HTHSCI 3BB3 - F2023 - 11A - Nutrition Pregnancy Lactation Infancy

What happens during the embryonic stage of development

the cells of the embryo begin to differentiate, arrange themselves and begin organ development

What happens during the fetal stage of development

the fetus continue to grow, developing the internal and external organ structures

Placenta

- made up of maternal and fetal tissue

- maternal and fetal blood supply do not mix

- brings fetal and material blood in close enough proximity to allow nutrient transfer

- placenta also releases hormones that are needed to maintain pregnancy

Weight gain during pregnancy

Birthisassociatedwith~5kg (~10 lbs) of weight is leaving the body

Too little weight gain is associated with:

low birth weight or pre-term birth

increases in the child's risk of developing heart disease or diabetes later in life

Too much weight gain is associated with:

high blood pressure

diabetes,

difficult delivery and Caesarean section

infants who are Large-for- gestational-age

gestational diabetes

Consistently elevated blood glucose level during pregnancy in a person without previously diagnosed

diabetes

3-20%of all pregnancies

Most common in obese individuals and those with a family history of type 2 diabetes

Increases risk for type 2 diabetes later in life

Accumulating evidence suggests that fetal overnutrition (and similarly undernutrition) lead to .....

persistent epigenetic changes in developmentally important genes, influencing neuroendocrine functions, energy homeostasis and metabolism

After instructing a patient about desired weight gain during pregnancy, the nurse determines that they understand when they state which of the these?

a) "A total weight gain of approximately 20 lbs (9kg) is recommended"

b) "A weight gain of 6.6 lbs (3 kg) in the second and third trimesters is considered normal"

c) "A weight gain of about 12 lbs(5.5kg) every trimester is recommended"

d) "Although it varies, a gain of 25-35 lbs (11.5 to 16 kg) is about average"

"Although it varies, a gain of 25-35 lbs (11.5 to 16 kg) is about average"

Vital nutrients during pregnancy:

• Zinc

• Iron

• Folate

A small amount of extra energy is needed during pregnancy and lactation

1st trimester no additional kcal/day needed

2nd trimester ~350 kcal/day

3rd trimester ~450 kcal/day

Pre-pregnancy BMI <19.8 or gaining too little weight during pregnancy----->

- Anemia, premature rupture of the membranes, hemorrhage after delivery

- Low birth weight, preterm birth

Pre-pregnancy BMI <26 or gaining too much weight during pregnancy----->

Hypertensive disorders of pregnancy, gestational diabetes, difficult delivery, Caesarean section

Large-for-gestational-age, low Apgar scores (a score used to assess the health of a baby in the first minutes after birth), and neural tube defects

Malnutrition

Decreased ability to conceive, anemia

Fetal growth retardation, low birth weight, birth defects, preterm birth, spontaneous

abortion, stillbirth, increased risk of chronic disease later in life

Phenylketonuria ----->

- High blood levels of phenylketones

- Mental retardation if low- phenylalanine diet is not carefully followed by mother

Hypertension --->

Stroke, heart attack, premature separation of the placenta from the uterine wall

Low birth weight, fetal death

Diabetes ---->

Difficulty adjusting insulin dose, pre- eclampsia, Caesarean section

Large-for-gestational-age, congenital abnormalities, fetal death

Frequent pregnancies: 3 or more during a 2-year period ----->

Malnutrition

Low birth weight, preterm birth

Alcohol consumption ---->

Poor nutritional status

Alcohol-related birth defects and neurodevelopmental disorders, fetal alcohol disorder spectrum

Poor obstetric history or history of poor fetal outcome ---->

Recurrence of problem in subsequent pregnancy

Birth defects, death

Exposure to Toxic Substances::

Teratogens are substances of chemical or biological origin that can cause birth defects

Different organ systems are particularly susceptible at different times

Canadian Prenatal Nutrition Program (CPNP)

provides funding to community groups to help to improve the health of pregnant women, new mothers and their babies, who face challenges that put their health at risk, such as::

Poverty

Teen pregnancy

Social and geographic isolation

Substance use

Family violence

The nurse is discussing dietary concerns with pregnant teens. Which of these choices is convenient for teens yet nutritious for both the pregnant teen and fetus?

a) Milkshake or yoghurt with fresh fruit or granola bar

b) Cheese pizza with pepperoni and mushroom topping

c) Chicken nuggets with tatter tots

d) Cheeseburger with tomato, lettuce, pickle, ketchup and baked potato

a) Milkshake or yoghurt with fresh fruit or granola bar

What is true about the energy and nutrient needs of a pregnant person?

a) the RDA for protein is increased during pregnancy

b) the RDA for carbohydrate during pregnancy is 130 grams per day

c) fat intake needs to increase by 10% during pregnancy

d) the need for energy increases dramatically starting with the first trimester

a) the RDA for protein is increased during pregnancy

lactation

involves the synthesis of milk components, including protein, lactose and lipids, and the movement of the milk through the milk ducts to the nipple.

colostrum

immature milk,secreted during the first days after delivery. Colostrum is rich in protein and immune factors.

What is known about the nutritional needs of lactating individuals?

a) iron needs are increased during lactation

b) they need to consume about 2 cups of additional fluid per day

c) they can meet their nutritional needs only with supplements

d) some of their energy needs come from fat stores

d) some of their energy needs come from fat stores

Nutritional Needs During Infancy

-more fats

- double protein

Vitamin B12 supplementation is needed for infants of individuals following a vegan dietary pattern

Breast milk is also a poor source of iron, iron-rich foods are needed at 6-months of age, once infant iron stores are depleted

Breast milk includes most nutrients needed for infant growth, but supplementation is needed for:

vitamin D and K

Fluoride supplementation is recommended at what age in breast-fed infants?

6 months

• Hyperplasia

increase in cell number

Hypertrophy

increase in cell size

Accretion

increase in intercellular substances

Malnutrtition terms

- Undernutrition (weight for age)

• Stunting (length for age)

• Wasting (weight for length, BMI for age)

• Overnutrition (weight for length, BMI for age)

Breast milk contains the perfect amount of __________ for baby and antibodies that prevent disease.

nutrients

Brain Power: Children who were breastfed score __________ on IQ tests.

higher

A 2010 study found women most likely to breastfeed for the first 6 months were those who:

• have partners

• do not smoke during pregnancy

- deliver in their home

- do not work

How do the macronutrient needs of newborns compare with those of adults?

a) Newborns need about the same proportion of macronutrients as an adult

b) Newborns need a large proportion of calories from carbohydrate

c) Newbornsneedalargerproportionofcaloriesfromfat

d) Newborns need less protein per pound of body weight

c) Newborns need a larger proportion of calories from fat

When can you introduce solid foods?

6 months

Nutrition and Health Concerns in Children

- Dental Caries (Cavities)

• Food Allergies

• Diet and Hyperactivity

- Childhood Obesity

The nurse discusses the eating habits of school-age children with their parents, explaining that these habits are most influenced by:

a) Food preferences of their peers

b) Smell and appearance of foods offered

c) Examples provided by parents at meal times

d) Parental Encouragement to eat nutritious foods

c) Examples provided by parents at meal times

Remember 5-3-2-1-0

5 servings of fruits and veggies

3 meals a day

2 hours of screen time

1 hour of activity

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