PERINATAL NUTRITION

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PERINATAL NUTRITION

• Nutrition during pregnancy and lactation
• Nutrition during infancy.

Rama Bhat , MD. Department of Pediatrics, Universi
ty of Illinois Hospital Chicago, Illinois.
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Nutrition During Pregnancy

• Improved maternal nutrition benefits both mother
  
• and infant.
• Maternal nutrition has a major influence on
  birth
• weight.

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FETAL ORIGINS OF ADULT DISEASE

• DEVELOPMENTAL PLASTICITY
• A PHENOMENA BY WHICH ONE GENOTYPE CAN GIVE RISE
  TO A RANGE OF DIFFERENT PHYSIOLOGICAL OR
  MORPHOLOGICAL STATES IN RESPONSE TO DIFFERENT
  ENVIRONMENTAL CONDITIONS DURING DEVELOPMENT.

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Birth Weight as an Indicator of Risk

• Low birth weight has high risk for coronary
• heart disease
• b) Higher risk for hypertension

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Godfrey and Barker, 2001
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Godfrey and Barker, 2001
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Godfrey and Barker, 2001
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Weight gain recommendations for pregnancy
BMI(Weight for height) Recommended gain
Low BMI ( lt19.8 ) 12.5 - 18 kg (28-40
lbs) Normal BMI (19.8 - 26.0) 11.5 - 16 kg (25
- 35 lbs) High BMI (26.0 - 29.0 ) 7 -
11.5 kg(15 - 23 lbs) Obese (BMI gt 29.0) 6
kg (15 lb.).
BMI ( Wt. In kg./ht. In m2)
National Academy of Sciences 1990.
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RDAs of Nutrients during Pregnancy
Non-Pregnant Pregnant
Energy(Kcal) 2200 2500 Protein(g) 44-50
60 Calcium(g) 0.8 1.2 Iron(mg) 15
30 Folate(mcg) 180 400 Zinc(mg) 12
15 Phosphorus(mg) 800 1200 Vitamin D (mg)
5 10
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NUTRITION DURING PREGNANCY Energy
Requirement

• Cost of extra work during pregnancy has
  been estimated 85,000 calories.
• 41,000 calories for protein and fat stored in
  products of conception.
• 36,000 calories from increased O2 consumption.
• 8,000 calories to convert dietary to
  metabolizable energy.

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CALCIUM METABOLISM IN PREGNANACY

• 99 of calcium is in the skeleton
• Total body calcium 1200 grams.
• 1.0 of calcium is in the ECF.
• Calcium is essential for
• nerve conduction
• muscle contraction
• blood clotting
• membrane permeability

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CALCIUM METABOLISM IN PREGNANACY

• Calcium requirements increase by 33
  during pregnancy.
• Net transfer across placenta is about 25 -
  30 grams.
• Calcium transfer is active.
• RDA for calcium during pregnancy is 1200 mg.

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IRON METABOLISM IN PREGNANCY

• Iron is needed for
• Expansion of red cell mass.
• The fetus and placenta
• Replace the blood loss at delivery

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IRON METABOLISM IN PREGNANCY

• Iron requirements double during pregnancy
• Estimated total pregnancy iron needs is 1000
  mg
• Mother transfers about 200 - 300 mg of iron
  to the fetus.
• Iron absorption during pregnancy increases to 20
  - 40 .
• Iron deficiency in the mother does not lead to
  iron deficiency in her infant

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ADVERSE EFFECTS OF IRON DEFICIENCY

• Mother
• Fatigue
• Leucocyte function
• Tolerance at delivery
• Preterm delivery ( OR 1.9)

Neonate Low birth weight Neonatal
death(developing countries)
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Vitamins
Folic acid

• helps to produce additional blood cells
• helps to support rapid growth of placenta and
  fetus
• (needed for DNA)

Deficiency increases

• NTD (Meningomyelocele and anencephaly).
• Low birth weight
• Prematurity

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VITAMINS

• Folic acid
• Supplementation decreases NTDs (3.6 - 1.0 ).
• In USA alone 2000 - 3000 infants are born
• with NTDs.
• Worldwide incidence 300 -400,000/yr.

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MRC VITAMIN STUDY

• Randomized control trial
• Double blind using a placebo
• Four treatment groups
• A. Mineral folic acid
• B. Mineral Folic acid M.V.
• C. Mineral Placebo
• D. Mineral MV (- Folic acid)

Comparison A B vs C D Folic acid effect B
D vs A C Effect of other vitamins
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MRC Vitamin Study
Relative Risk 0.29 (95 CI 0.12 - 0.71, plt
0.001)
21/602 (3.5)
NTD risk ()
6/593 (1.0 )
WITH FOLIC ACID
WITHOUT FOLIC ACID
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RECOMMENDED COMPOSITION OF MULTIVITAMIN AND
MINERAL SUPPLEMENTS FOR PREGNANT WOMEN
Mineral Requirement Calcium 250
mg Copper 2 mg Folate 300
ug Iron 30 mg Vitamin B6 2
mg Vitamin D 5 ug Zinc 15 mg
National Academy of Sciences 1990.
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Pregnancy and Physical Activity

• Source of considerable debate
• Outcome of well conducted studies
• Increased activity does not result in
• increased absorption.
• Active women have less difficulty
  during labor.
• Infants of very active women were
  smaller.
• Advice Exercise in moderation during 3rd
• trimester.

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FOOD CRAVINGS AND AVERSIONS

• Dietary changes during pregnancy
• Some by advice of the physician.
• Some by folk medical beliefs.
• Some by change in appetite.
• Food cravings
• Sweets and dairy products.
• Aversions
• Alcohol, coffee and meats.

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FOOD CRAVINGS AND AVERSIONS
Cravings and Aversions are not necessarily
deleterious.
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SOCIAL AND ENVIRONTMENTAL FACTORS

• Drug abuse
• HIV infection

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DRUG ABUSE DURING PREGNANCY

• Prevalence 10 - 15.
• Commonly Abused drugs

• Cocaine
• Heroin
• Marijuana
• Tobacco
• Alcohol
• PCP

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ALCOHOL ABUSE

• Increased incidence of addiction (18 - 52).
• Poor maternal nutrition.
• Fetal Alcohol Syndrome ( 1.9 - 2.2 /1000)
• CNS involvement
• growth retardation
• fetal dysmorphology

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HIV INFECTION

• Nutritional Deficiency with AIDS

• protein caloric Malnutrition
• Zinc and selenium deficiency
• Calcium and Magnesium
• Vitamin A, B6, B12, C, E deficiency

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BABY BUILDING BASICS

• Choose food from all FIVE food groups.
• Aim of 25-35 lbs weight gain.
• Add 300 calories/day to your diet.
• Add calcium supplement (1000 mg/day).
• Add daily prenatal vitamins.
• Avoid alcohol and smoking.
• Do not eat raw or uncooked foods.
• Drink 64 ounces of fluid.

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Nutritional Assessment

• Dietary Evaluation Recommendation
• Access to Registered Dietician
• Evaluation Nutritional Status
• Weight for Height
• Eating Habits.
• Modification of the Diet to Existing Medical
  Condition

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Benefits of Maternal Nutrition Services
Preconceptional Prenatal Postpartum
Improves overall maternal health Allows time
to change habits Allows reduction of risk
factors prior to conception
Increases breast- feeding success improves
mat. nutrition. Provides opportunity to promote
healthful eating for entire family.
Improves birth weight,may reduce perinatal
morb. Impr. Maternal health comfort, incr.
initiation of breast feeding.