1. NUTRITION CHPT 11 Diet During Pregnancy & Lactation

2. How long is a pregnancy
38-40 weeks long

3. During pregnancy, who/what does mom provide nutrients to?
Fetus - the growing baby
Amniotic fluid – the fluid that surrounds the fetus in the womb
Placenta – organ in the uterus that links blood supply from mom to fetus

4. Mom also provides nutrients to cause an increase in blood volume, breast and uterine and fat tissue
She is not just eating for herself any more

5. Mental Retardation
Is believed to be caused in part by malnutrition on the mother’s part

6. Low birth weight
Babies weighing less than 5.5 pounds

7. Weight gain with 1 baby during pregnancy
25-35 pounds over the weeks
Mom should increase her calories by 300 calories per day along with what she was used to eating

8. Trimesters A trimester consists of 3 months
In pregnancy, there are 3 trimesters

9. Usually, women only gain 2-4 pounds in the 1st trimester however…
Weight gain should occur at a rate of 1 pound a week during the 2nd and 3rd trimester
This wt gain is to aid in the growth of the increase in maternal tissue and in the growth of the fetus

10. Adolescent and weight gain
A pregnant adolescent who is still growing needs more nutrients
Adolescents already don’t have healthy diets, probs occur d/t this
Offer help from agencies like WIC, Birthright or other organizations
Their weight gain depends on the size they are before pregnancy

11. Weight loss during pregnancy
NO ONE SHOULD LOSE WEIGHT DURING PREGNANCY
Malnutrition side effects could be worse than gaining weight

12. Folic Acid
BEFORE a couple decides to become pregnant, they should visit the Dr. to discuss…
Folic acid – it’s a water soluble vitamin, it aids in protein metabolism and formation of hemoglobin
400 mcg of Folic acid should be taken daily. Folic acid should be started 1 month before conception
Folic acid deficiency causes spinal cord and brain defects, megablastic anemia where large immature RBCs don’t carry O2 well

13. Megablastic anemia It’s JUST LIKE ALL THE OTHER ANEMIAS: SOB Fatigue
Weakness
Pallor
Bad RBCs which can’t carry good O2

14. DIET DURING PREGNANCY Food pyramid should be followed
NO HOLLOW CALORIES or EMPTY CALORIES

15. Vitamins & Supplements
Folic acid – (member of the vit B complex)
Vitamin A – fat soluble
Vitamin D – fat soluble
Vitamin E – fat soluble
Vitamin K – fat soluble
Iron (Fe)- to aid in the increase of blood volume during pregnancy

16. Vitamin C is an iron enhancer and increase absorption of iron
Vitamin B’s they aid in metabolism and development of RBC’s, water soluble
Calcium to build bone and teeth, needed for blood clotting and muscle action

17. How important is iron?
Due to increase blood volume, more iron is therefore needed. Doubled during pregnancy
The fetus increases its hemoglobin level to twice its normal level while in the womb. After birth, the infant’s hemoglobin level is reduced back to normal as the extra hemoglobin breaks down. The resulting iron is stored in the liver and is available when needed
Iron deficiency causes dizziness, weakness, S.O.B.

18. Drinking additional milk each day while pregnant provides:
Protein
Phosphorus
Calcium
And other nutrients

19. Problems During Pregnancy
NAUSEA – the feeling of a need to vomit, usually lasts through to the end of the 1st trimester
A.K.A morning sickness although, nausea comes on at any time

20. Suggestions to help relieve morning sickness
Eat dry crackers or dry toast before rising
Eat small, frequent meals
Avoid foods with an offensive odor
Avoid liquids at mealtime

21. Hyperemesis Gravidarum
Nausea so severe as to be life threatening
Mother may need to be hospitalized for IV and food – parenteral nutrition
Zofran given for nausea P.O. or I.V.
Phenergan I.V or P.R. or P.O.

22. Parenteral Nutrition
Nutrition provided through a vein called TPN (total parenteral nutrition)
Parenteral – any med route other than the alimentary (mouth) canal such as I.V, SQ, IM
Pt usually must be in the hospital for this type
If home care nurse available and insurance, pt may get this at home

23. CONSTIPATION
Progesterone is increased during the 3rd trimester to get ready for baby to be born
This causes relaxation of the cardiac sphincter and smooth muscle
Can’t push as strong, stool doesn’t come out

24. Treatment of pregnancy related constipation
Eating high fiber diet
Daily exercise
Drink plenty of fluids 8 glasses of water per day
Respond immediately to the the urge to deficate

25. HEARTBURN
As the fetus grows, it pushes on the mom’s stomach, this causes stomach acid to move into the lower esophagus causing heartburn

26. Relief of heartburn Eating small frequent meals vs. large meals
Avoid spicy or greasy foods
Avoid liquids with meals, you get too full
Wait at least 1 hour before laying down after eating

27. Obesity
Stay away from low nutrient dense foods like chips, sodas, candy
Follow the food pyramid, drink lots of low-fat or fat-free milk
Eat raw, crisp veggies, fruits and low-fat items

28. PIH Pregnancy induced hypertension
(High blood pressure caused by pregnancy)
A.K.A toxemia or preeclampsia
Occurs in the 3rd trimester
S&S: HTN, proteinuria – albumin in the urine and edema

29. PIH
The edema = wt gain
This early stage can progress to the eclamptic state= seizures or convulsions and death

30. PIH, who gets it Adolescents Obese woman
Women on inadequate protein sufficient diets
First time pregnancies
Multiple birth pregnancy

31. PICA Abnormal cravings for non-food substances such as:
Starch like laundry detergent
Clay or soil
ice

32. Causes of PICA Unknown Believed to stop nausea
More common in pregnant women
Can be cultural

33. Anemia
A condition caused by insufficient numbers of red blood cells, hemoglobin or blood volume
Hemoglobin – the iron-containing pigment of the RBC that carries O2
Pt does not receive enough O2 from the blood and feels weak and tired

34. During pregnancy…
The increased volume of blood creates the need for additional iron
Baby takes what it needs from mom, mom is tired and deficient = anemia
Can be treated with daily iron supplements

35. Folate Deficiency Results from a form of anemia
There are too few RBCs and very large immature RBCs
When new RBCs are being formed, the body needs more folic acid
Supplement is given of folate = folic acid

36. Fetal Alcohol Syndrome
Mental retardation or subnormal physical and mental developmental delays
These infants are of low birth wt
When mom drinks, it enters the fetal bloodstream but baby cannot metabolize the alcohol out

37. Physical Characteristics of FAS
Small head (microcephaly)
Short eye slits
Flat midface
Thin upper lip
Ht and wt deficiency
ADD or ADHD
seizures

38. Caffeine
Crosses the placenta and enters the baby’s bloodstream and causes fetus in womb or baby, to become irritable or hyperactive
Pregnant rats who were given caffeine, showed that it caused birth defects in baby rats
No data shows this in humans, mom should still limit caffeine to 2 cups/day

39. Tobacco and pregnancy Causes low birth wt
Smoking reduces the O2 and nutrients carried by the blood and then baby can’t get what it needs
SIDS, spontaneous abortion (miscarriage occurring naturally), intellectual and behavioral problems can occur

40. Gestational Diabetes
Diabetes that occurs during pregnancy and disappears after the delivery of baby
Remember, Diabetes Mellitus is when one cannot use or store glucose normally d/t the inadequate production of insulin

41. What happens to baby if mom has gestational diabetes?
Physical or mental defect in baby
Stillborn
Macrosomia – birth wt over 9 lbs
Every woman is tested for diabetes btwn weeks 16-28
Insulin may be needed oral hypoglycemics are not recommended
Mom will see a dietician

42. Lactation The period during which the mother is nursing the baby
Breast milk is most nutritional for baby
Breast milk contains the right amts of lactose, H2O, fatty acids and amino acids for brain development growth and digestion
Human milk contain at least 100 ingredients not found in formula

43. How is mom’s milk made and released to baby
Prolactin is responsible for milk production
Oxytocin is responsible for milk ejection from the breast
Baby sucking initiates the release of oxytocin, causing the “let-down reflex” to occur (this is a supply and demand mechanism)

44. Calorie requirements during lactation
Increase of 500 calories per day while breastfeeding
Must drink lots of water
Increase in Vitamin C is needed
Increase in milk to gain protein
Natural wt loss occurs for mom by the burning of the stored fat for milk production during lactation

45. Medicine, caffeine, alcohol, tobacco
Most chemicals enter the mom’s milk
Mom’s diet can cause irritability in baby such as gas
Check with Dr. as to what meds cross mom’s breast milk and into baby
Mom may take drugs that cause addiction to her and baby

46. The End