Chapter 4: Nutrition during pregnancy

Neonatal period

first four weeks of a child’s life

Risks for low birth weight, preterm babies

• at risk of dying in first year of life

How to reduce infant mortality/morbidity

• improve birthweight of newborns (birthweight of: 3500-4000 grams)

• helping women stay healthy before/during/after pregnancy

Rates of preterm/low birthweight delivery for all

preterm: 10.5

low birthweight: 8.5

Rates of preterm/low birthweight delivery for non-Hispanic Blacks

Preterm: 14.75

Low birthweight: 14.66

Rates of preterm/low birthweight delivery for non-Hispanic whites

preterm: 9.5

low birthweight: 7.18

Rates of preterm/low birthweight delivery for American Indian/ Alaskan Native

Preterm: 12.26

Low birthweight: 8.11

Rates of preterm/low birthweight delivery for Asian/Pacific Islander

Preterm: 12.69

Low birthweight: 9.14

Rates of preterm/low birthweight delivery for Hispanic

preterm: 9.23

low birthweight: 6.9

How long is the average pregnancy

38 weeks, begins at conception

Body water changes during pregnancy

• increases from 7 to 10 liters: intra and extracellular

• high gains in body water associated with edema

Edema

swelling in feet, ankles, and hands due to increased fluid retention

What are the hormonal changes during pregnancy?

• modulated by hormones produced by placenta

• key role is production of steroid hormones: progesterone and estrogen

What is progesterone’s role during pregnancy?

• maintains implant

• stimulates growth of endometrium and its secretion of nutrients

• relaxes smooth muscles of uterine blood vessels and gastrointestinal tract

• stimulates breast development

• promotes lipid deposition

What is estrogens role in pregnancy?

• increases lipid formation and storage, protein synthesis, uterine blood flow

• prompts uterine and breast duct development; promotes ligament flexibility

Human chorionic somatotropin (hCS) role in pregnancy

• increases maternal insulin resistance to maintain glucose availability for fetal use

• promotes protein synthesis and the breakdown of fat for energy for maternal use

Human placental lactogen role in pregnancy

• supports fetal growth and development by triggering metabolic changes that increase the availability of glucose and amino acids

Leptin role in pregnancy

• may participate in regulation of appetite and lipid metabolism

Human chorionic gonadotropin (hCG) role in pregnancy

• maintains early pregnancy by stimulating corpus luteum to produce estrogen and progesterone

• stimulates growth of endometrium

• placenta produces estrogen and progesterone after first 2 months of pregnancy

What is the preferred fuel for the fetus

Glucose

Carbohydrate metabolism in early pregnancy

• progesterone and estrogen stimulate insulin

• increases glucose conversion to glycogen and fat

Carbohydrate metabolism in late pregnancy

human chorionic somatotropin (hSC) and prolactin inhibit conversion of glucose to glycogen and fat

Diabetogenic effect of pregnancy

• results from maternal insulin resistance

What is calcium needed for in pregnancy

Bone formation

• increased maternal absorption and calcium mobilization

What is sodium needed for in pregnancy

Accumulation in mother, placenta and fetus

• restriction of sodium is potentially harmful and may lead to functional and growth impairments

Functions of the placents

• hormone and enzyme production

• nutrient and gas exchange

• removal of waste products

What is the placentas structure

• double lining of cells separating maternal and fetal blood

Whose needs does the placenta prioritize

• fulfills own needs before nutrients are available to fetus

• placenta compromised if nutrient supplies fall short

Nutrient prioritization

• nutrients first used for maternal needs, then placenta, then fetus

• fetus is harmed more by poor maternal nutritional health than mother