All about changes occurring during pregnancy and nutrient needs of a pregnant lady.

1. PHYSIOLOGICAL AND
BIOCHEMICAL
CHANGES
AND
NUTRIENT NEEDS OF
PREGNANT LADY
N DIET 307
MATERNAL AND INFANT NUTRITION

3. PHYSIOLOGY OF PREGNANCY
Pregnancy is an awe-inspiring process of growth and development
that has a great influence on both mother and fetus.While the
fertilized ovum is developing from a mass of dividing cells to an
embryo to a fetus, changes keep on occurring inside the mother as
well.These changes are and integral part of maternal-fetal system
which creates the most favorable environment possible for a child’s
development.The changes are necessary to:
•Regulate maternal metabolism
•Promote fetal growth
•Prepare the mother for labor
•Birth and lactation

4. PHYSICAL CHANGES

5. RESPIRATORY SYSTEM
1. Respiratory adaptations occur during pregnancy to meet both
maternal and fetal needs.
2. The maternal oxygen demand increases in response to :
1. Increased metabolic rate
2. The need to add to the tissue mass in the uterus and breasts
3. The fetus requires oxygen
4. A way to eliminate carbon dioxide
3. As the uterus enlarges, there is resultant increase in the intra-
abdominal pressure and increase in diaphragmatic breathing.
4. The pregnant lady breathes deeper ( greaterTIDALVOLUME) but
increases her respiratory rate only by few breathes.
5. Efficiency of gas exchange a alveolar level increases: the oxygen
carrying capacity of the blood increases accordingly.

7. CARDIOVASCULAR SYSTEM
1. Extensive physiological and anatomic changes occurring in
cardiovascular system, serve to protect the woman’s normal
physiological functioning to meet the metabolic demands
pregnancy imposes on her body, and to provide fetal development
and growth needs.
2. The cardiac output increase; it’s a result of increased stroke volume
and is in response to increase tissue demand for oxygen.
3. There is decline in resistance in vessels; leading to increased stroke
volume of heart and increased cardiac output.
4. The blood pressure drops in pregnancy i.e. there is decrease in both
systolic and diastolic blood pressure.The drop in blood pressure is
the result of peripheral vasodilatation from increased levels of
progesterone.

8. HAEMATOLOGICAL
CHANGES
1. These are the changes in
blood volume and
composition.
2. The plasma volume
increases by 50%.This
increased level is linked
with obstetric performance.
3. The RBC production is
stimulated during
pregnancy so that their
number rise but increase is
not large as the expansion
of plasma volume.

9. ENDOCRINE SYSTEM CHANGES
The pregnant lady secrets several
hormones throughout gestation. Some
are those that are present during
pregnancy whereas others that are
normally present; have altered their
secretion rate. Most hormones are
protein or steroids that are synthesized
from precursors such as amino acids and
cholesterol in the endocrine gland.Their
production is influenced by mothers
general health and nutritional status.
•They prepare the mother for pregnancy
•Help to maintain pregnancy
•Prepares mother for parturition

11. PROGESTERONE
Chief action is to cause relaxation of
smooth muscles of the uterus; so
that they can expand as the fetus
grows.
The relaxation of the muscles of the
gastrointestinal tract reduces
motility in the gut, allowing more
time for nutrients to get absorbed
and account for constipation in
pregnant lady.
General metabolic function of this
hormone is
•To induce maternal fat deposition
•Reduce alveolar and arterial pco2
(facilitate exchange of lung gases)
• Increase renal sodium excretion.
ESTROGEN
Its secretion is lower then
progesterone in the early months but
rises sharply near term. It promotes
the growth and control function and
the uterus.
Alters the structure of
mucopolysaccharides in connective
tissue.The alteration is beneficial as it
makes the tissue more flexible and
helps in uterus dilation during birth,
but also increases affinity of
connective tissue to water.
Because of estrogen many pregnant
women complain of excess fluid
retention in skin.Their faces and
fingers become puffy, and there are
indications of generalized edema.

12. Pregnant women may feel warm and hot flushes due to increased
hormonal level and basal metabolic rate.
The parathyroid gland increases slightly in size to meet up the
increased calcium requirement. In addition the hormones HCG, HPL,
prolactin, cortisone, progesterone, estrogen, and variety of proteins
and glycoprotein help in suppression of lymphocytes produced in
response to graft rejection.
β- HCG
•The increased level of this hormone indicates pregnancy.
•The hormone peaks up just before three months then goes down slowly.
•The hormone is produced by placenta.
A great variety of regulatory hormones are produced in placenta,
including HCG, human placental lactogen (HPL), chorionic
somatomamotropin, and human chronic thyrotropin (HCT).

13. MUSCULOSKELETAL CHANGES
•The uterus enlarges, it rises up and
out of pelvic cavity.This action
displaces the stomach, intestine
and other adjacent organs.
•Pregnant women have an
exaggerated arch in their back
(called lumbar lordosis) as the spine
realigns to maintain balance.The
ligaments become more lax due to
hormones, causing back pain and
pelvic pain (called symphysis pubis
dysfunction)

14. DERMATALOGICAL CHANGES`
•Stretch marks
•Hyper pigmentation
•Spots/ acne
•Broken veins
•Sensitivity and itching
•Obstetric choleostasis
The areas that get hyper pigmented are:
Nipples and surrounded skin
Moles and freckles
At face around forehead, cheeks and neck
Around tummy

16. REPRODUCTIVE SYSTEM CHANGES
1. Changes in structure of uterus; increasing its size 5 times the normal.
2. The capacity of uterus expands.
3. The abdominal content displaces towards side and uterus expands.
4. Vagina lactobacilli proliferation
1. Increase in lactic acid
2. Lower ph of vagina
3. Resulting in protective environment that prevents
development of other microorganisms.
5. Enlargement of breasts
1. Preparation for feeding
2. Peaked up adipose tissue enlarge breasts

18. METABOLIC CHANGES
•A rise in BMR during pregnancy is the major reason for weight gain.
•BMR increase up to 5% during first trimester and 12% during third
trimester.
•Calorie intake is increased by 350kcal/day in first trimester and by
500kcal/day in third trimester.
RENAL CHANGES
•Reabsorption of nutrients decreases as the blood volume increases
which causes a rise in glomerular filtration rate.
•Mild glycosuria and proteinuria is seen
•Sodium retention occurs
•Urinary tract infections are common

19. GASTROINTESTINAL CHANGES
•Heart burn (pyrosis) is common
•Appetite increases
•Alteration in GI tract-reduced
motility due to hormones-
results in nausea, vomiting and
constipation.
•Ptyalism is seen.
•Possibility of having gallstone
complication.
•Gums become swollen and
bleeding (gum hypertrophy)

20. Health risks associated with malnutrition during pregnancy.
Pregnant women who receive inadequate nutrition experience
greater maternal morbidity and have a higher risk of
poor pregnancy outcomes (e.g. premature birth, miscarriage).
Deficiency of micronutrients during pregnancy may lead to:
•Zinc and Magnesium: pre-eclampsia and preterm birth.
•A lack of Iron andVitamin B12: anemia.
•Vitamin B12: neurological issues.
•Vitamin K: excessive bleeding during childbirth.
•Iodine: miscarriage and stillbirth.
EFFECT OF MALNUTRITION ON
MOTHER FETUS

21. MICRONUTRIENT DEFICIENCY
DURING PREGNANCY ADVERSELY
AFFECT THE BABY
MICRONUTRIENT AFFECT ON BABY
Iodine congenital abnormalities, neurological
cretinism, mental deficiency, cretinism, etc.
It can also increase infant mortality risk.
Zinc fetal growth retardation and congenital
abnormalities
Vitamin D deficiency can lead to rickets in the fetus
Folate neural tube defects in the infant.
Calcium poor fetal skeletal development
Iron low levels in the mother’s body can cause
fetal growth retardation.

22. AN UNBALANCED DIET DURING PREGNANCY COULDTAKE A
TOLL ONTHE NEWBORN’S HEALTH INTHE FOLLOWINGWAYS:
It can lead to stillbirth.
•It can cause a premature birth.
•It can increase prenatal mortality risk.
•It can lead to neurological, respiratory, intestinal and circulatory
complications in the infant.
•It may lead to birth defects and brain damage.

23. MATERNAL UNDER-NUTRITION LEAD TO HEALTH
COMPLICATIONS, IN THE LONG RUN:
•Renal dysfunction.
•She may face cardiovascular issues like – hypertension,
atherosclerosis, and coronary heart disease.
•Osteoporosis.
•Breast Cancer.
•Organ dysfunction of testes, ovaries, brain, heart, liver, and
small intestine, etc.
•Maternal malnutrition can also negatively affect mental
development and school performance of a child

24. NUTRIENTS REQUIRED FOR
GENERAL HEALTH
ENERGY- During pregnancy, energy requirements increase.
Additional, 150 kcal are given to a women in first trimester. And
additional, 350 kcal in 2nd and 3rd trimester.The fat that
accumulates throughout pregnancy (especially for the first 30
weeks) acts as an energy reserve.
BVITAMIN: Since, energy is increased therefore, b-vitamin.
Requirement will also increase.
So, thiamine gets increased by 0.2 mg/day., riboflavin is
increased by 0.3 mg/day. Whereas, niacin is increased by 2
mg/day.

25. PROTEIN: In addition to normal 0.8 g/kg body weight extra 27.2 g of
protein is needed per day.
For a vegan, who excludes all the animal foods from her diet,
the increased need for high quality protein during pregnancy
demands attention.
They should practice mutual supplementation.
VITAMIN B6: since, protein is increased so vitamin b6 requirement
increases by 0.5 mg/day.
FATS:Total fat should be 20% of energy. Requirement ofVisible fat is
30 g/day.
A pregnant women should consume 200mg of DHA per day.
Essential fatty acid are needed to relax muscles of uterus and
making delivery easy.

26. NUTRIENTS FOR BLOOD
PRODUCTION AND CELL GROWTH
FOLACIN ANDVITAMIN B-12:
folacin and vitamin b-12
requirement increases because
there is increase in total blood
volume.
Deficiency of folic acid can result in
megaloblastic anemia , spina
bifidia and encephalopathy. Its
requirement increases by 200
microgram/day.
Animal foods are only source of
vitamin b-12. its requirement
increases by 0.2 microgram/day.

27. • IRON : Iron requirement increases by 8
mg/day. Iron requirement increases mainly in
2nd and 3rd trimester by 3.3mg and 5 mg
respectively.
• VITAMIN- C: Intake triple iron absorption.
• ZINC: Zinc requirement increases to
12mg/day. It is required for DNA, RNA and
protein synthesis.
• To much folic acid supplements
interfere with zinc absorption.

28. NUTRIENTS FOR BONE
DEVELOPMENT
 Calcium: calcium requirement increases to 1200mg/day.
 Calcium needed for calcification of fetal bones.
 Deficiency of calcium leads to osteoporosis.
 Vegan need to take special care.
 Vitamin- D: in pregnancy, about 400 I.U of it is required.
 Important for absorption and utilization of calcium.
 Maternal deficiency leads to poor fetal bone development.

29.  FLUORIDE : needed for
formation of bones and teeth.
Sources limited hence,
supplements given, if needed.
 Magnesium: required for
building skeleton. Also needed
for muscle relaxation and
energy production.

30. OTHER NUTRIENTS
 Vitamin- A requirement increases by 200 microgram/day. It is
needed for storage in fetal liver and to prevent night blindness.
 Vitamin- C requirement increases to 60 mg/day. Low intake result
in increased neonatal death rates.
 Extra 25 microgram of iron required per day as its deficiency leads
to still birth, abortion, congenital malformations, etc.
EFFECTS OF POTENTIALLY HARMFUL FOODS
 ALCOHOL :Physical and mental development impaired. Infants
inhibit poor rates of weight gain.
 CAFFEINE : Can cause low birth weight

31. FOODS GOOD
DURING
PREGNANCY
FOODS AVOIDED
DURING
PREGNANCY
 Cheese, made with
mould and can contain
listeria bacteria.
 Raw eggs, as risk of
salmonella food
poisoning.
 Unpasteurized milk.
 Some fishes like tuna.
 Whole grains, because of rich folic
acid and iron content.
 Beans, provide protein and fibre.
 Salmon, omega-3 fatty acids are
good for baby's brain and eyes.
 Eggs
 Berries
 Low fat yogurt.

32. FOOD FALLACIES
 Don’t eat twin banana.
 Don’t take a photo.
 Use kids tooth brush.
 Follow your cravings else
you’ll get miscarriage.
 If you are blooming during
pregnancy expect a baby
girl.

33. THANK YOU
PRATIBHA L-2014-HSC—BND
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