Nutrition Across Pregnancy

Diane L. Habash PhD, MS, RD, LDClinical Associate ProfessorDivision of Health Sciences & Medical Dietetics, SHRS/COMWith help from CRC Research Assistants:Katelyn Gordon, Ida Doutt, Dylan Bair & Deepa Balaran, BS.Narrated by Dr. Jonathan Schaffir

“(Other than the air we breathe), Food intake is the environmental factor

to which we are ALL exposed necessarily and

permanently from conception to death.”

Ordovas, 2008

Objectives for this module:

Describe the nutritional needs of the pregnant and breastfeeding woman Discuss how caloric requirements change in pregnancy Describe the possible adverse effects of insufficient or excessive

dietary intake in pregnancy Identify which vitamins and minerals should be supplemented in

pregnancy and why Explain how to counsel a woman about her diet in pregnancy Discuss the unique dietary needs of breastfeeding mothers

Pregnancy during Adulthood (20-50yrs)

Attributes/Circumstances as Adults:• Focused on career/little time for cooking, planning, shopping• Food is fuel, comfort, enjoyment, tradition, ritual, celebration, safe,

appetizing, and available when/how we want/need• Environment of ‘fast-easy access’ foods• Trends in food consumption/eating out

– 35% in 1992 to 45% in 2006; stable until now (2012)

• Time of further exploration of diets, fads, supplements, etc• Growth completed; lean mass maintained til our 40s/50s• ↑↑ Obesity/overweight (~66% of US is ovwt/obese)• Risk of chronic diseases

– ↑obesity & diabetes– ↓Cancer, Stroke, Heart Disease;

• Goal: Maintenance of good health &/or avoidance of chronic diseases

Adulthood (as a comparison):Nutrients of Focus & Recommendations• Kcal ranges from 20 to 60 yrs

– 2800 to 2100 men; 1800 to 1500 women

• Fats (~30% of total kcals); <10% as saturated fats• Cholesterol (<300 mg/d)• Fiber (25-35 g/d)• Folate (400 mcg/d)• Vitamin E (15 mg TE/d)• Calcium (1000 mg/d)• Vitamin D (400 IU/d)• Magnesium (320/420 mg/d)• Iron ( 8/18 mg/d)

Pregnancy/Gestation:Circumstances/Attributes• Single cell to 3500 g in ~40

weeks• Critical Periods for organ

development • Modifiers: maternal diet &

environment• Teratogens:

– Substances that can produce malformation

• Nutrient Gatekeepers– Mom’s Diet (amt, timing, frequency)– Placenta

Critical Periods of Development

Pregnancy….“Infant Mortality…a mirror of population’s health status”

Illustration 4.1 page 62 in Brown;Time-related terms before, during, and after pregnancy.

Risks increased by:• Gestational Diabetes*• Malnutrition of mother*• Multi-fetal Pregnancies*• Hypertensive Disorders of Pregnancy*• HIV/AIDS During Pregnancy*• Eating Disorders in Pregnancy*• Adolescent Pregnancy*

(*require ↑ nutrition therapy)

Maternal Physiology and Nutritional Requirements

Blood Volume – Increased red cell mass (30%) and plasma volume (50%) High requirement for fluids and iron

Hemodilution – serum levels will seem lower Blood Lipids – Cholesterol, LDL, TGs, HDL all increase Blood Glucose – Insulin resistance increases, making

insulin levels higher Organs/Tissues – many tissues (esp uterus!) enlarge Circulation – inc HR and SV require inc energy Respiration – inc TV and O2 consumption also needed

Maternal Physiology and Nutritional Requirements, cont’d

Food Intake – may be reduced by NVP, taste/ odor sensitivities

GI – inc transit time, heartburn, constipation Renal – higher GFR may result in increased wastage of

protein, glucose; Na conserved Basal Metabolism – increased, with change in thermostat Hormones – large amt production Psychological – cravings, mood changes

Mother as giver

Fetus has more glucose available due to maternal insulin resistance

Iron stores preferentially used by fetus in RBC production Ca funneled to infant via bone resorption

Maternal Gestational Weight Gain

ACOG wt gain charts by BMI category

© BMJ Publishing Group Limited 2011. All rights reserved. Accessed Aug 25 2012.

Maternal Nutrients of Focus90% of Fetal Growth Occurs in Wks 20-40 Calories (↑ 340/d in 2nd trimester; 450/d in 3rd) Protein (~70 g/d) All B vitamins

Folate, B6, riboflavin, niacin, thiamin, B12

Minerals Iron, Zinc, Iodine, Calcium

Vitamins A, D, C Essential Fatty Acids (Linoleic + alpha-linolenic)

Nutrient Recommendations

• USDA www.nutrition.gov

• Moderate Level Dose for MV-supplement:• Vitamins

– B6 (2 mg), Folate (200 mcg), C (50 mg), D (5 mg)

• Minerals– Iron (30 mg), Zinc (15 mg), Cu (2 mg), Ca (250 mg)

Overweight/Obesity Challenges with Pregnancy Maternal

Infertility High blood pressure, preeclampsia Gestational diabetes Labor/delivery complications

Infant Birth defects (NTD and spina bifida) Miscarriage/stillbirth Preterm birth/labor Shoulder dystocia Childhood obesity

Lactation: Attributes/Circumstances

Extremely personal for the mother Need education, support, & confidence Is time consuming, social constraint, ever-present (q2

hrs for newborn) Sensitive to mother’s diet, drug, herbal use (limits in

caffeine, spicy foods, etc) Work/social/family pressures impact longevity Lactation Consultants now common support

“Thinking that baby formulais as good as breast milk

is believing that 30 years of technology is superior to 3

million years of nature’s evolution.”

Christine Northrup, MD.

Human Milk Benefits

• Dynamic composition suits human species• Isosmotic for infant; & a complete meal!• Low protein content good for infant gut (↓ allergies)• High content of all fats; impacts cognition, sight, neural

function• Minerals are protein-bound & [appropriate]• ↑ [immune components, cells, growth factors]• Shown to reduce infant mortality/illnesses

– (eg. ear infections of infant)

Lactation-Mom’s Diet Nutrients of Focus

• EAT a NORMAL diet packed with fruits/veg/whole grains/lean meats and extra dairy

• Water-follow usual adult reccs (1mL/kcal eaten)• Energy (kcals) (~750 kcals/d to produce milk)• Lipids-keep healthy intake of poly-fats• Protein (a little increased but not high for USdiet)• DHA (long chained fatty acid)• Cholesterol

Nutrition in Pregnancy Quiz

Links/References

• American Dietetic Association (www.eatright.org)• American Heart Association (www.americanheart.org)• Calorie Control Council (www.caloriecontrol.org)• CDC (www.cdc.gov)• Consumer Lab (www.consumerlab.com)• Vegetarian Resource Group (http://www.vrg.org)• USDA’s My Plate (www.choosemyplate.gov)• Nutrition Through the Life Cycle, 1st & 2nd ed. Judith Brown, Ed.;

Wadsworth Group. 2002/2008.• Position Papers:

– Journal of the Academy of Nutrition and Dietetics:– 2012;112:1255-1277 (Elderly)– 2008;108:1038-1047 (Ages 2-11)– 2008;108:553-561 (Pregnancy)

http://iom.edu/Reports/2012/Accelerating-Progress-in-Obesity-Prevention/Infographic.aspx?utm_medium=etmail&utm_source=Institute%20of%20Medicine&utm_campaign=08.12+IOM+News&utm_content=IOM%20Newsletter&utm_term=Academic

Thank you

For questions, contact:diane.habash@osumc.edu

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