Maternal Nutrition

Preconception » Lifestyle issues» Preexisting conditions

Physiological changes during pregnancy» Nutritional implications

Nutrient requirements during pregnancy

Recommended weight gain

Lifestyle choices

Preconception

______ _________ _________ medical conditions psychological

readiness/stress ________, e.g.

» restrictions, eating disorders» folic acid intake

_______________________________________

previous __________

Preexisting Medical

Conditions/Pregnancy related

Conditions

1) Inborn Errors of Metabolism2) Other conditions

______________________» Lack of _________ to convert

phenylalanine (phe) to tyrosine (tyr) leads to

__________________– mental retardation, death

Risk for:

Phenylketonuria (PKU)

PKU treatment

maintain __________ as low as possible

maintain serum ________ control ____________

» special low-phe foods are necessary

maintain ______________ ________ during pregnancy

People with PKU should not use aspartame

Celiac Disease

Sensitivity to ______ (in wheat, rye, barley…)

Causes malabsorption of ___ and ______________

general _____________

general nutrient _________

___________

Often undiagnosed! Must follow _________ diet

pregnancy will make ____________ even harder

increased need for ________ uncontrolled blood glucose

can cause damage to fetus as well as stress on mother

____________ fairly common during pregnancy» blood _________,

» glomerular filtration rate

(GFR)

Type I Diabetes

Risk factors:

Risk for:» _______________» spontaneous __________» perinatal ___________» later development of Type II

diabetes (_________)

Gestational Diabetes

Pregnancy-induced

hypertension (PIH)

[preeclampsia eclampsia]

Characterized by:

Risk for:» ______________________» HBP, _______________, type II

diabetes

PIH risk factors

preexisting ____________ ____________ PIH history dietary deficiencies:

age extremes

Do not restrict ________!

Physiological Changes during

Pregnancy

Glossary

___________ = protein to which oxygen bind in RBC

___________ = volume of packed red blood cells (RBC)

__________ = physiological (normal) anemia of pregnancy

_______________ = waves of involuntary muscle contractions in the GI system

_____ = Urinary tract infections Glomerular filtration rate (GFR) =

rate at which fluid passes through the kidneys

GI system

changed ___________ increased __________ decreased __________

» hypoperistalsis

enhanced ____________ heartburn nausea, vomiting, constipation

» avoid strong smells or fried, greasy foods; eat dry crackers before getting out of bed; try small, frequent meals; megadoses of vitamin B6?

_____________

Blood» blood __________: 150%

» blood ____________– 12-50 ml/min to 500-600 ml/min

» RBC increase less than BV = ________________ aka “physiological anemia of pregnancy”

Body ________content increases as much as 20%

Fluids

drops early, then prone to rise in later pregnancy

_________________ increases due to increased efficiency of gas exchange in the lungs

shift of diaphragm position leads to ____________

Blood pressure

Normal Pregnancy

Hematocrit 35% 29-31%

Hemoglobin 13-14 g/dl 10-11 g/dl

Cholesterol <200 mg/dl

200-325 mg/dl

Folacin 5-21mcg/dl

3 mcg/dl

Iron >50mcg/dl

>40mcg/dl

TIBC 250-400mcg/dl

300-450mcg/dl

Clinical Blood Values

Table 4-10, p. 95

growth of uterus causes ______________» greater need to ____________» susceptibility to __________

renal ________ and ____ increase» greater capacity to __________» greater amounts of nutrients are

___________, perhaps more than

healthy kidneys can ________

_____uria and ______uria

are fairly common increased need for _____________

Renal function

Basal metabolic rate (BMR) ___________

____________ nitrogen balance

Fuel Usage

Fetus: needs mostly ________» 50-70%CHO, 20%aa, rest from fat» hoards __________ for tissue

building Mother: _____ becomes more

important» _______________ decreases

because of relative lack of ____________

» more ____ is stored for future needs, including _________

» (with less GNG and more lipolysis, __________ may occur)

1) _____________» relaxes smooth muscle cells

– GI motility

» maternal ________ stores» capillary tension» renal _____ excretion

2) ____________» promotes _____ growth/function» alters _______________

structure– flexibility

– water ______ = normal if without HBP and proteinuria

Hormones (proteins, steroids)

The Placenta

Organ that supports __________» ___________ to the uterus» site of ________ synthesis

–establish pregnancy–provide for fetal metabolism

and glandular systems–suppress ______________

» ______ of oxygen, nutrients, and ______________

Mother and fetal blood supplies are always ____________

Affected by ____________, insufficient blood supply, inappropriate _____________

Placental Nutrient Exchange

Simple (passive) diffusion

» oxygen, CO2, fatty acids, fat-

soluble vitamins, electrolytes

Facilitative diffusion» CHO

Active ________

» amino acids, water-soluble

vitamins, minerals

Pinocytosis

» immunoglobulin G (IgG)

Stages of Fetal Growth

1) _________________(~ 2 weeks)» rapid ______________» early placenta» implantation of ____________

2) __________ stage (to 2 months)» ____derm CNS, hair, ____» ____derm voluntary

muscles, _____, cardiovascular system, ______ systems

» ____derm digestive and ________ systems, glandular organs

3) ____ stage (to 38-40 weeks)» ______ from 6 g to 3000-3500 g

Stages of Fetal Growth

Blastogenesis and embryonic» Hyperplasia occurs» ____________ status important» only serious general

malnutrition would cause harm» certain deficiencies/exposures

could cause __________– _______ is closed by day ____

_____ stage» hyper_____ and hyper____,

then just _____________» malnutrition now probably not

teratogenic, but could easily affect __________

Illustration 4-11, p. 105

________ = term for synthetic form used in supplements and in food fortification

________ = term for naturally occurring form found in foods; generic term

________ = generic term

Tetrahydrofolate (THF) = __________

Terminology forpteroylglutamic

acid

Functions of Folate

_________ and _________» synthesis of

formation of

Co-enzyme in transfer of one-carbon units

DRIs for Folate

Dietary Folate Equivalents (DFEs)

1 DFE = 1 mcg food folate =

0.6 mcg synthetic folic acidin combination with food =

0.5 mcg synthetic folic acidtaken on empty stomach

DRIs for Folate

Adults

Pregnant women

400#

600#

#All women capable of becoming pregnant are recommended to consume 400 mcg of folic acid

Life stage group RDA (mcg/day)

Growth Retardation

Severity, timing, and duration of deficiencies matter

If only hyper______ affected, later rehabilitation might reverse effects

Other effects might persist Fetus does not always act as an

efficient “___________”

Growth failure low __________ (____) baby = <_____ g» postnatal risk of

» tissue changes: placental cells, brain cell #, _________, organ size, altered ___________

Table 4-15, p. 103

Correlates of fetal birth weight

_____________ (prepregnancy height, weight)

» ______weight (____ healthy wt)– risk for ____, premature birth,

____, pregnancy complications (caesarian birth), low Apgar score

» _______ (~____ healthy wt)– risk for

________________________, prolonged labor, pregnancy complications (caesarian)

– baby: ______, difficulty regulating blood glucose

Maternal weight gain » _______ pound gain

recommended

Maternal Weight Gain

Depends on prepregnancy weight and health

BMI Recommended gain:kg lb

12.5-18 28-40

11.5-16 25-35

7-11.5 15-25

5-9.1 11-20

15.9-20.5 35-45

(<18.5)

(18.5-24.9)

(25 to 29.9)

Low

Normal

High

Obese

Twins

(30+)

Nutrient Needs during Pregnancy

Dietary Guidelines for Americans,

2005Executive Summary

http://www.health.gov/dietaryguidelines/dga2005/document/html/executivesummary.htm

Nutrient Needs during Pregnancy

BMR, physical activity

tissue growth

DNA synthesis DNA synthesis,

neurological function

Bone Bone Bone Teeth Calcium metabolism

Nutrient Why change?

Nutrient Needs during Pregnancy

kcal needs kcal needs kcal needs protein needs Cell differentiation

oxygen transport DNA synthesis,

enzyme co-factor...

Thyroid function Connective tissue No change!

Nutrient Why change?

Bioavailability of Calcium in Foods

FoodTotal Ca (mg)

Available Ca (mg)

Servings to = milk

MilkJuice w/ CaTofu, Ca-setSpinachBeans, whiteTurnip greensKaleBroccoliCabbageSoy milk

300300258122113 99 47 35 25 5

96150 80 6 20 51 28 18 16 2

1.0 0.6 1.215.5 5.0 2.0 3.5 5.0 5.060.5

Table 4-29, p. 122

Food Beliefs, Cravings, Aversions,

Avoidances

Cultural beliefs and attitudes» perhaps restrict food intake in

order to have a smaller baby ____________ = compulsions

for or against certain foods» very _________» ____ = compulsion to consume

non-food items– displace nutrients– lead, heavy metal poisoning– __________– __________

__________: No known safe level of intake» Fetal Alcohol Spectrum,

including Fetal Alcohol ________» primary cause of preventable

mental retardation in the U.S. _______:possible _______

» < moderate use recommended food ____________

» saccharin?» aspartame: not for PKU

_______: O2 to fetus ____

__________ = conscious

decisions about food

Update: Trends in Fetal Alcohol Syndrome -- United States, 1979-1993

MMWR Weekly April 07, 1995 / 44(13);249-251

http://www.cdc.gov/ncbddd/fasd/data.html; accessed February 2, 2012

Listeriosis» L. monocytogenes thrives at

refrigerator temperatures

Toxoplasmosis» T. gondii transmitted from

cat litter (not house cats)

Mercury contamination» predator fish

SO…don’t eat undercooked fish or meat, poorly stored processed meat, unpasteurized milk or cheese, predator fish

Food Safety Concerns

Physiological Effects of Smoking

BMR, blood pressure need for V.C, folate damages platelets

blood clots bone density nitrosamine exposure

Risk factor for chronic diseases:

»lung cancer

»coronary heart disease

»stroke

»hypertension

»osteoporosis

Multiplies risks from alcohol

Health Effects of Smoking

Effects during pregnancy:

placental blood flow– nutrient delivery– waste removal

» oxygen delivery to fetus» birth weight

Health Effects of Smoking during

Pregnancy

Smoking correlates with:» intellectual and

behavioral development» SIDS» earlier menopause

Smoking decreases volume of breast milk

Exercise during Pregnancy

Vigorous exercisers:» fewer spontaneous

abortions» “easier” labor and delivery» higher Apgar scores» no greater preterm

complications BUT babies were of lower

birth weight (lower body fat reserves)

So…moderate exercise during third trimester is recommended

Eating Pattern Messages

Eat 3 meals and 2 snacks a day

Eat a fruit or vegetable at each meal and snack

Drink 3 glasses of milk each day

Take a vitamin supplement with folic acid each day

Walk at least 30 total minutes a day

Visualize breastfeeding your baby