CHAPTER 16
NUTRITIONAL ASPECTS OF PREGNANCY AND BREASTFEEDING
LEARNING OUTCOMES
• Discuss factors that predict a successful pregnancy outcome• List major physiological changes that
occur in the body during pregnancy and describe how nutrient needs are altered• Specify the optimal weight gain during
pregnancy for adult women• Describe the special nutritional needs of
lactating and pregnant women, summarize factors that put them at risk for nutritional deficiencies.
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LEARNING OUTCOMES
• Identify nutrients that often need to be supplemented during pregnancy and lactation and explain the reason for each• Discuss potential nutrition-related
problems that occur during pregnancy and suggest techniques for coping with these problems• List substances and practices to avoid
during pregnancy and lactation and describe why they are harmful• Describe the physiological process of
breastfeeding
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PREGNANCY
• Gestation• Favorable pregnancy outcome• Full term (>37 weeks)• Infant weighing greater than 5.5 lbs
• Pre-term• Born before 37 weeks
• Low birth weight• Weighing less than 5.5 lbs
• Small for gestational age• Weighing less than expected for gestational age
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PRE-NATAL DEVELOPMENTAL STAGES
• Conception (sperm + egg)• Zygote (fertilized egg)
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PRE-NATAL DEVELOPMENTAL STAGES
• Embryonic (zygote becomes embryo)• Fetal• Trimesters• Critical periods• Spontaneous
abortion
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NOURISHING THE ZYGOTE, EMBRYO, AND FETUS
• Zygote: absorb from uterus and digest uterine lining• Embryo: placenta• Umbilical cord
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NUTRIENT NEEDS OF PREGNANCY
• Energy needs increase• 1st trimester: no additional increased needed• 2nd trimester: +350 kcal daily• 3rd trimester: +450 kcal daily
• Will depend on many factors (mother’s weight and activity level)• Nutrition during pregnancy DOES impact baby’s
future health
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NUTRIENT NEEDS OF PREGNANCY
•Nutrient needs for new cells:• Protein needs increase by 50%• Essential fatty acid (omega 3)• Zinc-smoking, medications, alcohol also have impact
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NUTRIENT NEEDS OF PREGNANCY
• Folate and Vitamin B-12• Folic acid
fortification• Neural tube
defects
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NUTRIENT NEEDS OF PREGNANCY
• Iron needs increase significantly (more maternal RBC and building fetal stores)• Less blood loss• Increased absorption• Physiological anemia vs iron deficiency
anemia• Factors to consider if taking iron
supplements
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NUTRIENT NEEDS OF PREGNANCY
•Nutrient needs for bone and teeth• Calcium and Vitamin D• Recommended intake stay the same, but
important to meet these recommendations• Highest risk groups: vegans, pregnant
teens, hypertension, no dairy products
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PRE-NATAL VITAMIN AND MINERAL SUPPLEMENTS
• Prenatal vitamins are vitamin supplements intended to be taken before and during pregnancy and during postnatal lactation• Vitamins such as folic acid and the other B
vitamins, zinc and iron are in higher amounts while nutrients such as Vitamin A are reduced.• Other factors:• Iron• Calcium• DHA• Nausea, vomiting (ginger root, probiotics)
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CRAVINGS?
• Are they telling you something?• Common cravings• Pica• Eating non food substances
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PHYSICAL ACTIVITY DURING PREGNANCY
Benefits•To mom: improved cardiovascular function, easier labor, prevent gestational diabetes•To baby: leaner and more neurologically mature
Avoid•Strenuous or endurance (30 minutes moderate)•Deep flexing•Laying flat on your back•Things that can cause abdominal trauma
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NUTRITION RELATED FACTORS AFFECTING PREGNANCY OUTCOME
• Maternal pre-pregnancy weight• Maternal weight gain• Pattern of maternal weight gain• Young maternal age• Maternal eating patterns
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MATERNAL WEIGHT GAIN
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*11-20 pounds
NUTRITION RELATED FACTORS AFFECTING PREGNANCY OUTCOME
•Maternal health• Pregnancy history• Pre-natal care• Pregnancy induced hypertension• Preeclampsia to eclampsia
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NUTRITION RELATED FACTORS AFFECTING PREGNANCY OUTCOME
• Gestational diabetes• 4-7% in those who were not diabetic before
pregnancy• Risk factors: family history of diabetes,
obesity, older than 25, prior gestational diabetes
• Usually starts weeks 20-28• Risks: deplete fetal iron stores, large baby,
fetal low blood sugar at birth• Treatment: exercise, low glycemic load diet,
insulin
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NUTRITION RELATED FACTORS AFFECTING PREGNANCY OUTCOME
• Maternal sociocultural factors• Expanded Food and Nutrition Program (EFNEP)• Women, Infants and Children (WIC)• Food Stamps
• Maternal food supply• Environmental contaminants (mercury in fish)• Foodborne illness (raw meat and seafood, deli
meat, animal feces, soft cheeses)• Caffeine (300 mg)• Food additives (artificial sweeteners)
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NUTRITION RELATED FACTORS AFFECTING PREGNANCY OUTCOME
•Maternal lifestyle• Alcohol• Drugs (including aspirin, cold
medications)• Herbal and botanical products• Nicotine and carbon monoxide
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PHYSIOLOGICAL CHANGE OF CONCERN DURING PREGNANCY
•Heartburn• Constipation•Nausea and Vomiting• Ginger, B6
• Edema
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LACTATION
• Prolactin promotes milk production• Sucking (supply and demand)
• Release of milk from the breast• Let-down reflux• Oxytocin
• Milk types and composition• Colostrum• Lactobacillus bifidus factor
• Transitional• Mature
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NUTRIENT NEEDS OF BREASTFEEDING WOMEN
• Maternal nutritional status• Water• Increase 32 ounces of fluid
• Calories• It takes about 800 calories to produce daily milk
supply• Increase daily intake 400-500 calories
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NUTRIENT NEEDS OF BREASTFEEDING WOMEN
• Food choices during lactation• Problem nutrients: calcium, magnesium,
zinc, folate, B6• Other considerations: omega 3, nuts,
alcohol
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