Nutrition: Chapter 14 Pregnancy and Breastfeeding

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Pregnancy & Breastfeeding

Zygote

a fertilized ovum

Embryo

stage in prenatal development from 2 to 8 weeks

Fetus

8 weeks until birth

Uterus

the "home" of the fetus

Placenta

Organ that feeds the fetus and removes waste

Amniotic Sac

fluid filled sac that protects the fetus

First Trimester

first 13-14 weeks of pregnancy; rapid increase in cell number and size; nutritional deficiency or toxicity & medication, radiation, and trauma can be harmful to embryo; half of all pregnancies miscarry during this time

Second Trimester

fetus begins to look more like an infant; still susceptible to toxin exposure; preparation for lactation: increase of 2-4 lbs in the breast and the deposit of fat tissue

Third Trimester

rapid growth: 2x in length and 2-3x in weight; transfer of fat, calcium, and iron to fetus during the last month; iron: fetus may deplete mother's store of Iron if intake is low

Low Birth Weight Infants

less than 5.5 pounds at birth; usually due to preterm births (less than 37 weeks); increased medical costs; small for gestational age full-term babies, low birth weight, and more likely to have medical complications

A Successful Pregnancy

mother's physical and emotional health; infant is more than 37 weeks, birth weight is more than 5.5 lbs, sufficient lung development, the longer the gestation, the less the health risk

Success in Pregnancy

prenatal care, maternal age (20-35 yrs old); closely spaced and multiple births; smoking, medication and drug abuse; food safety; nutritional status

Nutrition in Pregnancy

supports fetal growth; supports maternal changed-to support pregnancy and lactation; inadequate calories-can retard fetal growth, higher risk for maternal and fetal death in famine areas; the poorer the nutritional status of the mother, the poorer the outcome

WIC

Women, Infant, and Children

Listeria Monocytogenes

found in unpasteurized, milk, soft cheeses make from raw milk, raw cabbage; causes flu-like symptoms: 7-30 days after exposure; may contribute to spontaneous abortion; recommend pasteurized milk, thoroughly cooked meats, fish, and poultry

Energy Needs During First Trimester

Balanced and adequate diet

Energy Needs During Second and Third Trimesters

350-450 extra kcal per day; more for exercise; nutrient dense foods and adequate weight gain for best outcome

Weight Gain in First Trimester

2-4 lb weight gain

Weight Gain in Second and Third Trimester

0.75-1 lb weekly weight gain

Total Weight Gain Goal

25-35 lb for normal weight women (BMI 19.8-25.9)
28-40 lb for low weight (BMI < 19.8)
15-25 lb for high weight (BMI 26-29)
15 lb for obese (BMI > 29)

Physical Activity

low impact and non contact activities need 30 + mins on most days and promotes easier delivery; non active women should not begin an intense exercise program; high risk pregnancies may need to restrict activities

Protein and Carbohydrate Needs

RDA for protein: additional 25 g per day & many (non pregnant) women already consume recommended amount of protein.
RDA for carbohydrate: prevent ketosis, 175 g per day (most women exceed this amount)

Lipid Needs

20-30 % of total calories from fat; 7% or less from saturated fat; 1% or less from trans fat
Omega 6 & Omega 3 are required for fetal growth, brain and eye development
13 g a day for Omega 6
1.4 g a day for Omega 3

Mineral Needs

Iodide- 220 ug a day to prevent goiter
Calcium-1000 mg a day for adequate mineralization of fetal skeleton and teeth and low amounts present in prenatal supplements
Zinc-11 mg/day supports growth and development

Vitamin Needs

Folate (600-800ug a day) -synthesis of DNA; fetal and maternal growth; increased red blood cell formation; neural tube defect
All women of childbearing age should consume at least 400 ug a day
Other B Vitamins needs are also increased

Iron Needs

Iron- 27 mg a day: increased hemoglobin and iron stores for the fetus
Iron supplement between meals: be aware of nutrient-nutrient interaction and maximize bio- availability
Possible effects of iron-deficiency anemia: preterm delivery, low birth weight, fetal deaths

Supplements for Pregnant Women

Prenatal supplements are routinely prescribe: higher iron needs, higher folate needs, easier than changing a diet
Recommended especially for women with poor eating habits
Vitamin A should not exceed 3000 ug RAE a day
Watch for herbs and megadoses

Using MyPyramid

first trimester:2200 calories
-3 cups milk group & vegetable group
-6 ounces meat and bean group
-2 cups fruit
-7 ounces grain group
-6 tsp vegetable oil
-supplies adequate vitamin D, folate, calcium, iron, and zinc

Discomforts of Pregnancy: Heartburn

To prevent avoid lying down after eating and avoid spicy foods
-check with physician regarding use of antacids

Pregnant Vegetarians

Women usually meet nutritional needs
She must plan diet very carefully which requires sufficient protein and focuses on vitamins D, B-6, and B-12; Iron, calcium and zinc
Prenatal supplements may be necessary

Discomforts of Pregnancy: Edema

Placental hormone causes body tissue to retain fluid increase in blood volume; some swelling is normal; salt restriction and/or diuretics not needed for mild edema; only a problem if accompanied by hypertension and protein in urine

Discomforts of Pregnancy: Constipation

relaxation of the intestinal muscle; fetus competes with the GI for space
recommendations: Regular exercise and fluid (10 cups a day) and Fiber (28 g a day)
Hemorrhoids caused from straining during elimination

Discomforts of Pregnancy: Morning Sickness

70-80 % will experience in first trimester; may be due to heightened sense of smell; can occur any time of day; avoid nauseating foods or smells; eat small, frequent bland meals; consider changing prenatal supplement; megadose of vitamin B-6

Pregnancy Complications: Physiological Anemia

Mother's blood volume increases to 150% of normal; red blood cells increase by only 20-30 %; lower ratio of red blood cell leads to anemia; occurs as normal response to pregnancy; requires medical attention if severe

Pregnancy Complications: Gestational Diabetes

Hormones synthesized by placenta decrease action of insulin; in 4% of pregnancies; routine screening at 24-28 weeks gestation; diabetic diet may be recommended; insulin may be needed ins me cases; increased birth weight, low blood glucose, trauma, malformations; usually disappears after birth but is linked to diabetes later in life for mother and infant

Pregnancy Complications: Pregnancy-Induced Hypertension

high risk disorder; preeclampsia (mild form); Eclampsia (severe form)
Signs are elevated blood pressure, protein in the urine, edema, change in blood clotting; convulsions in third trimester, and liver and kidney damage could lead to death

Ability to Breastfeed

Almost all women can do it; barriers to breast feeding include lack of support and appropriate information, inexperienced mothers, monitoring of infants, and requires patience

Breastfeeding

solely for the first six months of life; solid foods and breast milk until 1 year which is recommended by American Dietetic Association and American Academy of Pediatrics; The World Health Organization requires to breastfeed for at least 2 years; 70% of all mothers breastfeed in the hospital but the number decreases as infants get older

Production of Human Breast Milk

1. sucking by infant
2. stimulates hypothalamus
3. Initiates the release of hormones prolaction and oxytocin by the pituitary gland
4. EITHER prolactin stimulates milk production then OR oxytocin causes release of milk from breast which lets down reflex
5. milk supply for the infant

Well Nourished Breastfed Infant

Infant has 6 + wet diapers a day; shows normal weight gain; passes 1+ stool per day; may take 2-3 weeks to establish breastfeeding routine; introduce bottle-feeding only after breastfeeding is well established

Mature Milk

Thin, watery, slightly bluish composition
Easily digested proteins where protein binds to iron, reducing bacteria growth
High linoleic acid and cholesterol content where its needed for brain development
Long chain Omega-3 fatty acids (DHA) which synthesizes the development of brain tissues, central nervous system and eyes

Colostrum

Thick, yellow fluid produced during late pregnancy and few days after birth
Contains antibodies, immune-system cells and Lactobaccillus bifidus factor
Provides protection to infacnt against infections
Facilitates the passage of 1st stool (meconium)

Milk Composition: Fore Milk

resembles skim milk
17% fat, 74 % CHO, and 9% protein

Milk Composition: Hind Milk

Resembles cream
66% fat, 74% CHO, and 6% protein
Released 10-20 minutes into the feeding

Fluid Needs

Human milk: provides adequate hydration for baby
Additional fluid needed for hot climate, diarrhea and vomiting
Too much water leads to brain disorders and causes low blood sodium

Lactation Nutritional Needs

Most substances ingested are secreted into mother's milk
Milk production requires ~800 kcal/day
Energy RDA is additional 400-500 kcal/day
kcal difference will contribute to mother's gradual weight loss
Increased need for vitamins A, E, C, riboflavin, copper, chromium, iodide, magnanese, selenium, and zinc
Follow the diet plan for pregnancy

Food Plan for Lactating Moms

Calcium-rich sources: 3 cups
Meat, meat substitute group: 6 ½ ounces
Vegetable group: 3 ½ cups
Fruit group: 2 cups
Grain group: 8 ounce equivalents
7 teaspoons of vegetable oil

Overall Food Plan

Balanced variety of foods
Moderate fat intake
Adequate fluid
Reduction of milk supply caused by restricting kcal, ingestion of alcohol, and smoking
Limit high mercury fish and intake of known allergies

Barriers to Breastfeeding

misinformation, lack of role model, returning to work, social embarrassment, medical contraindications for example mothers with AIDS or HIV +

Advantages of Breastfeeding

fewer infections, fewer alergies, ease of digestion, improved cognitive development, decreased risk of childhood obesity and heart disease

Environmental Contaminants in Breast Milk

Avoid freshwater fish from polluted water, carefully wash and feel fruits and vegetables, remove fat from meats (higher in pesticides)

Preventing Birth Defects

Folic Acid
Iodide
Antioxidants
Vitamin A
Caffeine
Aspartame
Obesity and chronic health conditions
Alcohol
Environmental contaminates

Aspartame in Pregnancy

harmful for mothers with PKU and moderate use not harmful for women who do not have PKU

Caffeine in Pregnancy

Decreases Iron absorption
May reduce blood flow through the placenta
Caffeine withdrawal symptoms in newborn
Risk of Spontaneous abortion
Risk of low birth weight infant
Limit intake to 3 cups or less per day

Fetal Alcohol Syndrome

Large amounts of alcohol during pregnancy which reaches the fetus whom cannot metabolize alcohol
Poor fetal and infant growth
Mental retardation and physical deformities
Irritability and hyperactivity

Importance of Prenatal Care

Adequate diet
Medical assessment throughout pregnancy
Learn what to avoid
Proper health habits
WIC supplemental food program

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