Life Cycle Nutrition: Pregnancy and Lactation

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Life Cycle Nutrition Pregnancy and Lactation

• Chapter 15

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Nutrition Prior to Pregnancy

• Achieve and maintain a healthy body wt.
• Choose an adequate balanced diet
• Be physically active
• Receive regular medical care
• Manage chronic conditions
• Avoid harmful substances
• Smoking, alcohol, drugs
• 50 of all pregnancies are unplanned

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Nutrition and Pregnancy

• Strong correlation between mothers prepregnancy
  weight and infants birthweight
• Infant birthweight is most potent indicator of
  infants future health status
• Pregnancy Nutrition impacts future generations
  low iron stores portend poor brain development
  for the fetus.

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The Placenta

• An organ that develops in the uterus to deliver
  nutrients and oxygen to the fetus and remove
  waste products and carbon dioxide.
• Produces hormones that maintain the pregnancy and
  prepare the breasts for lactation.

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Fetal Growth Development

• Hyperplasia
• Increase in of cells
• Zygote single cell, implants in uterus in 2
  weeks Embryo cells double every 24 hours
• Hypertrophy
• Increase in cell size
• At 8 weeks all organ systems in place
• Cell and size increase simultaneously
• In 7 months fetus grows from 1 oz to 7.5

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Fetal Growth Development

• Zygote Single cell, divides into many cells
  (hyperplasia), within 2 weeks implanted in
  uterine wall
• Embryo Developing infant 2-8 weeks after
  conception cells double every 24 hours organ
  systems develop
• Fetus Developing infant 8 weeks-term
  hyperplasia hypertrophy
• Gestation 38-42 weeks

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Fetal Development
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First Trimester

• First 12 14 weeks of pregnancy
• Period of cell hyperplasia hypertrophy
• Most organs are formed by the end of first
  trimester
• Expected weight gain for the mom is 2 4 pounds
• Emphasis on high quality, nutrient dense foods

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Figure 15-4Page 510
Critical Periods of Developments
Key
Critical development
Continued development
Central nervous system
Heart
Ears
Eyes
Tissue
Legs and arms
Teeth
Palate
External genitalia
0
2
4
8
12
16
Term
Zygote
Embryo
Fetus
Weeks of gestation
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Neural Tube Development
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Second Trimester

• Second 12 14 weeks of pregnancy
• Heartbeat detectable, limbs ears formed
• Expected weight gain for mom is approx. 1 pound
  weekly
• Deposition of 2 4 lbs of breast tissue and fat
  tissue for lactation

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Third Trimester

• Last 12 14 weeks of pregnancy
• Crucial time for fetal growth
• Calcium and iron stores to the fetus during the
  last month
• Approximately 1 lb/week weight gain for the mom

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Weight Gain Guidelines

• Underweight prior to pregnancy, lt18.5 BMI
• 28 - 40 lbs
• Healthy weight prior to pregnancy, 18.5-24.9 BMI
• 25 - 35 lbs
• Overweight prior to pregnancy,24.9-29.9 BMI
• 15 - 25 lbs (no less than 15 lbs)
• Obese prior to pregnancy, gt30 BMI, 15 lb min.
• Pregnancy is NOT a time to diet

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Expected Weight Gain
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Composition of Weight Gain

• Infant at birth
• Placenta/amniotic fluid
• Tissue fluid
• Maternal blood
• Enlargements of uterus
• Breasts
• Maternal stores
• Total

• 7 - 8 lbs
• 3 - 4 lbs
• 5 - 6 lbs
• 3 - 4 lbs
• 2 - 3 lbs
• 1 - 2 lbs
• 5 - 8 lbs
• 26 - 35 lbs

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Weight Gain in the Mother
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Low Birth Weight (LBW) Infants

• Weighing less than 5.5 lbs at birth
• Usually due to preterm births lt 37 weeks
  gestation
• Small for gestational age
• Are full term babies with low birth weight

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Nutritive Needs in Pregnancy

• Energy
• 2nd trimester 340 kcal/day
• 3rd trimester 450 kcal/day
• Protein 25 gm/day
• Nutrients for Blood Production Cell Growth
• Folic acid (600 mg)during pregnancy
• Neural tube defects
• Vitamin B12- 2.6 µ/d
• Iron 27 mg/d
• Zinc 11 mg/d

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Nutritive Needs in Pregnancy, continued

• Iron (27 mg/day)
• Increased Fe absorption, increase in blood volume
• Fetal stores for first 4 months of life
• Especially 2nd and 3rd trimesters
• Nutrients for Bone Development
• Calcium (1000 mg)
• Teeth formation (last 10 wks, form permanent
  teeth)
• Vitamin D to absorb use calcium

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Figure 15-10 (1)Page 519
Comparison of Nutrient Recommendations for
Nonpregnant, Pregnant and Lactating Women
0
250
50
100
150
200
Key
Energya
Protein Carbohydrate Nonpregnant (set at 100 for
a woman
Protein
Carbohydrate
Pregnant
Fiber
Lactating
Linoleic acid
Linolenic acid
Vitamin A
Vitamin D
Vitamin E
Vitamin K
Thiamin
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Figure 15-10 (2)Page 519
Comparison of Nutrient Recommendations for
Nonpregnant, Pregnant and Lactating Women
0
250
50
100
150
200
Key
Riboflaven
Protein Carbohydrate Nonpregnant (set at 100 for
a woman
Niacin
Biotin
Pantothenic acid
Pregnant
Lactating
Vitamin B 6
Folate
Vitamin B 12
Choline
Vitamin C
Calcium
Phosphorus
Magnesium
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Figure 15-12Page 521
Example of a Prenatal Supplement
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Pregnancy Food Guide Pyramid

• Food Pyramid Guidelines
• Meat/meat alternatives 3 (vs 2)
• Milk 3- 4 (vs 3)
• Vegetables 3 (vs 3)
• Fruits 2 (vs 2)
• Breads/grains/cereal 7 (vs 6)

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Menu for Pregnancy
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Discomforts of Pregnancy

• Nausea/ Morning sickness
• Usually 1st trimester due to hormonal changes
• Avoid offending foods or smells
• Eat small, frequent meals
• Constipation/hemorrhoids
• Increase fiber and fluids
• Exercise

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Discomforts of Pregnancy, Cont

• Heartburn
• Small, frequent meals
• Avoid strong spices/ greasy foods
• Pica non food cravings
• Laundry starch, clay, dirt, freezer ice
• Possible sources of lead associated with anemia
• Risk of infections from parasites

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Practices Incompatible with Pregnancy

• Smoking
• Fetal growth retardation
• Low birthweight
• Complications at birth
• Sudden infant death syndrome (SIDS)

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Potential Hazards of Pregnancy

• Drugs
• Can cause serious birth defects
• NO street drugs, OTC drugs, or vitamin
  supplements w/out MD consent
• Caution with herbal supplements
• Dieting
• Low CHO can deprive brain of glucose/other
  nutrients
• Can result in brain damage, growth retardation

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Potential Hazards to Pregnancy

• Aspartame
• NOT w/ phenylketonuria (PKU)
• Sugar substitutes are acceptable, follow FDA
  guidelines
• Alcohol
• Fetal alcohol syndrome brain damage, physical
  retardation
• Malnutrition

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Potential Hazards to Pregnancy

• Caffeine
• Crosses the placenta
• Fetus has limited ability to metabolize
• gt2 cups/day may increase risk of spontaneous
  abortion
• Limit lt 150 mg ( 1 cup coffee/day)
• Decreases Fe absorption

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Nutritional Risk Factors

• At Onset of Pregnancy
• Age (under 15 or over 35)
• gt 3 pregnancies in 2 years
• Poor history of pregnancy outcome
• Poverty
• Pica, eating disorders
• Substance abuse
• Chronic diseases
• Prepregnancy BMI lt 18.5 or gt 25

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Nutritional Risk Factors

• During pregnancy
• Low iron stores
• Inadequate wt. gain
• Excessive wt. Gain
• Low folate stores 400 ug/d recommended before
  pregnancy

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High Risk Pregnancies

• Gestational Diabetes (Type 3)
• Carbohydrate intolerance during pregnancy
• 1 out of 14 pregnancies
• Pre-existing Diabetes
• Type 1 Insulin Dependent
• Type 2 Non-insulin Dependent

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Gestational Diabetes

• Onset during pregnancy
• Age 35 BMI gt 25 previous high birth wt.
• Risks macrosomia and hypoglycemia
• Usually begins at 20 28 weeks gestation
• Usually disappears after birth, with increased
  risk for mom of developing diabetes later in life

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Pregnancy Induced Hypertension

• Preeclampsia Eclampsia
• Symptoms elevated blood pressure, edema all
  over the body, protein in urine
• Risks decreased blood flow and decreased fetal
  nourishment retarded growth still birth
• Placental function impaired
• Resolves once pregnancy ends

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Iron Deficiency Anemia

• Iron is in greatest demand during last half of
  pregnancy
• Related to expanded blood volume
• Critical for fetal brain development and iron
  stores for new born infant
• Medical Nutrition Therapy
• Iron-rich foods
• Deficient when Hgb lt 11, Hct lt 32

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In-text Figure Page 531
A woman who decides to breastfeed offers her
infant a full array of nutrients and protective
factors to support optimal health and development.
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Breast Feeding Impact on Mother

• Requires adequate nutrition
• Production of 25 oz milk/day ( 3 cups)
• Energy requirement 330 kcal/d 1st 6 mo 400
  kcal/d 2nd 6 months
• Increased need for fluids
• Nutritional deficiency affects quantity (vs
  quality) of milk missing nutrients are pulled
  from mothers stores

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Table 15-4Page 531
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Benefits of Breast Milk

• Immunological protection
• Colostrum
• Produced first 2-3 days
• Contains antibodies that help protect infant from
  infections
• Bifidus factors
• Found in colostrum and breast milk
• Favor growth of lactobacillus bifidus to help
  control growth of undesirable intestinal bacteria
• Lactoferrin helps infant absorb Fe (49 vs 4)
• Binds Fe, bacteria cant use, inhibits bacterial
  growth, protective against diarrhea

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Benefits of Breast Milk, continued

• Breast milk is sterile
• Decreases incidence of allergic reactions Special
  bonding time for mother and baby
• Always ready at right temperature, right mixture
• Decrease in ear infections, BBTD, protects
  against necrotizing entercolitis

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Substance Use and Breast Milk

• Substances can enter breast milk
• Alcohol
• Infants drink less breast milk
• 1-1/2 oz may reduce milk production
• Drugs
• Most do enter breast milk
• CONSULT MD

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Colic and Breast Milk

• Caffeine
• Irritability and wakefulness in infant
• Moderate consumption ex. 1 -2 cups coffee/d
• Strong spices
• Individual variations
• Garlic may enhance suckling
• Fresh cows milk may use cheese, yogurt, etc.

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Composition of Breast Milk

• Composition designed for infants
• Lactose, EFA, alpha lactalbumin (protein) easy to
  digest
• Composition
• 6 protein
• 55 fat
• 39 CHO

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Composition of Breast Milk, continued

• Correct AA composition for infants
• Amino acids are the building blocks of protein
• Low phenylalanine, high in taurine
• Alpha lactalbumin (main protein) produces less
  stress on the infants kidneys
• Vitamins/minerals designed for baby
• May require vit. D and/or fluoride supplements in
  first 6 months
• May require iron supplement after 6 months

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Breast Feeding Contraindications

• Women shouldnt breast feed if...
• have communicable disease that would threaten
  infants life (not the common cold)
• have communicable disease that may pass to infant
  via breast milk (ie, HIV, AIDS)
• use certain prescription medications 15 drugs
• abusing alcohol/drugs/tobacco
• All pass into breast milk

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Post-Partum Nutrition Needs for Bottle-Feeding
Moms

• Calorie and nutrient needs approximate that of
  the nonpregnant woman
• Follow Food Guide Pyramid recommendations