Nutritional Aspects of Pregnancy and Breastfeeding Chapter 16

Learning Outcomes Discuss factors that predict a successful pregnancy outcome List major physiological changes that occur in the body during pregnancy and describe how nutrient needs are altered Specify the optimal weight gain during pregnancy for adult women Describe the special nutritional needs of lactating and pregnant women, summarize factors that put them at risk for nutritional deficiencies.

Learning Outcomes Identify nutrients that often need to be supplemented during pregnancy and lactation and explain the reason for each Discuss potential nutrition-related problems that occur during pregnancy and suggest techniques for coping with these problems List substances and practices to avoid during pregnancy and lactation and describe why they are harmful Describe the physiological process of breastfeeding

Pregnancy Gestation Favorable pregnancy outcome Pre-term Full term (>37 weeks) Infant weighing greater than 5.5 lbs Pre-term Born before 37 weeks Low birth weight Weighing less than 5.5 lbs Small for gestational age Weighing less than expected for gestational age

Pre-natal Developmental Stages Conception (sperm + egg) Zygote (fertilized egg)

Pre-natal Developmental Stages Embryonic (zygote becomes embryo) Fetal Trimesters Critical periods Spontaneous abortion

Nourishing the zygote, embryo, and fetus Zygote: absorb from uterus and digest uterine lining Embryo: placenta Umbilical cord

Nutrient Needs of Pregnancy Energy needs increase 1st trimester: no additional increased needed 2nd trimester: +350 kcal daily 3rd trimester: +450 kcal daily Will depend on many factors (mother’s weight and activity level) Nutrition during pregnancy DOES impact baby’s future health

Nutrient Needs of Pregnancy Nutrient needs for new cells: Protein needs increase by 50% Essential fatty acid (omega 3) Zinc-smoking, medications, alcohol also have impact

Nutrient Needs of Pregnancy Folate and Vitamin B-12 Folic acid fortification Neural tube defects

Nutrient Needs of Pregnancy Iron needs increase significantly (more maternal RBC and building fetal stores) Less blood loss Increased absorption Physiological anemia vs iron deficiency anemia Factors to consider if taking iron supplements

Nutrient Needs of Pregnancy Nutrient needs for bone and teeth Calcium and Vitamin D Recommended intake stay the same, but important to meet these recommendations Highest risk groups: vegans, pregnant teens, hypertension, no dairy products

Pre-natal vitamin and mineral supplements Prenatal vitamins are vitamin supplements intended to be taken before and during pregnancy and during postnatal lactation Vitamins such as folic acid and the other B vitamins, zinc and iron are in higher amounts while nutrients such as Vitamin A are reduced. Other factors: Iron Calcium DHA Nausea, vomiting (ginger root, probiotics)

Cravings? Are they telling you something? Common cravings Pica Eating non food substances

Physical activity during pregnancy Benefits To mom: improved cardiovascular function, easier labor, prevent gestational diabetes To baby: leaner and more neurologically mature Avoid Strenuous or endurance (30 minutes moderate) Deep flexing Laying flat on your back Things that can cause abdominal trauma

Nutrition Related Factors Affecting Pregnancy Outcome Maternal pre-pregnancy weight Maternal weight gain Pattern of maternal weight gain Young maternal age Maternal eating patterns

Maternal Weight Gain

*11-20 pounds

Nutrition Related Factors Affecting Pregnancy Outcome Maternal health Pregnancy history Pre-natal care Pregnancy induced hypertension Preeclampsia to eclampsia

Nutrition Related Factors Affecting Pregnancy Outcome Gestational diabetes 4-7% in those who were not diabetic before pregnancy Risk factors: family history of diabetes, obesity, older than 25, prior gestational diabetes Usually starts weeks 20-28 Risks: deplete fetal iron stores, large baby, fetal low blood sugar at birth Treatment: exercise, low glycemic load diet, insulin 19

Nutrition Related Factors Affecting Pregnancy Outcome Maternal sociocultural factors Expanded Food and Nutrition Program (EFNEP) Women, Infants and Children (WIC) Food Stamps Maternal food supply Environmental contaminants (mercury in fish) Foodborne illness (raw meat and seafood, deli meat, animal feces, soft cheeses) Caffeine (300 mg) Food additives (artificial sweeteners)

Nutrition Related Factors Affecting Pregnancy Outcome Maternal lifestyle Alcohol Drugs (including aspirin, cold medications) Herbal and botanical products Nicotine and carbon monoxide

Physiological Change of Concern During Pregnancy Heartburn Constipation Nausea and Vomiting Ginger, B6 Edema

Lactation Prolactin promotes milk production Sucking (supply and demand) Release of milk from the breast Let-down reflux Oxytocin Milk types and composition Colostrum Lactobacillus bifidus factor Transitional Mature

Nutrient Needs of Breastfeeding Women Maternal nutritional status Water Increase 32 ounces of fluid Calories It takes about 800 calories to produce daily milk supply Increase daily intake 400-500 calories

Nutrient Needs of Breastfeeding Women Food choices during lactation Problem nutrients: calcium, magnesium, zinc, folate, B6 Other considerations: omega 3, nuts, alcohol