NUTRITION IN LIFE CYCLE:

PREGNANCY

The goal of wellness

Prepare woman for the changes by helping her become aware, knowledgeable and responsible for her own health and the well being of her infant.

DEFINITION OF TERMS
Pregnancy the period from conception to delivery; the condition of having a developing embryo and later a fetus within the uterine environment after the union of an ovum and sperm: also known as gestation Zygote the fertilized ovum Embryo the developing organism from the second to the eighth week of gestation, when most of the cell differentiation takes place Fetus the developing human from three months after conception to birth

Premature infants babies born less than 37 weeks of gestation Low birth weight (LBW) infants babies weighing less than 2500 grams (5.5 lbs)
Postmature infants babies born after 42 weeks or more of gestation

Parturition act of giving birth; delivery of the fetus from the mother.

Stages of human fetal growth

Implantation, organogenesis and growth Implantation- periods which the fertilized ovum implants itself in the uterus organogenesis- undergoes differentiation growth- increase in number of cells and size of organs

Preparing for Pregnancy

A mothers nutritional status before and during pregnancy can affect a childs health for the rest of its life. Mothers should establish good eating habits prior to becoming pregnant. Nutrient stores are especially important for early development even before the mother learns she is pregnant. Dads should also focus on good nutrition and avoid alcohol.

Preparing for Pregnancy

Mother too thin-low birth weight babies with a variety of health problems: Low IQ, other brain impairments & learning difficulties Short stature Babies under 5 lbs. are 40X more likely to die in the 1st year. Mother too fat: gestational diabetes, hypertension & infections in the mother. Babies are large (even when premature) and may have: Heart defects Neural tube defects*

Preparing for Pregnancy

Implantation of zygote and development of the placenta depends on good nutritional status prior to conception. Placenta is the connection between the babys and the mothers blood
Provides nutrients, hormones & antibodies to the fetus. Removes waste products from the fetus.

 A full term pregnancy lasts 38 to 42 weeks. First trimester: conception to week 13 Second trimester: week 14 to week 27 Third trimester: week 28 to week 40 Embryonic stage: approximately day 15 to week 8. After week 8, the developing baby is called a fetus.

The First Ten Weeks

After implantation, the placenta develops and begins to provide nourishment to the developing embryo. An embryo five weeks after fertilization is about 1/2 inch long

A newborn infant after nine months of development measures close to 20 inches in length. The average birthweight is about 7 1/2 pounds. From eight weeks to term, this infant grew 20 times longer and 50 times heavier.

Events of Pregnancy
Critical periods Times during which tissues and organs differentiate and mature. If proper building blocks (proteins, carbohydrates, lipids) are not present the tissue/organ does not develop properly and cannot catch up.

Weight Gain During Pregnancy

Set weight goals according to mothers pregnancy nutritional status and body mass index Underweight women: 28 to 40 lbs. Normal-weight women: 25 to 35 lbs. Overweight women: 15 to 24 lbs. Obese women: approximately 15 lbs. Teenage girls: 35 to 40 lbs. Women carrying twins: 35 to 45 lbs.

Weight Gain During Pregnancy

Quality of foods consumed to increase weight is important. Weight reduction should never be undertaken during pregnancy. Average amount of weight gain during first trimester: 2 to 4 lbs. 1 lb. per week weight gain during remainder of pregnancy Two to three g per day sodium needed.

Approximate Weight of Products of a Normal Pregnancy

Weight gain (lb) Increase in breast size Increase in mother's fluid volume 2 4

Placenta
Increase in blood supply to the placenta Amniotic fluid Infant at birth Increase in size of uterus and supporting muscles Mother's necessary fat stores

1
4

2 7 2

7 30

1st trimester

2nd trimester

3rd trimester

Energy Needs
Mother needs more energy to: Supply the increased fuel demanded by the enlarged metabolic workload for mother and fetus. Spare protein for added tissue-building requirements. Increase energy by 300 kcals per day Inceased complex carbohydrates and protein in the diet are the preferred sources of energy.

Protein
Protein is required to build fetal tissue. The mother also needs adequate protein for growth of her tissues. For these reasons, the RDA for protein for pregnant women is 71 grams per day. A complication arises if a woman with phenylketonuria (PKU) consumes a regular diet during pregnancy. The high level of phenylalanne in such a womans bloodstream can cross the placenta and cause fetal malformations and defects.

Protein
All woman should asked directly if they have ever had a special diet prescription. The health-care worker should investigate further when a woman cites a history of troubled pregnancies, congenital abnormalities, a mentally retarded infant, spontaneous abortion, or stillbirth. Protein serves as the building blocks for growth of body tissues during pregnancy. Rapid growth of the fetus Development of the placenta Growth of maternal tissues Increased maternal blood volume Amniotic fluid Storage reserves

Calcium
As with iron, intestinal absorption of calcium increases during pregnancy. Poor general nutrition, low calcium intake, and a positive family history of osteoporosis seem to be strong risk factors for pregnancy- and lactationassociated osteoporosis. These amounts can be obtained from 3.3 to 4.3 servings of mild or mild products equivalent in calcium. Essential for fetal development of bones and teeth Supplements might be needed in cases of poor maternal stores or pregnancies involving more than one fetus RDA met by milk lactose intolerant avoid milk.

Folate
Required for cell division Critical in the first 28 days for development of the neural tube which becomes the brain and spinal cord 400 g/day for sexually active women 600 g/day for pregnant women Builds mature red blood cells during pregnancy May require folate supplements

Iron
During pregnancy, the mothers blood volume increases about 35 percent. Additional iron is needed for the red blood cells in the fetus, placenta, and umbilical cord. Iron-deficiency anemia during the first two trimesters of pregnancy is associated with twice the risk for preterm delivery and three times the risk for producing a LBW infant.

Iron
The Centers for Disease Control Recommends education clients about iron-rich foods and those that enhance iron absorption as well as prescribing a daily 30-milligram supplement beginning when clients enter prenatal care.

If Iron needs are not met, a pregnant woman may develop iron deficiency anemia.
Lower values are expected during the first and second trimester because of expanding blood volume.

Iron essential for increased hemoglobin synthesis

Sodium
1,500 mg/day, same as for nonpregnant women

Iodine
Need for iodine increases significantly 220 g/day can be obtained from iodized salt

Zinc
Critical for making proteins, DNA, RNA Need increases 38% during pregnancy (11 mg/day)

Vitamin A
Needs increase by 10% in pregnancy 770 g/day

Excess vitamin A can cause abnormalities in fetal kidneys and nervous system.
Supplementation is not recommended due to toxicity risk. Beta-carotene (provitamin A) associated with birth defects. is not

Vitamin A sometimes used to treat acne, could pose a risk to the fetus of a teenager who unintentionally becomes pregnant.

Vitamin D
Ensures absorption and utilization of calcium and phosphorus for fetal bone growth Daily intake of three to four cups fortified milk Exposure to sunlight increases endogenous synthesis of vitamin D

Vitamin D
Excessive vitamin D can cause developmental disabilities in newborns If exposure to sunlight is limited or milk consumption is low, supplementation is advised Prenatal vitamin supplements contain 10 g/dose

Vitamin C
Production of collagen (connective tissue) 85 mg/day during pregnancy

Deficiency results in elevated risk for preterm births and preeclampsia

Fluids During Pregnancy

The need for fluids increases to 3 liters per day Increase in maternal blood volume Body temperature regulation Production of amniotic fluid to protect and cushion the fetus Combat fluid constipation retention and

Reduce risk of urinary tract infections

Water and Weight Gain

Plasma volume during pregnancy expands by about 50 percent that necessitates a fluid intake of about 9 cups daily. There current recommendation is based on a BMI that incorporates the womans height and weight before pregnancy. On average, a woman or normal weight should gain 2 to 4 pounds during the first trimester, followed by 1 pound per week for the remainder of the pregnancy.

Nutrition-Related Concerns
Nutrition-related problems during pregnancy can include Morning sickness Cravings and aversions Heartburn Constipation and hemorrhoids Gestational diabetes Preeclampsia

Nutrition-Related Concerns
Adolescent pregnancy Vegetarianism Dieting Caffeine Alcohol Exercise

Morning Sickness
Morning sickness: nausea and vomiting associated with pregnancy. Can occur at any time; often lasts all day May begin after the first missed period and can last 12 to 16 weeks Can be severe enough to require hospitalization No cure, but symptoms can be reduced Small, frequent, dry, easily-digested energy foods may relieve symptoms.

Cravings and Aversions

Most women crave a certain type of food (sweet, salty) rather than a specific food. Little evidence supports the idea that cravings indicate a deficiency Due to hormonal fluctuations, physiologic changes, or familial or cultural roots Pica: craving a non-food item (ice, clay) Food aversions are common, but not universal among pregnant women

Heartburn
Heartburn and indigestion are common Heartburn occurs when the sphincter above the stomach relaxes, allowing stomach acid into the esophagus Hormones in pregnancy relax smooth muscles, thereby increasing heartburn Enlargement of the uterus pushes up on the stomach and compounds the problem Dividing days food intake into a series of small meals usually relieves condition.

Constipation and Hemorrhoids

Constipation
May occur in latter part of pregnancy. It is the result of increased pressure of enlarging uterus and reduced normal peristalsis. Remedies include exercise, increased fluid intake, high-fiber foods.

Hemorrhoids
Caused by increased weight of baby. Usually controlled by dietary suggestions used for constipation.

Gestational Diabetes
Gestational diabetes: insufficient insulin production or insulin resistance that increases blood glucose levels during pregnancy. 7 % of pregnancies Condition resolves after birth occurs Risk of delivering a large baby Uncontrolled blood glucose levels may lead to preeclampsia

Gestational Hypertension
Preeclampsia: pregnancy-induced hypertension. Hypertension (SBP > 140 mmHg or DBP < 90 mmHg), proteinuria

78 % of pregnancies
Can be fatal if left untreated

Deficiencies in vitamin C, vitamin E, and magnesium increase the risk

Gestational Hypertension
Preeclampsia: Treatment focuses on managing blood pressure and often includes bed rest The only cure is childbirth
May occur after the 20th week of pregnancy Nursing intervention: check urine sample Mag. sulfate is the drug of choice for tx.

Gestational Hypertension
Eclampsia Emergency; danger of convulsions

Careful monitoring of pregnant women pre-natally and after birth, early intervention is crucial

Adolescent Pregnancy
Nutritional needs of pregnant adolescents are higher than those of adult women Adolescent bodies are still growing and changing, adding to the nutritional needs of pregnancy Pregnant adolescents are more likely to have preterm babies, lowbirth weight babies, and other complications

Vegetarianism
A vegetarian consuming eggs and dairy products has the same nutritional concerns as a nonvegetarian.

A complete vegetarian (vegan) must carefully monitor the intake of vitamin D calcium vitamin B6 iron vitamin B12 zinc

Dieting
Dieting to lose weight is not advisable during pregnancy Calorie restriction limits nutrient availability for the mother and the fetus Fad diets are often unbalanced in macronutrients and micronutrients

Consumption of Caffeine
Caffeine is a stimulant that crosses the placenta and reaches the fetus One to two cups of coffee per day very likely causes no harm More than two cups of coffee may slightly increase the risk of miscarriage and low-birth weight

Consumption of Alcohol
Alcohol is a known teratogen that crosses the placenta and is associated with various birth defects, delivery complications, sudden infant death syndrome, and increased risk of miscarriage Fetal alcohol syndrome (FAS): variety of characteristics associated with prenatal exposure to high quantities of alcohol Malformations of face, limbs, heart Many developmental disabilities

Smoking and Drug Use

Maternal smoking exposes the fetus to toxins. Smoke contains lead, cadmium, cyanide, nicotine, and carbon monoxide Fetal blood flow is reduced

Increased risk of miscarriage, stillbirth, placental abnormalities, preterm delivery, low-birth weight
Most drugs pass through the placenta into fetal blood Newborns suffer withdrawal symptoms

Exercise During Pregnancy

Keeps a woman physically fit Is a great mood booster Helps compensate for an increased appetite Helps keep blood pressure down Makes it easier to lose weight after the pregnancy

Hyperemesis gravidarum
Severe nausea and vomiting after 14th week of pregnancy

Can be life-threatening

Malnutrition in the prenatal and postnatal periods also affects learning ability and behavior

Meal Pattern
Mature women who become pregnant consuming one additional cup of mild, an additional ounce of meat, and an additional cup of fruit or vegetable rich in vitamin C each day.

Pregnant teenagers should have additional mild, meat, vegetables grains, and oils over and above the intake recommended for mature pregnant women.

Meal Pattern
Careful food selection is critical for pregnant vegetarian women. Strict vegetarians particularly, may be prescribed a vitamin and mineral supplement that at a minimum provides folate, cobalamin, iron and zinc.

Substances to Avoid
Soft cheeses and ready-to-eat meats
Listeriosis Often fatal in newborns Outbreaks of listeriosis have been associated with raw or contaminated milk, soft cheeses, contaminated vegetables, and ready to eat meats. Listeria infections during pregnancy can cause influenza-like symptoms, with fever and chills, Illness may not appear until 2 to 8 weeks after a person has eaten the contaminated food. To prevent Avoid soft cheese. Cook leftover food or ready to eat foods until steaming hot. Avoid deli.

Substances to Avoid
Certain species and amounts of fish Mercury
Mercury can hinder nervous sx tissue development Avoid shark, swordfish, King mackerel, and tilefish Other fish Generally limit to 6 ounces/week

Substances to Avoid
Undercooked meat and cat litter Avoid changing cat litter Congenital toxoplasmosis Produces retardation, blindness, epilepsy Cook meat, poultry, seafood thoroughly Peel or meticulously wash raw fruits and vegetables