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Nutrition during Pregnancy and Lactation
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The mother’s food habits and nutritional status before conception, as well as during pregnancy, influence the outcome of the pregnancy.
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Mother needs more energy to:Supply the increased fuel demanded by
the fetus (increased metabolic workload)
Increase energy by 350 to 450 kcal/day (during 2nd & 3rd trimesters) Increased complex carbohydrates and
protein in the diet are the preferred sources of energy
The fetus requires glucose as its major source of fuel
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Protein serves as the building blocks for growth of body tissues during pregnancy.Rapid growth of the fetusDevelopment of the placenta Increased maternal blood volumeAmniotic fluid
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Protein intake should increase 25 g/day Increase by 50% Milk, eggs, cheese, soy products, meat Legumes, grains
Protein-rich foods contribute calcium, iron, B vitamins
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CalciumEssential for fetal development of bones
and teethSupplements might be needed in cases of
poor maternal stores or pregnancies involving more than one fetus
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Iron
*needed for Hemoglobin synthesis *consuming foods high in vit. C will help
with iron absorption *Iron supplements often needed during
pregnancy
Iodine Iodine essential to produce more
thyroxine Sources
Iodized salt7
FolateBuilds mature red blood cells during
pregnancyNeeded during early pregnancy (and prior
to conception)DRIs recommend daily folate intake of
600 mcg during pregnancy and 400 mcg/day for nonpregnant women during childbearing years
May require folate supplementsTO PREVENT NEURAL TUBE DEFECTS !!!
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Neural Tube Defects
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Vitamin DEnsures absorption and utilization of
calcium and phosphorus for fetal bone growth, including teeth
Daily intake of at least 3 cups fortified milk (low fat, skim)
Exposure to sunlight increases synthesis of vitamin D
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Set weight goals according to mother’s pregnancy nutritional status and body mass indexUnderweight women: 28 to 40 lbNormal-weight women: 25 to 35 lbOverweight women: 15 to 25 lbObese women: approximately 15 lbTeenage girls: 35 to 40 lbWomen carrying twins: 35 to 45 lbWomen carrying triplets: overall gain of 50
lbMinimum = 15 lb.
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Weight reduction should never be undertaken during pregnancy
Average amount of weight gain during first trimester: 2 to 4 lb
1 lb per week weight gain during remainder of pregnancy
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Pregnant women should avoid tobacco, alcohol and caffeine use during pregnancy and lactation
Less than 300mg caffeine/day may be acceptable, check with MD first !
Avoid: shark, swordfish, mackeral Higher levels of mercury Limit tuna (6 oz/wk), shrimp,salmon, catfish (12
oz/week)
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Undercooked meat, unwashed fruits/veget, Cat litter
Toxoplasmosis (infection) Mental retardation Blindness Epilepsy
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Nausea and vomitingMorning sickness occurs briefly during first
trimester. Is caused by hormonal changes.Small, frequent, dry, easily digested energy
foods may relieve symptoms.Toast, crackers
Severe and prolonged sickness requires medical treatment (hyperemesis gravidarum)
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ConstipationMay occur in latter part of pregnancyThe result of increased pressure of
enlarging uterus and reduced normal peristalsis
Remedies include exercise, increased fluid intake, high-fiber foods
HemorrhoidsCaused by increased weight of babyUsually controlled by dietary suggestions
used for constipation
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HeartburnCaused by pressure of enlarging uterus
crowding the stomachDividing day’s food intake into a series of
small meals usually relieves condition Effects of iron supplements:
Gray or black stool, nausea, constipation, diarrhea
Take iron supplements 1 hour before or 2 hours after a meal with water or orange juice
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Identifying risk factors and addressing them early are critical.
Identifying poor food patterns can prevent nutrition problems. Insufficient food intakePoor food selectionPoor food distribution throughout day
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Teenage pregnancySpecial care must be given to support
adequate growth of mother and fetus.Teens have higher rates of low-
birthweight infants & infant mortalityConcerns: still growing, no income, ?
Smoking, ? Drug use, dieting, wt. gain fears
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Fetal alcohol effects
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TobaccoAssociated with prematurity and low birth
weight Drugs
Potential addiction in unborn child Caffeine
Should avoid
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Special counseling needsVitamin abuse by megadosing also may
cause fetal damage.Caffeine used in extreme excess may result
in fetal injury.Poverty puts pregnant women in danger –
will need resources for financial assistance & food (ie, WIC)
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AnemiaDeficiency of iron or folate in mother’s
dietAdditional supplements may be required
(beyond prenatal vitamins) Neural tube defect
Caused by low folate intake Intrauterine growth failure
Caused by low pregnancy weight, inadequate weight gain, smoking
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Hypertensive disorders (preeclampsia)Related to diets low in appropriate
kilocalories, calciumOptimal nutrition important, medical
treatment required Gestational diabetes
Results from increased metabolic workload
Important to identify based on risk factors and treat with special diet or insulin
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Breastfeeding on rise since 1960 >70% of North American mothers
currently initiate breastfeeding.Goal = 75% in early post-partum period
(2010)More mothers are informed of benefits
Practitioners recognize human milk can meet unique infant needs.
Maternity wards and birth centers support lactation.
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Milk production requires an extra 330 to 400 kcal/day.
Need for protein during lactation is 25 g/day more than woman’s average need.
About 3 L/day of water, juices, milk, and soup contribute to necessary fluids.
Rest, moderate exercise, and relaxation are necessary.
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Fewer infections Fewer allergies and intolerances Ease of digestion Convenience and economy Improved cognitive development May protect against breast cancer
(mom)
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