Chapter 14 Lecture Outline Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display Planned Pregnancies Have the Best Outcome ? Many practices can be harmful to the fetus ? Minimize exposure even prior to conception ? Nutrition is important ? ~50% of all pregnancies are unplanned The First Trimester ? First 13-14 weeks of pregnancy ? Rapid increase in cell number and size ? Nutritional deficiency or toxicity ? Can be harmful to embryo ? Medication, radiation, trauma ? Can be harmful to embryo ? ~ Half of all pregnancies miscarry during the first trimester The Second Trimester ? Fetus begins to look more like an infant ? Still susceptible to toxin exposure ? Preparation for lactation ? Increase of 2-4 lb. in breast tissue ? Deposit of fat tissue ? Nutritional deficiency at this time affects mother?s ability to breastfeed The Third Trimester ? Rapid growth ? 2X length ? 2X-3X 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 A Successful Pregnancy ? Mother?s physical and emotional health ? Infant: ? >37 weeks gestation ? Birth weight > 5.5 pounds ? Sufficient lung development ? The longer the gestation, the less the health risk Low Birth Weight Infants ? Less than 5.5 pounds at birth ? Usually due to preterm births ? Increased medical costs ? Small for gestational age ? Full-term babies ? Low birth weight ? More likely to have medical complications Success in Pregnancy ? Prenatal care ? Maternal age ? Closely spaced and multiple births ? Smoking, medication and drug abuse ? Food safety ? Nutritional status Listeria monocytogenes ? Found in unpasteurized milk, soft cheeses make from raw milk, raw cabbage ? Causes flu-like symptoms ? 7 to 30 days after exposure ? May contribute to spontaneous abortion ? Recommend pasteurized milk, thoroughly cooked meats, fish, and poultry Does Nutrition Matter? YES! ? Supports fetal growth ? Supports maternal changes ? 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 ? Women, Infant, and Children (WIC) Energy Needs During Pregnancy ? 1st trimester ? Balanced and adequate diet ? 2nd and 3rd Trimester ? 350-450 extra kcal per day ? Choose nutrient-dense foods ? Adequate weight gain ? The best predictor of outcome Recommended Weight Gain During Pregnancy ? 2 - 4 lb. weight gain during 1st trimester ? 0.75 - 1 lb. weekly weight gain during 2nd and 3rd trimester ? Total weight gain goal ? 25 - 35 lb. for normal weight women ? 28 - 40 lb. for low weight (BMI < 19.8) ? 15 - 25 for high weight (BMI 26-29) ? 15 - 25 lb. for obese (BMI > 29) Components of Weight Gained During Pregnancy Protein and Carbohydrate Needs During Pregnancy ? RDA for protein ? Additional 25 gm/day ? Many (non-pregnant) women already consume recommended amount of protein ? RDA for carbohydrate ? Prevent ketosis ? 175 gm/day ? Most women exceed this amount Lipids ? Recommendations ? 20-30% of total calories from fat ? 7% or less from saturated fat ? 1% or less from trans fat ? Omega-6 and omega-3 ? Required for fetal growth, brain and eye development ? 13 g/day Omega-6 ? 1.4 g/day Omega-3 Additional Vitamin Needs ? Folate (600 µg/day) ? Synthesis of DNA ? Fetal and maternal growth ? Increased red blood cell formation ? Neural tube defect ? Other B-vitamin needs are also increased Additional Mineral Needs ? Iodide (220 µg/day) to prevent goiter ? Calcium (1000 mg/day) ? Adequate mineralization of fetal skeleton and teeth ? Low amounts present in prenatal supplements ? Zinc (11 mg/day) ? Supports growth and development Iron Needs ? Iron (27 mg/day) ? Increased hemoglobin ? Iron stores for the fetus ? Iron supplement between meals ? Be aware of nutrient-nutrient interaction ? Maximize bioavailability ? Possible effects of iron-deficiency anemia ? Preterm delivery ? Low birth weight ? Fetal deaths Should Pregnant Women Take Supplements? ? Prenatal supplements routinely prescribed ? Higher iron needs ? Higher folate needs ? Easier than changing diet ? Recommended especially for women with poor eating habits ? Vitamin A ? Should not exceed 3000 µg RAE/day Using MyPyramid ? 3 cups milk group ? 6 ounces meat and bean group ? 3 cups vegetable group ? 2 cups fruit ? 7 ounces grain group ? 6 tsp vegetable oil ? Supplies adequate vitamin D, folate, calcium, iron, and zinc Pregnant Vegetarians ? Lacto-ovo or Lacto-vegetarian ? Can usually meet nutritional needs ? Vegan must plan diet carefully ? Requires sufficient protein ? Focus on vitamins D, B-6, and B-12; iron, calcium, and zinc ? Prenatal supplements may be necessary Discomforts of Pregnancy ? Heartburn ? Hormone relaxes muscles in uterus and intestine ? Stomach acid refluxes into esophagus ? Avoid lying down after eating ? Avoid spicy foods ? Check with physician regarding use of antacids Discomforts of Pregnancy ? Constipation ? Relaxation of the intestinal muscle ? Fetus competes with the GI for space ? Recommendations ? Regular exercise ? Fluid (10 C/day) and fiber (28 gm/day) ? Hemorrhoids ? Straining during elimination ? A result of constipation 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 ? ?Morning Sickness? ? 70-80% will experience in 1st 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 ? 4% of pregnancies ? Routine screening at 20 - 28 weeks gestation ? Diabetic diet may be recommended ? Insulin may be needed in some cases ? Increased birth weight, low blood glucose, trauma, malformations ? Usually disappears after birth but is linked to diabetes later in life for mother Pregnancy Complications ? Pregnancy-induced hypertension ? High-risk disorder ? Preeclampsia (mild form) ? Eclampsia (severe form) ? Signs: ? Elevated blood pressure, protein in the urine, edema, change in blood clotting ? Convulsions in third trimester ? Liver and kidney damage, leading to death Breastfeeding ? First 6 months of life breastfeed solely ? Solid foods and breast milk until 1 year ? Recommended by American Dietetic Association and American Academy of Pediatrics ? The World Health Organization ? Breastfeed for at least 2 years ? 70% of all mothers breastfeed in the hospital ? Number decreases as infants get older Ability to Breastfeed ? Almost all women are physically capable ? Barriers to breastfeeding: ? Lack of support ? Lack of appropriate information ? Inexperienced mothers ? Monitoring of breastfed infants ? Requires patience How Human Milk is Produced Simulates hypothalamusSuckling by infant Initiates the release of hormones prolactin and oxytocin by the pituitary gland Prolactin stimulates milk production Oxytocin causes release of milk from storage (breast) Let-down reflex Milk supply for the infant Inhibited by nervous tension, lack of confidence, fatigue Let-Down Reflex Well-nourished Breastfed Infant ? Infant has 6 + wet diapers a day ? Shows normal weight gain ? Passes 1+ stool per day ? Softening of breast tissue? May take 2-3 weeks to establish breastfeeding routine ? Introduce bottle-feeding only after breastfeeding is well established Colostrum ? Thick, yellow fluid produced during late pregnancy and few days after birth ? Contains antibodies, immune-system cells and Lactobacillus bifidus factor ? Provides protection to infant against infections ? Facilitates the passage of 1st stool (meconium) Mature Milk ? Thin, watery, slightly bluish composition ? Easily digested proteins ? Protein binds to iron, reducing bacteria growth ? High linoleic acid and cholesterol content ? Needed for brain development ? Long chain omega-3 fatty acids (DHA) ? Synthesis of brain tissues, central nervous system, eyes Milk Composition ? Fore milk ? Resembles skim milk ? ~17% fat, ~74% CHO, ~9% protein ? Hind milk ? Resembles cream ? ~66% fat, ~28% CHO, ~6% protein ? Released 10-20 minutes into the feeding Fluid Needs ? Human milk ? Provides adequate hydration for baby ? Additional fluids needed ? Hot climate, diarrhea, vomiting ? Too much water ? Leads to brain disorders ? 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: 2-3 servings ? Meat, meat substitute group: 2 servings ? Vegetable group: 4 servings ? Fruit group: 3 servings ? Bread, cereal, rice, pasta group: 9 servings Overall Food Plan ? Balanced variety of foods ? Moderate fat intake ? Adequate fluids ? Reduction of milk supply caused by: ? Restricting kcal ? Ingestion of alcohol ? Smoking ? Limit high mercury fish and intake of peanuts (allergens) Advantages of Breastfeeding Barriers to Breastfeeding ? Misinformation ? Need to return to work force ? Embarrassment and modesty ? Medical conditions ? Infant with galactosemia ? Infant with PKU ? Mothers on medications ? Mothers with TB, AIDS, HIV+, undergoing chemotherapy Environmental Contaminants in Breast Milk ? Avoid freshwater fish from polluted water ? Carefully wash and peel fruits and vegetables ? Remove fat from meats Preventing Birth Defects ? Folic Acid ? Iodide ? Antioxidants ? Vitamin A ? Caffeine ? Aspartame ? Obesity and chronic health conditions ? Alcohol ? Environmental Contaminants Folic Acid ? Prevention of neural tube defects ? Periconceptional period ? Fortified grain products ? Woman of childbearing years need 400 micrograms/day Iodide ? Low iodide during first trimester ? Cretinism ? Causes physical and mental impairment Antioxidants ? Balanced multivitamin and mineral supplements ? Diet rich in whole grains, legumes, fruits and vegetables Vitamin A ? Teratogenic effect in high doses ? Facial and cardiac effects ? Supplements should not exceed 3000 micrograms RAE per day What About Caffeine? ? Decreases iron absorption ? May reduce blood flow through the placenta ? Caffeine withdrawal symptoms in newborn ? Risk of spontaneous abortion ? Heavy caffeine use in the 1st trimester ? Risk of low-birth-weight infant ? Limit caffeine intake (< 3 cups coffee/day) What About Aspartame? ? Harmful for mothers with phenylketonuria (PKU) ? Disrupts fetal brain development ? Moderate use not harmful for women who do not have PKU Fetal Alcohol Syndrome ? Large amounts of alcohol during pregnancy ? Excess alcohol reaches the embryo/fetus ? Embryo/fetus cannot metabolize alcohol ? Poor fetal and infant growth ? Physical deformities ? Mental retardation ? Irritability and hyperactivity Fetal Alcohol Syndrome Environmental Contaminants ? Mercury ? Avoid swordfish, shark, king mackerel and tile fish ? < 6 ounces of tuna per week Importance of Prenatal Care ? Medical assessment throughout pregnancy ? Adequate diet ? Learn what to avoid ? Proper health habits ? Women, Infants, and Children (WIC) supplemental food program Robert W. Wassmer Chapter 10: Anorexia Nervosa and Bulimia Nervosa
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