Lesson 3 Nutrition during Pregnancy Chapters 4 & 5

1
Lesson 3Nutrition during PregnancyChapters 4
5

• Everyone is kneaded out of the same dough but
  not baked in the same oven.
  Yiddish proverb

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Calorie Requirements

• Energy requirements in pregnancy
• 300 additional kcal/d in 2nd trimester 3rd
  trimesters
• Estimating Energy needs
• Pre-pregnancy DBW kg x 30 calories/d 300
  kcals per day OR
• Kg x 34 1st trimester
• Kg x 36 2nd trimester
• Kg x 38 3rd trimester

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Carbohydrates, Artificial Sweeteners and Alcohol

• Carbohydrate intake (50-65)
• Glycemic index (GI) of carbohydrates
• High-GI foods increase fetal fat
• Artificial sweeteners
• No scientific evidence of harm
• Alcohol ingestion
• Strongly advised to avoid during pregnancy

4
Protein

• Protein requirements
• 25 g/day or 71 g
• Average intake of typical female 78 g
• 1.3 g/kg pre-pregnancy weight

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Vegetarian Diets in Pregnancy Vegetarian Food
Guide Adapted for Pregnant Women
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Maternal Intake of Omega-3 Fatty Acids and
Pregnancy Outcome

• Adequate EPA DHA during pregnancy lactation
  linked to higher intelligence, better vision
  more mature CNS
• Dietary intake recommendations for EPA DHA
• AI 300 mg UL 2 g

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Vegan DietCase Study 4.1p. 108
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Other Nutrient Needs

• The need for water during pregnancy
• 9 cups of fluid daily more if exercising and
  sweating.
• Folate and pregnancy outcome
• Functions of folate- methyl group donor enzyme
  cofactor in metabolism, DNA synthesis, expression
  and regulation. Deficiency fetal development,
  placenta rupture, stillbirth, preterm delivery,
  preeclampsia, etc.
• Folate and congenital abnormalities- spina bifida
• Dietary sources of folate
• Recommended intake of folate 600 mcg

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A Newborn Child with Spina Bifida
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Food Sources of Folate
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Other Nutrient Concerns

• Vitamin A and pregnancy outcome excess
  malformations UL5000IU
• Vitamin D requirements deficiency fetal
  growth poor bone formation UL 2000IU
• Calcium requirements in Pregnancy
• Calcium and release of lead from bones
• Fluoride teeth development

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Iron Status and the Course and Outcome of
Pregnancy

• Additional iron needs for pregnancy
• 300 mg for fetus placenta
• 250 mg lost at delivery
• 450 mg for increased RBC
• Iron-deficiency anemia in pregnancy
• Seen in 18 of pregnant women in developed
  countries
• Assessment of iron status

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Iron Status and the Course and Outcome of
Pregnancy

• Recommendations related to iron supplementation
  in pregnancy
• Recommended intake of iron during pregnancy

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Other Mineral Concerns

• Zinc requirements in pregnancy- deficiency
  growth retardation malformations
• Iodine and pregnancy outcome deficiency
  hypothyroidism in offspring
• Antioxidants from plants
• Antioxidants help protect fetal DNA
• Maternal vitamin E intake reduces risk of asthma
  in children
• The need for sodium during pregnancy
• Restriction not indicated in normal pregnancy or
  for control of edema or high blood pressure

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Basics of a Good Diet for Normal Pregnancy
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MyPyramid Guide for Pregnant Women
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Example of One Days Typical Diet for a Pregnant
Women Based on MyPyramid Food Intake
Recommendations for a 2,400-Calorie Diet.
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Effect of Malnutrition on Fetus during pregnancy

• Maternal Malnutrition leads to
• ? decrease in blood volume expansion
• ? inadequate increase in cardiac output
• ? decrease in placental blood flow
• ? decrease in placental size
• ? reduced nutrient transfer
• ? fetal growth retardation

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Herbs to Avoid in Pregnancy
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Exercise and Pregnancy Outcome

• No evidence that moderate or vigorous exercise
  undertaken by healthy women is harmful
• Exercise recommendation for pregnant women
• 3-5 times each week for 30 minutes cardio, 2
  times each week light resistance and daily
  stretching

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Benefits of Exercise during Pregnancy

• Increases energy levels
• Reduces discomfort
• Improves mood
• Improves ease of childbirth
• Sleep better
• Reduces stress
• Improves self-image
• Maintains fitness level

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Food Safety Issues during Pregnancy

• Foodborne illness
• Listeria monocytogenes
• Toxoplasma
• Mercury contamination
• high levels in large, long-lived predatory fish
• lower content in bottom feeders
• avoid shark, swordfish, king mackerel and tile
  fish

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Common Health Problems during Pregnancy

• Nausea and vomiting
• Hyperemesis gravidarum
• Management of nausea and vomiting
• Dietary supplements for the treatment of nausea
  and vomiting
• Vitamin B6, multivitamins, ginger
• Heartburn
• Management of heartburn
• Constipation

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PICA

• Eating disorder - compulsion for persistent
  ingestion of unsuitable substances that have no
  nutritional value
• Geophagia - clay/dirt
• Amylophagia - laundry starch/cornstarch
• Pagophagia ice/freezer frost
• Burnt matches, hair, stone, charcoal, cigarette
  ashes, antacid tables, baking soda, coffee
  grounds, tire inner tubes, etc.

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WIC program

• -1972 pilot program was so successful in 1974
  became nationally funded in US
• -Due to high rate of LBW babies, mothers with
  malnutrition, and lack of nutrition information
  available.
• -For pregnant women who are at nutrition risk,
  poverty level, and their children up to age 5.

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WIC Program

• Includes
• -Nutrition education for pregnancy, lactation
  and children (birth age 5).
• -Supplemental food stamps milk, cereal, juice,
  beans, cheese, etc.
• -Health care and social service-immunizations,
  routine MD visits
• -Saves 3 million/year in health care costs

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Health Conditions

• Health conditions impacting pregnancy
  interventions are covered to include
• Hypertensive disorders of pregnancy
• Preexisting gestational diabetes
• Obesity
• Multifetal pregnancies
• HIV/AIDS
• Eating disorders
• Fetal alcohol spectrum
• Adolescent pregnancy

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Hypertensive Disorders of Pregnancy

• Hypertension (HTN) is defined as blood pressure
  140 mm Hg systolic or 90 mm Hg diastolic blood
  pressure
• Affects 6 to 8 of pregnancies
• Contributes to stillbirths, fetal newborn
  deaths, other complications
• Pregnancy-induced hypertension is being
  replaced with hypertensive disorders of
  pregnancy

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Ways to Reduce Oxidative Stress

• Exclude trans fats from diet
• Adequate intake of vitamins C E, the
  carotenoids, antioxidants from plants
• Ample physical activity
• Weight loss if overweight (not recommended during
  pregnancy)
• Consume low-glycemic index foods

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Preeclampsia-Eclampsia

• A pregnancy-specific syndrome occurring gt20 weeks
  gestation accompanied by proteinuria
• Proteinuriaurinary excretion of 0.3 gram
  protein in 24-hour urine sample (or gt30 mg/dL
  protein or 2 on dipstick reading)
• Eclampsiaoccurrence of seizures not attributed
  to other causes

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Characteristics of Preeclampsia-Eclampsia

• Oxidative stress, inflammation, endothelial
  dysfunction
• Blood vessel spasms constriction
• Increased blood pressure
• Adverse maternal immune system responses to the
  placenta
• Platelet aggregation blood coagulation due to
  deficits in prostacyclin relative to thromboxane
• Alterations of hormonal other systems related
  to blood volume pressure control
• Alteration in calcium regulatory hormone
• Reduced calcium excretion

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Nutritional Recommendations with Preeclampsia

• 1000-2000 mg supplemental calcium / day
• 400 IU Vit E and 200 mg Vit C daily
• 5 veggies and fruits daily
• No sodium restriction, unless chronic HTN\
• Follow my pyramid 3 meals 2 snacks
• Moderate exercise 30 minutes 3 times/wk
• Healthy weight gain

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Diabetes in Pregnancy

• Diabetes the 2nd leading complication in
  pregnancy
• Forms of diabetes include
• Type 1 diabetesResults from destruction of
  insulin-producing cells of pancreas
• Type 2 diabetesDue to bodys inability to use
  insulin normally, or produce enough insulin
• GestationalCHO intolerance with 1st onset during
  pregnancy

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Gestational Diabetes

• Seen in 3-7 of pregnant women
• Women who develop gestational diabetes appear to
  be predisposed to insulin resistance type 2
  diabetes
• Associated with increased levels of blood
  glucose, tryglycerides, fatty acids blood
  pressure

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Potential Consequences of Gestational Diabetes

• Elevated glucose from mother reaches fetus
  resulting in increased insulin production
• Increased insulin leads to increased glucose
  uptake triglyceride formation in fetus
• Fetal changes may increase likelihood of
  complications later in life such as
• Insulin resistance
• Type 2 diabetes
• High blood pressure

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Glucose Screening

• First screen is a 50-g oral glucose challenge
  test
• If elevated, 3-hour, 100-g oral glucose tolerance
  test is given
• Gestational diabetes diagnosed if 2 of the
  following levels are exceeded
• Overnight fast 95 mg/dL
• 1-hour after glucose load 180 mg/dL
• 2-hours after glucose load 155 mg/dL
• 3-hours after glucose load 140 mg/dL

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Treatment of Gestational Diabetes

• First approach is to normalize blood glucose
  levels with diet exercise
• If postprandial glucose remains high 2 weeks
  after adhering to diet exercise, insulin
  injections are added
• Medical nutrition therapy decreases risk of
  adverse perinatal outcomes

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Nutritional Management of Women with Gestational
Diabetes

• Assess dietary exercise habits
• Develop individualized diet exercise plan
• Monitor weight gain
• Interpret blood glucose urinary ketone results
• Ensure follow-up during after pregnancy

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THE DIET PLAN

• Whole-grain breads cereals, vegetables, fruits,
  high-fiber foods
• Limited intake of simple sugars
• Low-GI foods, or carbohydrate foods that do not
  greatly raise glucose levels
• Monounsaturated fats
• Three regular meals 3 snacks, include HS snack

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Example of Meal Plans
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Gestational Diabetes Case Study 5.2

• Plot Elizabeth on the Pregnancy Chart
• Pre-pregnancy 61 140 lbs.
• 5 weeks 145 lbs
• 13 weeks 146 lbs.
• 20 weeks 150 lbs.
• 32 weeks 157 lbs.

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Risks Associated with Multifetal Pregnancy
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Nutrition and the Outcome of Multifetal Pregnancy

• Weight gain in multifetal pregnancy
• 35-45 pounds
• Rate of weight gain in twin pregnancy
• 0.5 pounds per week in 1st trimester
• 1.5 pounds per week in 2nd 3rd trimesters
• Weight gain in triplet pregnancy
• Gain of 50 pounds or 1.5 pounds per week

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Prepregnancy Weight Status Weight-Gain
Relationships in Twin Pregnancy
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Fetal Alcohol Spectrum
?

• Fetal alcohol spectrum describes range of
  effects that fetal alcohol exposure has on mental
  development physical growth
• Effects include
• Behavioral problems
• Mental retardation
• Aggressiveness
• Nervousness short attention span
• Stunting growth birth defects

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Effects of Alcohol on Pregnancy Outcome
?

• Heavy drinking (4-5 drinks/day) increases risk of
  miscarriage, stillbirth, infant death
• 40 of fetuses born to women who drink heavily
  will have fetal alcohol syndrome
• Because a safe dose of alcohol consumption
  during pregnancy has not been identified, it is
  recommended that women do not drink alcohol while
  pregnant

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Fetal Alcohol Syndrome

• First identified in 1973
• Characteristics include
• anomalies of eyes, nose, heart CNS
• growth retardation
• small head
• mental retardation

• Features of FAS in children

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Nutrition and Adolescent Pregnancy

• Growth during adolescent pregnancy
• Teen growth in height weight at expense of
  fetus
• Infants born to teens average 155g less than
  those born to older adults

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Risks Associated with Adolescent Pregnancy
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Dietary Recommendations for Pregnant Adolescents

• Young adolescents may need more calories to
  support their own growth as well as that of fetus
• Caloric need should be from nutrient-dense diet
• Calcium DRI for pregnant teens is 1300 mg

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Nutritional Management of Adolescent Pregnancy

• Multidisciplinary counseling services should
  include
• Individualized nutrition assessment
• Intervention education
• Guidance on weight gain
• Follow-up birthweight outcomes