1. Nutrition during pregnancy and lactation Nutrition during infancy.
PERINATAL NUTRITION
Nutrition during pregnancy and lactation
Nutrition during infancy.
Rama Bhat , MD.
Department of Pediatrics,
University of Illinois Hospital
Chicago, Illinois.

2. Nutrition During Pregnancy
Improved maternal nutrition benefits both mother
and infant.
Maternal nutrition has a major influence on birth
weight.

4. Birth Weight as an Indicator of Risk
Low birth weight has high risk for coronary
heart disease
b) Higher risk for hypertension

5. Earlier maternal nutrient restriction increases placental
size and alters the expression of genes regulating
glucocorticoid and renin angiotensin systems.

6. Genetic and Environmental Contributions (%)
To Birth weight
Genetic %
Maternal genotype %
Fetal genotype 16 %
Fetal sex 2 %
Environmental 62 %
General Maternal environment %
Immediate maternal environment 6 %
Maternal age & Parity 8 %
Unknown environmental 30 %

7. Weight gain recommendations for pregnancy
BMI(Weight for height) Recommended
gain
Low BMI ( <19.8 ) kg (28-40 lbs)
Normal BMI ( ) kg ( lbs)
High BMI ( ) kg( lbs)
Obese (BMI > 29.0) kg (15 + lb.).
BMI = ( Wt. In kg./ht. In m2)
National Academy of Sciences 1990.

9. RDAs of Nutrients during Pregnancy
Non-Pregnant Pregnant
Energy(Kcal)
Protein(g)
Calcium(g)
Iron(mg)
Folate(mcg)
Zinc(mg)
Phosphorus(mg)
Vitamin D (mg)

10. NUTRITION DURING PREGNANCY
Energy Requirement
Cost of extra work during pregnancy has been estimated 85,000 calories.
41,000 calories for protein and fat stored in products of conception.
36,000 calories from increased O2 consumption.
8,000 calories to convert dietary to metabolizable energy.

11. RECOMMENDED COMPOSITION OF MULTIVITAMIN AND MINERAL SUPPLEMENTS
FOR PREGNANT WOMEN
Mineral Requirement
Calcium mg
Copper mg
Folate ug
Iron mg
Vitamin B mg
Vitamin D ug
Zinc mg
National Academy of Sciences 1990.

12. CALCIUM METABOLISM IN PREGNANACY
99% of calcium is in the skeleton
Total body calcium: 1200 grams.
1.0 % of calcium is in the ECF.
Calcium is essential for:
nerve conduction
muscle contraction
blood clotting
membrane permeability

13. CALCIUM METABOLISM IN PREGNANACY
Calcium requirements increase by % during pregnancy.
Net transfer across placenta is about grams.
Calcium transfer is active.
RDA for calcium during pregnancy is 1200 mg.

14. IRON METABOLISM IN PREGNANCY
Iron is needed for:
Expansion of red cell mass.
The fetus and placenta
Replace the blood loss at delivery

15. IRON METABOLISM IN PREGNANCY
Iron requirements double during pregnancy
Estimated total pregnancy iron needs is mg
Mother transfers about mg of iron to the fetus.
Iron absorption during pregnancy increases to %.
Iron deficiency in the mother does not lead to iron deficiency in her infant

16. ADVERSE EFFECTS OF IRON DEFICIENCY
Mother:
Fatigue
Leucocyte function
Tolerance at delivery
Preterm delivery ( OR 1.9)
Neonate:
Low birth weight
Neonatal death(developing countries)

17. Vitamins Folic acid: Deficiency increases:
helps to produce additional blood cells
helps to support rapid growth of placenta and fetus
(needed for DNA)
Deficiency increases:
NTD (Meningomyelocele and anencephaly).
Low birth weight
Prematurity

20. VITAMINS Folic acid: Supplementation decreases NTDs (3.6 - 1.0 %).
In USA alone infants are born
with NTDs.
Worldwide incidence ,000/yr.

21. Randomized control trial Double blind using a placebo
MRC VITAMIN STUDY
Randomized control trial
Double blind using a placebo
Four treatment groups
A. Mineral + folic acid
B. Mineral + Folic acid + M.V.
C. Mineral + Placebo
D. Mineral + MV (- Folic acid)
Comparison:
A + B vs C + D Folic acid effect
B + D vs A + C Effect of other vitamins

22. MRC Vitamin Study 21/602 (3.5%) NTD risk (%) 6/593 (1.0 %)
Relative Risk = 0.29
(95% CI , p< 0.001)
21/602 (3.5%)
NTD risk (%)
6/593 (1.0 %)
WITH FOLIC ACID
WITHOUT FOLIC ACID

23. Pregnancy and Physical Activity
Source of considerable debate
Outcome of well conducted studies
Increased activity does not result in
increased absorption.
Active women have less difficulty during labor.
Infants of very active women were smaller.
Advice: Exercise in moderation during 3rd
trimester.

24. FOOD CRAVINGS AND AVERSIONS
Dietary changes during pregnancy:
Some by advice of the physician.
Some by folk medical beliefs.
Some by change in appetite.
Food cravings:
Sweets and dairy products.
Aversions:
Alcohol, coffee and meats.

25. Cravings and Aversions are not necessarily deleterious.
FOOD CRAVINGS AND AVERSIONS
Cravings and Aversions are not
necessarily deleterious.

26. SOCIAL AND ENVIRONTMENTAL FACTORS
Drug abuse
HIV infection

27. DRUG ABUSE DURING PREGNANCY
Prevalence %.
Commonly Abused drugs:
Cocaine
Heroin
Marijuana
Tobacco
Alcohol
PCP

28. ALCOHOL ABUSE Increased incidence of addiction (18 - 52%).
Poor maternal nutrition.
Fetal alcohol syndrome ( /1000)
CNS involvement
growth retardation
fetal dysmorphology

30. HIV INFECTION Nutritional Deficiency with AIDS
protein caloric Malnutrition
Zinc and selenium deficiency
Calcium and Magnesium
Vitamin A, B6, B12, C, E deficiency

31. BABY BUILDING BASICS Choose food from all FIVE food groups.
Aim of lbs weight gain.
Add 300 calories/day to your diet.
Add calcium supplement (100mg/day).
Add daily prenatal vitamins.
Avoid alcohol and smoking.
Do not eat raw or uncooked foods.
Drink 64 ounces of fluid.

32. Nutritional Assessment
Dietary Evaluation &Recommendation
Access to Registered Dietician
Evaluation Nutritional Status
Weight for Height
Eating Habits.
Modification of the Diet to Existing Medical Condition

33. Benefits of Maternal Nutrition Services
Preconceptional Prenatal Postpartum
Improves overall
maternal health
Allows time to
change habits
Allows reduction
of risk factors
prior to
conception
Improves birth
weight,may reduce
perinatal morb.
Impr. Maternal
health & comfort, incr. initiation of
breast feeding.
Increases breast-
feeding success
improves mat.
nutrition.
Provides opportunity to
promote healthful
eating for entire
family.