1. UNIT-1
MATERNAL NUTRITION
By : Muhammad Awais M.Phil. Human Nutrition And
Dietetics (UAF) Nutritionist DHQ Hospital Hafizabad
2. Outline
⢠Pre-pregnancy nutrition
â Conditions and interventions
⢠Pregnancy in adolescents
⢠Pregnancy physiology that alters nutritional needs
⢠Nutrient requirements during pregnancy
⢠Nutritional concerns during pregnancy and interventions
⢠Nutritional risk factors of pregnancy
⢠Pregnancy in adolescents
⢠Prevalence iron deficiency anemia in Pakistan
3. Pre-pregnancy nutrition
⢠Both a manâs and a womanâs nutrition may affect fertility
⢠But the womanâs nutrition has direct influence on the developing fetus
⢠Her body provides the environment for the growth and development of
newborn
⢠In preparation for a healthy pregnancy, a woman can establish the
following habits
â Achieve and maintain A healthy body weight
â Choose an adequate and balanced diet
â Be physically active
â Manage chronic conditions
â Avoid harmful influences
4. Conditions and Interventions
Premenstrual Syndrome
⢠Reduce Caffeine Intake
⢠Increasing daily physical
activity
Magnesium, Calcium, Vitamin
D, and
Vitamin B6 Supplementation
Obesity and Fertility
⢠balance diet
⢠Exercise
Eating Disorders (anorexia
nervosa and bulimia
nervosa)
⢠CBT
Polycystic Ovary Syndrome
⢠Weight loss
Diabetes Mellitus
Diet management
5. Pregnancy Physiology That Alters
Nutritional Needs
1- Altered Metabolism:
⢠Increase the basal metabolic rate: by the fourth month of
gestation and rises to 15 - 20% above normal by term.
⢠Altered the metabolism of nutrients: fat becomes the
major source of maternal fuel, making glucose available for
the fetus.
6. CONTINUE
2- Gastrointestinal Changes:
⢠Slow gastrointestinal motility: an advantage of slowed motility
is that nutrient absorption increases
⢠Nausea and vomiting are common in the first trimester and may
be related to hypoglycemia, decreased gastric motility, relaxation
of the cardiac sphincter, or anxiety.
⢠Increases in appetite and thirst
⢠Heartburn and constipation: due to slow motility or enlarging
uterus
7. COUNTINUE
3- Blood Volume Changes:
⢠Increase total body water throughout pregnancy.
⢠Hemodilution or a physiologic anemia of pregnancy: due
to the increase in blood volume.
⢠Minor edema: may be considered normal if it is not
accompanied by hypertension and proteinuria.
8. CONTINUE
⢠Recommendations for weight
gain are divided into three
categories based on the
womanâs pre-pregnancy
weight.
⢠The weight category is
determined using body mass
index (BMI).
⢠The range for women carrying
twins is 35 lb to 45 lb (16 - 20
kg).
4- Ideal Weight Gain:
⢠The average weight gain is
about 25 to 30 lb (11.5 kg to
14.0 kg).
⢠Weight gain during pregnancy
consists of the weight of the
fetus and associated fetal
tissues (e.g. placenta), plus
the weight increases in
maternal tissue.
10. Nutrition During Pregnancy
⢠Maternal diet and nutritional status have a direct impact on
the course of pregnancy and its outcome
⢠Malnutrition that occurs in
â Early months of pregnancy affects development and the
capacity of the embryo to survive
â Poor nutrition in the latter part of pregnancy affects fetal
growth
11. Nutrient Requirements During Pregnancy
⢠Actual requirements during pregnancy are influenced by
previous nutritional status and health history, including:
chronic illnesses, multiple pregnancies
⢠The requirement for one nutrient may be altered by the intake
of another. E.g., women who do not meet their calorie
requirements need higher amounts of protein.
⢠Nutrient needs are not constant throughout the course of
pregnancy - nutrient needs change little during the first
trimester and are at their highest during the last trimester.
12. ENERGY
Energy needs increase because of:
⢠The increase in basal metabolic rate.
⢠Weight gain increases the amount of calories burned during
activity.
⢠Uses additional calories to store energy in preparation for
lactation after delivery.
⢠An additional 300-340 kcalories per day during the second
trimester
⢠An extra 450 kcalories per day during the third trimester
13. Carbohydrates
⢠Ample carbohydrate (ideally, 175 grams or more per
day and certainly no less than 135 grams) is
necessary to fuel the fetal brain
⢠Sufficient carbohydrate ensures that
⢠the protein needed for growth will not be broken
down and used to make glucose
14. Protein
The protein RDA â for pregnancy is an additional 25 grams per day
higher than for nonpregnant women.
Sources: meats, milk products, and protein-containing plant foods
such as legumes, whole grains, nuts, and seeds
Protein needs increase to support :
⢠Fetal growth and development.
⢠The formation of the placenta and amniotic fluid.
⢠The growth of maternal tissues and the expanded blood volume.
15. Fats and Essential Fatty Acids
⢠Intake of 30g of visible fat/day is recommended during pregnancy
⢠The high nutrient requirements of pregnancy leave little
room in the diet for excess fat
⢠But the essential long-chain polyunsaturated fatty acids are
particularly important to the growth and development of the fetus.
⢠The brain is largely made of lipid material,
â Requires the long-chain omega-3 and omega-6 fatty acids for its
growth, function, and structure
16. Nutrients for Blood Production and Cell
Growth
⢠New cells are laid down at a tremendous pace as the fetus grows
and develops. At the same time, the motherâs red blood cell mass
expands.
⢠All nutrients are important in these processes, but folate, vitamin
B12, iron, and zinc needs more
⢠The increased requirement for vitamin B6 is proportional to the
increase in protein because it is involved in protein metabolism.
17. Folate And Vitamin B12
⢠The requirement for folate
increases dramatically during
pregnancy
⢠Prevent neural tube defect
Folate RDA : 600 Îźg/day
Folic acid sources:
⢠Natural form of folic acid
(folate): orange juice, other
citrus fruits and juices, green
leafy vegetables, dried peas
and beans, broccoli, and
whole-grain products.
⢠Because vitamin B12 is
necessary for the metabolism
of folate, a slight increase in
intake is recommended.
⢠Vitamin B12 RDA during
pregnancy: 2.6 Îźg/day
18. Iron
⢠A daily supplement of 30 mg
of ferrous iron is
recommended for all women
during the second and third
trimesters.
⢠It is preferably taken between
meals or at bedtime on an
empty stomach to maximize
absorption.
Importance for iron during
pregnancy:
⢠To support the increase in
maternal blood volume.
⢠To provide iron for fetal liver
storage, which will sustain the
infant for the first 4 - 6
months of life.
⢠Iron RDA during
pregnancy:27 mg/day
19. Nutrients for Bone Development
⢠Vitamin D and the bone-building minerals calcium, phosphorus,
magnesium, and fluoride are in great demand during pregnancy
⢠The calcium requirement for an adult woman is 400mg/day. During
pregnancy the need increases to 1000mg/day.
⢠Insufficient intakes may produce abnormal fetal bones and teeth
⢠Vitamin D plays a vital role in calcium absorption and utilization
⢠severe maternal vitamin D deficiency
â Rickets in the infant
â Osteomalacia in the mother
⢠Regular exposure to sunlight and consumption of vitamin Dâfortified
milk
20. Dietary Guide Lines for pragnant
1- Eat in moderation.
2- Aim for balance.
3- Eat three meals daily plus two or three snacks.
4- Drink adequate fluids.
5- Do not restrict salt intake
6- Be aware of food borne risks during pregnancy.
22. Nutritional concerns during pregnancy and
intervention
1- Nausea and Vomiting
Women should be advised to:
⢠Eating small, frequent meals every 2 to 3 hours.
⢠Eat carbohydrate foods such as: dry crackers, Melba toast, dry cereal, or
hard candy before getting out of bed in the morning.
⢠Avoid drinking liquids with meals.
⢠Avoid coffee, tea and spicy foods.
⢠Limit high-fat foods, because they delay gastric emptying time.
⢠Eliminate individual intolerances.
23. Continue
2. Constipation
may be caused by:
⢠Relaxation of gastrointestinal
muscle tone and motility
⢠Pressure of the fetus on the
intestines.
⢠Decrease in physical activity
⢠Inadequate intake of fluid and
fiber.
⢠Side effect of the consumption
of iron supplements.
Intervention
⢠Increase fiber intake.
⢠Drink at least eight 8-ounce
glasses of liquid daily.
⢠Try hot water with lemon or
prune juice upon waking to
help stimulate peristalsis
⢠Participate in regular
exercise.
24. Continue
3- Heartburn:
⢠Eat small, frequent meals and eliminate liquids immediately
before and after meals to avoid gastric distention.
⢠Avoid coffee, high-fat foods and spices.
⢠Eliminate individual intolerances.
⢠Avoid lying down or bending over after eating.
25. Continue
4- Inadequate Weight Gain:
⢠Inadequate weight gain during pregnancy increases the
risk of giving birth to a low-birth-weight (LBW) infant
(i.e., a baby weighing less than 2500 g).
⢠The recommended weight gain for normal weight women
is @ 0.44 kg/week,
⢠Underweight women more than 0.44 kg/week whilst
overweight women about 0.29 kg/week and women
pregnant with twins at least 0.44 kg/week.
26. Continue
5- Excessive Weight Gain, may be related to:
⢠Overeating.
⢠Stress.
⢠Decrease in physical activity.
⢠Counsel the client on the recommended rate and quantity of
weight gain associated with optimal maternal and infant health
and successful breast-feeding.
27. Nutritional Risk Factors Of Pregnancy
⢠Pre-partum Weight < 85% Or > 120% Of Ideal Weight
⢠Use Of A Therapeutic Diet For A Chronic Disease
⢠Use Of Alcohol, Tobacco, Or Drugs
⢠Food Faddism, Unbalanced Diet, Pica
⢠Teens And Women Older Than 40 Years Of Age
⢠Poor Obstetric History (LBW, Stillbirth, Abortion, Fetal Anomalies)
⢠Repetitive Pregnancies At Short Intervals
⢠Low Socioeconomic Status
⢠Chronic Preexisting Medical Problems, Such As Hypertension, Diabetes, Heart Disease,
Pulmonary Disease, Renal Disease, Maternal PKU
⢠Untimely Prenatal Care
28. Pregnancy in Adolescents
⢠Nourishing a growing fetus adds to a teenage girlâs nutrition burden,
especially if her growth is still incomplete.
⢠increases the risks of pregnancy complications among adolescent mothers
include
â iron-deficiency anemia (which may reflect poor diet and inadequate
prenatal care)
â prolonged labor (which reflects the motherâs physical immaturity)
⢠On a positive note, maternal death is lowest for mothers under age 20
⢠Pregnant teenagers have higher rates of stillbirths, preterm births, and
low-birthweight infants than do adult women
29. Prevalence Iron Deficiency Anemia In
Pakistan
⢠NNS 2018 confirms that micronutrient deficiencies are
widespread in Pakistan.
⢠Anemia was common in non-pregnant women of
reproductive age 43.0% and 53.1% in girls
⢠Iron deffieciency anemia 21.2% s in women of reproductive
age 15â49 years
(NNS 2018)
30. References
⢠Understanding Of Normal And Clinical Nutrition
⢠National Nutrition Survey 2018
⢠Nutrition Through The Life Cycle
⢠Nutrition by Deepti Chauhan