NUTRITION

DURING
PREGNANCY

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 Nutrition before conception
Risk assessment, health
promotion, intervention
Weight
Maintain a healthy weight
Vitamins
Folic acid/day
Avoid high doses of retinol
Substance use
Eliminate prior to
pregnancy

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Effect of nutritional status on
pregnancy outcome

1. Maternal size
- maternal size ~ placental size
indicator of placental health
determines the amount of nutrient
available to the fetus birth weight
- prepregnancy weight << lighter
weight placenta risk for LBW
 2. Weight Gain
During Pregnancy
 Recommended weight gain during
pregnancy based on BMI

Total 1st 2nd & 3rd

weight gain trim weekly gain

Underweight 12.5 18 2.3 0.49

(BMI < 19.8)
Normal weight 11.5 16.0 1.6 0.44
(BMI 19.8 26)
Overweight 7.0 11.5 0.9 0.3
(BMI 26 29)
Obese 6.0
(BMI > 29)
Twins 15.9 20.4
Triplets/multiples >22.7
 Normal components of maternal
weight gain during pregnancy
Organ, tissue or fluid (g)
Uterus 970
Breasts 450
Blood 1250
Water 1680
Fat 3350
Maternal components = 7700
Fetus 3400
Placenta 650
Amniotic fluid 800
Non-maternal components = 4850
Total = 12550
 3. Obesity
risk
- Gestational DM
- Pregnancy induced hypertension
- Cesarean section
- IUFD
Hesitant to gain weight during pregnancy
Should be told that pregnancy is not a time for
weight loss
 4. Adolescence
Risk factor for poor pregnancy outcome in teenagers

- Maternal age 15 yrs - Substance abuse :

- Pregnancy < 2 yrs after
onset of menarche
- Poor nutrition & low
prepregnancy weight
- Poor weight gain
- Infection
- STD infection
- preexisting anemia
smoking, drinking, drugs
- Poverty
- Lack of social support
- Lack of education
- Rapid repeat pregnancies
- Lack of access to age-
appropriate prenatal
care
- Late entry into the
health care system
 Deficiencies of :
- folic acid
- other vitamins
- calcium
- vitamin D
- energy
- micronutrients
 Clinical findings :
- poor weight gain during pregnancy
- LBW
- premature birth
Physiologic changes in the GI tract

Primarily as a result of the relaxation of

smooth muscle
Esophageal regurgitation, emptying time
of the stomach, reverse peristalsis heart
burn
water absorption from the colon
constipation
Hormonal changes nausea & vomiting
 Nutritional requirements

Energy
- additional energy is required
- metabolism by 15%
- 2002 DRI :
- 1st trim : = not pregnant
- 2nd trim : + 340 360 kcal/day
- 3rd trim : + 112kcal/day
 Protein

Additional protein is required support the

synthesis of maternal & fetal tissues
RDA : 71 g (> 25 g than not pregnant)
Deficiency adverse consequences
Specific nutrients to consider

Folic acid
Calcium
Iron
Zinc
 Folic acid

req, for - maternal erythropoiesis

- fetal & placental growth
- prevention of NTD

RDA : 600 g 400 g from fortified foods or

supplement & 200 g from
foods

Deficiency :
- megaloblastic anemia
- congenital malformations
 The Centers for Disease Control &
Prevention :

all female of childbearing age their intake of

folic acid, because :
- 50% of all pregnancies in US are unplanned
- neural tube closed by 28 days of gestation

Supplementation should begin before

conception
 US Public Health Service :
- all women of childbearing age capable of
becoming pregnant should consume 400 g
folic acid /day

The American College of OG :

- women who are planning a pregnancy & have
previously had a child with NTD take 4 mg of
folic acid/day beginning 1 mo prior to
conception 3 mo of pregnancy
 Three major type of Neural Tube Defects

Anencephaly Spina bifida Encephalocele

PHYSICAL IMPACT
Spina bifida often
causes lifelong
disabilities:
paralysis
NTDs can require complex medical
management, often including multiple
surgeries.
 Folate-rich Foods

Orange juice, oranges

Liver
Avocado
Dried beans and peas; lentils
Dark green leafy vegetables
(spinach, mustard, turnip,
collard greens)
Broccoli
Asparagus
 Fortified Foods

Good way to get synthetic

folic acid with minimal
behavior change

Blood levels are increasing

Pasta fortified with 140 micrograms per 100 grams flour
(FDA, January 1998)

Folic acid 30%

 Iron
RDA 27 mg/day (18 mg for non pregnant)
Many women start pregnancy with poor iron
stores & target iron intake is often not achieved
from diet alone supplementation is often
necessary
30 mg in divided doses of ferrous iron
supplements daily during the 2nd & 3rd trim
 Calcium

AI 1000 1300 mg
Supplementation is necessary for those
who do not drink milk or eat dairy
products
Daily intake < AI calcium loss from
maternal skeleton
Increased Requirements
Nonnutritive substances in food

Caffeine
- risk of 1st trim
spontaneous abortion
as consumption from 100
mg to > 500 mg /day
 Food beliefs

Most change their diets medical advice,

beliefs, food preferences, appetite
May be idiosyncratic or culturally patterned
Harmful :
- elimination of animal protein
- attempt to limit weight gain to produce
smaller fetus easier delivery
 Pica

Consumption of substance with little or no

nutritional value (dirt, clay, ice, chalk, baking
soda, hair, stone, cigarette ashes)
Some reasons :
- relief of nausea or nervous tension
- a deficiency of an essential nutrient
- pleasant sensation when chewing
Possible risks : gastrointestinal disorders
 Nausea & Vomiting

Common during 1st trim, resolves 13th 14th wk

Vomit excessively deficit in protein, energy,
vitamins & minerals
Fluid & electrolyte imbalance (+) hospitalized
for rehydration & prevent ketosis
 Recommendation for nausea &
vomiting

Eat crackers or dry cereal before getting out of

bed in the morning
Eat small, frequent meals
Liquids are best consumed between meals
Avoid drinking coffee and tea
Avoid or limit intake of fatty and spicy foods
 Heartburn

Common during the latter part of

pregnancy
Often occurs at night
Effect of pressure from the enlarged
uterus on the intestine & stomach,
relaxation of the esophageal sphincter
regurgitation
Recommendation for heartburn

Eat small low-fat meals, slowly

Drink fluids between meals
Avoid spices
Avoid lying down for 1 to 2 hours after eating
or drinking
Wear loose-fitting clothing
 Constipation & hemorrhoids

Usually occurs in the 3rd trim

Causes :
- gut motility
- physical inactivity
- pressure exerted on the bowel by the
enlarged uterus
Recommendation for constipation

Drink 2 to 3 quarts of fluids daily

Eat high-fiber foods, including cereals,
whole grains, legumes and fresh fruits and
vegetables
Be physically active
Avoid taking laxatives
 Gestational DM
Goal :
- provide all required nutrients
- prevent hyperglycemia & ketosis
- insure appropriate weight gain
Meal plan is individualized & expert care is
needed
 Summary

Energy intake to meet nutritional needs and

allow for about 0.4kg weight gain /wk during
the last 30 wk of pregnancy
Protein intake to meet nutritional needs
Mineral & vitamin intakes to meet RDA
( For folic acid requires supplementation and
for iron it is also likely that is required)
Alcohol omitted
Caffeine in moderation
HEALTHY BABIES
START WITH
HEALTHY MOMS