Stages of Fetal Growth Blastogenic rapid cell division First 2 weeks Implantation in uterine wall Implanted ovum secretes HCG which can be detected in urine Embryonic critical period of development Organs and body structures formed Risk for congenital abnormalities 2nd to 8th week from conception may not realize pregnant yet Fetal Stage 500 fold weight increase Longest stage of pregnancy Physiology of Pregnancy Maternal changes Growth of adipose breast uterine tissues Increase blood volume Slower GI motility Pregnancy GI Distress Distribution of Weight Gain Maternal weight gain Recommendations depend on BMI Underweight BMI 19 8 28 40 lbs Normal weight BMI 19 8 26 25 35 lbs Overweight BMI 26 29 15 25 lbs Obese BMI 29 15 lbs Weight During Pregnancy Maternal obesity can complicate pregnancy and delivery and may compromise a baby s health Being too thin meanwhile carries its own risks Lean women with a BMI less than 20 kg m2 have increased risks of preterm delivery and delivering a low birth weight infant Overweight and obese women have increased risk for the following high blood pressure gestational diabetes preeclampsia a form of diabetes that is associated with pregnancy it often is controlled through diet alone a condition marked by high blood pressure fluid retention and protein in the urine prolonged labor unplanned cesarean section difficulty initiating and continuing breastfeeding preterm delivery stillbirth Food Choices for Pregnancy Metabolism increases by 15 Calorie needs DRIs Second Trimester need an additional 340 kcals day Third Trimester need an additional 450 kcal day Consequences of energy restriction Decrease intake of essential nutrients Key Macronutrients in Pregnancy Protein Fat Needed for synthesis of maternal and fetal tissue Needs continue to increase throughout pregnancy Provides vital fuel for the mother and the developing placental tissue Carbohydrate Fiber Key Micronutrients in Pregnancy Important for GI regulation Important to promote availability of glucose to the fetus Pregnant women have an increased need for a number of vitamins and minerals to support growth and development Increase needs for the following Vitamins Thiamine Riboflavin Niacin B6 B12 Pantothenic Acid Vitamin C Vitamin A Folate 600 micrograms day Most mineral needs are higher during pregnancy Most notably is Iron 27 mg day Supplementation Iron and Folate intake is hard to achieve with food alone Most women take prenatal vit min supplements Avoid high dose Vit supplements of A and D due to risk for toxicity Avoid herbal preparations not evaluated for safety during pregnancy Non Nutrient Effects Issues Alcohol Caffeine Consumption during pregnancy will result in fetal alcohol syndrome Remains controversial only found to decrease birth weight when in conjunction with alcohol Artificial sweeteners Considered acceptable Smoking Increase risks of miscarriages stillbirth low birth weight and premature delivery Beliefs avoidances cravings and aversions Pica eating non food items Transfer of Substances Across the Placental Membrane Food Safety During Pregnancy Foodborne illnesses Can result in exhaustion and dehydration Prevention by avoiding raw fish oysters soft cheese specifically those that are not pastreurized and raw or undercooked meats fish and eggs Mercury contamination FDA advises to limit fish to 12 oz or less per week Lactation During the 1900s almost all infants were breastfed During the 1970s the rate of breastfeeding reached an all time low In 2001 the breastfeeding rate was 69 5 which was Likely due to the health promotion strategies relating to breastfeeding Physiology of lactation Changes during pregnancy Increased breast tissue Maturation of structure Hormonal controls Prolactin stimulates milk production Oxytocin stimulates milk release Let down reflex Nutrition During Lactation Nutrition for breastfeeding women Energy and protein Higher needs than pregnancy Vitamins and minerals Most are higher or same as pregnancy Iron and folate needs are lower Water Nutritional requirements of lactation Energy needs DRI 330 kcals more during the 1st 6 months 400 kcals more during the last 6 months Protein needs DRI Carbohydrates 25g protein day or total of 71g day 160g 210g day to produce adequate volumes of milk Lactation Lipids no DRI for total lipids Polyunsaturated FA n 6 13g day Polyunsaturated FA n 3 1 3g day Benefits of breastfeeding Benefits for infants Optimal nutrition Reduced incidence of respiratory GI ear infections Convenience Other benefits Benefits for mother Convenience Enhanced recovery of uterus size Other benefits Contraindications to breastfeeding Energy Nutrients in Human and Cow s Milk Advantages of Human Over Cow s Milk Infant Nutrition Key Nutrition Concepts The dynamic growth experienced in infancy is the most rapid of any age Inadequate nutrition in infancy however leads to consequences that may be lifelong harming both future growth and development Infancy Growth is the best marker of nutritional status Evaluated using growth charts Weight gain Double birth weight by 4 6 months Triple birth weight by 12 months Increase length by 50 percent by 12 months Length gain Head circumference Common Terms Full Term Infant born between 37 40 wks weights are typically 5 5 8 5 lbs lengths are typically 18 5 21 5 inches full term infants are expected to have typical growth and development Preterm Infant born at or before 37 wks gestation Low Birth Weight Infants LBW Infants do not have the same level of digestive enzymes or stomach emptying as older children that is why it is very important to wait on the introduction of solid foods Extremely Low Birth Weight ELBW 5 lbs 8 oz 3 lbs 3 oz Gross Motor Development Infant Development At birth Digestion and Development GI tract maturation takes 6 months Parenting learning the infants temperament Nutritional Needs based on the DRIs Energy Estimated Energy Requirements EER 0 3 months 89 x wt kg 100 175 kcal day 4 6 months 89 x wt kg 100 56 kcal day 7 12 months 89 x wt kg 100 22 kcal day Protein Fat 0 6 months 1 52g kg 9 1g day 6 12 months 1 2g kg 11g day Carbohydrate Minimum requirement 0 6 months 31g day 6 12 months 30g day 0 6 months 60g day 6 12 months 95g day Nutritional Needs cont Energy and nutrient needs of infants Key vitamins and minerals Feeding infants Breastfeeding Infant formula Supplements for infants Water Requirements Nutrient Concerns of Infants Vit D Human milk is low in vitamin D If not exposed to sun Supplement