Nutrition CH 16-18

Pregnancy duration

Approximately 39 to 40 weeks divided into 3 periods known as trimesters (approximately 13 1/3 weeks each).

Preterm (premature)

Before 37 weeks of gestation.

Low birthweight (LBW)

Less than 5.5 lbs.

Small for gestational age (SGA)

Those that experience growth retardation during prenatal development.

Favorable pregnancy outcome

Defined by two major criteria: a gestation period greater than 37 weeks (ideally 39-40 weeks) and a birth weight greater than 5.5 pounds (2.5 kg).

Embryo

Size of a pea, from 3 to 8 weeks of gestation.

Fetus

From 9 weeks until birth.

Fetal growth

90% of all fetal growth occurs in the last 20 weeks of gestation.

Critical time for organ development

3 to 8 weeks of gestation.

1st Trimester growth

Embryonic/fetal growth begins with mostly hyperplasia (rapid increase in cell number/cell division) and later some hypertrophy (increase in cell size).

Hyperplasia stage of growth

Irreversible stage of growth (-plasia = formation).

Hypertrophy stage of growth

More likely to be reversible stage of growth (-trophy = development), dependent on the nature of the insult/injury.

Embryo development by end of 1st trimester

Most organs are formed, fetus can move, heart begins beating by Day 35, eyes and limb buds are visible.

Fetal development during 2nd trimester

At the beginning of the 2nd trimester, fetus weighs approximately 1 ounce, arms, hands, fingers, legs, feet, and toes are fully formed, heartbeat can be detected.

Fetal development during 3rd trimester

At the beginning of the 3rd trimester, fetus weighs approximately 2-3 lbs; baby continues to grow and develop dramatically.

Calorie needs during pregnancy

1st trimester: No increase; 2nd trimester: increase by 350 kcals; 3rd trimester: increase by 450 kcals.

Teenaged pregnancies

Need more kcals because they are still growing themselves.

Insufficient maternal kcal intake

More likely to result in fetal death after birth.

Extra kcals for breastfeeding mom

Needed from diet only; remainder is supplied by fat stored during pregnancy.

Protein needs during pregnancy

Increase by more than 50% compared to non-pregnancy.

Carbohydrate needs during pregnancy

Must be met with a minimum intake, avoid weight loss diets, and fasting longer than 12 hours to prevent ketosis.

Essential fatty acids

Vital for normal fetal growth & development, especially brain & eyes.

Omega-3 FAs

May improve gestation duration & infant birth weight, length, & head circumference.

Folate

Needed in greater amounts in women who have the potential to become pregnant to prevent disorders like NTD.

Folate DRI (pregnancy)

600mcg; should start higher dosage at least 1 month prior to conception and continue through pregnancy.

NTD

Neural tube defects, such as spina bifida, which can be increased by inadequate folate.

Folate fortification of grains

Began in 1998 and has greatly reduced NTD in infants.

Zinc

Deficiency may cause birth defects, fetal growth retardation, premature birth, & miscarriage.

Iron DRI increase

Increases significantly during pregnancy (by 300%) to support maternal blood supply and fetal RBC synthesis.

Iron supplementation

Generally required to meet increased needs during pregnancy under MD direction.

Calcium & Vitamin D

Needs increase during pregnancy; critical for absorption/utilization of calcium in the growing fetus.

Vitamin B12

Found only in animal foods; vegans must consume a B12 supplement per MD advice.

Vitamin B6

Important for hemoglobin/RBC synthesis during pregnancy.

Vitamin D

Aids calcium absorption to form bone.

Prenatal vitamin/mineral supplements

Generally recommended for most pregnancies by MD.

Supplemental Vitamin A

Should not be consumed beyond the prenatal supplement as it can be very toxic to the fetus.

Exercise guidelines during pregnancy

Must ensure pregnancy kcal needs are met to avoid a kcal deficit.

MyPlate Guidelines for pregnancy

Adequate servings from the Milk and Protein groups are critical for calcium, iron, and zinc.

Maternal weight gain recommendations

Based on prepregnant weight status—underweight, normal weight, overweight, and obese.

Iron-rich foods

Should be consumed along with iron supplements to improve absorption.

Smoking & alcohol

Should be absolutely avoided as they impair zinc transfer into the placenta to the fetus.

Calcium from mother's bone mass

Fetus may take calcium from mom's bone mass if inadequate intake, leading to osteoporosis later in life.

Appropriate weight gain

Promotes optimal fetal growth while minimizing the risks of delivery complications, postpartum maternal weight retention, and the baby's chance of developing chronic diseases later in life.

Risk Factors

Factors that may adversely affect conception or pregnancy outcome, some of which are controllable and/or avoidable.

Male fertility

Impacted by obesity, inactivity, excessive exercise, high-fat diets, tobacco, marijuana, alcohol, hot tub/sauna use, and low nutrient intakes (Zn, folate & Vit. C affect sperm quality).

Maternal pre-pregnancy body weight status

Influences pregnancy weight gain and outcomes.

Obesity in pregnancy

Often leads to inability to conceive, hypertension, gestational diabetes, and increased risk of C-section delivery; baby at higher risk of neural tube defects, oral clefts, and high infant birth weight.

Weight loss before conception

Should occur in obese women to avoid risks and improve fertility.

Underweight women

Often unable to conceive due to amenorrhea and have an increased risk of low birth weight and preterm babies.

Healthy weight before conception

Reduces risks and improves fertility.

Inadequate weight gain during pregnancy

Increases the risk of low birth weight, preterm, or small for gestational age babies, or babies that die soon after birth.

Infants born small

Have a higher risk of developing cardiovascular disease, high blood lipids, diabetes, high blood pressure, and impaired immune function.

Excessive weight gain during pregnancy

Increases the risk of very large babies, complications at delivery, infant mortality, chronic disease later in life, and postpartum maternal weight retention.

Food behaviors

Include unhealthy/excessive food cravings or aversions, pica, and eating disorders.

Sociocultural factors

Include poverty, inadequate health care, poor health practices, marginal health status, limited educational status, and lack of family/social support network.

Teen pregnancy

Involves age under 18 years, leading to inadequate weight gain during pregnancy and higher risks of low birth weight, preterm birth, and less likelihood of receiving adequate prenatal care.

Advanced maternal age

Associated with higher rates of C-section, low birth weight, preterm babies, Down's Syndrome, fetal deaths, and infant birth defects.

Closely spaced births

Those less than 1 year apart are more likely to be low birth weight, preterm, or small for gestational age due to insufficient nutrient stores.

Multiple births

Present challenges in consuming adequate calories and nutrients for optimal growth, leading to increased risk for preterm and low birth weight babies.

Inadequate prenatal health care

Leads to untreated nutrient deficiencies and diseases, increasing the risk of low birth weight babies by 3 times.

Pre-pregnancy hypertension

Increases the risk of intrauterine growth retardation and preterm birth.

Prenatal nutrition

May be compromised by weight loss diets, crash diets, eating disorders, and fasting over 12 hours during pregnancy, which can impair fetal brain development.

Vegan diets during pregnancy

Require careful planning to ensure adequate high-quality protein and all necessary vitamins and minerals.

Prenatal multivitamin-mineral supplement

Highly recommended supplement during pregnancy, but may contain limited calcium; discuss with MD.

Lifestyle factors

Alcohol, smoking, caffeine, prescription and/or illegal drugs, and some herbals/botanicals may increase risks for the fetus.

Fetal Alcohol Spectrum Disorders (FASD)

Conditions resulting from alcohol consumption during pregnancy that can impair ability to become pregnant.

Caffeine

Should be limited or avoided during pregnancy due to increased fetal heart rate and decreased absorption of some nutrients.

Accutane

A prescription acne medication that can cause severe birth defects, nervous system abnormalities, and facial and cardiovascular deformities.

Aspartame

Artificial sweetener that may disrupt fetal brain development if the pregnant mother has hereditary phenylketonuria (PKU); discuss PKU diet restrictions with MD.

Over-the-counter medications

Should be avoided unless directed by a medical doctor.

Environmental contaminants

Includes lead, mercury, PCBs, and pesticides; careful washing of fruits and vegetables is advised.

Listeria infection

Serious foodborne illness from consumption of raw or undercooked meat, unpasteurized milk, and contaminated soft cheeses, leading to spontaneous abortion, preterm delivery, stillbirth, and infections in newborns.

Toxoplasmosis

Parasite that can cause infant death and brain damage; avoid raw meat and contact with cat and bird feces during pregnancy.

Pregnancy-related physiological changes

Changes due to pregnancy hormones affecting the body, including heartburn, constipation, nausea, vomiting, and edema.

Iron deficiency anemia

Occurs due to hemodilution during pregnancy, where blood volume increases faster than red blood cell production, increasing iron needs.

Gestational Diabetes (GDM)

Develops in 2-9% of pregnancies; requires dietary changes and insulin therapy if diagnosed.

Risk factors for GDM

Includes family history of diabetes, obesity, glycosuria, prior gestational diabetes, delivery of a large baby, PCOS, and certain ethnicities.

GDM screening

Typically occurs at 24-28 weeks of pregnancy; onset of high blood glucose occurs at 20-28 weeks.

Untreated GDM

May severely deplete fetal iron stores and requires medical monitoring.

Fetal insulin production

Increased maternal glucose leads to higher fetal insulin production, affecting fetal growth.

Risks associated with GDM

Includes miscarriage, preterm delivery, infant hypoglycemia, increased risk of birth trauma and organ defects, and infant death.

Long-term risks for babies born to GDM mothers

Increased risk of lung and breathing issues, obesity, and Type 2 diabetes in adulthood.

Type 2 diabetes risk for GDM mothers

Mothers with gestational diabetes are at greater risk of developing Type 2 diabetes, especially if obese.

Blood glucose screening post-delivery

Recommended 6 weeks post-delivery and then annually for mothers who had gestational diabetes.

Pregnancy-Induced Hypertension (PIH)

Characterized by abnormally high blood pressure during pregnancy.

BP during pregnancy

Impairs delivery of oxygen & nutrients to the fetus, leading to restricted growth, premature birth, or death of mom and/or baby.

Risk factors for mom

High BMI, 1st pregnancy or multiple-birth pregnancies, 35 years or older, Black ethnicity, DM and/or HTN before pregnancy, and previous preeclampsia/eclampsia or family history of this disorder.

Preeclampsia

A pregnancy complication characterized by high blood pressure and signs of damage to another organ system, often the kidneys.

3 primary Preeclampsia symptoms

Abnormally high blood pressure (≥ 140/90), excess protein lost in urine, and serious fluid retention (edema).

Additional serious symptoms of Preeclampsia

Decreased urine output, headaches, dizziness, blurred vision, abdominal pain, nausea, vomiting, changes in blood clotting, and nervous system disorders.

Eclampsia

A severe progression of preeclampsia that includes maternal convulsions, seizures, liver & kidney damage, hemolysis, stroke, coma, and death of mom and/or fetus.

Treatment for Preeclampsia

May require complete bed rest and magnesium sulfate; delivery of the baby is the only cure.

Effects of alcohol during pregnancy

Displaces nutrient-dense foods and slows nutrient & oxygen delivery to baby, retarding growth & development.

Alcohol crossing the placenta

Alcohol freely crosses the placenta to the developing baby and is present in the amniotic fluid.

FASD characteristics

Facial malformations, growth retardation, CNS defects, and lifelong learning difficulties.

Alcohol intake threshold

As little as 1 oz of alcohol intake by the mother per day has resulted in mental & physical defects in the baby.

Recommendation for women regarding alcohol

Experts recommend avoiding alcohol completely due to potential early embryonic damage.

Breastfeeding recommendation

AAP & ADA recommend exclusive breastfeeding for the first 6 months of life, with continued breastfeeding & infant foods until age 1 year.

Prolactin

A hormone that promotes lactation.

Oxytocin

A hormone that promotes the let-down reflex in breastfeeding.