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Life Cycle Nutrition: Pregnancy and Lactation

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Nutrition Prior to Pregnancy. Achieve and maintain a healthy body wt. ... Nutrition and Pregnancy ... Pregnancy: Nutrition impacts future generations; low iron ... – PowerPoint PPT presentation

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Title: Life Cycle Nutrition: Pregnancy and Lactation


1
Life Cycle Nutrition Pregnancy and Lactation
  • Chapter 15


2
Nutrition Prior to Pregnancy
  • Achieve and maintain a healthy body wt.
  • Choose an adequate balanced diet
  • Be physically active
  • Receive regular medical care
  • Manage chronic conditions
  • Avoid harmful substances
  • Smoking, alcohol, drugs
  • 50 of all pregnancies are unplanned

3
Nutrition and Pregnancy
  • Strong correlation between mothers prepregnancy
    weight and infants birthweight
  • Infant birthweight is most potent indicator of
    infants future health status
  • Pregnancy Nutrition impacts future generations
    low iron stores portend poor brain development
    for the fetus.

4
The Placenta
  • An organ that develops in the uterus to deliver
    nutrients and oxygen to the fetus and remove
    waste products and carbon dioxide.
  • Produces hormones that maintain the pregnancy and
    prepare the breasts for lactation.

5
Fetal Growth Development
  • Hyperplasia
  • Increase in of cells
  • Zygote single cell, implants in uterus in 2
    weeks Embryo cells double every 24 hours
  • Hypertrophy
  • Increase in cell size
  • At 8 weeks all organ systems in place
  • Cell and size increase simultaneously
  • In 7 months fetus grows from 1 oz to 7.5

6
Fetal Growth Development
  • Zygote Single cell, divides into many cells
    (hyperplasia), within 2 weeks implanted in
    uterine wall
  • Embryo Developing infant 2-8 weeks after
    conception cells double every 24 hours organ
    systems develop
  • Fetus Developing infant 8 weeks-term
    hyperplasia hypertrophy
  • Gestation 38-42 weeks

7
Fetal Development
8
First Trimester
  • First 12 14 weeks of pregnancy
  • Period of cell hyperplasia hypertrophy
  • Most organs are formed by the end of first
    trimester
  • Expected weight gain for the mom is 2 4 pounds
  • Emphasis on high quality, nutrient dense foods

9
Figure 15-4Page 510
Critical Periods of Developments
Key
Critical development
Continued development
Central nervous system
Heart
Ears
Eyes
Tissue
Legs and arms
Teeth
Palate
External genitalia
0
2
4
8
12
16
Term
Zygote
Embryo
Fetus
Weeks of gestation
10
Neural Tube Development
11
(No Transcript)
12
Second Trimester
  • Second 12 14 weeks of pregnancy
  • Heartbeat detectable, limbs ears formed
  • Expected weight gain for mom is approx. 1 pound
    weekly
  • Deposition of 2 4 lbs of breast tissue and fat
    tissue for lactation

13
Third Trimester
  • Last 12 14 weeks of pregnancy
  • Crucial time for fetal growth
  • Calcium and iron stores to the fetus during the
    last month
  • Approximately 1 lb/week weight gain for the mom

14
Weight Gain Guidelines
  • Underweight prior to pregnancy, lt18.5 BMI
  • 28 - 40 lbs
  • Healthy weight prior to pregnancy, 18.5-24.9 BMI
  • 25 - 35 lbs
  • Overweight prior to pregnancy,24.9-29.9 BMI
  • 15 - 25 lbs (no less than 15 lbs)
  • Obese prior to pregnancy, gt30 BMI, 15 lb min.
  • Pregnancy is NOT a time to diet

15
Expected Weight Gain
16
Composition of Weight Gain
  • Infant at birth
  • Placenta/amniotic fluid
  • Tissue fluid
  • Maternal blood
  • Enlargements of uterus
  • Breasts
  • Maternal stores
  • Total
  • 7 - 8 lbs
  • 3 - 4 lbs
  • 5 - 6 lbs
  • 3 - 4 lbs
  • 2 - 3 lbs
  • 1 - 2 lbs
  • 5 - 8 lbs
  • 26 - 35 lbs

17
Weight Gain in the Mother
18
Low Birth Weight (LBW) Infants
  • Weighing less than 5.5 lbs at birth
  • Usually due to preterm births lt 37 weeks
    gestation
  • Small for gestational age
  • Are full term babies with low birth weight

19
Nutritive Needs in Pregnancy
  • Energy
  • 2nd trimester 340 kcal/day
  • 3rd trimester 450 kcal/day
  • Protein 25 gm/day
  • Nutrients for Blood Production Cell Growth
  • Folic acid (600 mg)during pregnancy
  • Neural tube defects
  • Vitamin B12- 2.6 µ/d
  • Iron 27 mg/d
  • Zinc 11 mg/d

20
Nutritive Needs in Pregnancy, continued
  • Iron (27 mg/day)
  • Increased Fe absorption, increase in blood volume
  • Fetal stores for first 4 months of life
  • Especially 2nd and 3rd trimesters
  • Nutrients for Bone Development
  • Calcium (1000 mg)
  • Teeth formation (last 10 wks, form permanent
    teeth)
  • Vitamin D to absorb use calcium

21
Figure 15-10 (1)Page 519
Comparison of Nutrient Recommendations for
Nonpregnant, Pregnant and Lactating Women
0
250
50
100
150
200
Key
Energya
Protein Carbohydrate Nonpregnant (set at 100 for
a woman
Protein
Carbohydrate
Pregnant
Fiber
Lactating
Linoleic acid
Linolenic acid
Vitamin A
Vitamin D
Vitamin E
Vitamin K
Thiamin
22
Figure 15-10 (2)Page 519
Comparison of Nutrient Recommendations for
Nonpregnant, Pregnant and Lactating Women
0
250
50
100
150
200
Key
Riboflaven
Protein Carbohydrate Nonpregnant (set at 100 for
a woman
Niacin
Biotin
Pantothenic acid
Pregnant
Lactating
Vitamin B 6
Folate
Vitamin B 12
Choline
Vitamin C
Calcium
Phosphorus
Magnesium
23
Figure 15-12Page 521
Example of a Prenatal Supplement
24
Pregnancy Food Guide Pyramid
  • Food Pyramid Guidelines
  • Meat/meat alternatives 3 (vs 2)
  • Milk 3- 4 (vs 3)
  • Vegetables 3 (vs 3)
  • Fruits 2 (vs 2)
  • Breads/grains/cereal 7 (vs 6)

25
Menu for Pregnancy
26
Discomforts of Pregnancy
  • Nausea/ Morning sickness
  • Usually 1st trimester due to hormonal changes
  • Avoid offending foods or smells
  • Eat small, frequent meals
  • Constipation/hemorrhoids
  • Increase fiber and fluids
  • Exercise

27
Discomforts of Pregnancy, Cont
  • Heartburn
  • Small, frequent meals
  • Avoid strong spices/ greasy foods
  • Pica non food cravings
  • Laundry starch, clay, dirt, freezer ice
  • Possible sources of lead associated with anemia
  • Risk of infections from parasites

28
Practices Incompatible with Pregnancy
  • Smoking
  • Fetal growth retardation
  • Low birthweight
  • Complications at birth
  • Sudden infant death syndrome (SIDS)

29
Potential Hazards of Pregnancy
  • Drugs
  • Can cause serious birth defects
  • NO street drugs, OTC drugs, or vitamin
    supplements w/out MD consent
  • Caution with herbal supplements
  • Dieting
  • Low CHO can deprive brain of glucose/other
    nutrients
  • Can result in brain damage, growth retardation

30
Potential Hazards to Pregnancy
  • Aspartame
  • NOT w/ phenylketonuria (PKU)
  • Sugar substitutes are acceptable, follow FDA
    guidelines
  • Alcohol
  • Fetal alcohol syndrome brain damage, physical
    retardation
  • Malnutrition

31
Potential Hazards to Pregnancy
  • Caffeine
  • Crosses the placenta
  • Fetus has limited ability to metabolize
  • gt2 cups/day may increase risk of spontaneous
    abortion
  • Limit lt 150 mg ( 1 cup coffee/day)
  • Decreases Fe absorption

32
Nutritional Risk Factors
  • At Onset of Pregnancy
  • Age (under 15 or over 35)
  • gt 3 pregnancies in 2 years
  • Poor history of pregnancy outcome
  • Poverty
  • Pica, eating disorders
  • Substance abuse
  • Chronic diseases
  • Prepregnancy BMI lt 18.5 or gt 25

33
Nutritional Risk Factors
  • During pregnancy
  • Low iron stores
  • Inadequate wt. gain
  • Excessive wt. Gain
  • Low folate stores 400 ug/d recommended before
    pregnancy

34
High Risk Pregnancies
  • Gestational Diabetes (Type 3)
  • Carbohydrate intolerance during pregnancy
  • 1 out of 14 pregnancies
  • Pre-existing Diabetes
  • Type 1 Insulin Dependent
  • Type 2 Non-insulin Dependent

35
Gestational Diabetes
  • Onset during pregnancy
  • Age 35 BMI gt 25 previous high birth wt.
  • Risks macrosomia and hypoglycemia
  • Usually begins at 20 28 weeks gestation
  • Usually disappears after birth, with increased
    risk for mom of developing diabetes later in life

36
Pregnancy Induced Hypertension
  • Preeclampsia Eclampsia
  • Symptoms elevated blood pressure, edema all
    over the body, protein in urine
  • Risks decreased blood flow and decreased fetal
    nourishment retarded growth still birth
  • Placental function impaired
  • Resolves once pregnancy ends

37
Iron Deficiency Anemia
  • Iron is in greatest demand during last half of
    pregnancy
  • Related to expanded blood volume
  • Critical for fetal brain development and iron
    stores for new born infant
  • Medical Nutrition Therapy
  • Iron-rich foods
  • Deficient when Hgb lt 11, Hct lt 32

38
In-text Figure Page 531
A woman who decides to breastfeed offers her
infant a full array of nutrients and protective
factors to support optimal health and development.
39
Breast Feeding Impact on Mother
  • Requires adequate nutrition
  • Production of 25 oz milk/day ( 3 cups)
  • Energy requirement 330 kcal/d 1st 6 mo 400
    kcal/d 2nd 6 months
  • Increased need for fluids
  • Nutritional deficiency affects quantity (vs
    quality) of milk missing nutrients are pulled
    from mothers stores

40
Table 15-4Page 531
41
Benefits of Breast Milk
  • Immunological protection
  • Colostrum
  • Produced first 2-3 days
  • Contains antibodies that help protect infant from
    infections
  • Bifidus factors
  • Found in colostrum and breast milk
  • Favor growth of lactobacillus bifidus to help
    control growth of undesirable intestinal bacteria
  • Lactoferrin helps infant absorb Fe (49 vs 4)
  • Binds Fe, bacteria cant use, inhibits bacterial
    growth, protective against diarrhea

42
Benefits of Breast Milk, continued
  • Breast milk is sterile
  • Decreases incidence of allergic reactions Special
    bonding time for mother and baby
  • Always ready at right temperature, right mixture
  • Decrease in ear infections, BBTD, protects
    against necrotizing entercolitis

43
Substance Use and Breast Milk
  • Substances can enter breast milk
  • Alcohol
  • Infants drink less breast milk
  • 1-1/2 oz may reduce milk production
  • Drugs
  • Most do enter breast milk
  • CONSULT MD

44
Colic and Breast Milk
  • Caffeine
  • Irritability and wakefulness in infant
  • Moderate consumption ex. 1 -2 cups coffee/d
  • Strong spices
  • Individual variations
  • Garlic may enhance suckling
  • Fresh cows milk may use cheese, yogurt, etc.

45
Composition of Breast Milk
  • Composition designed for infants
  • Lactose, EFA, alpha lactalbumin (protein) easy to
    digest
  • Composition
  • 6 protein
  • 55 fat
  • 39 CHO

46
Composition of Breast Milk, continued
  • Correct AA composition for infants
  • Amino acids are the building blocks of protein
  • Low phenylalanine, high in taurine
  • Alpha lactalbumin (main protein) produces less
    stress on the infants kidneys
  • Vitamins/minerals designed for baby
  • May require vit. D and/or fluoride supplements in
    first 6 months
  • May require iron supplement after 6 months

47
Breast Feeding Contraindications
  • Women shouldnt breast feed if...
  • have communicable disease that would threaten
    infants life (not the common cold)
  • have communicable disease that may pass to infant
    via breast milk (ie, HIV, AIDS)
  • use certain prescription medications 15 drugs
  • abusing alcohol/drugs/tobacco
  • All pass into breast milk

48
Post-Partum Nutrition Needs for Bottle-Feeding
Moms
  • Calorie and nutrient needs approximate that of
    the nonpregnant woman
  • Follow Food Guide Pyramid recommendations
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