Prior 1
Nutrition to Conception
Changes
in a womens body:
First
decade: bodys primary focus on its own
growth and development
Menstruation begins: body begins to offer ova
for reproduction
Fertilization: union of egg
and
spermatozoon to
create
zygote
2
Nutrition Before Conception
A
healthful diet before conception includes
Avoiding
teratogens: substances that cause
birth defects
Includes
Avoiding
alcohol and illegal drugs
other possible hazards
Smoking,
caffeine, medications, some herbs and
supplements
BMI
between 19.8 and 26.0 kg/m2 and
appropriate level of physical activity
3
Nutrition Prior to Conception
Sources
of Disruption in Fertility
Undernutrition
Obesity
Over-exercising
Effect
of nutrients
Male fertility issues
4
Nutrition Before Conception
A
healthful diet before conception reduces
the risk of developing nutrition-related
disorders during pregnancy, such as
Gestational
diabetes
Preeclampsia
5
Nutrition Prior to Conception
Some
deficiency related problems develop
very early in pregnancy.
Neural
tube defects
Related
to inadequate level of folate
Effects the embryo in the first few weeks
Adequate folate (400g daily) before
conception can reduce the risk
6
7
Photo, p. 602
Ovulation, Conception, and
Implantation
8
Figure15.1
Nutrition During Pregnancy
A
full term pregnancy lasts 38 to 42
weeks.
First
trimester: conception to week 13
Second trimester: week 14 to week 27
Third trimester: week 28 to week 40
Embryonic
stage: approximately day 15 to
week 8.
After week 8, the developing baby is
called a fetus.
9
Nutrition During Pregnancy
First
trimester
Zygote
(fertilized egg) travels through the
fallopian tube and implants in the wall of the
uterus
Development of organs, limb buds, facial
features, placenta
Embryos are extremely vulnerable to
teratogens during this time
10
11
Figure 15.4 (1 of 2)
The First Ten Weeks
12
Figure 15.2
Placental Development
13
Figure 15.3
Nutrition and Pregnancy
Placental
Maternal
Development and Function
blood never leaves the mothers circulatory
system.
Fetal blood never leaves the fetal vessels.
Exchange of materials (oxygen, nutrients and waste
products) takes place within the sponge-like
endometrium, but maternal and fetal blood never
intermingle.
The placenta provides the respiratory, absorptive and
excretory functions that the fetuss lungs,
gastrointestinal tract, and kidneys provide after birth.
14
14
Nutrition and Pregnancy
15
Nutrition and Pregnancy
Placental
Development and Function
Uses
glucose as fuel and provides glucose to
the fetus
Blood flow to the placenta increases 25% of the
cardiac output.
This increase in blood flow influences the rate
of oxygen and nutrient delivery and waste
exchange.
Water, oxygen, carbon dioxide, and electrolytes cross the
placenta by passive diffusion.
Glucose, calcium, phosphorus, magnesium and other nutrients
16
cross it via active transport.
16
Nutrition and Pregnancy
17
Nutrition During Pregnancy
Second
trimester
Continued
development of organ systems
Growth from approximately 3 inches to over
one foot long by the end of the second trimester
18
Nutrition During Pregnancy
Third
trimester
Time
of considerable growth
Fetus gains three-quarters of its weight in this
time
Brain growth is also extensive
Lungs become fully mature
A balanced, adequate diet for the mother is
essential during this time
19
20
Figure 15.4 (2 of 2)
21
Nutrition and Pregnancy
Fetal-Origins
Hypothesis of Later Disease
Risk
Theory
that exposure to adverse nutritional and
other conditions during critical periods of growth
can permanently affect body structures and
functions.
These changes may predispose individuals to
cardiovascular diseases, type II DM, HTN,
gestational DM, chronic bronchitis, among
others.
22
Nutrition and Pregnancy
Examples of diseases and other conditions in adults related to
smallness or thinness at birth:
Allergies
Autoimmune diseases
Bronchitis
Cardiovascular disease
Decreased bone mineral
content
Gestational diabetes
Hypertension
Irritable bowel syndrome
Kidney disease
Metabolic syndrome
Mood disorders
Obesity
Ovarian cancer
Polycystic ovarian
syndrome
Schizophrenia
Short stature
Stroke
Subfertility in males
Suicide
Type II diabetes
23
Nutrition During Pregnancy
Preterm
babies are born before 38 weeks
and may be low-birth weight babies.
Small
for gestational age are babies born
at term but weigh less than would be
expected for their gestational age.
Nutrition
plays a major role in these
conditions.
24
Nutrition During Pregnancy
An
undernourished mother is more likely
to give birth to a low-birth weight baby.
Low-birth
weight: any baby born weighing less
than 5.5 pounds
Increased risk of infections, learning disabilities,
impaired physical development, and death in
the first year
25
26
Figure 15.5
Nutrition and Pregnancy
27
Nutrition and Pregnancy
28
Nutrition During Pregnancy
Weight
gain during pregnancy
Women
who do not gain enough weight are at
risk of having a low-birth weight baby
Compromises
fertility
Increases chance of premature delivery and
intrauterine growth retardation
Apgar scores are often low
29
Nutrition During Pregnancy
Weight
Gain During Pregnancy
Too much weight gain is also risky
Gestational diabetes
High blood pressure during pregnancy
Problems during delivery
Cesarean deliveries
Childhood obesity
Macrosomia in the infant
Greater risk for postpartum weight retention
Women should not diet during pregnancy since this may
deprive the fetus of critical nutrients
30
Nutrition During Pregnancy
Attain
and Maintain a Healthy Body Weight
Children of obese women are at risk of:
Macrosomia
Low Apgar scores
Shoulder dystocia
Childhood obesity
Difficulty regulating blood sugar after delivery
Perinatal mortality due to greater difficulty with delivery
Obese women are at greater risk of hypertension,
gestational diabetes, induced labor, prolonged labor and
caesarean sections.
31
Recommended Weight Gain During
Pregnancy
32
Suggested Maternal Weight Gains for
Multiple Births
Single
25 to 35 pounds
Twins 35 to 45 pounds
Triplets at least 45 pounds
Increase energy intake by 600 kcal per
day rather than 300 kcal per day if carrying
multiple babies
33
Nutrition During Pregnancy
34
Table 15.1
WEIGHT GAIN during PREGNANCY
35
Nutrition During Pregnancy
The
requirement for nearly all nutrients
increases during pregnancy.
Pregnant
women must pay attention to
their intake of
Macronutrients
Micronutrients
Fluids
36
Macronutrients
1.
Energy
An
additional 300 to 450 kcal/day may be
required in the second and third trimesters
Nutrient-dense foods are essential in order to
obtain sufficient nutrients
2.
Proteins and carbohydrates
1.1
g/day/kg body weight (~ additional 25 g/day)
of protein
At least 175 g/day of carbohydrates
37
38
39
Macronutrients
3.
Fat
The
percentage of calories obtained from fat
should not change during pregnancy
Limit saturated fat, avoid trans fats
Fat is required by the newborn for temperature
regulation and as an energy source
Consume rich sources of docosahexaenoic acid
(DHA) an omega-3 polyunsaturated fatty acid
40
Micronutrients
The
micronutrients that are most critical
during pregnancy include:
folate
calcium
vitamin B12
iron
vitamin C
vitamin A
vitamin D
zinc
sodium
iodine
41
Micronutrient Requirements in Pregnancy
42
Micronutrients
Folate
Required
for cell division
Critical in the first 28 days for development of
the neural tube which becomes the brain and
spinal cord
400 g/day for sexually active women
600 g/day for pregnant women
43
44
Figure 15.7
Micronutrients
Vitamin
B12
Regenerates
the active form of folate
2.6 g/day during pregnancy
Vitamin
C
Production
of collagen (connective tissue)
85 mg/day during pregnancy
Deficiency results in elevated risk for preterm
births and preeclampsia
45
Micronutrients
Vitamin
A
Needs
770
increase by 10% in pregnancy
g/day
Excess
vitamin A can cause abnormalities in
fetal kidneys and nervous system
Supplementation is not recommended due to
toxicity risk
Beta-carotene (provitamin A) is not associated
with birth defects
46
Micronutrients
Vitamin
D
AI
does not increase during pregnancy
Excessive vitamin D can cause developmental
disabilities in newborns
If exposure to sunlight is limited or milk
consumption is low, supplementation is advised
Prenatal vitamin supplements contain 10
g/dose
47
Micronutrients
Calcium
1,000
mg/day, same as for nonpregnant women
Calcium absorption is more efficient during
pregnancy
48
Micronutrients
Iron
Increased
need for red blood cells increases
the need for iron by 50% (27 mg/day)
Maternal iron deficiency anemia can result in
pre-term delivery, low birth weight, and fetal
growth restriction.
Fetal need for iron increases in the third
trimester
Iron stores of mother are depleted to support
needs of the fetus
Iron-deficiency anemia is common during
49
pregnancy
Micronutrients: Iron Intake
50
Micronutrients
Zinc
Critical
for making proteins, DNA, RNA
Need increases 38% during pregnancy (11
mg/day)
51
Micronutrients
Sodium
1,500
mg/day, same as for nonpregnant women
Iodine
Need
for iodine increases significantly
220 g/day can be obtained from iodized salt
52
Should I Take Supplements During My
Pregnancy?
May
be necessary especially for:
women
of low socio-economic status
pregnant teenagers
mothers with a poor diet
multiple fetuses (twins, etc)
vegetarians
May
be useful for all other women
53
Fluids During Pregnancy
The
need for fluids increases to 3 liters per
day
Increase
in maternal blood volume
Body temperature regulation
Production of amniotic fluid to protect and
cushion the fetus
Combat fluid retention and constipation
Reduce risk of urinary tract infections
54
Nutrition-Related Concerns
Nutrition-related
problems during
pregnancy can include
Morning
sickness
Cravings and aversions
Heartburn
Constipation and hemorrhoids
Gestational diabetes
Preeclampsia
55
Morning Sickness
Morning
sickness: nausea and vomiting
associated with pregnancy.
Can
occur at any time; often lasts all day
May begin after the first missed period and can
last 12 to 16 weeks
Can be severe enough to require hospitalization
No cure, but symptoms can be reduced
56
Cravings and Aversions
Most
women crave a certain type of food
(sweet, salty) rather than a specific food.
Little
evidence supports the idea that cravings
indicate a deficiency
Due to hormonal fluctuations, physiologic
changes, or familial or cultural roots
Pica: craving non-food a item (ice, clay)
Food aversions are common, but not universal
among pregnant women
57
Heartburn
Heartburn
and indigestion are common
Heartburn
occurs when the sphincter above the
stomach relaxes, allowing stomach acid into the
esophagus
Hormones in pregnancy relax smooth muscles,
thereby increasing heartburn
Enlargement of the uterus pushes up on the
stomach and compounds the problem
58
Constipation and Hemorrhoids
Pregnancy
hormones that cause smooth
muscles to relax also slow the movement of
material through the large intestine
Hemorrhoids: swollen varicose veins in the
rectum that are caused by or exacerbated by
constipation
Reduce constipation by consuming 2535
g/day of fiber, plenty of fluids, and remain
physically active
59
Gestational Diabetes
Gestational
diabetes: insufficient insulin
production or insulin resistance that
increases blood glucose levels during
pregnancy.
7
% of pregnancies
Condition resolves after birth occurs
Risk of delivering a large baby
Uncontrolled blood glucose levels may lead to
preeclampsia
60
Gestational Hypertension
Preeclampsia:
pregnancy-induced
hypertension.
78
% of pregnancies
Can be fatal if left untreated
Deficiencies in vitamin C, vitamin E, and
magnesium increase the risk
Treatment focuses on managing blood pressure
and often includes bed rest
The only cure is childbirth
61
Nutrition-Related Concerns
Adolescent
pregnancy
Vegetarianism
Dieting
Caffeine
Alcohol
Exercise
62
Adolescent Pregnancy
Nutritional
needs of pregnant adolescents are
higher than those of adult women
Adolescent bodies are still growing and
changing, adding to the nutritional needs of
pregnancy
Pregnant adolescents are more likely to have
preterm babies, low-birth weight babies, and
other complications
63
Vegetarianism
A
vegetarian consuming eggs and dairy
products has the same nutritional
concerns as a non-vegetarian.
A
complete vegetarian (vegan) must
carefully monitor the intake of
vitamin D
calcium
vitamin B6
iron
vitamin B12
zinc
64
Dieting
Dieting
to lose weight is not advisable during
pregnancy
Calorie restriction limits nutrient availability for
the mother and the fetus
Fad diets are often unbalanced in
macronutrients and micronutrients
65
Consumption of Caffeine
Caffeine
is a stimulant that crosses the placenta
and reaches the fetus
One to two cups of coffee per day very likely
causes no harm
More than two cups of coffee may slightly
increase the risk of miscarriage and low-birth
weight
66
Consumption of Alcohol
Alcohol
is a known teratogen that crosses the
placenta and is associated with various birth
defects, delivery complications, sudden infant
death syndrome, and increased risk of
miscarriage
Fetal alcohol syndrome (FAS): variety of
characteristics associated with prenatal
exposure to high quantities of alcohol
Malformations
of face, limbs, heart
Many developmental disabilities
67
Smoking and Drug Use
Maternal
smoking exposes the fetus to
toxins.
Smoke
contains lead, cadmium, cyanide,
nicotine, and carbon monoxide
Fetal blood flow is reduced
Increased risk of miscarriage, stillbirth,
placental abnormalities, preterm delivery, lowbirth weight
Most drugs pass through the placenta into fetal
blood
Newborns
suffer withdrawal symptoms
68
Birth Spacing
Birth
Spacing
Minimum of 27 month span between births
recommended.
Give time to rebuild nutritional stores in mom
Shortened length may cause:
Low birth weight and premature delivery
Greater risk of bleeding during delivery, premature rupture
of the bag of water, increased risk of maternal death.
69
Exercise During Pregnancy
Keeps
a woman physically fit
Is a great mood booster
Helps compensate for an increased appetite
Helps keep blood pressure down
Makes it easier to lose weight after the
pregnancy
70
The Benefits of Breastfeeding
High
quality nutrition
Protection from allergies and infections
Assists the mother in weight loss
Suppresses ovulation
Provides an opportunity for bonding
Convenient and cost efficient
Immune protection
Easily digested proteins
Appropriate mineral concentration
Convenience of "preparation
Not necessary to clean and sterilize bottles
71
More Benefits of Breastfeeding
Contains everything a human infant needs for first 4-6
months of life
Improves glucose profile in gestational diabetics
Long-chain polyunsaturated fatty acids, especially DHA,
promote optimal development of CNS
Minerals are highly bioavailable and meet infant needs
Promotes faster shrinking of the uterus
Reduces postpartum bleeding
Faster return to prepregnancy weight
Decreases risk of breast and ovarian cancer
Improves bone density
72
Even More Benefits of Breastfeeding
Decreases risk of diarrhea and respiratory infections
Promotes correct development of jaws, teeth, and
speech patterns
Decreases risk of childhood obesity
Increases cognitive function
Reduces risk for heart disease
Decreases risk for hip fracture
Protects against infectious and non-infectious diseases
Lower respiratory infection, otitis media, bacterial
meningitis, necrotizing enterocolitis, childhood leukemia,
SIDS, celiac disease, inflammatory bowel disease,
neuroblastoma
73
Breastfeeding
Lactation:
production of breast milk.
Prolactin: hormone responsible for the
synthesis of milk.
Produced
toward the end of pregnancy
Suppressed by estrogen and progesterone until
childbirth
Oxytocin:
hormone responsible for milk let
down.
74
Breastfeeding
75
Figure 15.9
Breastfeeding
76
Figure 15.8
Nutrition During Lactation
77
Colostrum
Colostrum:
First
milk produced (from birth up to seven days)
Yellowish and thicker than normal milk
Rich in proteins, antibodies, vitamins, and
minerals
Contains certain immune factors
Has laxative properties
Contains Lactobacillus bifidus factor
78
Mature Milk
More
watery and blue in color than
colostrum
Main protein is lactalbumin
Has iron-binding proteins
Contains immune proteins
Fat composition increases during each
feeding
79
Breastfeeding
Composition
of milk changes during a
feeding
Foremilk
is watery and low in fat
Hindmilk is very high in fat
It
is important to let infant suckle for at
least 20 minutes
80
Breastfeeding
Milk
production requires 700800 kcal/day
Lactating women should consume 330 kcal/day
above their pre-pregnancy needs the first six
months, 400 kcal/day the second six months
This allows a woman to gradually lose weight
(14 pounds per month)
1520 g of protein and 80 g of carbohydrate
required per day above pre-pregnancy needs
Fluid/many micronutrient needs are increased
81
Breastfeeding
Nutritional
quality of breast milk
The
main protein, lactalbumin is easily digested
Primary carbohydrate is lactose
Rich source of omega-3 fatty acids, readily
absorbed calcium and magnesium
82
Infant Nutrition
Optimal
nutrition is critical in the first year
because
High
energy needs, 4050 kcal/lb/day
4050% of energy should come from fat
Iron, vitamin D, zinc, fluoride, and iodine needs
are a concern
The nervous system continues to develop
Infants typically grow 10 inches in length and
triple their weight in the first year
83
84
Infant Nutrition
85
Figure 15.10
Infant Nutrition
Infants
nutritional needs are unique
because
Their
energy needs are high to support rapid
growth
Their digestive tracts and kidneys are still
immature
They are small in size
86
Supplements for Infants?
Several
micronutrients may need
supplementation.
Vitamin
D because of limited exposure to
sunlight
Ironstores are depleted by the sixth month
Fluoride for tooth development
Vitamin B if the mother is a vegan
12
Water
is generally not required unless loss is
excessive (diarrhea, vomiting, fever, hot
weather)
Care must be taken to prevent over
87
Infant Nutrition
World
Health Organization (WHO) recommends
breastfeeding for at least the first two years
Breast milk or formula should be supplemented
with solid food beginning at 4 to 6 months
88
ADVANTAGES of BOTTLE-FEEDING
Convenient if mother is sick or taking medications
Some women are not comfortable with breast feeding
Today's commercial formulas contain adequate nutrients
89
Formulas
Very
tightly regulated by federal
government
Minimum
and maximum standards for 29
nutrients
Protein source: casein or whey from cows milk
Carbohydrate source: lactose and sucrose
Fat source: vegetable oils or microbiologically
produced lipids
Specialized
formulas are available: soybased, predigested, others for certain
medical conditions.
90
91
When to Introduce Solid Food
Introduce
solid food at 6 months
Tongue
movement allows swallowing
Muscle development allows infant to sit up
Digestive system and kidneys have matured
Less likely to develop food allergies
Iron-fortified cereals are well-tolerated
92
93
Photo, p. 629
Infant Nutrition
Infants
should not eat
Foods
they could choke on
Corn syrup or honey
Goats milk
Cows milk
Large quantities of fruit juice
Too much salt or sugar
Too much breast milk, formula, or water
94
Infant Nutrition
Nutrition-related
concerns for infants
include
Allergies
Dehydration
Colic
Anemia
Nursing
bottle syndrome
Lead poisoning
95
Infant Nutrition
Allergies
Solid
food should be introduced one at a time
for a week to watch for allergies
Cows milk, egg whites, peanuts, and wheat
commonly trigger food allergies
Dehydration
Extremely
dangerous for infants
Caused by diarrhea, vomiting, inadequate fluid
intake
Pediatric electrolyte solution may be used
96
Infant Nutrition
Colic
Uncontrollable
crying that can last for hours
Precise cause is unknown
Anemia
Infants
are born with enough iron for only six
months
Anemia can develop
Iron-fortified cereal/supplement may be needed
97
Infant Nutrition
Nursing
Bottle Syndrome
Leaving
an infant alone with a bottle can lead to
cavities (dental caries) and tooth decay
The high-carbohydrate fluid provides an optimal
food source for bacteria that cause dental
caries
Rather than a bottle, begin using a cup by 8
months and no bottle after 18 months
98
99
Figure 15.12
Infant Nutrition
Lead
poisoning
Especially
toxic to infants since the brain and
nervous system are still developing
Results in reduced mental capacity, behavioral
problems, impaired growth
Remove old lead based paint
Allow tap water to run a minute before use to
discard lead leached from pipes
100
WHAT IS "WIC"?
WIC = Special Supplemental Food Program for
Women, Infants, and Children
Provides special food vouchers to pregnant and lactating
women, and children under 5 years of age.
Purpose is to increase likelihood of a healthy baby.
101