At this point, a numbers of excellent responses have been provided vis-à-vis conversions of RGB imagery to CMYK and lossiness of such conversions.
On behalf of Adobe:
(1) There will be extra lossiness in performing a conversion of an image from RGB to CMYK if this conversion is done post PDF creation. If you really believe you need a PDF file totally in CMYK, that should be accomplished when the PDF file is created, not afterwards if you wish to avoid any lossiness.
(2) The simple act of converting RGB to CMYK either in PDF creation or afterwards in Adobe Acrobat Pro will not be so lossy that you end up with pixelation where you had sharp imagery before. Such pixelation would occur if you are simultaneously significantly downsampling the image such as 300dpi to 72dpi or even 100dpi. Converting color spaces of JPEG images after-the-fact in Acrobat will also incur some lossiness (although typically not pixelation) – why? The image has to be decompressed from JPEG, converted, and then converted back to JPEG which by definition adds more lossiness! That's exactly why any color changes should occur either when creating the PDF or better, where it belongs, at the RIP/DFE!
To answer the specific question, the color conversion functionality of Adobe Acrobat Pro does not do any image downsampling! Such downsampling does occur if you try to combine color conversions with other operations.
(3) Modern PDF print publishing workflows absolutely do not require conversions of content from RGB to CMYK. The ISO PDF/X-4 standard provides for printing from ICC color managed PDF exported/saved from any modern publishing/illustration software. All RIPs/DFEs produced over the last decade should be able to handle PDF/X-4 files at least as well if not much better than any PDF/X-1a or totally-CMYK PDF (with flattened transparency) from original RGB content. Any print service provider that tells you otherwise is either (a) burdened with antique production software, (b) ignorant, (c) a Luddite, or (d) some combination of these. A print service provider that insists that all transparency be flattened and that all content be converted to CMYK as a prerequisite for their printing a job is a good indication that you should consider looking for an alternative print service provider!
- Dov