Ch 12 pregnancy nutrition

why is nutrition important during pregnancy?

maternal health, fetal growth and development, prevention of complications

how much should a woman gain based off of pre-pregnancy BMI?

18\.5: 28-40

18\.5-24.9: 25-35

25-29.9: 15-25

30+: 11-20

what is the weight gain distribution?

breast: 1-1.5 kg

extra fluids: 1-1.5

blood: 2kg

uterus: 1-1.5

baby: 2.5-3.5

placenta and fluid: 2-2.5

energy stored as fat: 2-3.5

how many additional calories are needed per trimester?

1st: 90-125

2nd: 286-350

3rd: 466-500

what are the best ways to achieve recommended weight gain?

early and frequent motivational counseling act weight and diet

personalized dietary advice, beginning early in pregnancy

supervised group and/or home exercise programs

showing women how their weight gain compares to target BMI range

what is the recommended protein need for pregnancy?

DRI: 1.1g/kg

25 g more/day than non-pregnant

food sources: lean meats, poultry, seafood, eggs, milk/milk products, legumes, nuts/seeds

what is recommended carb intake for pregnancy?

45% energy needs

DRI: 175g/day

choose whole grains, veggies, fruits, legumes, low fat dairy

what are the fat needs for pregnancy?

no DRI, emphasize quality of quantity

omega 3 fatty acids: needed for brain development from 3rd trimester to 1st year, at least 200mg DHA and 500 mg DHA/EPA per day

what should fluid intake be like during pregnancy?

AI: 3 L/day

supplied by water, beverages, and foods

total intake is 10 cups/day

what are calcium needs during pregnancy?

essential for fetal development, helps builds bones and teeth

DRI is same: 1300 mg 14-18 yrs and 1000mg 19-50 yrs

72% Ca in US diet is supplied by milk/milk products

why is iron important during pregnancy?

essential role in transfer of O2 to tissues

most prevalent deficiency in world

during pregnancy more is needed to supply O2 to baby

deficiency anemia in 1st 2 trimesters increases risk of preterm labor, low birth weight, post part hemorrhage and infant mortality

RDA: 18 mg/day non-pregnant and increase to 27mg

where can iron be found?

red meats, poultry, fish, dried fruits, iron-fortified cereals

vitamin c enhances absorption

tea, coffee, legumes, and whole grain cereals inhibit absorption

describe vitamin D need during pregnancy

promotes Ca absorption

RDA during pregnancy and breastfeeding: 600

most prenatal vitamins have 400

food sources: fatty fish, fortified milk, yogurt, fortified cereals

at risk women are those who: have little sun exposure, adhere to vegan diets, have darker skin

why is folate important during pregnancy?

prevents neural tube defects

400 mcg/day from fortified foods and/or supplements and folate rich foods 1-2 months before pregnancy

increase to 600mcg/day

sources: legumes, green leafy veggies, citrus fruits and juices; fortified cereals, breads, and pasta

what are the iodine needs during pregnancy?

50% increase in maternal thyroid production; required for neuronal and brain development in fetus

150 mcg/day prior to pregnancy and 220 mcg/day during

fetal thyroid does not start working till half way through pregnancy

why is choline important during pregnancy?

maternal deficiency can interfere with normal brain development of fetus

AI: 450 mg/day

sources: egg, salmon, kidney or navy beans, low fat milk

prenatal vitamins do not normally contain this or iodine

how should pregnant women avoid food-borne illness?

cook protein food to safe internal temps

avoid unpasteurized juice, milk, and milk products

reheat deli/lunch meat and hot dogs to steaming hot to kill listeria bacteria

avoid eating raw sprouts and unwashed fruits/veggies

what should pregnant women know about mercury?

higher levels in children associated w/deficits in memory, learning, and behavior

8-12 oz seafood/week meets recommendations for omega 3 fatty acid intake

limit albacore tuna to 6 oz/ week

avoid shark, swordfish, tilefish, and king mackerel

what are the recommendations for caffeine and alcohol?

caffeine:

what are common GI complaints during pregnancy?

Nausea/vomiting: dry foods, small frequent meals, avoid offensive odors and greasy/spicey foods, adequate fluid intake, fresh air, ginger products

reflux: Ca based antacids, avoid lying down after eating, sleep with head slightly elevated, avoid greasy/spicy/acidic foods, carbonated beverages, and caffeine

constipation: increase fluids and fiber, get regular physical activity

what is hyperemesis gravidarum?

pressmen vomiting

weight loss >5%

lyte imbalance

dehydration

treatment: IV hydration w/ multivitamins, antiemetic medications, monitor for lytes and urine ketones, hospitalization

what are common cravings and aversions?

cravings: chocolate, citrus fruits, pickles, chips, ice cream

aversions: coffee/tea, fried/fatty foods, spicy foods, meat, eggs

what is pica?

compulsive intake of non-food substance over a sustained period of time

clay/dirt, laundry starch, ice/freezer first, soap, paint, corn starch, baking soda

screen for nutritional deficiencies and exposure to toxic substances

what are the concerns with obesity and pregnancy?

increased risk for adverse prenatal outcomes: maternal complications, long term maternal health risks, fetal effects, long term childhood effects

weight loss prior to pregnancy is strongly recommended

what is gestational diabetes?

diagnosed in 2nd or 3rd trimester

associated w/complications during and after pregnancy

strategies for prevention: achieve optimal glycemic control, follow carb controlled meal plan w/adequate nutrition, aim for gestational weight gain based on pre-pregnancy BMI, increase physical activity, use medications if unable to attain glycemic control w/lifestyle changes

what is pre-eclampsia?

diastolic BP>/= 90 or sys >/= 140 and proteinuria w/onset after 20 weeks

increased risk for preterm delivery, intrauterine growth retardation, maternal morbidity and mortality

Ca supplements of at least 1000 mg/day may reduce BP and risk

what are some high risk populations?

adolescence: biological immaturity and inadequate nutritional status, nutritional competition w/ fetus

bariatric surgery: reduce risk of GDM, HTN, pre-eclampsia, and fetal macrosomia; increase risk of SGA infants and preterm birth; can create deficiencies

multiple/short interval pregnancies: increase for depletion of stores, assess weight between gestations

previous complications evaluate diet and intake of women w/ history of multiple births, preterm delivery, and pre-eclampsia

how can diet effect pregnancy?

vegetarian/vegan: may be deficient in some micronutrients

gluten-free: untreated celiac disease increase risk of spontaneous abortions, LBW, SGA, and stillbirth; low in macro and micro nutrients

food insecurity: lower consumption of fruits and veggies

what should exercise be like during pregnancy?

normally considered safe

if active before becoming pregnant, likely safe to remain active during

exercise not for weight loss

benefits: reducing backaches, relieving constipation, help prevent or treat GDM, increase energy, improves mood, helps regulate sleep, may make weight loss after pregnancy easier

when should a women not exercise while pregnant?

HTN, premature rupture of membranes, intrauterine growth retardation, preterm labor, incompetent cervix, persistent bleeding in 2nd or 3rd trimester