NDT-LEC-LAB-midterm

Pregnancy & Lactation

  • Duration of pregnancy: usually from 38 to 42 weeks.

  • Caloric needs:

    • Non-pregnant women: 1500-2000 calories

    • Pregnant women: additional 300 calories during 2nd and 3rd trimesters

Basic Principles of Healthy Eating

  • Fruits and Vegetables: Eat plenty of various kinds and colors.

  • Whole Grains: Includes whole-grain bread and cereals.

  • Lean Proteins: Incorporate lean protein foods.

  • Dairy: Low-fat or fat-free milk and dairy products.

  • Healthy Fats: Consume in moderation.

  • Limit: Sodium, solid fats, added sugars, and refined grains.

Sources of Folic Acid

  • Fortified foods:

    • 100% ready-to-eat breakfast cereals,

    • enriched flour (mandated in the US and Canada),

    • Leafy green vegetables (e.g., spinach),

    • Citrus fruits,

    • Dried peas and beans (e.g., lentils, soybeans, pinto beans).

Physiological Basis

  1. Stages of Pregnancy:

    • Implantation

    • Organogenesis: impacts of malnutrition

    • Growth

  2. Blood Volume and Composition: Increased blood volume leads to potential anemia.

  3. Circulatory System Changes:

    • Cardiac hypertrophy, tachycardia, palpitations

    • Bradycardia post-delivery

    • Pregnancy-induced hypertension (PIH)

  4. Respiratory System: Changes due to estrogen and growing fetus.

  5. Renal Function: Effects of malnutrition and developing hypertension.

  6. GIT Function: Hormonal influences (progesterone, estrogen, human chorionic gonadotropin).

  7. Weight Gain:

    • Document weight before and during pregnancy.

    • Recommended: 2-4 lbs by the end of the 1st trimester, 1 lb/week thereafter.

    • Average weight gain: 25-35 lbs.

    • Note: Low sodium intake is advised.

Problems During Pregnancy

  1. Nausea and Vomiting (Morning Sickness):

    • Recommendations: eat dry crackers/toast before rising, ice chips, small frequent meals, avoid offensive odors and liquids at meals.

    • Severe case: Hyperemesis gravidarum (hospitalization required).

  2. Heartburn:

    • Management: small frequent meals, avoid spicy/greasy foods, wait to lie down post-meal.

  3. Constipation:

    • Relaxation of smooth muscles; manage with high-fiber diet and hydration.

  4. Edema:

    • Physiologic in the 3rd trimester; pathologic with toxemia.

  5. Leg Cramps:

    • Likely due to Calcium-Phosphorous imbalance, often at night.

  6. Rapid Weight Gain:

  7. Weight Loss:

    • First trimester: <500 grams/month

    • Second trimester: <250 grams/month

    • Risk of poor outcomes (e.g., preterm delivery).

  8. Pregnancy-Induced Hypertension (PIH):

    • Pre-eclampsia: Hypertension, Edema, low platelets, Proteinuria.

    • Eclampsia: all symptoms + Coma.

  9. Anemia:

    • Commonly Iron and Folate deficiencies.

  10. PICA:

  • Cravings for non-food substances (e.g., starch, clay).

  1. Gestational Diabetes Mellitus:

  • Stress-related, requires monitoring.

Dietary Guidelines for Childbearing Age

  • Iron: High heme iron & Vitamin C-rich foods for absorption.

  • Folic Acid: 400 micrograms synthetic daily + natural sources.

  • Maintain Healthy Weight: Reduces complications and promotes healthy infant weight.

  • Alcohol: Avoid to prevent fetal complications.

  • Seafood Intake: 8-12 oz/week, limit albacore tuna, avoid high mercury fish.

  • Iron Supplementation: Recommended during pregnancy.

  • Folate Requirement: 600 g/day during pregnancy.

Lactation

  • Caloric Requirements:

    • 85 calories to produce 100 ml of milk.

    • Average milk production: 750 ml (640 calories).

    • 6 months: 600 ml (510 extra calories).

    • 500 extra calories daily recommended during lactation.

Breastfeeding Support

  • Lactation specialists assist mothers with breastfeeding issues.

Infancy

  • Breastmilk: Ideal nutrition for infants, easily digestible components.

  • Nutrient Needs: Critical for rapid growth in the first year.

  • Growth Parameters:

    • Weight: Doubles by 6 months, triples by 12 months.

    • Height: Increases by 50% by 12 months.

  • Caloric Requirement: 98-108 kcal/kg during the first year.

  • Indicators of Adequate Intake: Wet diapers, normal growth, bowel movements.

Recommended Dietary Intake for Infants

  • Focus on high protein and calorie needs.

  • Guidelines:

    • Exclusive breastfeeding/formula for 4-6 months.

    • Introducing solid foods around 6 months.

    • Observe developmental readiness for solids.

Weaning

  • Signals readiness include effective drinking from cups and reduced infant irritability.

Toddler Growth Parameters

  • Weight Gain: 4-5 lbs/year.

  • Dietary Intake: 1300 kcal/day, with specific restrictions on fats.

Common Problems in Childhood

  • Address risks including obesity and malnutrition with proper nutrition guidelines.

Adolescence (13-20 years)

  • Rapid growth and development.

  • Nutritional Challenges: Trends towards fast food and fad diets.

  • Common Problems: Anorexia, Bulimia, overweight issues.

Young and Middle Adulthood

  • Nutritional needs persist into adulthood; maintain healthy habits to prevent future health problems.

Aging Considerations

  1. Nutritional Changes: Requirements decrease with age.

  2. Common Problems: Malnutrition, obesity, frailty, sarcopenia.

  3. Nutritional Therapy: Focus on calcium, Vitamin D, and protein intake.