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Nutrition Before 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 (400mg daily) before conception can reduce the risks. - PowerPoint PPT Presentation
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Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Nutrition Before 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 (400mg daily) before
conception can reduce the risks
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Nutrition Before Conception
A healthful diet before conception includes• Avoiding teratogens: substances that cause
birth defects• Includes alcohol and illegal drugs
• Avoiding other possible hazards• Smoking, caffeine, medications, some herbs and
supplements
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Nutrition Before Conception
A healthful diet before conception reduces the risk of developing nutrition-related disorders during pregnancy, such as
• Gestational diabetes• Preeclampsia
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Nutrition During Pregnancy
A full term pregnancy lasts 38 – 42 weeks:• 1st trimester: conception to 13th week• 2nd trimester: 14th to 27th week• 3rd trimester: 28th to 40th week
Embryonic stage: ~ day 15 to the 8th weekAfter the 8th week, the developing baby is called a fetus.
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Nutrition During Pregnancy
1st 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
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Ovulation, Conception, and Implantation
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
The First Ten Weeks
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Placental Development
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Nutrition During Pregnancy
2nd trimester• Continued development of organ systems• Growth from ~ 3 inches to over a foot long by
the end of the 2nd trimester
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Nutrition During Pregnancy
3rd trimester• Time of considerable growth• Fetus gains ¾ of it’s 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
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
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 1st year
Preterm babies are born before 38 weeks and may be low-birth weight babies.
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Nutrition During Pregnancy
Weight gain during pregnancy:• Women who do not gain enough weight are at
risk of having a low-birth weight baby.• Too much weight gain is also risky.• Women should not diet during pregnancy since
this may deprive the fetus of critical nutrients.
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Nutrition During Pregnancy
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Nutrition During Pregnancy
The requirement for nearly all nutrients increases during pregnancy.
Pregnant women must pay attention to their intake of:
• Macronutrients• Micronutrients• Fluids
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Macronutrients
1. Energy• An additional 300 kcal/day may be required
in the 2nd and 3rd trimesters• Nutrient-dense foods are essential in order to
obtain sufficient nutrients2. Proteins and Carbohydrates
• 60 grams/day of protein• 130 grams/day of carbohydrates
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
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
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Micronutrients
The micronutrients that are most critical during pregnancy include
folate calciumvitamin B12 ironvitamin C zincvitamin A sodiumvitamin D iodine
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
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
• 400mg/day for sexually active women• 600mg/day for pregnant women
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Micronutrients
Vitamin B12• Regenerates the active form of folate• 2.6mg/day during pregnancy
Vitamin C• Production of collagen, a component of
connective tissue• 85 mg/day during pregnancy• Deficiency results in infections, preterm births
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Micronutrients
Vitamin A• Needs increase by 10% in pregnancy• Excess vitamin A can cause abnormalities in
fetal kidneys and nervous systemVitamin D
• AI does not increase during pregnancy• Excessive vitamin D can cause developmental
disabilities in newborns
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Micronutrients
Calcium• 1000mg/day, same as for nonpregnant women• Pregnant women absorb calcium better
Zinc• Critical for making proteins, DNA, RNA• Need increases 38% during pregnancy
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Micronutrients
Iron• Increased need for red blood cells increases the
need for iron by 50%• Fetal need for iron increases in 3rd trimester• Fetus will take iron from mother causing iron-
deficient anemia
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Micronutrients
Sodium• 1500 mg/day, same as for nonpregnant women
Iodine• Need for iodine increases significantly• 220 mg/day can be obtained from iodized salt
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Fluids During Pregnancy
The need for fluids increases to 3 liters per day for
• Increase in the mother’s blood volume• Regulating body temperature• Production of amniotic fluid to protect and
cushion the fetus• Combat fluid retention and constipation• Prevent urinary tract infections
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Nutrition-Related Concerns
Nutrition-related problems during pregnancy can include
• Morning sickness• Cravings and aversions• Heartburn• Constipation and hemorrhoids• Gestational diabetes• Preeclampsia
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Nutrition-Related Concerns
• Adolescent pregnancy• Vegetarianism• Dieting• Caffeine• Alcohol• Exercise
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Morning Sickness
Morning sickness: nausea and vomiting associated with pregnancy.
• Can occur at any time; often lasts all day• May begin after the 1st missed period and last
12 to 16 weeks• High levels of 2 pregnancy hormones may be
the cause• No cure, but symptoms can be reduced
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
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.
• Pica: craving a non-food item (ice, clay).• Food aversions are common, but not universal
among pregnant women.
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Heartburn
• 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.
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Constipation and Hemorrhoids
• Pregnancy hormones that cause smooth muscle 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 25-35 g/day of fiber and plenty of fluids.
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Gestational Diabetes
Gestational diabetes: insufficient insulin production or insulin resistance that increases blood glucose levels during pregnancy.
• Condition resolves after birth occurs• Risk of delivering a large baby• Uncontrolled blood glucose levels may lead to
preeclampsia
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Preeclampsia
Preeclampsia: pregnancy-induced hypertension.• 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
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
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
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Vegetarianism
• A vegetarian consuming eggs and dairy products has the same nutritional concerns as a non-vegetarian.
• A complete vegetarian (vegan) must carefully watch her intake of:vitamin D calciumvitamin B6 iron
vitamin B12 zinc
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
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.
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Consumption of Caffeine
• Caffeine is a stimulant that crosses the placenta and reaches the fetus.
• One to two cups of coffee per day is very likely causing no harm.
• Greater than two cups of coffee may slightly increase the risk of miscarriage and low birth weight.
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Consumption of Alcohol
• Alcohol is a known teratogen that crosses the placenta and is associated with various birth defects.
• Fetal alcohol syndrome (FAS): variety of characteristics associated with prenatal exposure to high quantities of alcohol.• Malformations of face, limbs, heart• Many developmental disabilities
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Exercise
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
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
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
childbirthColostrum: first milk produced; rich in proteins, antibodies, vitamins, minerals.
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Breastfeeding
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Breastfeeding
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Breastfeeding
• Milk production requires 700 – 800 kcal/day• Lactating women should consume an extra 500
kcal/day above their own needs.• This allows a woman to gradually lose weight
(1 – 4 pounds per month).
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Breastfeeding
The benefits of breastfeeding include• High quality nutrition• Protection from allergies and infections• Assisting the mother in weight loss• Suppressing ovulation• Opportunity for bonding• Convenient, cost efficient
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Breastfeeding
Obstacles to breastfeeding include• Many harmful substances are passed into breast
milk, including:• Illegal drugs, caffeine, nicotine, prescription and
over-the-counter medications
• HIV is passed through breast milk• Conflicts with mother’s employment
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Infant Nutrition
Optimal nutrition is critical in the first year because
• The baby’s organs are developing• The nervous system continues to develop• Babies typically grow 10 inches in length and
triple their weight in the 1st year
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Infant Nutrition
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
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
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Infant Nutrition
Infants need• 50 kcal per pound of body weight /day• At least 40% of calories from fat• No more than 20% of calories from protein• 2 ounces of fluid per pound of body weight
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Infant Nutrition
• World Health Organization (WHO) recommends breastfeeding for at least the first 2 years.
• Breast milk or formula should be supplemented with solid food beginning at 4 to 6 months.
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Infant Nutrition
Infants should not eat• Foods they could choke on• Corn syrup or honey• Goat’s milk• Cow’s milk• Large quantities of fruit juice• Too much salt or sugar• Too much breast milk or formula
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Infant Nutrition
Nutrition-related concerns for infants include• Allergies• Dehydration• Colic• Anemia• Nursing bottle syndrome• Lead poisoning
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Infant Nutrition
Allergies• Solid food should be introduced one at a time
for a week to watch for allergiesDehydration
• Extremely dangerous for infants• Caused by diarrhea, vomiting, inadequate fluid
intake• Pediatric electrolyte solution may be used
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Infant Nutrition
Colic• Uncontrollable crying that can last for hours• Precise cause is unknown
Anemia• Infants are born with enough iron for only 6
months• Anemia can develop after that
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Infant Nutrition
Nursing Bottle Syndrome• Leaving an infant alone with a bottle can lead
to cavities and tooth decay• Rather than a bottle, begin using a cup by 8
months and no bottle after 18 months
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
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