Introduction

The prenatal period is characterized by numerous physiologic, psychologic, and social

changes in the mother in preparation for birth and care of the infant. It is a time when a woman
often expresses interest and motivation in improving her eating habits, realizing she is the sole
source of nourishment for her developing baby. Following birth, lactation leads to changes for
the mother. Although providing human milk for one’s infant is exhilarating, the 24-hour demands
of a newborn lead to a reorganization of everyday life and can sometimes be overwhelming.
Societal and cultural influences also may affect the acceptability of breastfeeding (Riley, 2006).
With this, needs on nutritional intake are also addressed. Nutrition and pregnancy refers to the
nutrient intake, and dietary planning that is undertaken before, during and after pregnancy.
Nutrition of the fetus begins at conception. For this reason, the nutrition of the mother is
important from before conception (probably several months before) as well as throughout
pregnancy and breast feeding (Williamson, 2006). An ever-increasing number of studies have
shown that the nutrition of the mother will have an effect on the child, up to and including the
risk for cancer, cardiovascular disease, hypertension and diabetes throughout life. An inadequate
or excessive amount of some nutrients may cause malformations or medical problems in the
fetus, and neurological disorders and handicaps are a risk that is run by mothers who are
malnourished (Chen et al, 2016). According to Hiender an estimated 24% of babies worldwide
are born with lower than optimal weights at birth due to lack of proper nutrition. Personal habits
such as consumption of alcohol or large amounts of caffeine can negatively and irreversibly
affect the development of the baby, which happens in the early stages of pregnancy. A mother's
nutritional intake during pregnancy is believed to influence and possibly offer protective effects
against the development of allergenic diseases and asthma in children. Maternal intake of
vitamin d, vitamin e, and zinc have all been associated with a lower likelihood of wheezing in
childhood, suggesting a protective effect. Additionally, maternal intake of omega-3 long chain
polyunsaturated fatty acids has been associated with a reduced risk of development of eczema in
childhood and reduced likelihood to for infants exhibit sensitivity to foods in the first year of life
( Shils et.al 2013). Prenatal nutrition addresses nutrient recommendations before and during
pregnancy. Nutrition and weight management before and during pregnancy has a profound effect
on the development of infants. This is a rather critical time for healthy development since infants
rely heavily on maternal stores and nutrient for optimal growth and health outcome later in life.
There was a study at the national institution of health which found that babies born from an
obese mother have a higher probability to fail tests of fine motor skills which is the movement of
small muscles such as the hands and fingers. A common saying that a woman "is eating for two"
while pregnant implies that a mother should consume twice as much during pregnancy, but is
misleading. Although maternal consumption will directly affect both herself and the growing
fetus, overeating excessively will compromise the baby's health as the infant will have to work
extra hard to become healthy in the future. Compared with the infant, the mother possesses the
least biological risk. Therefore, excessive calories, rather than going to the infant, often get
stored as fat in the mother. On the other hand, insufficient consumption will result in lower birth
weight.
 Character of age group/ population

Pregnancy, also known as gestation, is the time during which one or more offspring
develops inside a woman. A multiple pregnancy involves more than one offspring, such as with
twins. Pregnancy is typically divided into three trimesters. The first trimester is from week one
through 12 and includes conception, which is when the sperm fertilizes the egg. The fertilized
egg then travels down the fallopian tube and attaches to the inside of the uterus, where it begins
to form the embryo and placenta. (Shehan cl, 2016).
during the first trimester, the possibility of miscarriage (natural death of embryo or fetus)
is at its highest. The second trimester is from week 13 through 28. Around the middle of the
second trimester, movement of the fetus may be felt. At 28 weeks, more than 90% of babies can
survive outside of the uterus if provided with high-quality medical care. The third trimester is
from 29 weeks through 40 weeks. (Kennedy, 2015)
According to Capuco 2009, lactating mothers are characterized by secretion of milk from
the mammary glands and the period of time that a mother lactates to feed her young. The process
can occur with all post-pregnancy female mothers. In humans the process of feeding milk is also
called breastfeeding or nursing.

Nutritional recommendations for pregnant women

Energy
it is difficult to estimate the true energy cost of pregnancy, but the best estimates place the total
energy cost somewhere between 68,000 kcal and 80,000 kcal, the current recommendation is for
a woman to consume an extra 300 kcal per day during the second and third trimesters of
pregnancy. If a pregnant woman fails to increase her energy intake during pregnancy it can result
to low birth weight ( Grodner, et.al 2016).

Protein
The recommended dietary allowance (RDA) for protein during pregnancy is 71 g per day for
adolescent and adult women. Pregnant patients may be counseled to include appropriate sources
of protein providing vitamins, minerals, and moderate amounts of fat. The increase in protein
intake over the nonpregnant state is necessary to build and maintain the variety of new tissues of
pregnancy. Retrieved from institute of medicine, food and nutrition board (IMFNB), 2018.
Vitamin and mineral supplementation
Vitamins of concern are vitamins a and d. While the RDA for vitamin a is 750 to 770 mcgrae
(retinol activity equivalents) preformed vitamin a, the tolerable upper intake level (ul) is set at
2800 to 3000 mcg rae preformed vitamin a per day because of the potential for birth defects from
excessive intake. Similarly, excessive vitamin d during pregnancy may cause birth defects so that
the adequate intake (ai) (5 mcg per day) and ul (50 mcg per day) are the same for women
regardless of physiological state (IMFNB, 2018).

Folate.
Substantial research has demonstrated that folate is important for the prevention of neural tube
defects (ntds) such as spina bifida and anencephaly ( Grodner, et.al 2016).

Iron.
The RDA for iron during pregnancy is 27 mg per day. This level may be difficult to achieve with
a normal diet, which maintains recommended fat and kcal guidelines. All women should take a
supplement with 30 mg ferrous iron daily beginning in the second trimester to prevent iron
deficiency anemia in pregnancy. Iron deficiency anemia is one of the most common
complications of pregnancy. The iron requirement increases secondary to the expansion of the
maternal red cell volume. Iron deficiency anemia can mean impaired oxygen delivery to the
fetus, which may have severe consequences ( Grodner, et.al 2016)).
Calcium.
The ai for calcium is 1000 mg per day for women and 1300 mg per day for adolescents, neither
of which is an increase over the nonpregnant state (Clausson, 2002). Although calcium needs are
great during pregnancy, particularly for mineralization of the fetal skeleton, changes occur in
maternal calcium homeostasis, which results in an increase in intestinal calcium absorption
Nutrition-related concerns of pregnant women
Caffeine
According to ( Li j, et.al 2015). Caffeine (1-, 3-, 7-trimethyxanthine) may alter deoxyribonucleic
acid (DNA) and, in some individuals, may alter circulating levels of neurotransmitters and
increase blood pressure. Caffeine consumption during pregnancy is associated with increased
risk of pregnancy loss and increased risk of low birth weight, defined as below 2500 grams (5.5
pounds).

Drugs
A pregnant woman should not consume any over-the-counter or prescription medications unless
prescribed by her primary health care provider (Grodner, et.al 2016). The growing fetus,
particularly during the period of organogenesis in the first trimester, is highly susceptible to
insult
Alcohol
The use of alcohol during pregnancy may produce fetal alcohol syndrome (FAS) or fetal alcohol
spectrum disorder (FASD) in the infant. Symptoms include central nervous systems defects and
specific anatomic defects such as a low nasal bridge, short nose, flat midface, and short palpebral
fissures.
Tobacco
Considerable research has been conducted on the effects of cigarette smoking during pregnancy.
Women who smoke during pregnancy are at greater risk for several adverse outcomes including
prematurity, low birth weight, sga, stillbirth, placenta previa (location in lower uterine area),
abruptio placentae (separation from uterine wall), and, postnatally, sudden infant death syndrome
(sids) (IMFNB, 2018). Smoking during pregnancy may cause prolonged effects of impaired
intellectual performance and decreased attention span in the offspring
Foodborne illness
Foodborne illness is a concern during pregnancy. Pathogens such as listeria monocytogenes,
salmonella species, and toxoplasma gondii are high risk for a pregnant woman and her fetus
( Grodner, et.al 2016)..
Exercise
according to Williamson, 2006. Women with normal pregnancies should stay active during
pregnancy, but the intensity of exercise is a matter of debate. Strenuous exercise was thought to
divert blood to the exercising muscles and thus reduce the blood supply to the fetus. There was
also speculation that intense exercise would place the mother at risk for premature labor.

Nutrition during lactation

Breastfeeding, also known as nursing, is the feeding of babies and young children with milk
from a woman's breast. Health professionals recommend that breastfeeding begin within the first
hour of a baby's life and continue as often and as much as the baby wants. (how do i breastfeed
retrived from good mothers.com)

During the first few weeks of life babies may nurse roughly every two to three hours, and the
duration of a feeding is usually ten to fifteen minutes on each breast. Older children feed less
often. (Capuco, 2009). Mothers may pump milk so that it can be used later when breastfeeding is
not possible.
Breastfeeding has a number of benefits to both mother and baby, which infant formula lacks.of
particular value is colostrum which is the fluid secreted from the breast during late pregnancy
and the first few days postpartum ( Grodner, et.al 2016).. When consumed by a newborn,
colostrum provides immunologic active substances (maternal antibodies) and essential nutrients.
Fluid

When a breastfed infant has poor weight gain or is acting fussy and dissatisfied, the mother is
often told to drink more fluids. Dusdieker and co-workers, 1985 found that women consuming an
average of 2000 ml of fluid each day produced an average of 814 ml of milk in 24 hours.
Increasing fluid intake by 25% had no effect on milk production.

Energy

Estimates of the energy required for milk production vary from 60% to 90% efficiency in
converting maternal kilocalories ingested into the kilocalorie content of breast milk. The
international recommended daily allowance for additional maternal calorie take for breastfeeding
is about 500 kcal/day. This is in addition to estimated basal energy requirements which range
from 1700 to 3100 kcal depending on height, activity level and weight for bmi correction factor.

Protein

The average protein content of human milk, a typical lactating mother needs 1.05 g/kg/day of
protein.

Carbohydrates
Approximately 90% of the carbohydrate in human milk is lactose. The amount of lactose in
human milk is relatively constant at 7.3–7.4 g/dl, and appears to be independent of the maternal
carbohydrate ingestion.

Fat

Fat is the major source of calories in human milk. The current literature recommends pregnant
and breastfeeding mothers should take either 4 g of regular fish oil capsules, or 2 g of
concentrated fish oil capsules daily. Capsules may be kept refrigerated or in the freezer to reduce
nausea (dusdieker et.al 1985). Alternatively, a supplement containing 200–300 mg daily of dha
may be taken.

Nutrition related concerns during breastfeeding

Coffee or cola

Drinks should be avoided or used on a minimal basis. They act as diuretics in the mother’s body,
and caffeine, a stimulant, passes into breast milk in small amounts. (chen et al, 2016).

Alcohol

Alcohol not only passes into milk, thus becoming available to the infant, but it also may inhibit
oxytocin, consequently reducing the let-down reflex.
Nursing management

Healthcare professionals may tell women that it’s ok to drink alcohol on occasion or even
in moderation, when they are pregnant. However, evidence shows that there is no known safe
type, safe amount, or safe time to consume alcohol while pregnant. Additionally, it’s important
for healthcare professionals to broach the subject of alcohol, drug and coffee consumption, not
only with their pregnant patients, but with all women of reproductive age it is important to
educate the client that prenatal exposure to substance can lead to a range of physical, mental,
behavioral, learning, and developmental disabilities, with possible lifelong effects for the child
exposed in utero. One syndrome is commonly known as fetal alcohol spectrum disorder or fasd,
nursing education cam also be geared towards the understanding that most
breastfeeding mothers can drink or eat their desired foods in moderation. But some babies,
particularly those under 6 months, may be more sensitive to mom's dietary intake. It is important
to imbed the importance of nutrition when managing the health of both the mother the baby, this
mean giving clear and concise information about the consequences and defects that can occur if
proper nutrition is not given. That is, it is also imperative to make mothers understand that they
are the ones who needs to stand guard and have extra awareness on their diet and behaviors that
may potentially affect the developing fetus or the lactating baby.

However, there are some substances that they may need to eliminate exposure with.
These are drugs and viral infections; this is because Drug use during early pregnancy can affect
the developing organs and limbs of the fetus. Even one episode of drug use during this period
can affect the development of your child. In most cases, it results in a birth defect or miscarriage.
Drug use later in pregnancy can affect the development of your baby's central nervous system.
After pregnancy, many drugs can pass through breast milk and harm the baby. Viral infection
during pregnancy is becoming more relevant as we confront growing risks of pandemics, which
may significantly affect the pregnant mother and the fetus. Pregnant women have a much higher
chance of developing complications (including life threatening complications) if they get flu,
particularly in the later stages of pregnancy. One of the most common complications of flu is
bronchitis, a chest infection that can become serious and develop into pneumonia, congenital
defects and abnormalities or even fetal death have also been reported due to viral infections.
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PREGNANCY AND LACTATION

BY GROUP 2

Aquino ,Jireh
Dasmariñas, Qyara Marnel
Generalao ,Angelito
Ortiz, John Paul
Schnaider,Angielle