1. Pregnancy and Lactation Pregnancy and Lactation Chapter 10: Pregnancy and Lactation J Pistack MS/Ed J Pistack MS/Ed

2. Nutritional Needs During Pregnancy On average, daily caloric intake should increase by approximately 340- 450 kilocalories per day The increase in calories should be from high nutrient density foods Major body organs form 2~3 months after conception From implantation to birth 100 mcg–7.5 lbs

3. Protein and Fat Needs Fatty acids have proved essential to fetal retina and brain development Protein essential for building fetal tissues

4. Vitamin Needs Vitamin C is necessary for collagen formation and tissue building Vitamin B 12 concentrated and stored in the fetal liver—provides infant stores to sustain them for the first several months of life Folic acid has been shown to decrease neural tube defects and is recommended to start before pregnancy

5. Fat Soluble Vitamins Vitamins A, E, and K is not recommended to supplement Vitamin D—no recommendations yet - it is however involved with multiple growth and development uses Immune system development Brain development Cellular differentiation

6. Mineral Needs Iron supports the mother’s increased blood volume, support fetal red blood cells, placenta, umbilical cord Calcium-30 grams are donated to a fetus at 350mg a day in the third trimester Iodine, fluoride, zinc – not transferred from mother – normal intake is required

7. Water and Weight Gain On average woman of normal weight should gain 2 to 4 pounds during the first trimester Followed by 1 pound per week for the remainder of the pregnancy Charts to plot weight gain based on pre-pregnancy BMI can be found here: www.nal.usda.gov/wicworks/Sharing_Center/NY/pre natalwt_charts.pdf

8. Substances to Avoid During Pregnancy Alcohol—fetal alcohol syndrome Caffeine Limit to < 300 mg/day Pregnancy outcomes unaffected by decaffeinated beverages Soft cheeses and ready-to-eat meats Listeriosis—often fatal in newborns

9. Substances to Avoid (continued) Certain fish, due to mercury content Undercooked meat Unwashed produce Cat litter—Toxoplasmosis

10. Common Problems During Pregnancy Morning sickness Dry crackers before arising Fruits and complex carbohydrates in small, frequent meals Avoidance of fatty foods Cold foods Liquids between meals High-protein snack at bedtime Leg cramps—magnesium supplement may help Pica – eating non food items

11. Common Problems During Pregnancy (Continued) Constipation Adequate fluid intake Regular exercise Up to 30 grams of fiber as food rather than supplements Heartburn Avoid spicy or acidic foods Eat small, frequent meals Sit up for 1 hour after meals

12. Complications of Pregnancy Hyperemesis gravidarum Severe nausea and vomiting after 14th week of pregnancy Can be life threatening Gestational diabetes Any degree of abnormal glucose tolerance beginning or first recognized in pregnancy Screening with glucose tolerance tests usually part of prenatal care Treated aggressively by health care team

13. Complications of Pregnancy Hypertensive disorders of pregnancy Chronic hypertension Gestational hypertension Pre-eclampsia—hypertension + proteinuria convulsions and coma, rarely coma alone, occurring in a pregnant or puerperal woman Eclampsia—pre-eclampsia + seizures Disorders of late pregnancy associated with high blood pressure, fluid retention, and protein in the urine Obstetrics emergency May occur postpartum

14. Nutritional Needs of the Breastfeeding Mother Vitamins Chronic maternal deficiencies may affect milk production Vegan mothers—check vitamin B12 status Minerals Calcium resorbed from bones regardless of intake and replaced after weaning Iodine critical for neurological development must be obtained dietarily

15. Breast feeding Benefits Through the release of oxytocin uterine muscles contract and return to their nonpregnant size which also minimizes postpartum blood loss Helps with child spacing Breastfeeding is associated with a decreased risk of breast cancer

16. Maternal Contraindications to Breastfeeding Certain diseases HIV in developed countries Active untreated tuberculosis Exposure to toxic chemicals Use of illegal drugs Some medications given to mother Antimetabolites Therapeutic radiopharmaceuticals