Chapter 10: During pregnancy, the mother needs more energy in the form of kilocalories, for what 2 important

reasons? -to supply the increased fuel demanded by the metabolic workload for both mother and fetus -to spare protein for the added tissue building requirements National standard recommends an increase of 340 kcal/day in the second trimester and approx 450 kcal/day during the third trimester, averaging about 2200-2800 kcal/day, 15-20% increase over the energy need of nonpregnant women. Active, large or nutritionally deficient women may require more Increased complex carbs and protein in the diet are preferred sources of energy, esp during late pregnancy and lactation Dietary guidelines regarding pregnancy and lactation? -women of childbearing age who may become pregnant: foods high in heme iron or consume iron rich plant foods or iron fortified foods, such as vitamin c rich foods -women of childbearing age who may become pregnant and those in first trimester: adequate folic acid daily from fortified foods or supplements, along with food forms of folate from varied diet -pregnant women: ensure proper weight gain. Incorporate 30 mins or more of moderate intensity physical activity on most, if not all days of the week. Avoid activities with high risk of falling -breastfeeding women: moderate weight reduction is safe and does not compromise infants weight gain. Neither acute nor regular exercise adversely affect the mothers ability to breastfeed. -infants and young children, pregnant women, older adults, and immunocompromised: no raw, unpasteurized milk or any products made from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, raw or undercooked fish, unpasteurized juices or raw sprouts -pregnant women, older adults, immunocompromised: only eat certain deli meats and frankfurters that have been reheated to steaming hot. Protein during pregnancy? -rapid growth of the fetus: increase of fetus size from one cell to millions of cells in 9 months indicates the relatively large amounts of protein required for such rapid growth -Development of placenta: lifeline to the mother. Mature placenta requires sufficient protein for its complete development as a vital and unique organ to sustain, support and nourish the fetus during growth -growth of maternal tissues: increased development of uterine and breast tissue is required to support pregnancy and lactation -increased maternal blood volume: mothers blood increases 20-50% which is necessary to support the increased metabolic workload and nourish the child. There is a need for more synthesis of blood components, especially hemoglobin and plasma protein, which are vital to pregnancy. Increase in hemoglobin helps supply oxygen to the growing number of cells. Plasma protein (albumin) production increases to regulate blood volume through osmotic pressure. Adequate albumin prevents an abnormal accumulation of water in tissues beyond the normal edema of pregnancy.

injury.

-amniotic fluid: contains various proteins and surrounds fetus during growth and guards it against shock or

-storage reserves: needed to prepare for the large amount of energy required during labor, delivery, immediate postpartum period and lactation. Protein intake should increase 25 g/day during pregnancy, on top of nonpregnancy needs. Increase is more than 50% of the average adult requirement. The only complete protein foods of high biologic value are? -milk, egg, cheese, soy products, meat. Certain other incomplete proteins from plant sources such as legumes and grains contribute additional secondary amounts Protein rich foods also contribute other nutrients such as calcium, iron and B vitamins. Key Minerals needed during pregnancy? -Calcium: good supply of calcium, along with phosphorus, magnesium and vitamin D is essential for fetal development of bones and teeth as well as the mothers own body needs. Calcium is also necessary for proper blood clotting. A diet that includes at least 3 cups of vitamin A and D fortified milk daily, plus dairy or dairy substitutes such as soy products, and generous amounts of green vegetables and enriched whole grains, usually supplies enough calcium. Calcium and zinc are both significantly bioavailable during pregnancy, which means the bodys enhanced capability to absorb and retain these nutrients during pregnancy helps meet nutrient needs of the growing fetus. -Iron, Zinc and Copper: Particular attention to iron. Iron is necessary for hemoglobin for greater maternal blood volume and for the babys necessary prenatal storage of iron. 27 mg/day are recommended, which is more than a womens average of 18 mg/day. Consuming foods high in vitamin C along with dietary sources of iron enhance the bodys ability to absorb and use low bioavailable iron. Avoid foods that inhibit iron absorption such as whole grain cereals, unleavened whole grain breads, legumes, tea and coffee. Because this 27 mg/day is hard to obtain, daily iron supplements are recommended. Zinc and copper are increased during pregnancy, absorption of both minerals is inhibited by iron. Supplements are recommended. -Iodine: Essential for producing more T4, which is the thyroid hormone needed in greater amounts to control increased bmr during pregnancy. Easily ensured by the use of iodized salt. Too much leads to mental retardation of fetus. Key vitamins during pregnancy? -Vitamin A and C: important elements in tissue growth -B Vitamins: play a vital role as coenzyme factors in energy production and protein metabolism -Folate: builds mature RBC during pregnancy and is particularly needed during early periconceptional period, from approx 2 months before conception to week 6 of gestation, to ensure healthy embryonic tissue development and prevent malformation of the neural tube. This tissue forms during critical period from 17-30 days gestation and grows into the mature infants spinal column and its network of nerves. Spina bifida and anencephaly are the two most common forms of neural tube defects, which is any malformation of the embryonic brain or spinal cord. Spina bifida occurs when the lower end of the neural tube fails to close, as a result, the spinal cord and backbones do not develop properly. Ranges from mild to severe, with limited movement and function. Anencephaly occurs when the upper end of the neural tube fails to close. In this case, the brain fails to develop or is entirely absent. Pregnancies affected by this usually end in miscarriages or death soon after delivery. 600 mcg/day of folate

is recommended during pregnancy and 400 mcg/day for nonpregnant women during child bearing years. All enriched flour and grain products as well as fortified cereals contain a well absorbed form of folic acid. Other natural sources include liver, dark green leafy vegetables, legumes, soybeans, wheat germ, orange juice, asparagus and broccoli. -Vitamin D: Increased vitamin D ensures absorption and utilization of calcium and phosphorus for fetal bone growth and can be met by 3 cups of fortified milk, or milk substitute daily. Fortified milk contains 10 mcg (400 IU) of cholecalciferol (vitamin D) per quart, which is twice the AI amount. The mothers exposure to sunlight increases endogenous synthesis of vitamin D as well. Lactose intolerant or vegetarian women can get it from fortified soy or rice milk products. Weight gain during pregnancy? The average weight gained is 29 lb. -Underweight women: 28-40 lb -Normal weight: 25-35 -overweight: 15-25 -obese: 15 lb -teenage girls: 35-40 -carrying twins: 34-45 lb -triplets: overall gain of 50 lb Severe caloric restriction during pregnancy is potentially harmful to the developing fetus and the mother. Such a restricted diet cannot supply all the energy and nutrients essential to the growth process. Approx 1-2 kg (2-4 lb) is the average weight gain in the first trimester. Thereafter, approx .5 kg (1 lb) a week during the remained of the pregnancy is usual Intra-uterine growth restriction (IUGR)? -an insufficient or low maternal weight gain in the second or third trimester. Less than 10% of fetal weight for gestational age. Multiple survival and growth problems. Factors include inadequate weight gain, low prepregnancy weight, use of cigarettes and alcohol. A moderate amount (approx 2-3 g/day) of dietary sodium is needed and can be achieved through the normal use of salt in cooking and seasoning. Typical American diet contains 3-6 g/day so you do not need to consume extra sodium during pregnancy. Strict vegans can meet dietary protein needs through the use of soy foods and complementary proteins Specific counseling on avoidance of alcohol, caffeine, tobacco and recreational drug use during pregnancy is also important. Information about direct effects of poor nutrition on the fetus, especially related to the brain development, learning problems, and developmental delays, help motivate many pregnant women to choose a well selected diet. Two important principles that govern the prenatal diet? -pregnant women should eat a sufficient quantity of high quality food

-pregnant women should eat regular meals and snacks, avoiding any habit of fasting or skipping meals, especially breakfast Morning sickness in early pregnancy (which can happen at any time, not just mornings) usually is mild and only occurs during the first trimester. It is caused by hormonal adaptations in the first weeks and may be increased by stress or anxieties. How to relieve symptoms of morning sickness? -small frequent meals and snacks that are fairly dry and consist mostly of easily digested energy foods (carbs), with liquids between, not with meals. Hyperemesis gravidurum? -women have persistent vomiting throughout the pregnancy that may result in fluid and electrolyte disturbances, weight loss and nutritional deficiencies. Hemorroids are fairly common complaint during the latter part of pregnancy. This vein enlargement usually is caused by the increased weight of the baby and the downward pressure it produces. May cause discomfort, burning and itching and may even rupture and bleed under the pressure of bowel movement, causing more anxiety to the mother. Dietary and rest help. Heartburn usually occurs especially after meals and are caused by the pressure of the enlarging uterus crowding the stomach. Gastric reflux of food may occur in the lower esophagus, causing irritation and a burning sensation. Often referred to as a full feeling. Iron supplements may give you gray or black stools and sometimes nausea, constipation or diarrhea. To help avoid these symptoms, iron supplements should be taken 1 hour before or 2 hours after a meal with a liquid such as water or orange juice, not milk or tea. Nutritional risk factors in onset pregnancy? -age: 18 or younger, 35 or older -frequent pregnancies: 3 or more during a 2 year period -poor obstetric history or poor fetal performance -poverty -bizarre or trendy food habits -abuse of nicotine, alcohol, drugs -therapeutic diet required for a chronic disorder -weight: 85% less or more than ideal weight Risk factors during pregnancy? -low hemoglobin or hematocrit -inadequate weight gain -excessive weight gain

3 types of dietary patterns that do not support optimal maternal and fetal nutrition? -insufficient food intake -poor food selection -poor food distribution throughout the day Pica? -craving for and consumption of non food items, sometimes seen in pregnant women, malnourished and is associated with iron deficiency anemia. Women over 35 may be at more risk for high blood pressure and gestational diabetes Women with a high parity rate (several pregnancies within a few years) may be drained of nutrition resources and usual face the increasing physical and economic pressures of child care Fetal Alcohol Syndrome and Fetal Alcohol Effects? -combination of physical and mental birth defects born to mothers who consumed alchohol during pregnancy. Leading cause of mental retardation and other birth defects in the US. Varies between populations and is influenced by environmental and behavioral conditions in addition to prepregnancy BMI and nutrition status. Nicotine? -smoking or environmental exposure to smoke is associated with placental abnormalities and fetal damage, including prematurity and low birth weight Drugs? -cross the placenta and enter the fetal circulation, thus creating a potential addiction in the unborn child. Dangers come from the drug and contaminated needles, as well as the impurities contained in street drugs. Vitamin abuse and megadosing? -Drugs made from vitamin A compounds, such as retinoids and tetinoin (accutane) which is prescribed for severe acne, have caused spontaneous abortion of malformed fetuses by women who coneived during acne treatment. Thus the use of these drugs without contraception is contraindicated. Caffiene? -Can cross the placenta and enter fetal circulation. Caffeine stays in the blood stream of a pregnant woman slightly longer in the third trimester Teratogens? -drug or substance causing birth defect Anemia? -most common nutritional deficiency. More prevalent in poor women. Deficiency of iron or folate.

Hypertensive disorders of pregnancy? -with accumulation of proteinuria the condition is called preeclampsia. Complications such as eclamptic convulsions and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) require hospitalization and often induced labor. Gestational diabetes? -in pregnancy glucose in the urine (glycosuria) is not uncommon. Glucose intolerance with onset during pregnancy, extra glucose spills into urine. Particular attention is given to women who are 30 or older, overweight and have a history of the following factors: previous history, family history or ethnicity, glucosuria, obesity, large babies, birth of babies with multiple congenital defects Children born to women with gestational diabetes are at greater risk for impaired glucose tolerance, being overweight and cryptorchidism (abnormal testicular decent in boys) Breastfeeding is recommended as the exclusive source of nutrition for infants up to 6 months of age. After 6 months, iron fortified complementary foods should be added to the basic diet of breast milk. Recommended for the first 12 months. Most women stop because of difficulties such as sore nipples, infant spitting up or engorged breasts. Upon delivery, milk production and secretion are stimulated by two hormones, prolactin and oxytocin. Stimulation of nipple from infant suckling sends nerve signals to the brain, the nerve signal then causes the release of prolactin and oxytocin. Prolactin? -milk producing hormone Oxytocin? -responsible for the let down reflex. Let down is the process of milk moving from the upper milk producing cells down to the nipple for infant suckling Breastfeeding mothers need adequate fluids such as milk, water, soups and juices contribute to the fluid producing milk. Prolactin inhibiters? -fatigue, prolonged bed rest, medical complications and irregular breastfeeding Advantages of breastfeeding for mother and infant? -fewer infections: mother transfers certain antibodies in human milk -fewer allergies and intolerances, especially in allergy prone infants -ease of digestion, human milk forms a softer curd in the GI tract that is easier for infant to digest -improved cognitive development in childhood -decreases in the rish of childhood obesity and heart disease

Benefits of breastfeeding for mother? -promotes faster shrinking of uterus -reduces postpartum bleeding -decreases risk of breast and ovarian cancer -delays resumption of the menstrual cycle -improves glucose profile in those with gestational diabetes -strengthens bond with infant -enhances self esteem in maternal role -eliminates need for preparing formula -saves money