nutrition in pregnancy and lactation
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Chapter 15Chapter 15
Nutrition in PregnancyNutrition in Pregnancy
AndAnd
LactationLactation
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PregnancyPregnancy
It is the most critical and unique period InIt is the most critical and unique period In
human life.human life.
The foundation of a new life is being laid thatThe foundation of a new life is being laid thatwill influence the future of succeedingwill influence the future of succeeding
generation.generation.
Has a social importance affecting not onlyHas a social importance affecting not only
individual but also their families and society asindividual but also their families and society as
a whole.a whole.
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During this stage theDuring this stage themother and child havemother and child have
an intimate andan intimate and
inseparable relationship.inseparable relationship.
It is the period fromIt is the period from
conception to birth andconception to birth and
for human being lastfor human being last
from 38from 38--42 weeks.42 weeks.
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Physiological basis of nutritionalPhysiological basis of nutritional
needs inP
regnancyneeds inP
regnancy
Stages of PregnancyStages of Pregnancy
ImplantationImplantation
OrganogenesisOrganogenesis
GrowthGrowth
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ImplantationImplantation
The period in which theThe period in which the
fertilized ovum implantsfertilized ovum implants
itself in the uterus anditself in the uterus and
being develop.being develop.
Occurs during the firstOccurs during the first
to second week ofto second week ofconception.conception.
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OrganogenesisOrganogenesis
The embryo undergoesThe embryo undergoes
differentiation or rapiddifferentiation or rapid
cell division that occurscell division that occurs
during 2during 2--8 weeks after8 weeks afterconceptionconception
This is a critical periodThis is a critical period
when organs are beingwhen organs are being
formed and mostformed and most
vulnerable to adversevulnerable to adverse
influences.influences.
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If cell division and the final cell number achievedIf cell division and the final cell number achieved
in an organ are limited during this period, it willin an organ are limited during this period, it will
have irreversible effects on later developmentalhave irreversible effects on later developmentalstage.stage.
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GrowthGrowth
Occurs during on theOccurs during on the
remaining 7 months.remaining 7 months.
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Blood Volume and CompositionBlood Volume and Composition
The plasma volume begin to increase towardsThe plasma volume begin to increase towardsthe end of the first trimester and by 34 weeks.the end of the first trimester and by 34 weeks.It is 50% greater at conception, if nutrients andIt is 50% greater at conception, if nutrients and
blood constituents do not keep up with theblood constituents do not keep up with theexpansion in plasma volume, theirexpansion in plasma volume, theirconcentration will decrease even the totalconcentration will decrease even the totalamounts may rise.amounts may rise.
It will lead to a condition calledIt will lead to a condition calledPhysiological anemia of pregnancyPhysiological anemia of pregnancy
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Circulatory SystemCirculatory System
There is a slight cardiac hypertrophy orThere is a slight cardiac hypertrophy or
dilation due to increased blood volume anddilation due to increased blood volume and
cardiac output.cardiac output.
As the diaphragm is displaced upward, theAs the diaphragm is displaced upward, the
heart is elevated upward and to the left, pulseheart is elevated upward and to the left, pulse
increases slowly up to the 10increases slowly up to the 10--15 bpm between15 bpm between
1414--20 and persist to term.20 and persist to term.
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Bradycardia and palpitation may occur afterBradycardia and palpitation may occur after
delivery and persist for one week.delivery and persist for one week.
There is decreased in systolic and diastolicThere is decreased in systolic and diastolic
blood pressure of 5 to 10 mm Hg due toblood pressure of 5 to 10 mm Hg due to
peripheral vasodilatation from hormonalperipheral vasodilatation from hormonalchanges in pregnancy during the first half ofchanges in pregnancy during the first half of
pregnancy.pregnancy.
During the third trimester, blood pressureDuring the third trimester, blood pressureshould return to the values obtained during theshould return to the values obtained during the
first trimester.first trimester.
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Cardiac output increases from 30Cardiac output increases from 30--50% by the50% by the3232ndnd week of pregnancy and declines to aboutweek of pregnancy and declines to about
20% increase at 40 weeks.20% increase at 40 weeks.
This is due to the increased stroke volume andThis is due to the increased stroke volume and
response to increased tissue demands forresponse to increased tissue demands for
oxygen.oxygen.
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RespirationRespiration
Maternal oxygenMaternal oxygen
requirements increases duerequirements increases due
to acceleration in basalto acceleration in basal
metabolic rate and the needmetabolic rate and the need
to add tissue mass in theto add tissue mass in the
uterus and breast.uterus and breast.
There is increasedThere is increased
vascularization in thevascularization in the
respiratory tract due torespiratory tract due toelevated levels of estrogen.elevated levels of estrogen.
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Edema and HyperemiaEdema and Hyperemia
-- occurs duringoccurs duringelevation of theelevation of the
capillaries.capillaries.
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Tympanic membrane and Eustachian tube swell,Tympanic membrane and Eustachian tube swell,
giving rise to symptoms of impaired hearinggiving rise to symptoms of impaired hearing
earaches of a sense of fullness in the ear.earaches of a sense of fullness in the ear.
Thoracic breathing replaces abdominal breathingThoracic breathing replaces abdominal breathing
with advancing pregnancy.with advancing pregnancy.
The pregnant women breaths more deeply butThe pregnant women breaths more deeply but
increases her respiratory only slightly (2bpm)increases her respiratory only slightly (2bpm)
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Renal FunctionRenal Function
Blood flow through the kidneys and theBlood flow through the kidneys and the
glomerular filtration rate are increased duringglomerular filtration rate are increased during
pregnancy to facilitate the clearance of wastepregnancy to facilitate the clearance of waste
production of fetal and maternal metabolism.production of fetal and maternal metabolism.
GlucoseGlucose
AminoAmino--acidacid
Water soluble vitaminsWater soluble vitamins
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-- they appears in the urine instead of beingthey appears in the urine instead of being
reabsorbed by the kidneys to preserve bodyreabsorbed by the kidneys to preserve bodybalance.balance.
The reason is that high glomerular filtration rateThe reason is that high glomerular filtration rateoffers the tubules greater quantities of nutrientoffers the tubules greater quantities of nutrient
that they can possibly absorb.that they can possibly absorb.
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Gastrointestinal functionGastrointestinal function
Loss of appetite, nausea and vomiting mayLoss of appetite, nausea and vomiting mayoccur during the 1occur during the 1stst trimester of pregnancy duetrimester of pregnancy dueto hormonal changes. There may be alterationto hormonal changes. There may be alteration
in the sense of taste such as preference forin the sense of taste such as preference forstronger salt solution compared with nonstronger salt solution compared with nonpregnant women.pregnant women.
Smooth muscle of GISmooth muscle of GI
-- decreased tome of the gallbladder and thisdecreased tome of the gallbladder and thiscondition together with hypercholesterolemiacondition together with hypercholesterolemia
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Due to increased progesterone, may be the cause
Due to increased progesterone, may be the causeof frequent gallstone during pregnancy.of frequent gallstone during pregnancy.
some cause of discomfort due tosome cause of discomfort due tointrointro-- abdominal alterationabdominal alteration
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Pelvic pressurePelvic pressure
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flatulenceflatulence
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distentiondistention
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Bowel crampingBowel cramping
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Venous pressure increases in the pelvic organVenous pressure increases in the pelvic organ
due to the displacement of the intestines anddue to the displacement of the intestines and
pressure from expanding uteruspressure from expanding uterus
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HormonesHormones
The pregnant women secretes more than 30The pregnant women secretes more than 30
different hormones during the pregnancy.different hormones during the pregnancy.
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PlacentaPlacenta
The function is theThe function is the
production ofproduction of
hormones to regulatehormones to regulate
the activity ofthe activity of
pregnancy.pregnancy.
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ProgesteroneProgesterone
Causes relaxation of theCauses relaxation of the
smooth muscles of thesmooth muscles of the
uterus and other smoothuterus and other smooth
muscles in the body.muscles in the body.
Effect of this is to favorEffect of this is to favor
maternal fat depositionmaternal fat deposition
and increased renaland increased renalsodium excretion.sodium excretion.
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EstrogenEstrogen
Promote growth and control thePromote growth and control the
function of the uterusfunction of the uterus
It changes the structure ofIt changes the structure of
mucopolyssacharides in connectivemucopolyssacharides in connective
tissues increasing its affinity to water.tissues increasing its affinity to water.
Changes in the cardiovascular systemChanges in the cardiovascular system
cause extra cellular fluid to accurate incause extra cellular fluid to accurate inthe feet and legs.the feet and legs.
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Mild edemaMild edema
-- physiological in pregnancy and the usualphysiological in pregnancy and the usual
measures commonly use to prevent it such asmeasures commonly use to prevent it such asusing diuretics and restricting dietary sodiumusing diuretics and restricting dietary sodium
is not recommended because it imposesis not recommended because it imposes
unnecessary risk.unnecessary risk.
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InsulinInsulin
Affects blood glucoseAffects blood glucose
level by facilitating itslevel by facilitating itstransport into cells totransport into cells to
be used for energy orbe used for energy or
fat synthesis.fat synthesis.
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Weight gainWeight gain
All women need to gain weight duringAll women need to gain weight during
pregnancy for fetal growth and maternalpregnancy for fetal growth and maternal
health.health.
Some are underweight, overweight, obeseSome are underweight, overweight, obese
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underweightunderweight
Laura at six monthsLaura at six monthspregnant.pregnant.
BMI
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overweightoverweight
Higher risk for havingHigher risk for havinghypertension gestationalhypertension gestationaldiabetes and post partumdiabetes and post partuminfection.infection.
More likely to born postMore likely to born postterm and weight more thanterm and weight more than9lbs.9lbs.
Overweight women shouldOverweight women should
try to achieve healthy bodytry to achieve healthy bodyweight before pregnancy.weight before pregnancy.Avoid too much gainingAvoid too much gainingweight.weight.
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Recommended RangeRecommended Range
HealthyHealthy
weightweight
UnderUnder
weightweight
OverOver
weightweight
ObeseObese CarryingCarrying
twinstwins
PregnantPregnant
adolescentadolescent
1111-- 15kg15kg
(25(25--
35lbs)35lbs)
1313--1818
kg (24kg (24--
40lbs)40lbs)
88--13.513.5
kg (18kg (18--
30lbs)30lbs)
1515--
30lbs30lbs
3535--
45lbs45lbs
35lbs35lbs
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The Role ofPlacentaThe Role ofPlacenta
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Plays an active role in reproduction and is notPlays an active role in reproduction and is nota passive barrier between the mother and thea passive barrier between the mother and thefetus.fetus.
It is the principle site for the production ofIt is the principle site for the production of
several hormones that regulate maternalseveral hormones that regulate maternalgrowth and developmentgrowth and development
The placenta supplies the fetus with maternalThe placenta supplies the fetus with maternalnutrients, and allows fetal waste to be disposednutrients, and allows fetal waste to be disposed
of via the maternal kidneysof via the maternal kidneys
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Mechanism for nutrient transferMechanism for nutrient transfer
Simple DiffusionSimple Diffusion
Facilitated diffusionFacilitated diffusion
PinocytosisPinocytosis
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Simple diffusionSimple diffusion a passive process In whicha passive process In which
nutrients move from high concentration in thenutrients move from high concentration in the
maternal blood to lower concentration in thematernal blood to lower concentration in thefetal capillaries until equilibrium is reached.fetal capillaries until equilibrium is reached.
Facilitated diffusionFacilitated diffusion involves a carrier in theinvolves a carrier in the
cell membrane so the rate of transfer is fastercell membrane so the rate of transfer is fasterthan simple diffusion. A sugar are transferredthan simple diffusion. A sugar are transferred
via facilitated diffusion.via facilitated diffusion.
PinocytosisPinocytosis the uptake of fluid materials by athe uptake of fluid materials by aliving cell, by means of invagination of the cellliving cell, by means of invagination of the cell
and vacuole formation.and vacuole formation.
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Nutrient RequirementsNutrient Requirements
Two factors thatTwo factors thatdetermine energydetermine energyrequirements are therequirements are the
mother usualmother usualphysical activity andphysical activity andthe increase inthe increase inmetabolic rate tometabolic rate tosupport the worksupport the work
required for growthrequired for growthof the fetus and theof the fetus and theaccessory motors.accessory motors.
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ProteinProtein
This nutrient is essential asThis nutrient is essential asit forms the structuralit forms the structuralbasis for all new cells andbasis for all new cells andtissues in the mother andtissues in the mother andfetus. it is based on thefetus. it is based on the
needs of the nonneeds of the non--pregnantpregnantwomen used as a referencewomen used as a referenceplus the extra amountsplus the extra amountsneeded for growth. Aboutneeded for growth. About925gm of protein are925gm of protein aredeposited in the normaldeposited in the normalfetus and maternal tissues.fetus and maternal tissues.
Maternal and fetal growthMaternal and fetal growthaccelerates only during theaccelerates only during thesecond month andsecond month andincreases progressivelyincreases progressivelyuntil just before terms.until just before terms.
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VitaminsVitamins
Important duringImportant during
pregnancy, the mostpregnancy, the most
importantly cited areimportantly cited are
folic acid, ascorbic acidfolic acid, ascorbic acid
and the B vitaminsand the B vitamins
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Ascorbic Acid RDAAscorbic Acid RDA
For pregnancy isFor pregnancy is80mgs/day,which is an80mgs/day,which is anadditional 10mg/day over theadditional 10mg/day over the
needs of non pregnant state.needs of non pregnant state.There had been studiesThere had been studiesshowing the role of vitaminsshowing the role of vitaminsC in premature rupture of theC in premature rupture of themembranes. Low plasmamembranes. Low plasma
levels of vitamin C had beenlevels of vitamin C had beenobserved in cases of preobserved in cases of pre--eclampsia.eclampsia.
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Thiamin,Riboflavin and NiacinThiamin,Riboflavin and Niacin
Related to caloricRelated to caloric
intakes, sinceintakes, since
caloric allowancescaloric allowances
increases duringincreases during
pregnancy, thepregnancy, the
caloric requirementcaloric requirement
also automaticallyalso automaticallyincreases duringincreases during
pregnancy.pregnancy.
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Folic AcidFolic Acid
Deficiencies of folicDeficiencies of folicacid around the time ofacid around the time ofconception has beenconception has beenassociated with neuralassociated with neuraltube defects (NTD),tube defects (NTD),
such as spina bifida.such as spina bifida. Many babies born withMany babies born with
spina bifida grow intospina bifida grow intoadulthood withadulthood with
paralysis of the lowerparalysis of the lower
limbs and varyinglimbs and varyingdegrees of bowel anddegrees of bowel andbladder incontinencebladder incontinence
Cause megaloblasticCause megaloblasticanemia.anemia.
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Vitamin B6Vitamin B6
May control nausea andMay control nausea andvomiting duringvomiting during
pregnancy is notpregnancy is notconclusive.conclusive.
Pyridoxal phosphatePyridoxal phosphate(PLP) is the active form(PLP) is the active formand is a cofactor in manyand is a cofactor in manyreactions of amino acidreactions of amino acidmetabolism, includingmetabolism, including
transamination,transamination,deamination, anddeamination, anddecarboxylation.decarboxylation.
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Vitamin AVitamin A
Essential nutrient because ofEssential nutrient because ofits critical role inits critical role inreproduction.reproduction.
a bia bi--polar molecule formedpolar molecule formed
with biwith bi--polar covalent bondspolar covalent bondsbetween carbon andbetween carbon andhydrogen, is linked to ahydrogen, is linked to afamily of similarly shapedfamily of similarly shapedmolecules, the retinoid,molecules, the retinoid,
which complete thewhich complete theremainder of the vitaminremainder of the vitaminsequence.sequence.
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Vitamin DVitamin D
Has a positive effect onHas a positive effect oncalcium balance duringcalcium balance duringpregnancy.pregnancy.
It may be involved in neonatalIt may be involved in neonatalcalcium homeostasis.calcium homeostasis.
Poor enamel development andPoor enamel development and
neonatal hypocalcemia hasneonatal hypocalcemia hasbeen associated with maternalbeen associated with maternalvitamin D deficiency.vitamin D deficiency.
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MineralsMinerals
Needs during pregnancy are increased soNeeds during pregnancy are increased so
that if the mothers diet does not providethat if the mothers diet does not provide
what is required by the fetus, pregnantwhat is required by the fetus, pregnant
women need to access their stores towomen need to access their stores toensure that the fetus have adequateensure that the fetus have adequate
support.support.
On the other hand, excess mineral intakesOn the other hand, excess mineral intakesmay adversely affect the fetus. Thus, onmay adversely affect the fetus. Thus, on
appropriate balance is needed.appropriate balance is needed.
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IronIron
Needed for the manufacture ofNeeded for the manufacture ofhemoglobin in maternal andhemoglobin in maternal andfetal red blood cells. The fetusfetal red blood cells. The fetusaccumulates most of its ironaccumulates most of its iron
during the third trimester.during the third trimester. Iron deficiency in the motherIron deficiency in the mother
affects pregnancy outcome.affects pregnancy outcome.
A reduction is hemoglobinA reduction is hemoglobin
increases her cardiac output toincreases her cardiac output tomaintain adequate oxygenmaintain adequate oxygenconsumption by placental andconsumption by placental andfetal cells.fetal cells.
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CalciumCalcium
Promote adequate mineralization ofPromote adequate mineralization ofthe fetal skeleton and deciduoles teeththe fetal skeleton and deciduoles teethduring pregnancy.during pregnancy.
The fetus acquires most of its calciumThe fetus acquires most of its calcium
during the last trimester when skeletalduring the last trimester when skeletalgrowth id maximum and teeth aregrowth id maximum and teeth are
being formed.being formed.
Dental carries is a commonDental carries is a commonoccurrence in pregnancy and there isoccurrence in pregnancy and there is
a belief that calcium deficiencya belief that calcium deficiencycauses demineralization of teeth.causes demineralization of teeth.
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MagnesiumMagnesium
The fetus accumulatesThe fetus accumulatesabout one gram magnesiumabout one gram magnesium
during gestation. Hence, theduring gestation. Hence, the
USUS--RDA recommends 360RDA recommends 360
to 400mg magnesium perto 400mg magnesium perday for pregnant women,day for pregnant women,
which is an additional 40 towhich is an additional 40 to
90mg magnesium per day90mg magnesium per day
over the needs for nonover the needs for nonpregnant women.pregnant women.
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IodineIodine
Should be adequatelyShould be adequatelyprovided during pregnancyprovided during pregnancybecause of an increased basalbecause of an increased basalmetabolic rate.metabolic rate.
Iodine injection in the formIodine injection in the formof iodized oil beforeof iodized oil beforepregnancy will preventpregnancy will prevent
cretinism. The adversecretinism. The adverseconsequence of iodineconsequence of iodineoverdose is mentaloverdose is mentalretardation in infants.retardation in infants.
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ZincZinc
When severe reductionWhen severe reductionof circulatory Zincof circulatory Zinc
occurs in the motheroccurs in the mother
blood, there is theblood, there is thepossibility of increasespossibility of increases
risk of spontaneousrisk of spontaneous
abortions andabortions and
congenitalcongenital
malformation.malformation.
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FluorideFluoride
Development of primaryDevelopment of primarydentition of the fetus startsdentition of the fetus starts
on the 10 to 12on the 10 to 12thth weeks ofweeks of
pregnancy.pregnancy. The 32 teeth are formedThe 32 teeth are formed
during gestation. Theduring gestation. The
adequate intake of fluorideadequate intake of fluoride
is 3mg/dayis 3mg/day 10mg/day10mg/day
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Common NutritionCommon Nutrition--RelatedRelated
concern during pregnancyconcern during pregnancy
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Nausea and VomitingNausea and Vomiting
Morning sicknessMorning sickness
Most common discomfort duringMost common discomfort during
the early part of pregnancythe early part of pregnancy
Nausea and vomiting occur afterNausea and vomiting occur aftergetting up in the morninggetting up in the morning
Caused by increase hormoneCaused by increase hormone
secretionsecretion
Disappear after the first trimesterDisappear after the first trimester
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Nutrition expert recommendsNutrition expert recommends
Frequent feeding of dry meals, instead of 3 large mealsFrequent feeding of dry meals, instead of 3 large meals
Food high in carbohydrate and low fat food can overFood high in carbohydrate and low fat food can over
come nausea and vomitingcome nausea and vomiting
Liquids are better taken between meals rather than mealLiquids are better taken between meals rather than meal
timetime
Avoid excessive mealtimeAvoid excessive mealtime
Piece of candy helps curb the nausea.Piece of candy helps curb the nausea.
* Severe prolonged episode of vomiting requires* Severe prolonged episode of vomiting requires
hospitalization to administerIV fluid and electrolytehospitalization to administerIV fluid and electrolytereplacements to avoid dehydrationreplacements to avoid dehydration
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HeartBurnHeartBurn
Common complaint in latter partCommon complaint in latter part
of pregnancyof pregnancy
Pressure of the enlarged uterusPressure of the enlarged uterus
on the stomachon the stomach
Esophageal sphincterEsophageal sphincter-- dilationdilation
or relaxation results inor relaxation results in
regurgitation of acidic stomachregurgitation of acidic stomach
contents into the esophagus.contents into the esophagus.
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Nutrition expert recommendsNutrition expert recommends
Limit the amount of food consumed at one timeLimit the amount of food consumed at one time
Eating less spicyEating less spicy
Less greasy foodLess greasy food
Drinks fluids between meals rather than with mealsDrinks fluids between meals rather than with meals Eat slowly and sit upright for at least 2hrs.after eatingEat slowly and sit upright for at least 2hrs.after eating
Avoid lying down after mealAvoid lying down after meal
Walk around the house after mealWalk around the house after meal
Loose clothing around the waist must be wornLoose clothing around the waist must be worn
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ConstipationConstipation
Pressure exerted by thePressure exerted by thedeveloping fetus on thedeveloping fetus on the
digestive track.digestive track.
Due to lack of exercise andDue to lack of exercise andinsufficient bulk and fluidinsufficient bulk and fluid
intakesintakes
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Nutrition expert recommendsNutrition expert recommends
Lots of fresh fruits, vegetables, andLots of fresh fruits, vegetables, and
fluidsfluids
Regular exerciseRegular exerciseDo not use medication like laxativesDo not use medication like laxatives
without the doctors advicewithout the doctors advice
Bulking stool softener isBulking stool softener isrecommendedrecommended..
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EdemaEdema
Present in the extremities inPresent in the extremities in
the 3the 3rdrd trimester.trimester.
Swelling of the lowerSwelling of the lowerextremities may be cause byextremities may be cause by
the pressure of the enlargingthe pressure of the enlarging
uterus on the veins thatuterus on the veins that
return fluid from legsreturn fluid from legs..
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RecommendationRecommendation
Does not require sodium restriction or otherDoes not require sodium restriction or other
dietary changedietary change
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Leg CrampsLeg Cramps
Sudden contractions ofSudden contractions ofgastrocnemius musclegastrocnemius muscle
Occur usually at nightOccur usually at night
Decline in serum calciumDecline in serum calcium
levels related to a calciumlevels related to a calcium--
phosphorus imbalancephosphorus imbalance
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Rapid weight gain or lossRapid weight gain or loss
Excessive weight gainExcessive weight gain
Increase of a kg or moreIncrease of a kg or moreper month in the secondper month in the secondand third 3and third 3rdrd semestersemester
Sudden increase inSudden increase inweight after about 20weight after about 20thth
week of gestation isweek of gestation iscause for suspecting thatcause for suspecting thatwater is being retained atwater is being retained at
an inordinate rate andan inordinate rate andwarning sigh ofwarning sigh ofimpending eclampsiaimpending eclampsia
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Excessive weight lossExcessive weight loss
Gain of less than 500 g/month duringGain of less than 500 g/month during
the 1the 1stst trimester of pregnancy and 250trimester of pregnancy and 250g during the 2g during the 2ndnd trimester istrimester is
considered a maternal risk factorconsidered a maternal risk factor*Effects of seriously underweight on entering*Effects of seriously underweight on entering
pregnancy (
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Unwise choices in selection of foodsUnwise choices in selection of foods
An underlying condition impairing absorptionAn underlying condition impairing absorption
*Protein calories supplements*Protein calories supplements
Correct past nutritional deficits and depleted storesCorrect past nutritional deficits and depleted stores
as well as provides for pregnancy needs.as well as provides for pregnancy needs.
Committee on Nutritional Status during PregnancyCommittee on Nutritional Status during Pregnancy
-- Recommends weight gain of 13Recommends weight gain of 13--18kg and18kg and
pregnant women carrying twins can gain 16pregnant women carrying twins can gain 16--
20kg.20kg.
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PregnancyPregnancy-- induced Hypertensioninduced Hypertension
Toxemia of pregnancyToxemia of pregnancy
Rapid weight gain, edema, high bloodRapid weight gain, edema, high blood
pressure, excretion of albumin in the urine andpressure, excretion of albumin in the urine and
convulsions are some clinical manifestationconvulsions are some clinical manifestation
Classifications:Classifications:
PrePre--eclampsiaeclampsia
EclampsiaEclampsia
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PrePre-- eclampsiaeclampsia
HypertensionHypertensionwithwith
proteinuria/edemaproteinuria/edema
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EclampsiaEclampsia
Convulsion/coma,Convulsion/coma,usually both whenusually both whenassociated withassociated with
hypertension,hypertension,proteinuria, edemaproteinuria, edema
Calcium andCalcium andmagnesiummagnesiumdeficiency may playdeficiency may playa role in thea role in thedevelopment of predevelopment of pre--eclampsiaeclampsia
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RecommendationsRecommendations
Protein foods of high biological valueProtein foods of high biological value
Sources of iron, calcium and other mineralsSources of iron, calcium and other minerals
Salt intake is restricted to edemaS
alt intake is restricted to edema Under go physician's careUnder go physician's care
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AnemiaAnemia
Combine deficiencyCombine deficiencyof iron and folic acidof iron and folic acid
Effect:Effect:
Newborn becomesNewborn becomes
anemicanemic
Increased chance ofIncreased chance of
premature birthpremature birth
*Preventive measure*Preventive measureunder physiciansunder physicians
care is safe.care is safe.
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Gestational Diabetes MellitusGestational Diabetes Mellitus
Diabetes may occur as aDiabetes may occur as atemporary response to the stresstemporary response to the stress
of pregnancy and it disappearsof pregnancy and it disappears
after the baby is bornafter the baby is born
EffectsEffects
Risk of perinatal deathRisk of perinatal death PrematurityPrematurity
Macrosamia of the infantMacrosamia of the infant
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Physiology ofLactationPhysiology ofLactation
Is the period of milk production by theIs the period of milk production by the
mammary glandsmammary glands
Its starts during adolescence when hormonalIts starts during adolescence when hormonal
changes brings about development andchanges brings about development and
increase;increase;
BreastBreast
AreolaAreola
NippleNipple
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Prolactin and oxytocinProlactin and oxytocin two main hormonestwo main hormonesresponsible for milk production.responsible for milk production.
ColostrumsColostrums-- The first milk is a thick, yellowishThe first milk is a thick, yellowishfluid that comes out on the 2fluid that comes out on the 2ndnd to the 5h dayto the 5h dayafter delivery.after delivery.
I
t is very important that the baby is fed thirdI
t is very important that the baby is fed thirdfirst milk because it contains antibodies andfirst milk because it contains antibodies andimmune cells.immune cells.
Rich in protein and lower in carbohydrates andRich in protein and lower in carbohydrates and
fats.fats. It is laxative, which initially cleans out theIt is laxative, which initially cleans out the
babys digestive organs.babys digestive organs.
N t iti l R i t d iN t iti l R i t d i
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Nutritional Requirements duringNutritional Requirements during
LactationLactation
EnergyEnergy
Water and other fluidsWater and other fluids
ProteinProtein LipidLipid
MineralsMinerals
VitaminsVitamins
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Advantages ofBreast FeedingAdvantages ofBreast Feeding
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1.1. Human milk is nutritionally superior to other kinds of milk.Human milk is nutritionally superior to other kinds of milk.
2.2. Breast milk is bacteriologically safe.
Breast milk is bacteriologically safe.
3.3. Breast milk is always fresh and the right temperature for theBreast milk is always fresh and the right temperature for the
body.body.
4.4. It contains immune cells and antibodies that will give naturalIt contains immune cells and antibodies that will give natural
immunity for the baby.immunity for the baby.
5.5. It is the least allergenic of any infant food.It is the least allergenic of any infant food.
6.6. It is inexpensive compared to commercial milks.It is inexpensive compared to commercial milks.
7.7. BreastBreast--feeding is convenient.feeding is convenient.
8.8. It promotes closer motherIt promotes closer mother--baby ties or contact.baby ties or contact.
9.9. Babies are least likely to be overfed with breastBabies are least likely to be overfed with breast--feeding.feeding.
10.10. BreastBreast--feeding promotes good tooth and jaw development.feeding promotes good tooth and jaw development.
T t t f l b tT t t f l b t
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Ten steps to successful breastTen steps to successful breast--
feedingfeeding
Have a written breastHave a written breast--feeding policy that Isfeeding policy that Isroutinely communicated to all health care staffroutinely communicated to all health care staffin the hospitalin the hospital
Train all health care staff to acquire the skillsTrain all health care staff to acquire the skillsnecessary to implement this policy.necessary to implement this policy.
Inform all pregnant women about the benefitsInform all pregnant women about the benefitsand management of breastand management of breast--feedingfeeding
Help the mother initiate breastHelp the mother initiate breast--feeding withinfeeding within30 minutes after birth.30 minutes after birth.
Sh h h b f d d h i iSh h h b f d d h i i
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Show mother how to breast feed and how to maintainShow mother how to breast feed and how to maintain
lactation, even if they are separated from the infants.lactation, even if they are separated from the infants.
Give new born infants no food or drink. Other thanGive new born infants no food or drink. Other thanbreast milk, unless medically indicated.breast milk, unless medically indicated.
Practice roomingPractice rooming--in; allow mothers and infants toin; allow mothers and infants to
remain together 24 hours a day.remain together 24 hours a day.
Encourage breastEncourage breast--feeding on demand.feeding on demand.
Give no artificial teats or pacifiers to breastGive no artificial teats or pacifiers to breast--fedfed
infants.infants.
Foster the establishment of breastFoster the establishment of breast--feeding groups andfeeding groups andrefer mother to them upon discharge.refer mother to them upon discharge.
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BreastBreast--Feeding ProblemsFeeding Problems
Medical advances have permitted breastMedical advances have permitted breast--feeding to mothers with chronic diseases,feeding to mothers with chronic diseases,which were not allowed in the past years towhich were not allowed in the past years to
nurse their babies.nurse their babies. Retracted or invert nipples, sore nipples,Retracted or invert nipples, sore nipples,
plugged milk ducts, breast abscess in one side,plugged milk ducts, breast abscess in one side,baby has narrow mouth, baby fall asleepbaby has narrow mouth, baby fall asleep
during feeding, engorged breast, poor milkduring feeding, engorged breast, poor milkproduction, poor letproduction, poor let--down reflex.down reflex.
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The endThe end
Thank you for listening!!Thank you for listening!!
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