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Chapter 13

V. Chan, MS, RD

Pregnancy: Impact of Nutrition


Establish eating habits before pregnancy


Fathers-to-be

Alcohol & malnourishment may affect fertility

Mothers-to-be Appropriate body weight before pregnancy


Pregnancy weight

Obese and underweight women >5 lbs is 40 times likely to die in 1st year of life Associated with low IQ, brain impairment, short stature Possibly contributing factors: heredity, disease conditions, smoking/ drinking during pregnancy Poor nutrition is major factor for low birthweight 2006: under 7 deaths per 1,000 births (declined over past years)

Low birthweight infant


Infant mortality rate


Pregnancy: Impact of Nutrition


Healthy placenta and other organs


Placenta

Supply depot and waste-removal system Two bloods never mix Metabolically active organ

Umbilical cord is the route of O2 into the fetus and route of waste removal Amniotic sac

Poor maternal nutrition prior to pregnancy could affect her grandchildren and children

Events of Pregnancy

Fertilized ovum/ egg is called a zygote Implantation


Within two weeks of fertilization Physical changes Fetus grows rapidly Trimesters Critical periods

Fetus at eight weeks Fetal period: last 7 months of pregnancy Gestation = 40 weeks
Avoid malnutrition

Increased Needs for Nutrients


Energy

Vary with progression of pregnancy


+340 kcal/ day during 2nd trimester +452 kcal/ day during 3rd trimester

Carbohydrate

175 g or more per day, no less than 130 g per day


Best to choose whole grain, fruits, vegetables

Protein

DRI for pregnancy: +25 g pro/ day Supplements

Discretionary calories

Increased Needs for Nutrients


Folate

Recommendation increases during pregnancy Neural tube defects


Anencephaly: brain fails to form Spina bifida: Spine formation deformed

Enrichment of grain products Important to get adequate amounts Assists folate with manufacture of new cells

Vitamin B12

Increased Needs for Nutrients


Vitamin D

Rickets

Calcium
Absorption doubles during pregnancy Recommendations are aimed at preserving maternal bone mass Recommended 600 mg/ day

Finals weeks of pregnancy, ~300 mg/ day transferred to fetus

Increased Needs for Nutrients


Iron

Most women do not have adequate iron stores prior to pregnancy Iron needs of fetus take priority

Help pregnant woman increase blood volume and provide for placenta and fetus needs Encouraged to be taken during 2nd & 3rd trimester

Iron supplements

Side effect

Enhance absorption by taking between meals, with liquids (not milk, phytates)

Zinc

Essential for protein synthesis, cell development Supplementation during pregnancy is not advised

Prevents absorption of iron

Prenatal supplements

Food Assistance Program


Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Nutritious foods Nutrition education Referrals to health and social services Benefits of the program

Supplemental Nutrition Assistance Program (SNAP)

Weight During Pregnancy


Weight gain

Women must gain weight during pregnancy


Benefits of appropriate weight gains Nearly all lean tissue

Ideal weight-gain pattern

Weight loss and pregnancy


Typical woman does not return to prepregnancy weight Important to have a healthy weight prior to pregnancy

Pregnancy & Physical Activity


Benefits of physical activity Consult physician Low impact activities


Avoid those that may cause falls or may get hit by a person or object
Prevent dehydration Prevent high internal temperature Avoid saunas, steam rooms, hot whirlpools

Recommendations

Teen Pregnancy

Special case of intense nutrient needs


Frequent teen deficiencies

Less likely to receive prenatal care More likely to smoke Weight gain

35 pounds (for a teen with normal BMI) Infant


Risks associated with teen pregnancy


Premature, lowbirth weight, higher infant mortality rate

Mother

Higher blood pressure later in life Nutrient deficiencies Feeling isolated, alone STDs

Common

Cravings/ Aversions During Pregnancy


Do not reflect physiological needs May be due to hormone- induced changes in taste/ sensitivities to smells

Tend to disappear after birth

Pica

Often associated with iron deficiency Occurs anytime May be due to hormonal changes

Morning sickness

Cautions for Pregnant Women


Smoking

Damage to fetal DNA


Developmental defects or diseases

Complications of birth Risk of SIDS (Sudden Infant Death Syndrome) No OTC drugs or herbal supplements

Medicinal drugs and herbal supplements


May cause birth defects

Prescriptions only with doctors advice

Cautions for Pregnant Women


Drugs of abuse

Cross the placenta Complications of use Lead


Environmental contaminants

Low birthweight infant with delayed mental and pyschomotor development Fish consumption

Mercury

Limit weekly consumption to 12 oz of seafood or 6 oz of fish

Cautions for Pregnant Women


Foodborne illness

Listeriosis

Foods to avoid

Vitamin-mineral megadoses

Vitamin A & fetal malformation of cranial nervous system

Dieting Sugar substitutes Caffeine


Limit 2 cup of coffee or 2 (12 oz) caffeinated sodas/ day

Drinking During Pregnancy


Labeling of alcoholic beverages Alcohol crosses placenta & is toxic


Direct effects in fetus

Fetal Alcohol Syndrome


Drinking alcohol during pregnancy


Fetal Alcohol Spectrum Disorders (FASD)


Fetal Alcohol Syndrome (FAS)

Alcohol-Related Neurodevelopmental Disorder (ARND) Alcohol-Related Birth Defects (ARBD)


Expert advice

Troubleshooting Diabetes

Special challenges for disease management


Problems with poor glycemic control Continuation of intensified management after pregnancy Diabetes risk later in life Increased odds of surgical birth and high infant birthweight

Gestational diabetes

Troubleshooting Hypertension & Preeclampsia


Hypertension

Chronic vs. gestational hypertension


Risks for mother and fetus

Preeclampsia

High blood pressure and protein in urine Occurrence Advancement to eclampsia (seizures)

Lactation

Preparation before birth


Read books/ research


Breast milk & Infant formula


Recommended for at least 1st 4-6 months Encouraged 6-12 months

Consult a certified lactation consultant Learn how to become nutritionally ready for lactation

Nutrition During Lactation


Energy cost

500 calories per day above a womans need


+330 kcals 1st 6 months (170 kcals drawn from fat stores), +400 kcals next 6 months

Fluid need

Prevent dehydration

Recommended 13 cups fluid/ day

Variations in breast milk


Quantity vs. quality of milk Food sensitivities and allergies


Infants who develop sensitivities/ allergies, would be best for lactating mother to omit certain common allergens from diet

Weight loss

Gradual Too rapidly may inhibit lactation/ reduce milk output

When Should a Woman NOT Breastfeed?


Alcohol and illicit drugs


Alcohol concentration peak within 1 hour (even in moderate amounts) Illicit drug users should NOT breastfeed

Tobacco and caffeine

When Should a Woman NOT Breastfeed?


Medicines/ supplements

Danger levels vary consult physician


Some oral contraceptives shorten/ suppress milk output

Maternal illness

Common cold Hepatitis or tuberculosis Cancer HIV


World Health Organization (WHO) only recommends HIV infected women to breastfeed 1st 6 months in developing countries

Feeding the Infant


Nutrient needs

Growth rate
Weight

and length

Basal metabolic rate Energy nutrients Vitamins/ minerals Water


More

in warmer temperatures

Why Breast Milk is so Good For Babies


AAP (American Academy of Pediatrics) & ADA (American Dietetic Association)


Recommend 6 months & breast feeding with complementary foods for at least 12 months Exception of vitamin D

Excels as source of nutrients


Supplementation

DHA, Arachidonic Acid Colostrum Lipids

Immune factors liquid gold


Energy-nutrient balance

Why Breast Milk is so Good For Babies


Easily digested Other potential benefits


May lower risk of obesity Beneficial for IQ

Formula Feeding

Offers an acceptable alternative to breastfeeding Nutrient composition


Recommended Iron fortified Soy based, hydrolyzed protein, amino acid based 1 year of age

Special formulas Transition to cows milk


Dietary indicators of readiness for cows milk Whole milk

Infants

st 1

Foods

Governing considerations
Nutrient needs

Iron and vitamin C Ability to swallow (4-6 months) 8 months- 1 year, hard crackers and other finger foods may be introduced (supervised) Introduce single-ingredient foods one at a time

Physical readiness

Need to detect & control allergic reactions


Wait 3-5 days between

Infants

st 1

Foods

Choices of foods Variety, balance, moderation Fat restriction


Dietary fat not on food label for foods for children 2 and under

Foods to omit Sweets and baby desserts may lead to obesity Sugar alcohols may cause diarrhea Canned foods contain too much salt and foodborne illness is a concern Honey & corn syrup may cause botulism Milk anemia

More than 2-3 cups of milk per day may displace iron rich foods, leading to iron deficiency anemia

Looking Ahead

First year of life lays the foundation for future health


Encourage healthy, varied eating habits Avoid concentrated sweets/ empty calories Encourage physical activity
Teeth decay as a result of babies regularly put to bed with a bottle May cause buck teeth, deformed teeth, etc

Nursing bottle syndrome


Not recommended to give bottles after age 1

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