2. Nutrition before Pregnancy
• Maintain a healthy
weight
• Nutrient status
– Folate
– Iron
– Vitamin B12
– Vitamin A
• Chronic conditions
• Substance use
7. Physiology of Pregnancy
• Fetal growth:
– Zygote: fertilized ovum
– Blastocyst: first 2 weeks
• Cells differentiate into fetus & placenta
– Embryo: weeks 2-8
• Development of organ systems
– Fetus: week 9-delivery
• Growth
– Newborn
8. Physiology of Pregnancy
• Placental Development
– Placenta: metabolically active organ
• Interwoven fetal and maternal blood vessels
• Exchange of oxygen, nutrients, and waste
products
– Amniotic sac
– Umbilical cord
11. Day 23
• 2mm long (=)
• Beginning
development of
major organs
• Critical stage for
neural tube
development
12. Day 28
• 6mm long (===)
• At this point, the
heart is beating,
• Lim buds will form
the arms and legs
13. Week 9
• 44mm long
• Embryo has become a
fetus
• Complete CNS,
beating heart,
digestive system, well-
defined fingers and
toes, beginnings of
facial features
14. Week 12
• 82mm long, weighs
about 1oz
• Arms, hands,
fingers, legs, feet
and toes formed
• Organs grow and
mature
• Less affected by
nutritional
deficiencies
15. Week 26
• 250mm long,
weighs 2-3 lbs
• 3rd trimester
• Rapid growth
• Able to survive if
born prematurely
– Lungs
– Nutrient stores
– Feeding
16. Week 40
• Baby ready to be
born
• Less amniotic fluid,
baby almost fills
uterus
• Plump arms and
legs
17. • Full term fetus usually weighs between 7
and 9 lbs at birth
• Full term: 38-42 weeks
18. Definition of a
Successful Pregnancy
• Gestation at least 37 weeks
– Lung development
• Birth weight >5.5 lb
• Otherwise
– Low birth weight (LBW)
– Small for gestational age (SGA)
– Preterm vs. SGA
• Potential for catch-up growth
• Malnutrition
19. If a baby is born at 38 weeks and
weighs 4lbs, he/she would be
considered:
a) Low birth weight (LBW)
b) Small for gestational age (SGA)
c) Preterm
d) Both a and b
e) All of the above
20. If a baby is born at 38 weeks and
weighs 4lbs, he/she would be
considered:
a) Low birth weight (LBW)
b) Small for gestational age (SGA)
c) Preterm
d) Both a and b
e) All of the above
21. Critical Periods
• Times of intense development and
rapid cell division
– Cellular activities can occur only during
these times
• Organ and tissue development
most vulnerable to adverse
influences
• First trimester
22.
23. Neural Tube Development
• Critical period is 17-30 days gestation
• Most women unaware they are
pregnant during this time
• Vulnerable to
– Nutrient deficiencies
– Nutrient excesses
– Toxins
24. Neural Tube Defects
• Anencephaly
– Brain either missing
or fails to develop
• Spina bifida
– Incomplete closure of
spinal cord and its
bony encasement
• Affects 30/100,000
newborns in US
27. Neural Tube Defects
• Cause unknown
• Risk factors
– Family history
– Maternal diabetes
– Maternal obesity
– Anti-seizure medications
– Mutations in enzymes
28. Which of the following has been
shown to prevent neural tube
defects?
a) Vitamin B12
b) Vitamin D
c) Calcium
d) Folate
29. Which of the following has been
shown to prevent neural tube
defects?
a) Vitamin B12
b) Vitamin D
c) Calcium
d) Folate
30. Folate Supplementation
• Prevents & reduces severity of neural
tube defects
• Folate status important prior to
pregnancy and during 1st trimester
• RDA: 600 micrograms
• Fortification of grains
– 50% of pregnancies are unplanned
31. Fetal Programming
• Adverse influences at critical stages
in utero may set the stage for chronic
disease development later in life
• Maternal nutrition status may change
gene expression in fetus
• Examples:
– beta cell growth and diabetes
– blood vessel growth, lipid metabolism
and CVD
34. How much weight should a healthy-
weight woman carrying a single
fetus gain during pregnancy?
a) 5-15 pounds
b) 15-25 pounds
c) 25-35 pounds
d) 35-45 pounds
35. How much weight should a healthy-
weight woman carrying a single
fetus gain during pregnancy?
a) 5-15 pounds
b) 15-25 pounds
c) 25-35 pounds
d) 35-45 pounds
36. Maternal Weight
• Birth weight is most reliable indicator
of infant health
• Maternal weight prior to conception
influences fetal growth
– Underweight
• Risk of LBW, preterm, infant death
– Overweight and obesity
• Medical complications for mother
• Risks for infant
37. Maternal Weight
• Weight gain during pregnancy
– Correlates closely to infant birth
weight
– Recommendations (single birth)
• Healthy weight: 25-35lbs
• Underweight: 28-40lbs
• Overweight: 15-25lbs
– Most women gain more than
recommended!
38. Maternal Weight Gain
•Normal: 3.5lbs in 1st tri, then 1lb/week after that
•Underweight: 5lbs in 1st tri, then just over 1lb/week
•Overweight: 2lbs in 1st tri, then 2/3lb per week
39. What makes up the weight?
• Weight gain supports growth and
development of…
– Placenta
– Uterus
– Blood supply
– Fluid volume
– Breasts
– Infant
• Fat stores (small amount)
40. Weight
gain (lb)
Increase in 2
breast size
Increase 4
mother's
fluid volume
Placenta 1 1/2
Increase in 4
blood supply
to the placenta
Amniotic fluid 2
Infant at birth 7 1/2
Increase in size 2
of uterus and
supporting
muscles
Mother's 7
necessary
1st trimester 2nd trimester 3rd trimester 30
fat stores
Stepped Art
Fig. 15-8, p. 502
41. Which of the following is true about
exercise and pregnancy?
a) Pregnant women should exercise
very little and rest as much as
possible
b) Pregnant women should get as much
exercise as possible, even if they did
not exercise prior to getting pregnant
c) Pregnant women can continue an
exercise regimen that they had prior
to getting pregnant with some
adjustments
42. Which of the following is true about
exercise and pregnancy?
a) Pregnant women should exercise
very little and rest as much as
possible
b) Pregnant women should get as much
exercise as possible, even if they did
not exercise prior to getting pregnant
c) Pregnant women can continue an
exercise regimen that they had prior
to getting pregnant with some
adjustments
43. Exercise during Pregnancy
• Benefits of physical activity
– improve fitness
– manage or prevent gestational diabetes
– facilitate labor
– reduce stress
– fewer discomforts
– strength to carry weight
• Inactive women should not begin an
intense exercise program during
pregnancy
44. Exercise during Pregnancy
Recommendations
• Regular, mild to
moderate
• Low-impact
• Avoid sports with risk
of falling or being hit
• Protect abdomen
• Maintain adequate
diet
• Heat and hydration
46. Energy & Nutrient Needs
• Needs tend to be higher than any
other time in life
• To meet needs
– Make careful selections
– Body maximizes absorption
– Body minimizes losses
47. Key Nutrients During Pregnancy
• Calories
• First trimester: No or little extra
• Second trimester: +340 kcals/day
• Third trimester: +450 kcals/day
• Protein
• +25 g/day (or 1.1 g/kg body weight)
• Carbohydrate
• 175 g/day
48. Key Nutrients During Pregnancy
• Folate
• B12
• Iron
• Zinc
These nutrients are needed for the
synthesis of DNA and new cells
51. Key Nutrients During Pregnancy
• Vitamin D
– AI does not increase during pregnancy
– Critical for bone and teeth development
• Calcium
– AI does not increase during pregnancy
– Absorption and retention increases
– Deficiency common; needed to conserve
maternal stores
52.
53. Nutrition during Pregnancy
• Vegetarians
– Able to meet most nutrient needs
through diet alone
– Exception: iron
• Vegans
– May require supplementation for B12,
calcium, vitamin D
– B12 deficiency: spinal chord damage,
psychomotor retardation
54. Common Concerns
• Nausea & vomiting
– “Morning sickness”
– Hormonal changes
• Constipation and hemorrhoids
• Heartburn
• Food cravings and aversions
– Hormone changes
– Pica
55. Malnutrition and Pregnancy
• Fertility
– Amenorrhea
– Sperm
– Loss of sexual interest
• Placental development
– Poor development
– Risk of LBW, physical and cognitive
abnormalities
56. Malnutrition and Pregnancy
• Fetal development
– Fetal growth retardation
– Birth defects
– Miscarriage and stillbirth
– Premature birth
– LBW
57. Risks During Pregnancy
• Gestational diabetes
– Affects 1/25 women
– Increased risk of type 2 diabetes and
hypertension later in life
– Complications during labor & delivery
– Effects on infant
• High birth weight
• Birth defects
– Avoid excessive weight gain
58. Risks During Pregnancy
• Preexisting hypertension
– Risk of LBW infant
– Risk of placental separation; stillbirth
• Gestational hypertension
– 50% mild, no adverse effect
– 50% early sign of preeclampsia
59. Risks During Pregnancy
• Preeclampsia (pregnancy-induced)
– Gestational hypertension + protein in
urine
– Affects nearly all maternal organs; may
retard fetal growth
– Risk of placental separation
– Cause unknown
– Genetic predisposition?
• Eclampsia: seizures & coma
60. Risks During Pregnancy
Fetal Alcohol Syndrome
• Irreversible mental and
physical retardation
• Recall CNS critical
period
• Entirely preventable
61. Risks during Pregnancy
Smoking
• Restricts blood
supply to fetus
• Lung development
• Increased risk for:
– Complications
– LBW infant
– Lung problems
– SIDS
• Preventable!
62. Risks during Pregnancy
Mercury
• Omega-3 fatty
acids
• Fish contain high
amounts of
mercury
• Mercury can impair
fetal growth and
CNS development
66. Which of the following is
true for you (females)?
a) I plan to breastfeed
b) I plan to formula feed
c) I plan to do a combination of both
d) I have never thought about how I
am going to feed my offspring
e) I do not plan on having children
67. Which of the following is
true for you (males)?
a) I want my future wife to breastfeed
b) I do not care whether my children
are breastfed or not
c) I have never thought about how I
want my offspring to be fed
d) I do not plan on having children
68. Recommendations
• American Academy of Pediatrics
• American Academy of Family Physicians
• American College of Obstetricians and Gynecologists
• American College of Nurse-Midwives
• American Dietetic Association,
• American Public Health Association
– Officially recommend that most infants
breastfeed for at least 12 months.
– Also recommend that for about the first six
months infants be exclusively breastfed,
meaning that they not be given any foods or
liquids other than breast milk.
69. Healthy People 2020
• Breastfeeding ever – 81.9%
• Breastfeeding at 6 months – 60.5%
• Breastfeeding at 1 year – 34.1%
• Exclusively through 3 months – 44.3%
• Exclusively through 6 months – 23.7%
• Reduce the proportion of breastfed newborns who
receive formula supplementation within the first 2
days of life – to 15.6% (from 25.6%)
70.
71. How far is the US from these goals?
U.S. Rates Healthy People
2020 Goals
Breastfeeding 75% 81.9%
Ever
Breastfeeding 43% 60.5%
at 6 months
Breastfeeding 22.4% 34.1%
at 12 months
72. Benefits for infant
• Optimal nutrition
– Nutritionally superior to formula
– Sterile and always fresh
– More easily digestible
• Immune protection
• Fewer allergies and intolerances
• Fewer respiratory, GI, and ear infections
• Cognitive benefits
• Infant-led feeding
• May protect against some chronic diseases
later in life
73. Benefits to Mother
• Increased rate of uterine contraction after
childbirth and consequent reduced risk of
postpartum blood loss
• Possible reduced risk of pre-menopausal
breast and ovarian cancers
• Amenorrhea and decreased fertility
• Promotes mother-infant bond
• Weight loss
• Convenience
• Economic benefits
77. Hormonal Control of
Lactation
• Hormonal controls
– Prolactin
– Oxytocin: MER
• Sucking stimulus
signals release of
prolactin
• Supply follows
demand
78. Composition of Breast Milk
• Colostrum
– First fluid, thick, yellowish
– Rich in immune factors and protein
– About 20 kcal/oz
– Bifidus flora
• In first 24hrs, total intake: 10-108ml
• Transitional milk: 6-13 days postpartum
79. Composition of Breast Milk
• 20 calories per ounce
• Whey:Casein (70:30)
– More easily digested
• Foremilk vs. hindmilk: fat content
– Don’t limit time at breast
– No clear distinction
• Contains small amount of Fe
– Sufficient for first 6 months
– Absorption is facilitated by high vitamin C
concentration
80. A newborn baby needs to be given
small amounts of water in addition
to breastmilk to meet his/her needs
a) True
b) False
81. Nutrient Requirements for
Lactation
• Energy requirement
– Extra 500 kcals/day
– Higher needs than pregnancy
• Increased need for carbohydrate
• Fluid intake
• Inadequacies reduce quantity and not
quality of milk
82. Contraindications to
Breastfeeding
• Maternal HIV
• Inborn errors of metabolism of child
(galactosemia)
• Alcohol
• Certain medications
• Smoking
• Illicit drugs
• Caffeine
83. Common Problems
• Sore nipples
• Engorgement
• Plugged duct
• Mastitis
Breastfeeding is a LEARNED SKILL!
86. Formula Feeding
• Safety and adequacy
• Preparation
• Can interfere with breastfeeding
– Supply & demand
– Nipple confusion/preference
• More likely to be overfed
– Increased risk of obesity?
89. Baby Friendly Hospital
Initiative
1. A written bf policy routinely communicated to staff
2. Train staff in skills to implement policy
3. Inform pregnant women about benefits and management
of breast feeding
4. Help mothers initiate bf within 30 minutes of delivery
5. Show mothers how to initiate and maintain bf
6. Give newborns no food or drink other than breast milk
unless medically indicated
7. Practice rooming in: allow mothers and infants to stay
together
8. Encourage breast feeding on demand
9. Give no pacifiers
10. Foster establishment of support groups and refer mothers
to them
Maternal nutrition status prior to pregnancy can have a significant impact on fetal growth and development, as well as a woman ’s ability to conceive in the first place! Weight: both underweight and overweight are associated with infertility and increased risk of complications; excess body fat can disrupt menstruation and hormone production. Achieve a healthy weight prior to pregnancy as dieting while pregnant is never a good idea! Importance of a balanced diet: Malnutrition reduces fertility and impairs early development of the fetus. Problems with nutrients can occur very early in pregnancy before woman recognizes she is pregnant. Folate, Iron, and B12 are especially important for fetal development; increased needs during pregnancy Vitamin A supplementation should be avoided as this may adversely affect the pregnancy Conditions such as diabetes, HIV/AIDS, PKU, and STDs can adversely affect a pregnancy and should be managed prior to pregnancy to ensure a healthy outcome Harmful substances, such as cigarettes, alcohol, drugs or environmental contaminants, can can cause miscarriage, birth defects, and can impair fertility -> eliminate use prior to pregnancy
Although the woman ’s nutrition has the most direct influence on the developing fetus, the man’s nutrition status is also important, since malnutrition can affect male fertility Overweight and obese men have low sperm counts and hormonal changes that reduce fertility Zinc is a cofactor for enzymes involved in testosterone production, DNA replication, protein synthesis, and cell division. Zinc helps protect sperm from bacteria and chromosomal damage and also plays a role in sexual organ development. A deficiency of zinc can impair male fertility but this can be reversed over time with supplementation. Antioxidants can help protect sperm from oxidative damage (free radicals). Men with diets rich in antioxidant nutrients have higher sperm counts and motility Heavy alcohol use can lower sperm production, but light to moderate intake does not appear to have an effect. Remember, the dietary guideline for alcohol use is no more than 2 drinks per day for males
Ovum (egg) + sperm = zygote Once the ovum is fertilized, it becomes a zygote. About 30 hours after fertilization, the zygote reproduces itself by dividing in half. Although the zygote begins as a single cell, it rapidly divides to become a blastocyst
Zygote travels down fallopian tube and continues to rapidly divide (to become blastocyst). Blastocyst arrives in uterus about 4-5 th day after conception. Implants into lining of uterus, usually within two weeks of fertilization. When the blastocyst has implanted, at around two weeks after conception the developing infant becomes an embryo .
Placenta is embedded in the uterine wall that develops in the early days of pregnancy. Placenta performs the respiratory, absorptive, and excretory functions that the fetus ’ lungs, digestive system, and kidneys will provide after birth. Placenta also produces an array of hormones involved in pregnancy and lactation. Amniotic sac: a fluid-filled balloonlike structure that houses the developing fetus; provides protection to developing fetus Umbilical cord: a ropelike structure containing fetal blood vessels that extends through the fetus ’s belly button-to-be to the placenta These three structures are expelled from the uterus during childbirth
As you can see from this diagram there is no actual mingling of fetal and maternal blood (placental villi are fingerlike projections, much like intestinal villi) Maternal arteries bring fresh blood with oxygen and nutrients to the fetus, while maternal veins carry fetal wastes away
During zygotic stage, cells rapidly divide; differentiate into fetus and placenta During embryonic stage, you see the beginning development of major organs; by the end of 8 weeks, the embryo (1.25in) has a complete central nervous system, a beating heart, a digestive system, well-defined fingers and toes and the beginnings of facial features During the fetal stage is when the major growth occurs: this infant grew 20 times longer and 50 times heavier during the fetal stage
Embryonic stage
Embryonic stage
By the end of the first trimester, the fetus weighs about 1 oz. Arms, hands, fingers, legs, feet and toes are fully formed. Organs begin to grow and mature. Still affected by nutritional deficiencies and other insults, but not as severe and a full recovery is possible (if not entirely likely).
Beginning of third trimester fetus weighs 2-3 lbs. Another time of rapid growth, and fetus will double in length and will multiply its weight by 5 times. An infant that is born at about 26 weeks has a good chance of surviving a premature delivery, with care in neonatal ICU. Lungs are not well developed. Baby will not have enough calcium and iron stored in its body, and also will not have much fat. Preterm infants also have less ability to suck and swallow, so feeding is challenging.
LBW infants < 5.5lbs; LBW infants more likely to have complications, birth defects, early death VLBW infants (<3.5lbs) struggle both in immediate survival and long-term development Preterm infants may be small, but if their size and weight are appropriate for their age, they can catch up in growth given adequate nutritional support; SGA infants have suffered growth failure in the uterus and do not catch up as well Infants, whether full or preterm, who weight less than they should for a fetus at their stage of gestation are called small for gestational age. For example, a baby born at 30 weeks, who is less than 5.5 lbs, may still be the appropriate weight for 30 weeks gestation – so it is LBW but not SGA. But baby born at 37 weeks but who weights less than 5.5 lbs is SGA but not preterm.
Nutritional deficiencies, some medications, high intakes of vitamin A, or radiation can change or stop development. The effects are often irreversible. Most spontaneous abortions, or miscarriages, happen during this time. (This is why most people wait until the second trimester to announce they are pregnant)
Each organ/tissue grows to maturity according to its own schedule, with greater intensity at some times more than others Each organ and tissue is most vulnerable to nutrient deficiencies or toxins during its own critical period. If the adversity occurs during the purple timeframe, the damage is likely to be severe and unlikely to be reversible. If it happens in the green timeframe, it is probably going to be less severe and possible reversible. Notice that CNS development begins after only two weeks of gestation; many women may not realize that they are pregnant at this time.
Anencephaly often results in miscarriage; infants born with anencephaly die shortly after birth
If the upper end of the neural tube fails to close, the brain will not develop, resulting in anencephaly. If it fails to close in the lower parts, spina bifida results.
Spina bifida is characterized by incomplete closure of the spinal cord and its bony encasement. The meninges membranes covering the spinal cord often protrude as a sac, which can rupture and lead to meningitis. Spina bifida is accompanied by varying degrees of paralysis depending on damage to spinal cord. Mild cases may not even be noticed, while severe cases can lead to death
High dose folate supplements require a prescription due to the fact that folate can mask vitamin B12 deficiency (pernicious anemia) Neural tube defects occur early in development before most women realize they are pregnant. Grain products are therefore fortified to ensure adequate intake in women of childbearing age. Fortification has been successful in improving folate status in women and reducing occurrence of neural tube defects
There ’s some evidence that certain adverse influences may set the stage for chronic disease later in life. For example, poor maternal nutrition may affect the baby’s blood vessel growth in the uterus, and may set the stage for lipid metabolism and lean body mass development in a way that will put the baby at risk for CVD later in life. Pancreatic (beta) cells are responsible for producing insulin. Malnutrition during the critical period of pancreatic cell growth may develop fewer beta cells, which may be insufficient in times of overnutrition during adulthood when body needs more insulin
Organ & tissue enlargement: heart, thyroid, liver, kidneys, uterus, breasts, adipose tissue Uterus and its supporting muscles increase in size and strength BMR increases dramatically; energy needs of prengant woman are greater Blood volume doubles to carry additional nutrients and other materials Joints become more flexible to prepare for pregnancy Estrogen promotes water retention, which can cause swelling Breasts enlarge in preparation for lactation
Mom: Obese women have high risk of medical complications, such as hypertension, gestational diabetes, and postpartum infections; have more complications with labor and delivery Infants of obese women: more likely to be post term & larger (>9lbs) -> this increases likelihood for difficult labor/delivery, birth trauma and cesarean section Poor development -> higher risk of heart defects and other abnormalities, likely due to poor glycemic control and undiagnosed diabetes Maternal obesity may double the risk for neural tube defects
Health care professionals monitor weight gain using prenatal weigh-gain grids like these A larger weight gain in a short time indicates excessive fluid retention and may be the first sign of preeclampsia
Only about 7 lbs of the 30 lbs is fat. That fat serves a necessary purpose, too: to provide energy for labor and lactation. Lose most, but not all of the weight fairly immediately after delivery. Most women do not return to their pre-pregnancy weight.
Inactive women may start moderate exercise program (e.g. walking) upon physicians approval Women with high-risk pregnancies will likely have to restrict physical activity
Many of exercise guidelines aimed at preventing excessively high internal body temperature and hydration, both of which can harm fetal development
Nutrient needs during pregnancy and lactation are higher than at any other time.
Pregnant woman have higher energy needs than non-pregnant women, due to increased BMR (2nd and 3rd trimester) Increase in nutrient needs is often greater than extra energy needs (15-20%), so nutrient-dense foods should be chosen to supply the extra calories Ample carbohydrate is necessary to fuel fetal brain; protein-sparing action Protein needs are higher; avoid high-protein supplements
It is best to obtain sufficient folate from a combination of supplements, fortified foods, and a diet that includes fruits, juices, green vegetables, and whole grains Slightly greater need for B12, which activates the folate enzyme. Need for B12 can easily be met by a diet that includes even modest amounts of meat, fish, eggs, or milk products together with body stores Vegans need to take daily supplements of B12 or B12-fortified foods to prevent neurological complications of a deficiency
Pregnant women need iron to support their enlarged blood volume and to provide for placental and fetal needs Body makes several adaptations to help meet exceptional needs for iron: menstruation stops & iron absorption improves Most women of childbearing age have inadequate iron stores and may need to take a supplement Zinc is required for DNA and RNA synthesis and thus for protein synthesis and cell development Zinc absorption increases when intakes are low; routine zinc supplementation is not advised
Vitamin D plays a role in calcium absorption and utilization; consequently, severe maternal vitamin D deficiency interferes with normal calcium metabolism, resulting in rickets in the infant and osteomalacia Although AI does not incease for either vitamin D or calcium, it is important that women get sufficient amounts of these nutrients in their diets
Pregnant women who make wise food choices can meet most of their nutrient needs, with the possible exception of iron Supplements are routinely prescribed by for pregnant women by most physicians. Some are over-the-counter, others by prescription because of their high folate content (1000 ug), which could be problematic for certain non-pregnant people, such as the elderly, since it would mask a vitamin B12 deficiency.
Giving infants vitamin B12 supplements corrects the blood and neurological symptoms of deficiency, as well as structural abnormalities, but cognitive and language development delays may persist
NAUSEA & VOMITING About 75% of women experience in early stages. Begins about 3 weeks, ends usually around 3 months. Pregnancy hormones: increases sense of smell; may be related to this. Probably evolved to serve a useful function: to protect pregnant women and embryo from food-borne infections and toxins. To help: avoid spicy or greasy foods, eat smaller, more requent meals; eat slowly and drink liquids between meals. CONSTIPATION & HEMORRHOIDS Pregnancy hormones alter muscle tone. Slowed movement of GI tract, possibly aggravated by high doses of iron. Later, fetus crowds out intestine. Generous amounts of fiber, adequate fluids and regular exercise. Hemorrhoids often accompany: straining. HEARTBURN Relaxed GI muscles: cardiac sphincter. Growing fetus puts increasing pressure on the mother ’s stomach. Avoid lying down right after eating; eat smaller, more frequent meals; eat less fat, so the stomach will empty faster; avoid spicy foods. May need to take an antacid, should consult MD but many are safe for pregnancy. FOOD CRAVINGS & AVERSIONS Most commonly craved items: fruit and juices; sweets; desserts and chocolates. Myth that mothers instinctively know what to eat and cravings are the result of a natural desire to consume needed nutrients. This isn ’t really the case (I.e. cravings do not reflect physiological needs). Cravings more likely to be related to hormonal changes or to family traditions. Some crave strange, non-food items, such as starch, chalk, soap, or dirt: pica . Can be risky, craved substances can be toxic and harmful. Not known why this occurs. Most common aversions are to non-alcoholic caffeinated beverages, meat, fish, poultry, and eggs.
Malnutrition can prevent the placenta from developing fully, so the placenta can ’t deliver optimal nutrients to the fetus.
Without adequate nutrition during pregnancy, fetal growth and infant health are compromised
GESTATIONAL DIABETES Usually develops during the second half of pregnancy, with subsequent return to normal after childbirth Some of the hormones of the placenta antagonize the action of insulin. This can lead to gestational diabetes, which is a high blood glucose concentration that develops during pregnancy and returns to normal after birth. Usually develops in the second half of pregnancy. Screening between 24 and 28 weeks recommended for all woman at “average” risk non fasting oral tolerance test (one hour after 50 g load) If positive, Oral glucose tolerance test: 100 grams glucose with measurements hourly for three hours: at one hour, over 180; at 2 hours over 155 and at 3 hours, over 140. More common in women with a family history of diabetes or who are obese. The fetus grows to be quite large – increased risk of c-section. Birth defects: heart damage, limb deformities, and neural tube defects Diet and exercise are the first two approaches Probably 3 regular meals with small snacks is the cornerstone of the diet. Also important to limit high GI foods. Glucose monitoring becoming increasingly common. If not normalized in two weeks, insulin is added to regimen If it ’s not controlled, there’s an increased risk of type 2 diabetes and hypertension later in life.
Blood flow through the vessels that supply oxygen and nutrients to the placenta diminishes. Preeclampsia is the most serious maternal complication of pregnancy. Symptoms include: upper abdominal pain, severe headaches, swelling, vomiting, blurred vision, sudden weight gain, fetal growth retardation
Head: small in size; forehead narrow and receding Nose short and upturned Jaw underdeveloped, receding chin, receding or flattened upper jaw Eyes: extra skinfolds on eyelids; drooping eyelids; downward slant of eyes; small eyes Ears: uneven in placement and size, poorly formed outer ear Lips: absence of groove in upper lip; flat & thin upper lip Irreversible mental retardation – one of the leading causes of MR.
Limits oxygen and nutrient delivery and waste removal
Provides optimal nutrition to the infant – and it ’s always safe & ready to go, does not require any preparation Less diarrhea, ear infections. Reduces the chances of some allergies Cognitive benefits on IQ are unclear. Thought to be due to ARA and DHA (docosahexanoic acid ). They ’ve started adding these to formula. Obesity. Not sure why. Could be self-regulation of energy intake, or lifestyle of families who breast feed. Overall seems to have a beneficial but small effect on overweight. Arthritis, heart disease, diabetes. Decreased cost of medical care for the infants. Don ’t need to purchase formula, which is still more expensive than the extra food a mother needs to eat to support breastfeeding.
Reduced risk of breast cancer related to lifetime duration of breast feeding. Evidence for ovarian cancer is less clear. Not reliable method of birth control though.
During pregnancy, hormones from the placenta stimulate cells in the breast to form milk-producing lobules.
After birth, the mother produces the hormone prolactin to maintain the changes in the breast and the ability to produce milk. The sucking of the infant stimulates the release of prolactin from the pituitary gland. Milk synthesis occurs as the infant nurses. The more the infant suckles, the more milk is produced – supply follows demand.
Can eat an extra 300 calories or so per day and let the fat stores of pregnancy provide the rest. In this way may help with the return to pre-pregnancy weight. Should not diet – may hinder milk production. Protein and fats about the same, need more carbs because glucose is used to make lactose in breast milk. Fluid demands increase; women should drink to thirst. One recommendation is to drink a glass of water every time the baby nurses.