Physiological changes, Diet during pregnancy,IUGR-maternal factors -environmental factors, child factors ,Barker's hypothesis, Foetal programming

1. IM.Sc Child Development

2. Introduction
• Pregnancy-40week period that involves
various physiological changes.
• Growing fetus fully depends on mother for
nourishment.
• So it is important to take care of the nutrition
of pregnant women.

3. Physiological changes
1. Growth of the baby-occurs in 3 stages
– Stage of Fertilized egg(0-2weeks)
– The embryo stage(2-8week)
– The foetal stage (8th week – birth)
2. Changes in maternal tissues
– Uterus expands to support growing baby
– Placenta is formed
– Blood volume increases
– Breast size increases
– Fat is stored in mother’s body to be utilized for energy during
lactation.

4. PHYSIOLOGICAL ADJUSTMENTS THAT AFFECTS
NUTRIENT NEEDS OF PREGNANCY
• The physiological adjustments are often grouped by
period of gestation
• First half of pregnancy-preparation for the demands of
rapid fetal growth that occur in pregnancy.
• Corpus luteum and placenta secrete hormones that
maintain pregnancy.

5. Hormonal profile in pregnancy
• Human Chorionic Gonadotrophin is detected in serum
and urine within few days of implantation-Maintains
corpus luteum –reaches at peak around 8 weeks of
gestation and then decreases to a stable value till birth.
• Human placental lactogen increases progressively-
affects CHO and lipid metabolism-maintains flow of
substrates to foetus; promotes mammary gland
development along with prolactin.

6. • Biosynthesis of the estrogens (estrone, estradiol &
estriol)- Stimulates uterine growth ,increases blood flow
to uterus, promote breast development-Induces prolactin
secretion by maternal pituitary gland.
• Progesterone-increases progressively of which the initial
sources is the corpus luteum and at the later stages it is-
placental sources
• Cortisol-Increased content in maternal plasma during
pregnancy-enhance glucose production from amino acid-
increases availability of glucose to foetus which relies on
glucose level.

7. • Expansion of plasma volume-Increases by 50% by 34 weeks of
pregnancy-fall in Hb concentration, haematocrit and RBC count.
• Fetal growth –rapid during last half of gestation-Changes in basal
metabolism, protein and mineral accretions- 60% increase in BMR.
• Energy metabolism and fetal growth –
– The cumulative energy needed for increase in basal metabolism is
approx. 36,000 Kcal
– To meet this requirements-following adjustments are made
• Alteration in intensity of physical activity
• Increases in food consumption and therefore energy intake-
depended on pre pregnancy energy status of the mother and
quality of her living conditions during pregnancy (King et. al
,1994)

8. • Underweight women living in constraints of limited food
and hard physical activity/ work –unable to increase the
food intake but have to maintain a high level of physical
activity for survival reducing the BMR to conserve
energy for their growing fetus.
• There is decreased ability to taste saltiness-physiological
mechanism for in taking salt.
• Maternal fat stores between 10th to 30th week of
gestation-Approx. 3.3 kg fat is deposited at maternal
stores-proving energy reserve

9. • Protein metabolism adjustment-for nitrogen
conservation& for fetal growth-it achieves full potential
during last quarter of pregnancy.
– Total serum proteins gradually along with sharp
decline in serum albumin- Vit. C, folic acid, Vit.B6, and
B12 is reduced in serum albumin levels.
– low dietary supply of protein –a great change in the
physiological adjustments is needed to meet fetal
needs

10. • Altered renal functions
– High glomerular filtration rate(50%) due to increased
blood volume
– renal tubules are found unable to adjust fully,and a
percentage of nutrients that would have been
reabsorbed in the non-pregnant women are excreted
in the urine
– Increased amount of amino acids, glucose and water
soluble vitamins may appear in the urine
– This may be reason for increased chance for urinary
tract infection among pregnant women.
– Water excretion is lowered-oedema in legs and ankles
are common.

11. • Less than half of the total wt resides in fetus, placenta
and amniotic fluid
• Remainder is found in maternal reproductive
tissue,fluids,blood and as maternal stores.
• As days progress – There is an increase in subcutaneous
fat in the abdomen, back and thigh-energy reserve for
pregnancy & lactation.
• Placental role-
– Responsible for production of various hormones for
regulation of fetal growth and development.
– Helps in the transfer of oxygen, nutrients and waste products
– Any inadequacy in placenta compromises the ability to
nourish the fetus –regardless how well the mother is/her
diet is.

12. • it is important to form a diet plan on individual basis-to meet
the nutritional needs of pregnant women
• Diet has conformed to the basis to meet her nutritional needs.
• During pregnancy-the lady should consume ‘body building ‘
and ‘protective’ foods-high in protein, vitamin and minerals.
• Vegetarians must consume
– increased amounts of pulses ,milk and curd
– Mixture of cereals (rice ,wheat & ragi) may be used to
provide energy.
– Leafy vegetables –source of iron, Ca, Vit. A and folic acid.
DIET IN PREGNANCY

13. • Daily diet -3cups milk/its equivalent,2 servings of
meat, fish, poultry, eggs or a source of complete
protein ,a dark green/yellow vegetables ,generous
serving of citrus fruits-provides foundation for
nutritionally adequate diet.
• 6th to 14th week of pregnancy-75% of women suffer
from nausea-affects their appetite provide
consumption of small & frequent meals at regular
intervals.
• Intake should be maintained at steady levels-weight
gain do not exceed 400g/wk in the 2nd and 3rd
trimester of pregnancy.

14. • Food preferences vary during pregnancy-Foods with
no nutritional consequences are disliked.
• At least 4-6 glasses of water (in addition to what is
contained in forms like milk & beverages) should be
taken ensures regular bowel functioning
,reduces urinary infections.
• Faulty beliefs and wrong food habits needed to be
corrected.
• Stress, anxiety, fatigue & other psychosocial
characteristics may influence the food choice of
pregnant women.

15. • Fasting & missing meals should be avoided.
• Introduce Fiber rich foods –avoids constipation.
Inclusion of 5-6 servings of fruits & vegetables
• Include Ca containing foods to avoid osteomalacia
• Iron rich foods/Fe supplements should be taken –to
prevent anemia & to meet RDA of iron
• Include Sodium in diet –in case of oedema or
hypertension Na is restricted.
• Avoid fried foods, excessive seasoning, strongly
flavoured vegetables –it may cause nausea, gastric
disorder.
• Control intake of tea, coffee /any caffeine
containing beverages.

16. • Include fish, flax seeds, soyabean to meet the
requirement of omega 3 fatty acids.
• Adequate amount of calories should be taken so that
enough fat is deposited – which is required for lactation
• Folic acid deficiency is common in India –include green
leafy vegetables, supplements –Marginal folic acid
deficiency may cause birth defects
• Other dietary considerations- nausea, constipation
,limited capacity to eat, or peculiar cravings are
common- To avoid / control provide small frequent
meals, high fibre diet and due attention to reasonable
carvings(Bijlani,2004)

17. Sample Menu plan for a pregnant woman
Time Food item Ingredients(weight in
gm)
6.30 am Coffee- 1 cup
Biscuits-2 no.s
Milk-50
Sugar-10
Biscuits-20
8.00am Appam-4no.s
Veg stew-1/2 cup
Rice flour-50
Potato-20
Carrot-20
Onion-20
Coconut-30
10.30am Pineapple-2 slices Pineapple-100
12.30pm Rice-2 cups
Beetroot pachadi-1/2 cup
Dal-Amaranth thoran
Mango pickle-1 tsp
Pappad-1no.
Rice-100
Beetroot-25
Onion-20
Coconut-15
Curd-120
Dal-30
Amaranth-50
Mango-10
Pappad-5

18. Time Food item Ingredients(weight in
gm/ml)
3.30 pm Sweet aval-1 cup
Plantain-1no.
Tea-1 cup
Aval-60
Jaggery-25
Coconut-20
Plantain-100
Milk-60
Sugar-10
5.30pm Fruit juice-1 glass Orange juice-120
Lime juice-15
Sugar-20
7.30pm Cheera chappathi-4no.s
Meet curry
Mixed raitha
Wheat flour-60
Cheera-40
Meat-10
Tomato-50
Cucumber-20
Sprouted green gram-20
Green peas(cooked)-10
Curd-100
10.00pm Orange custard-1/2 cup Orange-30
Milk-120
Sugar-15

19. • In this diet
– The food is distributed in frequent feeding so
that no single meal becomes too heavy
– Cheera and aval,supply Iron
– Pineapple,orange juice,limejuice provide Vit C
– Milk,curd and leafy veg-helps to meet Ca
requirements.
– Fruits,Veg and wheat flour-provide fibre.

20. INTRAUTERINE GROWTH
RETARDATION(IUGR)
• Condition resulting in growth
retardation of the child at
birth.
• These newborns –small for
date babies.
• Can have prematurity, growth
retardation or low birth
weight.

21. Factors causing IUGR
Maternal Factors
• Infections in mother including syphilis, herpes,
rubella, toxoplasmosis.
• Multiple foetuses in the same pregnancy
• Maternal nutritional factors
• Abnormal blood supply to the placenta.
• Abnormal shape or size of the mother’s womb.
• Disease conditions affecting blood vessels like High
B.P, toxemia/pre-eclampsia, recurrent bleeding
during pregnancy, diabetes mellitus.

22. Foetal factors and influences
• Chromosomal abnormality(Turner’s
syndrome,Down syndrome)
• Limited blood supply due to
compression0wrapping of the
umbilical cord around a body part
such as leg.
• In an identical twin birth, one of
the two foetuses may get a
significantly better blood supply
causing IUGR in the other twin.
• Various foetal defects including
abnormalities of heart

23. Environmental factors
• Legal and illegal drugs
• Medication
• Cigarettes
• Smoking
• Alcohol
• living in high altitude can be
• a cause.

24. Why is it important to determine IUGR
• IUGR babies have various medical problems
– Hypoglycemia(Low blood sugar)
– Polycythemia(thick blood)
– Meconium aspiration(swallowing of fluid from amniotic sac
at birth).
• Infants and yet to unborn baby have to be observed to check
for the signs of lack of Oxygen, infection, low
temperature(due to diminished fatty tissue which is important
for maintaining temperature)

25. • Epidemiologist David Barker explained on the fetal
origins of adult disease.
• Barker(1986) proposed the roots of cardiovascular
diseases-lay in under nutrition.
• He found that the lower birth weight, the higher is
the risk of dying from heart disease in later life.
• Barker suggests that fetuses learn to adapt to the
environment they expect to enter into once outside
of the womb- but a difference in the availability after
the birth can have adverse effects on the child.
BARKER’s HYPOTHESIS

26. • The thrifty phenotype hypothesis “a low availability of
nutrients during the prenatal stage followed -n
improvement in nutritional availability in early
childhood -an increase risk of metabolic disorders,
including Type II diabetes, as a result of permanent
changes in the metabolic processing of glucose-insulin
determined in utero”
• In poor communities-maternal malnutrition is poor-
fetus adapts itself to withstand the poor nutritional
conditions. After birth- when the baby is given with
accessible processed foods –find it hard to process the
metabolic functions because metabolic systems pre-set
to expect scarcity- leads to obesity and type 2
diabetes

28. • External factors can affect the development of the
foetus and some of these changes last for life time.
• Foetal programming emerged -Dutch famine during
the 2nd world war-food intake was 400-900KCal-
children of pregnant women exposed to famine –
susceptible to Diabetes ad other health problems.
• Emerging concept that links environmental
conditions during embryonic and foetal development
with risk of diseases in later life.
FOETAL PROGRAMMNG

29. • As mentioned, womb environment during sensitive
periods for specific outcomes –may alter foetal
development with a permanent effect on the child.
• Factors contributing to foetal programming
– Maternal undernutrition
– Maternal experiences, emotional and physical stress
during pregnancy
– Maternal Alcoholism(affect brain development)
– Smoking(slows down foetal growth and brain
development)
– Thalidomide(causes limb defects-physical deformities
and disabilities)

30. • Growing slowly in the womb affect both early and later
stages of life. Eg.some organs like kidney &pancreas
which grows differently at beginning –less able to
function properly in old age.
• In initial stages of pregnancy –foetus’s nerve cells
develop –later connects with one another to create a
specific pathway-last 20 weeks of pregnancy- brain
size increases in size 17 fold.
• High levels of stress hormone cortisol is found to
change the development of the brain
• Prenatal stress may not affect brain development in all
cases –but some foetuses are affected more than
others.