1. Nutritional Aspects of Pregnancy and Breastfeeding
Chapter 16

2. 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.

3. 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

4. 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

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

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

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

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

11. 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

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

13. 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

14. 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

15. 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)

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

17. 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

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

19. Maternal Weight Gain

20. *11-20 pounds

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

22. 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

23. 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)

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

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

27. 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

28. 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 calories

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