Nutrition during Pregnancy Chapter 14 Planned Pregnancies Have the Best Outcome Many practices can be harmful to the fetus healthy lifestyle choices Minimize exposure even prior to conception learn what to avoid Nutrition is important 50 of all pregnancies are unplanned Importance of Prenatal Care Medical assessment throughout pregnancy Adequate diet Learn what to avoid Proper health habits Women Infants and Children WIC supplemental food program The First Trimester First 13 14 weeks of pregnancy Rapid increase in cell number and size Nutritional deficiency or toxicity important Can be harmful to embryo Medication radiation trauma Can be harmful to embryo 50 of all pregnancies miscarry during the first trimester The Second Trimester Fetus begins to look more like an Still susceptible to toxin infant exposure Preparation for lactation Increase of 2 4 lb in breast tissue Deposition of fat tissue Nutritional deficiency at this time affects mother s ability to breastfeed The Third Trimester Rapid growth 2X length 2X 3X weight Transfer of fat calcium and iron to fetus during the last month Iron Fetus may deplete mother s store of iron if intake is low Fetal Development and Risk A Successful Pregnancy Mother s physical and emotional health Infant 37 weeks gestation Birth weight 5 5 pounds Sufficient lung development The longer the gestation the less the health risk Low Birth Weight Infants Less than 5 5 pounds at birth Usually due to preterm births Increased medical costs Small for gestational age Full term babies Low birth weight 5 5 lbs More likely to have medical complications Success in Pregnancy Prenatal care Maternal age Closely spaced and multiple births Smoking medication and drug abuse Food safety Nutritional status Listeria monocytogenes Found in unpasteurized milk soft cheeses make from raw milk raw cabbage Causes flu like symptoms 7 to 30 days after exposure May contribute to spontaneous abortion Recommend pasteurized milk thoroughly cooked meats fish and poultry Does Nutrition Matter YES Supports fetal growth Supports maternal changes To support pregnancy and lactation Inadequate calories 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 Women Infant and Children WIC Energy Needs During Pregnancy 1st trimester Balanced and adequate diet 2nd and 3rd Trimester 350 450 extra kcal per day Choose nutrient dense foods Adequate weight gain The best predictor of outcome Recommended Weight Gain During Pregnancy 2 4 lb weight gain during 1st trimester 0 75 1 lb weekly weight gain during 2nd and 3rd trimester Total weight gain goal 25 35 lb for normal weight women BMI 19 8 25 9 28 40 lb for low weight BMI 19 8 15 25 for high weight BMI 26 29 15 lb for obese BMI 29 Pre pregnancy weight Overweight and obesity Risk of medical complications Postterm likely to weigh 9 pounds Cesarean section DO NOT diet during pregnancy Underweight High risk of low birth weight High risk preterm delivery and possibly infant death Components of Weight Gained During Pregnancy Physical Activity Low impact and non contact activities 30 minutes on most days Promotes easier delivery Non active women Should NOT begin an intense exercise program High risk pregnancies May need to restrict activities Consult physician about possible limitations Protein and Carbohydrate Needs During Pregnancy RDA for protein Additional 25 gm day Many non pregnant women already consume recommended amount of protein RDA for carbohydrate Prevent ketosis 175 gm day Most women exceed this amount Lipids Recommendations 20 30 of total calories from fat 7 or less from saturated fat 1 or less from trans fat Omega 6 and omega 3 Required for fetal growth brain and eye development 13 g day Omega 6 1 4 g day Omega 3 Additional Vitamin Needs Folate 600 g day Synthesis of DNA Fetal and maternal growth Increased red blood cell formation Prevents neural tube defect Periconceptional period Fortified grain products Woman of childbearing years need 400 micrograms day Other B Vitamin needs also increased Other B vitamin needs are also increased Additional Mineral Needs Iodide 220 g day to prevent goiter Cretinism mental and physical delay Calcium 1000 mg day Adequate mineralization of fetal skeleton and teeth Low amounts present in prenatal supplements Zinc 11 mg day Supports growth and development Iron Needs Iron 27 mg day Increased hemoglobin Iron stores for the fetus Iron supplement between meals Be aware of nutrient nutrient interaction Maximize bioavailability Possible effects of iron deficiency anemia Preterm delivery Low birth weight Fetal deaths Should Pregnant Women Take Supplements Prenatal supplements routinely prescribed Higher iron needs Higher folate needs Easier than changing diet Recommended especially for women with poor eating habits Vitamin A Teratogenic effect in high doses Facial and cardiac effects Supplements should not exceed 3000 micrograms RAE per day Using MyPyramid 3 cups milk group 6 ounces meat and bean group 3 cups vegetable group 2 cups fruit 7 ounces grain group 6 tsp vegetable oil Supplies adequate vitamin D folate calcium iron and zinc Pregnant Vegetarians Lacto ovo or Lacto vegetarian Can usually meet nutritional needs Vegan must plan diet carefully Requires sufficient protein Focus on vitamins D B 6 and B 12 iron calcium and zinc Prenatal supplements may be necessary Discomforts of Pregnancy Heartburn Hormone relaxes muscles in uterus and intestine Stomach acid refluxes into esophagus Avoid lying down after eating Avoid spicy foods Check with physician regarding use of antacids Discomforts of Pregnancy Constipation Relaxation of the intestinal muscle Fetus competes with the GI for space Recommendations Regular exercise Fluid 10 Cups day and fiber 28 gm day Hemorrhoids Straining during elimination A result of constipation Discomforts of Pregnancy Edema Placental hormone causes body tissue to retain fluid Increase in blood volume Some swelling is normal Salt restriction and or diuretics not needed for mild edema Only a problem if accompanied by hypertension and protein in urine Discomforts of Pregnancy Morning Sickness 70 80 will experience in 1st May be due to heightened sense of trimester smell Can occur any time of day Avoid nauseating foods or smells Eat small frequent bland meals Consider changing prenatal supplement Megadose of vitamin B 6 Pregnancy Complications Physiological anemia Mother s blood volume
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