Nutrition in

pregnancy

Health habits that contribute to healthy pregnancies

Nutrition prior to
Growth & development
pregnancy
Placental development
Fetal growth & development during pregnancy
Critical periods

during pregnancy
Minidian Fasitasari
Weight prior to conception
Weight gain during pregnancy
Exercise during pregnancy
Medical School
Maternal weight of Unissula Semarang
Energy &2013
nutrition needs
Common nutrition-related concerns of pregnancy

Nutrition during
pregnancy
Malnutrition & pregnancy
The mothers age

Practices incompatible with pregnancy

High-risk pregnancies
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 Nutrition prior to pregnancy

Health habits that contribute to healthy

pregnancies
Achieve and maintain a healthy body weight.

Choose an adequate and balanced diet.

Be physically active

Receive regular medical care

Manage chronic conditions

Avoid harmful influences

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 Growth & Development during
Pregnancy

Placental development

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 Fetal growth & development

A newlyA fetus after After A newborn

fertilized ovum implantation: infant after 9m 11w
(a zygote). < 1w of placenta
of development
developmentdevelops
is & measures close
after just
provide
over an to 20 inches in
nourishment to fertilization: length. From 8w inch long.
rapidly
the developing
divided Notice the to term, this
multiple times & umbilical cord
embryo.An
& infant grew 20x
ready
embryo
for 5w blood vessels longer & 50x
about 1/2 inch
implantation connecting long. the
after 7 fetus with theheavier
fertilization is placenta.

Critical periods

Times of intense
development & rapid
cell division

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Neural tube defects

Previous
pregnancy with neural tube defects
Factors:
Maternal diabetes
Maternal use of antiseizure medications
Maternal obesity

Folate
supplementation reduces the risk

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Spina bifida

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 Folate suplementation

Reduces
risk of neural tube defects
RDA 400 g/day, during pregnancy: 600
g/day
Many fortified grains
Those who have previously given birth to a
child with a neural tube defect may be
prescribed a 4 milligram daily supplement.

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Maternal weight

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 Maternal Weight
A mothers weight prior to
conception & weight gain
during pregnancy influence
birthweight.
Higher birthweights present
fewer risks for infants.
Lower birthweights present
more problems.

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Underweight Overweight & obesity

Weight prior to conception
Tend to have lower birth Tend to be born post
weight babies term (>42 weeks)
Higher rates of preterm Tend to be greater than 9
(premature <38 weeks) pounds at birth
infants & infant deaths
More(macrosomia)
difficult labor and
delivery, birth trauma, and
cesarean sections
Higher risk for neural tube
defects, heart defects and
other abnormalities

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 Weight gain during pregnancy
Recommended Weight Gains

Weight-Gain Patterns
3 pounds first trimester
1 pound per week thereafter
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Exercise during pregnancy

Adjust duration and intensity as needed

Improves fitness, prevents gestational diabetes, facilitates
labor, and reduces stress
Low-impact activities are recommended.
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 Guidelines
Do Dont

Begin
gradually if just starting No vigorous exercise
Exercise
regularly Keep out of hot and humid
Warm
ups and cool downs weather
or more minutes of moderate No exercise when sick with fever
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No exercise while lying on your
activity back
Watch fluids No prolonged standing while
Enough energy intake motionless
Stop if painful, uncomfortable, or
fatiguing
No activities harmful to abdomen
No bouncy or jerky movements
No scuba dive, saunas, steam
rooms, or hot whirlpools

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Nutrition during pregnancy

Energy & Nutrient Needs during Pregnancy

Energy

Second trimester +340 kcal/day

Third trimester +450 kcal/day

Protein

+ 25 grams/day
Use food, not supplements

Essential Fatty Acids

Omega-3
Omega-6

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 Nutrients for Blood Production & Cell
Growth

Folate 600 g/day

2.6 g/day

Vitamin B12

27 mg/day
Iron
2 mg/day for adults 18 years of age
11 mg/day for adults 19-50 years of age
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Zinc

Nutrients for Bone Development

to use and absorb calcium

Vitamin D
effectively

to allow for calcification of

fetal bones
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Calcium

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Other nutrients
needed to support
growth,
development, &
health of the mother
and fetus

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Prenatal

Nutrient Supplements supplements

prescribed by
physicians
May help to reduce

risk for preterm
delivery, low infant
birthweights, and
birth defects

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 Common Nutrition-Related Concerns of
Pregnancy
Morning (anytime) sickness
Ranges from mild queasiness to debilitating nausea & vomiting
Nausea
Hormonal changes

Altered muscle tone & cramping space for organs

Constipation & Straining during bowel movements
hemorrhoids
Digestive muscles are relaxed and there is pressure on the mothers
stomach
Stomach acid backs up into the lower esophagus
Heartburn
Common
Do not reflect real physiological needs
Hormone-induced changes in sensitivity to taste and smell
Food cravings &
aversions
Pica
Often associated with iron-deficiency

Nonfood cravings
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Alleviation strategies

Nausea Constipation & Heartburn

Eat desired foods at desired hemorrhoids Relax & eat slowly
times High--fiber foods Chew food thoroughly
Arise slowly upon awakening Exercise regularly Eat small, frequent meals
Eat dry toast or crackers 8 glasses of liquids each day Drink liquids between meals
Chew gum or hard candies Respond promptly to the Avoid spicy or greasy foods
Eat small, frequent meals urge to defecate Sit up while eating; elevate
Avoid offensive foods Use laxatives only when head while sleeping
Consume carbonated Wait 1 hour after eating
prescribed by physicians
beverages & avoid citrus before lying down
juice, coffee, tea, water, or Wait 2 hours after eating
milk when nauseated before exercising

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 High--risk pregnancies

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 Infants birth weight
High risk pregnancy ~
low birth weight
Preterm infant = small, size
& weight ~ age catch up
(+) ~ nutritional support

SGA (small-for-gestational-
age) growth failure (+)
LBW complications >>

Low socioeconomic ~ LBW;
teen pregnancies, smoking,

alcohol & drug abuse

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Malnutrition & Pregnancy

Malnutrition & Fertility

Severe malnutrition & food deprivation reduce fertility

lose the ability to produce viable sperm
develop amenorrhea
Loss of sexual interest during starvation

Malnutrition & Early Pregnancy

Fetal
growth retardation
Placenta
Congenital
problems
malformations
Impaired
Spontaneous
development
abortion in infant
and stillbirth
Premature
birth
Low
Malnutrition & Fetal Development
infant birthweight

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 Mothers Age
Pregnancy in Older
Pregnancy in Adolescents
Women

Complications include Hypertension &

iron-deficiency anemia
diabetes
& prolonged labor
High rate of birth
Higher rates of defects Down
stillbirths, preterm
syndrome
births, & LBW infants
Major public health
problem & costly
Encourage higher weight
gains

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Medical disorders can threaten the life and health of
Maternal Health
both mother & fetus.
Diagnosed and treated early many diseases can be
managed to ensure a healthy outcomeanother
strong argument for early prenatal care.
The changes in pregnancy can reveal disease risks,

making screening important & early intervention
possible
Preexisting diabetes; Gestational diabetes; Chronic
hypertension; Gestational hypertension; Preeclampsia

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 - preexisting diabetes -

Risks of diabetes ~ how well it is managed

Before & during pregnancy

Mothers: high infertility rates, episodes severe

Infants: large, suffer physical & mental abnormalities,
hypoglycemia or hyperglycemia, preterm labor,
severe hypoglycemia or respiratory distress
Without proper management of maternal diabetes
pregnancy related hypertension

To minimize complications
Glucose control before conception & continued throughout
pregnancy

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- gestational diabetes -
Risk factors Consequences Managements

Age 25 or older Diabetes (usually Diet

BMI 25 or type 2) after Moderate exercise
excessive weight gain pregnancy Insulin or other
Complications in Complications during drugs
previous pregnancies: labor & delivery
gestational diabetes
High infant
or high birthweight birthweight
Prediabetes or
infant Birth defects symptoms of
diabetes
Family history of
diabetes

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 - chronic hypertension -

Hypertension complicates pregnancy

When the hypertension first develops How severe it becomes

Increases the risks

LBW infant Separation of the placenta from the wall
of the uterus before the birth stillbirth

Before a woman with hypertension becomes pregnant

Blood pressure is under control

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- gestational hypertension -

Some women develop gestational hypertension

50% 50%
BP is mild & does not
An early sign of the most
affect the pregnancy serious maternal
adversely complication of
BP usually returns to pregnancypreeclampsia
normal during the 1st few
weeks after childbirth

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 - preeclampsia -
Signs & symptoms The cause Consequences Treatments

Hypertension Remains unclear Affects almost all Control BP

Protein in the Usually occurs of the mothers
Prevent seizure
urine with 1st organsthe
Upper abdominal pregnancies & circulatory Induced labor or
pain most often after system, liver, cesarean section
Severe headaches 20 w gestation kidneys, and brain infant +
Preterm
Swelling of hands, Symptoms Fetal growth all problems: poor
feet, & face typically regress retardation lung development
Vomiting within 2 days of
Preterm birth or & special care
Blurred vision delivery stillbirth needs
Sudden weight Eclampsia Diet
gain (1 lb/day) maternal death
Exercise
Fetal growth stimulating
retardation placenta
vascularity growth &
reducing
oxidative stress

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Practices Incompatible with Pregnancy

Alcohol

Fetal alcohol syndrome

Medicinal drugs

Complications & problems with labor & serious birth defects

Herbal supplements

On the advice of physician only (may be safe or definitely harmful)

Illicit drugs

Easily cross the placenta & cause complications (preterm, LBW,

perinatal death, etc.)

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Practices Incompatible with Pregnancy

Smoking & Chewing Tobacco

Fetal
growth retardation
Low
birthweight
Complications
at birth
Mislocation
of the placenta
Premature
separation of the placenta
Vaginal
bleeding
Spontaneous
bleeding
Fetal
death
Sudden
infant death syndrome (SIDS)
Middle
ear diseases
Cardiac
and respiratory diseases

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Practices Incompatible with Pregnancy

Environmental Contaminants

Lead can affect the nervous system of a fetus

Fish with high levels of mercury should be avoided

Foodborne illness

Exhausted & dehydrated

Vitamin-mineral megadoses

Can be toxic, especially vitamin A

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 Practices Incompatible with Pregnancy

Caffeine

Moderate to heavy use may cause spontaneous abortion

Wise to limit consumption

Weight-loss dieting

Hazardous, not recommended during pregnancy

Sugar substitutes

Acceptable, but follow guidelines

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To enjoy healthy pregnancy

Get prenatal care

Eat a balanced diet, safely prepared

Take prenatal supplements as prescribed

Gain a healthy amount of weight

Refrain from cigarettes, alcohol, & drugs

(including herbs, unless prescribed by
physician)
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 Reference
Whitney E, Rolfes SR. 2011. Chapter 15 Life
Cycle Nutrition: Pregnancy & Pregnancy, in:
Understanding Nutrition 12th ed. Intl Student
ed. Wadsworth, Cengage Learning Inc., USA.

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