CHAPTER 16 NUTRITIONAL ASPECTS OF PREGNANCY AND BREASTFEEDING.

CHAPTER 16

NUTRITIONAL ASPECTS OF PREGNANCY AND BREASTFEEDING

LEARNING OUTCOMES

• Discuss factors that predict a successful pregnancy outcome• List major physiological changes that

occur in the body during pregnancy and describe how nutrient needs are altered• Specify the optimal weight gain during

pregnancy for adult women• Describe the special nutritional needs of

lactating and pregnant women, summarize factors that put them at risk for nutritional deficiencies.

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LEARNING OUTCOMES

• Identify nutrients that often need to be supplemented during pregnancy and lactation and explain the reason for each• Discuss potential nutrition-related

problems that occur during pregnancy and suggest techniques for coping with these problems• List substances and practices to avoid

during pregnancy and lactation and describe why they are harmful• Describe the physiological process of

breastfeeding

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PREGNANCY

• Gestation• Favorable pregnancy outcome• Full term (>37 weeks)• Infant weighing greater than 5.5 lbs

• Pre-term• Born before 37 weeks

• Low birth weight• Weighing less than 5.5 lbs

• Small for gestational age• Weighing less than expected for gestational age

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PRE-NATAL DEVELOPMENTAL STAGES

• Conception (sperm + egg)• Zygote (fertilized egg)

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PRE-NATAL DEVELOPMENTAL STAGES

• Embryonic (zygote becomes embryo)• Fetal• Trimesters• Critical periods• Spontaneous

abortion

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NOURISHING THE ZYGOTE, EMBRYO, AND FETUS

• Zygote: absorb from uterus and digest uterine lining• Embryo: placenta• Umbilical cord

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NUTRIENT NEEDS OF PREGNANCY

• Energy needs increase• 1st trimester: no additional increased needed• 2nd trimester: +350 kcal daily• 3rd trimester: +450 kcal daily

• Will depend on many factors (mother’s weight and activity level)• Nutrition during pregnancy DOES impact baby’s

future health

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NUTRIENT NEEDS OF PREGNANCY

•Nutrient needs for new cells:• Protein needs increase by 50%• Essential fatty acid (omega 3)• Zinc-smoking, medications, alcohol also have impact

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NUTRIENT NEEDS OF PREGNANCY

• Folate and Vitamin B-12• Folic acid

fortification• Neural tube

defects

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NUTRIENT NEEDS OF PREGNANCY

• Iron needs increase significantly (more maternal RBC and building fetal stores)• Less blood loss• Increased absorption• Physiological anemia vs iron deficiency

anemia• Factors to consider if taking iron

supplements

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NUTRIENT NEEDS OF PREGNANCY

•Nutrient needs for bone and teeth• Calcium and Vitamin D• Recommended intake stay the same, but

important to meet these recommendations• Highest risk groups: vegans, pregnant

teens, hypertension, no dairy products

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PRE-NATAL VITAMIN AND MINERAL SUPPLEMENTS

• Prenatal vitamins are vitamin supplements intended to be taken before and during pregnancy and during postnatal lactation• Vitamins such as folic acid and the other B

vitamins, zinc and iron are in higher amounts while nutrients such as Vitamin A are reduced.• Other factors:• Iron• Calcium• DHA• Nausea, vomiting (ginger root, probiotics)

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CRAVINGS?

• Are they telling you something?• Common cravings• Pica• Eating non food substances

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PHYSICAL ACTIVITY DURING PREGNANCY

Benefits•To mom: improved cardiovascular function, easier labor, prevent gestational diabetes•To baby: leaner and more neurologically mature

Avoid•Strenuous or endurance (30 minutes moderate)•Deep flexing•Laying flat on your back•Things that can cause abdominal trauma

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NUTRITION RELATED FACTORS AFFECTING PREGNANCY OUTCOME

• Maternal pre-pregnancy weight• Maternal weight gain• Pattern of maternal weight gain• Young maternal age• Maternal eating patterns

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MATERNAL WEIGHT GAIN

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*11-20 pounds

NUTRITION RELATED FACTORS AFFECTING PREGNANCY OUTCOME

•Maternal health• Pregnancy history• Pre-natal care• Pregnancy induced hypertension• Preeclampsia to eclampsia

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NUTRITION RELATED FACTORS AFFECTING PREGNANCY OUTCOME

• Gestational diabetes• 4-7% in those who were not diabetic before

pregnancy• Risk factors: family history of diabetes,

obesity, older than 25, prior gestational diabetes

• Usually starts weeks 20-28• Risks: deplete fetal iron stores, large baby,

fetal low blood sugar at birth• Treatment: exercise, low glycemic load diet,

insulin

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NUTRITION RELATED FACTORS AFFECTING PREGNANCY OUTCOME

• Maternal sociocultural factors• Expanded Food and Nutrition Program (EFNEP)• Women, Infants and Children (WIC)• Food Stamps

• Maternal food supply• Environmental contaminants (mercury in fish)• Foodborne illness (raw meat and seafood, deli

meat, animal feces, soft cheeses)• Caffeine (300 mg)• Food additives (artificial sweeteners)

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NUTRITION RELATED FACTORS AFFECTING PREGNANCY OUTCOME

•Maternal lifestyle• Alcohol• Drugs (including aspirin, cold

medications)• Herbal and botanical products• Nicotine and carbon monoxide

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PHYSIOLOGICAL CHANGE OF CONCERN DURING PREGNANCY

•Heartburn• Constipation•Nausea and Vomiting• Ginger, B6

• Edema

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LACTATION

• Prolactin promotes milk production• Sucking (supply and demand)

• Release of milk from the breast• Let-down reflux• Oxytocin

• Milk types and composition• Colostrum• Lactobacillus bifidus factor

• Transitional• Mature

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NUTRIENT NEEDS OF BREASTFEEDING WOMEN

• Maternal nutritional status• Water• Increase 32 ounces of fluid

• Calories• It takes about 800 calories to produce daily milk

supply• Increase daily intake 400-500 calories

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NUTRIENT NEEDS OF BREASTFEEDING WOMEN

• Food choices during lactation• Problem nutrients: calcium, magnesium,

zinc, folate, B6• Other considerations: omega 3, nuts,

alcohol

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