Chapter 13: Pregnancy and Breastfeeding

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Chapter 13 Pregnancy and Breastfeeding
2
Planned Pregnancies Have The Best Outcome

• Many practices can be harmful to the fetus
• Minimize exposure even prior to conception
• Nutrition is important
• 50 of all pregnancies are unplanned

3
The First Trimester

• First 13-14 weeks of pregnancy
• Formation of a zygote
• Rapid increase in cell number and size
• Nutritional deficiency or toxicity can be harmful
  
• Medication, drugs, radiation, trauma can also be
  harmful
• half of all pregnancies miscarry during the
  first trimester

4
Vulnerable Periods of Fetal Development
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The Second Trimester

• Begins to look more like an infant
• Still can be affected by toxin exposure
• Deposit of (2-4 lb.) of breast tissue and fat
  tissue for the mother
• Nutritional deficiency at this time will affect
  mothers ability to breastfeed

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The Last (3rd) Trimester

• Rapid growth
• Deposition of fat, calcium, and iron to the fetus
  during the last month
• Baby may deplete moms store of iron if there is
  low intake

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A Successful Pregnancy

• Mothers physical and emotional health
• 37 weeks gestation at the time of birth
• Sufficient lung development
• The longer the gestation, the less the health
  risk
• Birth weight 5.5 pounds

8
Low-Birth-Weight Infants

• Weighing less than 5.5 pounds at birth
• Usually due to
• preterm births (before 37 wks)
• Small for gestational age
• Are full term babies
• Low birth weight

9
Energy Needs During Pregnancy

• Balanced and adequate diet during the first
  trimester
• 300 extra kcal per day during the 2nd and 3rd
  trimester
• Seek nutrient dense foods
• Adequate weight gain is the best predictor of
  outcome

10
Recommended Weight Gain During Pregnancy

• 2 - 4 lb. of weight gain during the 1st trimester
• 0.75 - 1 lb. weekly weight gain during the 2nd
  and 3rd trimester
• Total weight gain goal is 25-35 lb. for normal
  weight women
• Underweight women should gain 28 - 40 lb.
• Obese women should gain 15 - 25 lb.

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Components of Weight Gained During Pregnancy
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Physical Activity

• Low impact and non-contact activities recommended
• Non-active women should not begin an intense
  exercise program
• High risk pregnancies may need to restrict
  activities
• Consult physician about possible limitations

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Protein and CHO Needs During Pregnancy

• RDA for protein is increased by 10-15 gm/day
• Many (non-pregnant) women already consume the
  recommended amount for protein
• Minimum of 100 gm of CHO to prevent ketosis
• Most women exceed the minimum needs of CHO

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Additional Vitamin Needs

• Vitamin D
• Increased for fetal bones development
• 20-30 min. of sun exposure several times a week
• Found in fortified milk and prenatal supplement
• Folate (600 ug/day)
• Synthesis of DNA
• Fetal and maternal growth
• Increase red blood cell formation
• Neural tube defect
• Decrease absorption with contraceptive use
• Other B-vitamins are increased

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Additional Mineral Needs

• Iron (30 mg/day during last 2 trimesters)
• Increased hemoglobin
• Iron stores for the fetus
• Need to take iron supplement
• Iodide (220 ug/day) to prevent goiter
• Calcium
• Adequate mineralization of fetal skeleton and
  teeth
• Low amounts in prenatal supplement
• Zinc
• Supports growth and development

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Using the Food Guide Pyramid

• 3 - 4 servings from the milk group
• 3 servings from the meat and meat substitute
  group
• 3 servings from the vegetable group
• 2 servings from the fruit group
• 6 servings from the bread group
• Will supply adequate vitamin D, folate, calcium,
  iron, and zinc

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Should Pregnant Women Take Supplements?

• High iron needs
• High folate needs
• Prenatal supplements are routinely prescribed
• Easier to take supplement than change diets
• Highly recommended for women with poor eating
  habits
• Vitamin A should not exceed 3000 RAE/day

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Vegetarian and Pregnant

• Lacto-ovo or Lacto-vegetarian can usually meet
  nutritional needs
• Vegan must plan diet carefully
• Requires sufficient protein vitamins D, B-6,
  B-12 iron, calcium, and zinc
• Prenatal supplements may be necessary

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Does Nutrition Matter?

• YES!
• Supports fetal growth
• Supports maternal changes to support pregnancy
  and lactation
• Inadequate kcal can retard fetal growth
• Higher risk for maternal and fetal death in
  famine areas
• The poorer the nutritional status of the mother,
  the poorer the outcome
• Success of WIC

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Other Factors on Pregnancy Outcome

• Socioeconomic status
• Closely spaced births (
• Teenage pregnancy
• Advanced maternal age
• Early prenatal care
• Lifestyle and use of drugs, tobacco
• Crash diets/fasting and prenatal ketosis
• Body weight and weight gain

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What About Caffeine ?

• Decreases iron absorption
• May reduce blood flow through the placenta
• Risk of spontaneous abortion with heavy caffeine
  use in the 1st trimester
• Risk of low-birth-weight infant
• Limit caffeine intake (

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What About Aspartame?

• Harmful for mothers with phenylketonuria (PKU)
• Will disrupt fetal brain development
• Does not seem harmful for women who do not have
  PKU

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Listeria monocytogenes

• From unpasteurized milk, soft cheeses make from
  raw milk, raw cabbage
• Cause flu-like symptoms
• Occur 7 - 30 days after exposure
• May attribute to spontaneous abortion
• Recommend pasteurized milk and thoroughly cooked
  meats, fish, and poultry.

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Importance of Prenatal Care

• Medical assessment
• Monitoring
• Educate about an adequate diet
• Learn what to avoid
• Proper health habits
• Women, Infants, and Children (WIC) supplemental
  food program

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The Discomforts of Pregnancy

• Heartburn
• Hormone relaxes muscles in the uterus and
  intestine
• Stomach acid more likely to slip up the esophagus
• Avoid lying down after eating
• Avoid spicy foods
• Check with physician regarding use of antacids

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The Discomforts of Pregnancy

• Constipation
• Relaxation of the intestinal muscle
• Fetus competes with the GI for space
• Regular exercise
• Fluid and fiber
• Reevaluate iron dose
• Hemorrhoids
• Straining during elimination
• A result of constipation

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The Discomforts of Pregnancy

• Edema
• Placenta hormone causes body tissue to retain
  fluid
• Increase in blood volume
• Some swelling is normal
• Salt restriction and/or diuretics not needed
• Only a problem if accompanied by hypertension and
  protein in the urine

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The Discomforts

• Morning sickness
• 50 of all women will experience in the 1st
  trimester
• May be related to heighten sense of smell
• Can occur anytime throughout the day
• Avoid nauseating foods or smell of food
• Eat small, frequent bland meals
• Consider changing brand of prenatal supplement

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Complications

• Physiological anemia
• Mothers blood volume increase 150 of normal
• Amount of red blood cell only increase 20 - 30
• A lower ratio of red blood cell leading to anemia
• Occurs as a normal response to pregnancy
• May need medical attention if iron store is
  insufficient

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Complications

• Gestational diabetes
• Hormones synthesized by the placenta decrease the
  action of insulin
• Usually begins 20 - 28 weeks gestation and are
  routinely screened
• Diabetic diet may be recommended
• Insulin may be recommended
• Usually disappears after birth but is linked to
  diabetes later in life for mom
• If untreated, can produce a large baby

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Complications

• Pregnancy-induced hypertension
• High-risk disorder
• Preeclampsia (mild form)
• Eclampsia (severe form)
• Elevated blood pressure, protein in the urine
• Edema, change in blood clotting
• Nervous system disorder, leading to convulsions
• Liver and kidney damage leading to death

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Breastfeeding

• Recommended for the first 4-6 months of life the
  American Dietetic Association and the American
  Academy of Pediatrics
• Only 55 of all mothers nurse in the hospital
• Number of moms still breast feeding decreases as
  infant gets older

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How Do You Know If The Infant Had Enough?

• Infant has 6 wet diapers a day
• Shows normal weight gain
• Passes 1 stool per day
• Softening of the breast tissue
• May take 2-3 weeks to establish a breastfeeding
  routine
• Try not to introduce the bottle until
  breastfeeding is well established

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Colostrum

• First fluid produced during late pregnancy and
  few days after birth
• Thick, yellow fluid
• Contains antibodies, immune-system cells and
  Lactobacillus bifidus factor
• Provides protection to infant against infections
• Facilitates the passage of 1st stool, meconium

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Mature Milk

• Composition changed, is thin, watery, slightly
  bluish
• Easy to digest proteins and protein binds to iron
  reducing bacteria growth
• High linoleic acid and cholesterol content for
  brain development
• Long chain omega-3 fatty acids (DHA) for
  synthesis of brain tissues, CNS, eyes
• DHA not available in formula yet

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Milk Composition

• Foremilk
• Resembles skim milk
• 17 fat, 74 CHO, 9 protein
• Makes up 60 of volume
• Hindmilk
• Resembles cream
• 66 fat, 28 CHO, 6 protein
• Makes up the last 5 of the volume
• Released 10-20 minutes into the feeding

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Fluid Needs

• Human milk provides adequate hydration
• Hot climate, diarrhea, vomiting may necessitate
  additional fluids
• Too much water may lead
• Lead to brain disorders
• Low blood sodium

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Nutritional Needs For Lactation

• Most substances ingested are secreted into
  mothers milk
• Milk production requires additional 800 kcal/day
• RDA for energy is an additional 500 kcal/day
• The 300 kcal difference will contribute to slow
  gradual weight loss for mom
• Increase in vitamins A, E, C, riboflavin, copper,
  chromium, iodide, magnanese, selenium, and zinc

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Food Plan

• Balanced and a variety of foods
• 1800 kcals/day
• Moderate fat
• Fluids
• Restriction of kcals will reduce milk supply
• Alcohol and smoking reduces milk supply
• Limit fish and intake of peanuts (allergens)

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Benefits of Breastfeeding

• Always ready, sterile, and meets nutritional
  needs for first 4-6 month
• Provides antibodies
• Contributes to maturation of the GI
• Reduces risk of food allergies
• Establishes eating in moderation
• Contributes to proper development of jaws, teeth
  for better speech
• Decreases ear infections
• Bonding with mom

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Benefits of Breastfeeding

• Quicker return of the uterus to its pre-pregnancy
  state
• Decreases risk of ovarian and premenopausal
  breast cancer
• Cheaper (than buying formulas)
• Bonding with child
• Increased energy need for mom

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Barriers

• Lack of information and role models
• Burden on mom
• Need to return to the work force
• Embarrassment and modesty
• Medial conditions
• Infant with PKU
• Mothers on medications
• Mothers with TB, AIDS, HIV, hepatitis

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Fetal Alcohol Syndrome

• Large amounts of alcohol during pregnancy
• Excess alcohol reaches the embryo/fetus
• Embryo and fetus cannot metabolize alcohol
• Poor fetal and infant growth
• Physical deformities
• Mental retardation
• Irritable and hyperactive

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Fetal Alcohol Effects

• Usually no telltale facial abnormalities
• Parents may not suspect the effects of alcohol
• Hyperactivity
• Attention deficit disorder
• Poor judgment
• Delayed learning

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Effects of Alcohol

• Unclear of how it causes its effects
• Abstinence is important, especially during the
  first trimester
• Binge drinking can arrest and alter cell divisions