Diet Pregnancy

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Report by: Rio and Ria Nofuente

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Body composition changes during pregnancy

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Following conception and continuing until parturition (childbirth), many metabolic, anatomic, hormonal, psychologic, and physiologic changes take place in the mother.



There are numerous steriod hormones, peptide hormones, and prostaglandins that influence the course of pregnancy.

 Some

of them, such as the placental hormones human placental lactogen and human growth hormones, are produced only during pregnancy.

 Progesterone

and estrogen have a particularly strong influence on pregnancy

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Hormones of pregnancy

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 The

action of progesterone promotes the development of the endometrium and relaxes the smooth muscle cells of the uterus

This relaxation serves both to help the uterus expand as the fetus grows and to prevent any premature contractions of the uterus.  The

same effect also influences other smooth muscle cells, such as the gastrointestinal tract.

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The resulting slowing of the GI tract during pregnancy may increase the absorption of several nutrients, most notably iron and calcium.  Progesteron

causes increased renal sodium excretion during pregnancy.

 Estrogen

promotes the growth of the uterus and breasts during pregnancy and renders the connective tissues in the pelvic region more flexible in preparation for birth.

 The

basal metabolic rate (BMR) rises during pregnancy by as much as 15% to 20% by term.

This increase is caused by the increased oxygen needs of the fetus and the maternal support tissues.  The

fetus prefers to use glucose as its primary energy source.

Changes occur in maternal metabolism to accommodate this need of the fetus.

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Metabolic changes

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 The

adaptation allows the mother to use fat as the primary fuel source, thus permitting glucose to be available to the fetus.

 Increased

macronutrient and micronutrient intake by the mother during pregnancy ensures that these increased metabolic needs are met.

 Plasma

volume doubles during pregnancy, beginning in the second trimester.

Failure to achieve this plasma expansion may result in a spontaneous absorption, a still birth, or low birth weight infant.  One

of the result of this increase in plasma volume is a hemodilution effect.

In other words, measured components in the plasma such as hemoglobin, serum proteins, and vit will appear to be lower levels during pregnancy because there is greater volume of

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Anatomic and physiologic changes

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 Cardiac

hypertrophy occurs to accommodate this increased blood volume, accompanied by an increased ventilatory rate.

 In

the kidneys, the glomerular filtration rate (GFR) increases to accommodate the expanded maternal blood volume being filtered and to carry away fetal waste products.

As a result of this increase in GFR, small quantities of glucose, amino acids, and watersoluble vitamins may appear in the urine.

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 Although

minor losses may be acceptable, a woman who excretes large amounts of protein may experience a more serious problem called pregnancy-induced hypertension, which needs strict medical monitoring.

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Weight gain in pregnancy 

There are three components maternal weight gain:

to

1.

Maternal body composition changes including increased blood and extracellular fluid volume;

2.

The maternal support tissues such as the increased size of the uterus and breasts and;

3.

the products of conception, including the fetus and the placenta.

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 Inadequate

weight gain by the mother during pregnancy suggests she may not have received the proper nutrients during pregnancy.

 Poor

weight gain may then lead to intrauterine growth retardation in the infant.

 Infants

born small for gestational age (SGA) or low birth weight are more likely to required prolonged hospitalization after birth or be ill or die during first year of life.

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 Additionally,

infant mortality rate, which in part reflects maternal weight gain, is regarded as one measure of a country’s health and well being.

Weight-for-height category

RecommendeTotal gain d Kg

lb

Low (BMI of <19.8)

12.5-18

28-40

Normal (BMI of 19.8 – 26.0)

11.5-16

25-35

7-11.5

15-25

High* (BMI of > 26-29)

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Recommended total weight gain ranges for pregnant women, by prepregnancy body mass index (bmi)

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NUTRITION DURING PREGNANCY



The dietary reference intakes (DRIs) recommend increases during pregnancy of all nutrients EXCEPT

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Energy and nutrient needs during pregnancy

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DRIs to Meet Needs of Pregnancy and Pregnant Lactating Lactation Adult

Energy (kcal) Protein (g) Vitamin A (RE) Vit D (mcg)t

Woman Woman (25-49 yrs of (3rd age) trimester) 2200 2500

Mothers

2700

50 800

60 800

65 1300

5

5

5

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Including phosphorus, fluoride, calcium, and biotin. There are separate dietary recommendations for adolescents who are pregnant.

Phosphorus (mg) Iron (mg) Zinc (mg) Iodine (mcg) Selenium

1.1

1.4

1.6

14

18

17

1.3 400 2.4 1000

1.9 600 2.6 1000

2.0 500 2.8 1000

700

700

700

15 12 150 55

30 15 175 65

15 19 200 75

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Riboflavin (mg) Niacin (NE mg) Vit B6 (mg) Folate (mcg) Vit B12 (mcg) Calcium (mg)t



Best estimates energy cost of pregnancy is somewhere between 68,000 kcal and 80,000 kcal.

 Increase

accommodates the rise in maternal BMR during pregnancy as well as the synthesis and support of the maternal and fetal tissues.

 The

current recommendation is for woman to consume an extra 300 kcal per day during the 2nd and 3rd trimesters of pregnancy.

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Energy

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Extra sandwich and a glass of milk can easily provide the additional 300 kcal per day, providing she was eating well before pregnancy.

 Recommended

Dietary Allowance (RDA) for protein during pregnancy is 60 grams per day for adolescent and adult women.

 Pregnant

Patients may be counceled to include appropriate sources of protein that provides vit, minerals, and moderate amounts of fat.

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PROTEINS

Food Group

Nonpregnant

Milk, yogurt, and cheese Meat, poultry, fish, dry beans, eggs and nuts Fruits

2-3 servings

Pregnant or Lactating 3-4 servings

2-3 servings

3 servings

2-4 servings

Vegetables

3-5 servings

Bread, cereal, rice and pasta

6-11 servings

2-4 servings (12 citrus) 3-5 servings (12 green leafy) 7-11 servings

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Changes in the daily food guide pyramid during pregnancy and lactation

 BREAKFAST

Whole grain toast Banana Oatmeal Skim milk or orange juice

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Sample menu for pregnant women

Cereal (ready to eat) Skim milk

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Snack

Roast beef (lean) sandwich on whole grain bread with lettuce and tomato. Green salad Orange wedges Skin milk

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lunch

•

Apple with cheese, or fruit and yogurt shake.

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snack

Sesame chicken (or fish) with broccoli and pasta Mixed salad (carrots, tomatoes, spinach, romaine lettuce) Italian bread and butter Fresh fruit salad Skim milk

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dinner

•

Fig or oatmeal raisin cookies or open faces peanut butter sandwich.

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snack

 The

DRIs are increased during pregnancy for most vitamins A and D.

 Micronutrient

needs may be met with a balanced diet, with a few notable exceptions including folate and iron.

All supplementation during pregnancy should be in the form of prenatal type multivitamin mineral supplements are recommended by primary healthcare providers or dietitians.

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Vitamin and mineral supplementation

Substantial research has demonstrated that folate is important for the prevention of neural tube defects (NTDs) such as spina bifida and anencyphaly, one of the most common congenital malformations in the united states.

 Iron.

The RDA for iron during pregnancy is 30 mg/day. This level may be difficult to achieve with a normal diet, which maintains recommended fat and kcaloric guidelines.

Therefore all woman should take a supplement with 30mg ferous iron daily beginning in the 2nd trimester to prevent iron deficiency anemia in pregnancy.

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 Folate.

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Iron deficiency anemia ü

one of the most common complications of pregnancy.

ü

Can mean impaired oxygen delivery to the fetus, which may have severe consequences.

In addition, during the last trimester, the fetus stores iron in its liver to use during the 1st 4months of life.

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Pica ü

Characterized by a hunger and appetite for non-food substances including ice, corn starch, clay, and even dirt.

ü

These substances contain no iron and may lead to loss of additional minerals, particularly when clay and dirt are consumed.

ü

Intestinal blockages caused by consumption of these substances may be life-threatening.

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 Calcium.

The Adequate Intake (AI) for calcium is 1000 mg/day for women and 1300 mg/day for adolescents, neither of which is an increase over the non-pregnant state.

 Although

calcium needs are great during pregnancy, particularly for mineralization of the fetal skeleton, changes occur in maternal calcium homeostasis, which results in an increase in intestinal calcium absorption.

A

number of non-nutritive substances that women may be exposed to during pregnancy may have the capability to act as teratogens.

Teratogen an agent capable of producing a malformation or a defect in the unborn fetus. Some anomalies are apparent at birth or shortly after, such as NTDs or a cleft lip or palate.

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Nutrition-related concerns

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Cleft lip or palate

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 Other

defects such as delayed growth or learning deficits may not be noticeable for several months or even years.

 Potential

teratogens include caffeine, drugs, alcohol, and tabacco.

Other concerns affecting the course and outcome of pregnancy include strenous exercise, maternal age, and medical conditions requiring nutrition intervention such as hypertension, diabetes, phenylketunoria, and human immuneodeficiency virus (HIV) infection.

 Whether

a woman should refrain from caffeine consumption during pregnancy has been a matter of debate.

 Caffeine

(1-, 3-, 7trimethyxanthine) may alter deoxyribonucleic acid (DNA) and, in some individuals, may alter circulating levels of neurotransmitters and increase blood pressure.

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caffeine

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 However

there is now enough evidence stating that caffeine is not a human teratogen, and even at modest doses (<300 mg/day or about 2 cups or less of coffee, there is no increased risk of spontaneous abortion or preterm labor.

A

pregnant woman should not consume any cover-the-counter or prescription medications unless prescribed by her primary healthcare provider.

 Although

not a direct nutrient concern, the acne medication isotretinion (accutane) contains high levels of

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drugs

 Use

of alcohol during pregnancy may produce

Fetal alcohol syndrome (FAS) Or fetal alcohol spectrum disorder (FASD) in the infant. Symptoms include specific anatomic defects such as a low nasal bridge, short nose, flat midface, and short palpebral.

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alcohol

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Fetal alcohol syndrome

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 Women

who smoke during pregnancy are at greater risk for several adverse outcomes including the following: prematurity, low birth weight, SGA, stillbirth, placenta previa (location in lower uterine area), placentae abruptio (separation from uterine wall), and postnatally, sudden infant death syndrome (SIDS).

 Smoking

during pregnancy may cause prolonged effects of impaired intellectual performance and decreased attention span in the offspring.

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tobacco

 Strenuous

exercise was thought to divert blood to the exercising muscles and thus reduce the blood supply to the fetus.

 If

a woman chooses to exercise during pregnancy she must remember to drink fluids before, after, and if necessary, during exercise and to choose nutritious snacks before and after exercise.

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exercise

ü

Limit workouts to 15 mins.

ü

Keep pulse rate below 140 bpm

ü

Drink plenty of fluids before, after, during exercise.

ü

Do not exercise lying in your back after the fourth month.

ü

Avoid exercising in hot, humid weather.

ü

Consume enough kcal to meet the extra needs of pregnancy plus the

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Guidelines for exercise during pregnancy:

 Adolescents

and women older than 35 years of age are at higher risk for poor pregnancy outcome.

 Women

who become pregnant after the age of 35 yrs have distinct nutritional needs, reflecting their longer medical history, potential long-term use of oral contraceptives (which may affect folate levels) and the possibility of a longer history of poor eating habits.

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Maternal age

Aka

pregnancyinduced hypertension (PIH), is a complex syndrome of deficient vascularization, platelet dysfunction, hyperlipidemia, and altered cytokine levels.

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preeclampsia

PRE-PREGNANCY FACTORS THAT MAY LEAD TO THE DEVELOPMENT OF PREECLAMPSIA INCLUDE THE FOLLOWING:  No

previous pregnancies

 Inadequate  Diabetes  Age

dietary intake

mellitus (type1; type 2)

at conception: 20 years or younger 35 years or older

 Family

history: hypertension, vascular disease

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Risk factors and symptoms of preeclampsia

 Poverty

in earlier pregnancies

that effects access to prenatal care

SYMPTOMS DURING PREGNANCY INCLUDE THE FOLLOWING:  Hypertension

(changed compared with usual

level)  Headaches  Dizziness  Edema

and blurred vision

of hands and face

 Sudden  Upper

(continuous and severe)

weight gain

abdominal pain

 Slowed

fetal growth

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 Preelampsia

 Women

with pre existing diabetes mellitus (DM) (type 1 and type 2 DM) requires specialized care during pregnancy.

 Other

complications include fetal macrosomia, dystocia, operative delivery, neonatal hypoglycemia and neonatal respiratory distress syndrome.

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Diabetes mellitus

defects;

Cardiac defects Nervous system defects including NTDs Kidney malformations, And skeletal anomalies.  These

infants may experience hypoglycemia after birth.

 The

maternal source of glucose is no longer available, and because glucose readily crosses the placenta, levels of glucose in utero tend to be high, especially if the diabetes has been poorly controlled.

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 Major

recommendation for women to achieve tight glucose control before conception

ü

Maximise the likelihood of a healthy mother and infant, while avoiding perinatal risks.

ü

Control includes prudent blood glucose monitoring, adherence to diet, moderate exercise, and strict adherence to the prescribed insulin regimen.

ü

Total energy intake and energy distribution will likely need modification during pregnancy because of the increased energy needs of pregnancy.

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 Current

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ü

Insulin dosages will require adjustment beacuse many of the hormones of pregnancy, such as estrogen, progesteron, human chorionic, somatotropin, and maternal cortisol, act in an antagonistic fashion with insulin.

ü

Form of diabetes that occurs during pregnancymost commonly after the 20th week of gestation.

ü

Px experience abnormal carbohydrate metabolism in a manner similar to other persons with diabetes.

ü

GDM is the most common, affecting 2% to 3% of all pregnancies.

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GESTATIONAL DIABETES MELLITUS (GDM)

ü

Primarily of dietary control combined with moderate exercise leading to an appropriate weight gain.

ü

Insulin may be required if glycemic control is not achieved through dietary control and exercise.

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TREATMENT OF GDM

Phenylketonuria

(PKU) an inborn error of metabolism characterized by extremely low levels of the enzyme phenylalanine hydroxylase, which catalyzes the conversion of phenylalanine to tyrosine.

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Maternal phenylketonuria

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The child on the left has PKU

 Pregnancy

may put an additional strain on the already fragile immune system because the hormones and proteins of pregnancy (including estrogen, progesterone, human chorionic gonadotropin, alfafetoprotein, corticosteroids, prolactin, and alphaglobulin) have immunosuppressive effects.

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Hiv infection

 Thank

you for listening;)

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en