactions; eliminates waste products; and is a major com-
ponent of mucus and other lubricating fluids (Dudek,
Table Types of Bottled Water
Artesian Water that comes from a confined aquifer (rock
Sources of Water
formation); water levels stand higher than the
natural water table.
Surface water and groundwater are the two main sources
Mineral Water that contains no less than 250 ppm* of total
of water (Whitney & Rolfes, 2002). Most major cities
dissolved solid minerals. These minerals are
obtain water from surface sources, which include lakes,
naturally present (not added). ‘‘Low’’ mineral
content water refers to water that contains 250 ppm
rivers, and reservoirs. Individuals in rural areas are more
to 500 ppm and ‘‘high’’ refers to amounts greater
likely to use groundwater, which is found in underground
than 1,500 ppm.
aquifers (rock formations) and pumped up through pri-
Purified Water that has been processed to remove minerals.
vate wells. The potential for contamination exists in both
Demineralization occurs by reverse osmosis,
deionization, and other similar processes. Distilled
types of water supplies. Surface water is more quickly
water has been purified by creating steam that is
contaminated because it is open and exposed to the ele-
recondensed into water. Minerals are removed as
ments. Potential sources of contamination include acid
the steam is recondensed.
Sparkling Water that contains carbon dioxide gas through
rain, highway runoff, and industrial wastes. In general,
either natural processes or artificial addition.
surface contamination is reversible because new water
Spring Water that comes from a natural spring in the
is added via fresh rain. In contrast, groundwater becomes
ground. May be carbonated.
contaminated more slowly. However, because ground-
*ppm (a unit of measure) ⳱ parts per million
water is replaced more slowly, contaminants can build
From Dudek, S. G. (2001). Nutritional essentials for nursing
practice (4th ed.). Philadelphia: Lippincott.
up over time and become more difficult to remove. Con-
41The Journal of Perinatal Education Vol. 11, No. 3, 2002
Nutrition Column: An Update on Water Needs
hot weather, diarrhea, and vomiting. Dehydration can
rapidly develop in an infant or small child who is losing
An adequate fluid supply also ensures that the mother
excessive water. Supplemental water (or intravenous flu-
has enough reserves to tolerate blood loss during
ids) may be required in extreme circumstances. Nor-
mally, increased fluid intake of breast milk or formula
Water supplementation of the infant during the early
breastfeeding weeks can be detrimental to establishing
lactation. In addition, newborns who receive water sup-
pregnant woman who already has a reduced immunity
plementation tend to have higher bilirubin levels than
related to the pregnancy. This problem is further compro-
those who do not (Nicoll, Ginsburg, & Tripp, 1982).
mised in the woman who is immune deficient for other
Water supplementation has also been associated with
reasons (e.g., HIV/AIDS infection) (Kraak, 2001). Addi-
greater weight loss in the first week of life (Glover &
tionally, a common complaint of pregnancy is constipa-
tion. Decreased gut motility and iron supplementation
In summary, water is an important nutrient to expec-
may contribute to this problem. Increased fluid intake
tant mothers and their infants.
can help to alleviate constipation. An adequate fluid
supply also ensures that the mother has enough reserves
to tolerate blood loss during delivery.
Dudek, S. G. (2001). Nutritional essentials for nursing practice
(4th ed). Philadelphia: Lippincott.
The Breastfeeding Mother
Glover, J., & Sandilands, M. (1990). Supplementation of
The breastfeeding mother should be encouraged to drink
breastfeeding infants and weight loss in hospital. Journal
of Human Lactation, 6, 163–166.
enough water to quench her thirst or a little more. A
Henderson, S. A., & Lenders, C. M. (1999). Nutrition in
common recommendation for the mother is to drink a
pregnancy and lactation. In G. Morrison & L. Hark (Eds.),
glass of water with meals and whenever she breastfeeds.
Medical nutrition and disease (2nd ed., pp. 61–75). Malden,
A woman who drinks additional fluids does not produce
MA: Blackwell Science.
additional breast milk (Whitney & Rolfes, 2002). Con-
Kraak, V. (2001). Water and food safety. In R. A. Smith (Ed.),
sumption of excess water can result in water toxicity;
Encyclopedia of AIDS. New York: Penguin Putnam, Inc.
however, water toxicity is rare in normal adults.
Nicoll, A., Ginsburg, R., & Tripp, J. H. (1982). Supplemental
feeding and jaundice in newborns. Acta Paediatr Scand,
Wardlaw, G. M. (2000). Contemporary nutrition (4th ed.).
Boston: McGraw Hill.
Like adults, infants have high water requirements. The
Whitney, E. N., & Rolfes, S. R. (2002). Understanding nutri-
younger the infant, the higher the percentage of body
tion (9th ed.). Belmont, CA: Wadsworth/Thomson Learn-
weight that is water (Whitney & Rolfes, 2002). Breast
milk or formula contains the appropriate amount of
Winson, G. (2001). HIV/AIDS nutritional management. In C.
water and replaces normal losses experienced by the
A. Kirton, D. Talotta, & K. Zwolski (Eds.), Handbook of
HIV/AIDS nursing. St. Louis: Mosby.
infant. Infants are particularly prone to water loss via
Bubble Bath for the Soul
Take a music bath once or twice a week for a few seasons, and you will find that it is to the soul what the
water bath is to the body.
Oliver Wendell Holmes
42 The Journal of Perinatal Education Vol. 11, No. 3, 2002