Nutrition Across Pregnancy Diane L. Habash PhD, MS, RD, LD Clinical Associate Professor Division of Health Sciences & Medical Dietetics, SHRS/COM With help from CRC Research Assistants: Katelyn Gordon, Ida Doutt, Dylan Bair & Deepa Balaran, BS. Narrated by Dr. Jonathan Schaffir
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Nutrition Across Pregnancy Diane L. Habash PhD, MS, RD, LD Clinical Associate Professor Division of Health Sciences & Medical Dietetics, SHRS/COM With.
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Nutrition Across Pregnancy
Diane L. Habash PhD, MS, RD, LDClinical Associate ProfessorDivision of Health Sciences & Medical Dietetics, SHRS/COMWith help from CRC Research Assistants:Katelyn Gordon, Ida Doutt, Dylan Bair & Deepa Balaran, BS.Narrated by Dr. Jonathan Schaffir
“(Other than the air we breathe), Food intake is the environmental factor
to which we are ALL exposed necessarily and
permanently from conception to death.”
Ordovas, 2008
Objectives for this module:
Describe the nutritional needs of the pregnant and breastfeeding woman Discuss how caloric requirements change in pregnancy Describe the possible adverse effects of insufficient or excessive
dietary intake in pregnancy Identify which vitamins and minerals should be supplemented in
pregnancy and why Explain how to counsel a woman about her diet in pregnancy Discuss the unique dietary needs of breastfeeding mothers
Pregnancy during Adulthood (20-50yrs)
Attributes/Circumstances as Adults:• Focused on career/little time for cooking, planning, shopping• Food is fuel, comfort, enjoyment, tradition, ritual, celebration, safe,
appetizing, and available when/how we want/need• Environment of ‘fast-easy access’ foods• Trends in food consumption/eating out
– 35% in 1992 to 45% in 2006; stable until now (2012)
• Time of further exploration of diets, fads, supplements, etc• Growth completed; lean mass maintained til our 40s/50s• ↑↑ Obesity/overweight (~66% of US is ovwt/obese)• Risk of chronic diseases
Pregnancy….“Infant Mortality…a mirror of population’s health status”
Illustration 4.1 page 62 in Brown;Time-related terms before, during, and after pregnancy.
Risks increased by:• Gestational Diabetes*• Malnutrition of mother*• Multi-fetal Pregnancies*• Hypertensive Disorders of Pregnancy*• HIV/AIDS During Pregnancy*• Eating Disorders in Pregnancy*• Adolescent Pregnancy*
(*require ↑ nutrition therapy)
Maternal Physiology and Nutritional Requirements
Blood Volume – Increased red cell mass (30%) and plasma volume (50%) High requirement for fluids and iron
Hemodilution – serum levels will seem lower Blood Lipids – Cholesterol, LDL, TGs, HDL all increase Blood Glucose – Insulin resistance increases, making
insulin levels higher Organs/Tissues – many tissues (esp uterus!) enlarge Circulation – inc HR and SV require inc energy Respiration – inc TV and O2 consumption also needed
Maternal Physiology and Nutritional Requirements, cont’d
Food Intake – may be reduced by NVP, taste/ odor sensitivities
GI – inc transit time, heartburn, constipation Renal – higher GFR may result in increased wastage of
protein, glucose; Na conserved Basal Metabolism – increased, with change in thermostat Hormones – large amt production Psychological – cravings, mood changes
Mother as giver
Fetus has more glucose available due to maternal insulin resistance
Iron stores preferentially used by fetus in RBC production Ca funneled to infant via bone resorption
Extremely personal for the mother Need education, support, & confidence Is time consuming, social constraint, ever-present (q2
hrs for newborn) Sensitive to mother’s diet, drug, herbal use (limits in
caffeine, spicy foods, etc) Work/social/family pressures impact longevity Lactation Consultants now common support
“Thinking that baby formulais as good as breast milk
is believing that 30 years of technology is superior to 3
million years of nature’s evolution.”
Christine Northrup, MD.
Human Milk Benefits
• Dynamic composition suits human species• Isosmotic for infant; & a complete meal!• Low protein content good for infant gut (↓ allergies)• High content of all fats; impacts cognition, sight, neural
function• Minerals are protein-bound & [appropriate]• ↑ [immune components, cells, growth factors]• Shown to reduce infant mortality/illnesses
– (eg. ear infections of infant)
Lactation-Mom’s Diet Nutrients of Focus
• EAT a NORMAL diet packed with fruits/veg/whole grains/lean meats and extra dairy
• Water-follow usual adult reccs (1mL/kcal eaten)• Energy (kcals) (~750 kcals/d to produce milk)• Lipids-keep healthy intake of poly-fats• Protein (a little increased but not high for USdiet)• DHA (long chained fatty acid)• Cholesterol
Nutrition in Pregnancy Quiz
Links/References
• American Dietetic Association (www.eatright.org)• American Heart Association (www.americanheart.org)• Calorie Control Council (www.caloriecontrol.org)• CDC (www.cdc.gov)• Consumer Lab (www.consumerlab.com)• Vegetarian Resource Group (http://www.vrg.org)• USDA’s My Plate (www.choosemyplate.gov)• Nutrition Through the Life Cycle, 1st & 2nd ed. Judith Brown, Ed.;
Wadsworth Group. 2002/2008.• Position Papers:
– Journal of the Academy of Nutrition and Dietetics:– 2012;112:1255-1277 (Elderly)– 2008;108:1038-1047 (Ages 2-11)– 2008;108:553-561 (Pregnancy)
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