Lecture 21Vitamin and mineral needs: Folate (natural in bananas, legumes, spinach) promote cell division and DNA production.For mother: Prevent macrocytic anemiaRecommended intake before & during pregnancy:400 mcg from folic acid + 200 mcg addition intake from folate. Total 600mcg. Need before, during, and after.Additional IRON needed for production of additional red blood cells, prevent anemia, and for fetal growth and development. Usually supplemented since difficult to meet needs with diet. Part of components of gaining weight is increase in bld volume (need more hemoglobin therefore need iron). Don't want to intake with Ca bc competes.Additional zinc needed for synthesis of proteins, RNA, and DNA synthesis.Vitamin A Deficiency à poor fetal growth. Excess before & very early in pregnancy à risk of facial & heart malformations (remember fetal pictures) Beta-carotene (precursor to Vit A) not harmful Limit Retinol and Vit A-containing medications, e.g., Acutane, retinoic acid for acne NUTR 202 1nd EditionBalance Diet meets MOST nutrients needs…BUT NOT “eating for two adults”. Need 20% more calories. Need 50% more Folate, Vit B6, Iron, Zinc, Iodine, Protein. Need adequate calcium (absorption doubles). May need more VIT D. Prenatal Supplements needed even on a good diet. Pregnant Moms risk not getting enough Ca, Vit D, Folate, Vit B-12, Fe, & Zn.Discomforts of Pregnancy: Physiological changes during pregnancy can cause uncomfortable side effects for the mother. These can include: Edema- increased blood volume, morning sickness- hormone related, heartburn, and constipation/hemorrhoids. During the first trimester, the mother is beginning to notice a newly heightened sense of taste or smell, and perhaps some sickness and cravings. Morning sickness: nausea (70%) and/or vomiting (37-58%) any time of day or night, usually in 1st trimester. Eat small, frequent snacks of dry/ starchy foods, avoid greasy foods, spicy foods & caffeine, cook in areas with good ventilation, on walking, and rise slowly.Common cravings: Ice cream, sweets, candy, citrus fruits, chocolate, fish, chips, pickles. Common aversions: coffee, highly seasoned foods, fried foods.Pica: craving for and ingestion of nonfood items (clay, ice, hair, laundry starch, ashes) with little or no nutrition may lead to iron deficiency. (More common in AA women, rural women and/or with family history/traditions). During 2nd and 3rd trimester: PROGESTERONE: helps relax muscles. Crowding of GI tract might cause: Heartburn: Limit high-fat, spicy foods; avoid heartburn-causing substances; eat small, frequent meals; remain upright after eating. Constipation and hemorrhoids: Maintain moderate level of physical activity and consume plenty of fluids and high-fiber foods. Critical Periods of Development time of rapid cell division or differentiation or migration and organization in specialized tissues or organs; varies depending on tissue/organ; once completed fate of cells/tissue/organ set,not reversible, no ‘do-overs. Why embryonic stage is so important. Def. in folate/folic acid or excess preformed Vitamin A. Immune system weakened during pregnancy, increasing number and severity of infectionsListeria infections often result in miscarriage, premature delivery, stillbirth, or fetal infection; bacteria commonly found in unpasteurized milk/juices, must wash fruits and vegetables, avoiding certain seafood (raw).Caffeine in excess associated with increased risk of miscarriage or low birth weight. Limit caffeine to <200 mg of caffeine/day (1-2 cups of coffee or 2–3 20-ounce soft drinks).Mercury in fish can cause developmental delays and brain damage. Consume 8–12 ounces of seafood/week from a variety of seafood types; avoid fish high in mercury; limit fish with lower amounts mercury. Don't eliminate because source of lean protein, omega-3 fatty acids, and iodine. Alcohol: A leading cause of preventable birth defects; teratogen that damages nervous system, affects fetal growth and development because it reduces blood flow to the placenta, can impair maternal nutritional status,and causes fetal alcohol spectrum disorders (FASD). Physical or behavioral conditions and functional or mental impairments linked to prenatal alcohol exposure; includes fetal alcohol syndrome.Gestational hypertension is an abnormal rise in blood pressure after the 20th week. Hypertension is 140/90. Atrisk: Especially common under 18 and over 35 years of age, in low-income mothers, and with chronic hypertension or kidney disease.Preeclampsia (mild form): high blood pressure with edema and protein in urine; reduces blood flow to the placenta: Requires bed rest and careful medical monitoring; usually resolves after delivery. Eclampsia (severe form) causes life-threatening seizures, coma and death.Gestational diabetes: High blood glucose levels that develop in a pregnant woman. At risk: More common withobesity and family history of type 2 diabetes and in African Americans, Hispanic/Latino Americans, Native Americans. Mother has a 20–50% chance of developing diabetes in 5–10 years (increased risk of diabetes). Fetus is at risk for being large for gestational age and developing diabetes. (from increase FA production from inc insulin.In the US, about 1 million adolescent girls between the ages of 12 & 19 becomes pregnant each year= Major public health problem!Teen pregnancy: Still growing à HIGHER nutrient needs PLUS extra nutrients for pregnancy. Higher risk pregnancy-induced hypertension, preterm and low weight babies. Might stop growing after delivery of baby. Need additional nutrients/vitamins.Mothers older than 35: Greater risk of given pregnancy-associated problems. If already a health disorder or obese à even greater risk, ex: hypertensive moms à even greater risk preterm, low birth wt. Higher risk Down’s syndrome.WIC program: Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federally funded program that provides vouchers for the purchase of nutritious foods and referrals to health and other services for low-income women who are pregnant, postpartum, or breast feeding, and for infants and children up to age 5 who are at risk of malnutrition. With WIC program- can only buy nutrient dense foods in order to guarantee healthy growth of baby!Breast milk is best for infant’s unique nutrition needs. Composition of breast milk changes as infant grows. Fluid produced after birth: Colostrum: High in immune