Basic Human Nutrition for a Healthy Pregnancy Nutrition

Basic Human Nutrition for a Healthy Pregnancy Nutrition for Healthy Infants

Prior To Pregnancy n Goals n Achieve and maintain a healthy body weight n Choose an adequate and balanced diet n Be physically active n Avoid harmful influences

Pre-conceptual Nutrition Issues n Maternal nutrient stores: n n Development of a healthy placenta Prevention of neural tube defects

Placenta Copyright 2005 Wadsworth Group, a division of Thomson Learning

Stages of Pregnancy n n Ovum (fertilized) implants in uterine wall– placenta begins to grow Zygote divides into many cells, these cells sort themselves into 3 layers. Embryo – 1 st month- organs start to form, spine and primitive brain form, arm & leg buds Foetus- nervous system, digestive tract, liver, kidney & spleen form.

Stages of Embryonic And Fetal Development

Critical Periods n n Neural tube defects n Anencephaly n Spina bifida Folate supplementation

Critical Periods Copyright 2005 Wadsworth Group, a division of Thomson Learning

Chronic Disease n n Nutrition is a primary determinant of beta cell growth, and infants who have suffered prenatal malnutrition have significantly fewer beta cells than wellnourished infants. They are also more likely to be low birthweight infants.

Copyright 2005 Wadsworth Group, a division of Thomson Learning

Weight Prior To Conception n n Underweight n Preterm births and infant deaths are higher. n High risk of having low-birthweight infant. Overweight and obesity n Infants are more likely to be born post term. n High risk of medical complications. n Increased likelihood of difficult labor and delivery, birth, trauma and cesarean section.

Recommended Weight Gain During Pregnancy BMI Category n < 20 n 20 - 25 n > 27 Recommended Gain n 12. 5 – 18. 0 kg (28 -40 pounds) n 11. 5 - 16. 0 kg ( 25 – 35 pounds) n 7. 0 - 11. 5 kg (15 – 25 pounds)

Weight Gain

Weight Gain continued n n n Normal –weight woman: 2 to 4 pounds in first trimester, 1 pound/week thereafter. Teenager: if normal BMI for age, should gain about 35 pounds Multiple pregnancy e. g. , twins, should gain about 35 to 40 pounds.

Exercise During Pregnancy Copyright 2005 Wadsworth Group, a division of Thomson Learning

Energy And Nutrient Needs Copyright 2005 Wadsworth Group, a division of Thomson Learning

Nutrient Needs During Pregnancy n n Energy: 300 additional calories n 2 nd and 3 rd trimesters only (Canadian) 340 additional calories n 2 nd and 451 kcal in the 3 rd trimester. (DRI) Protein: 5 g additional protein 1 st trimester 20 g additional protein – 2 nd trimester 24 g additional protein – 3 rd trimester Fat: no lower than 30% calories from fat n n Fatty acids necessary to development of foetal brain Carbohydrate: about 50% of calories

Comparison Of Nutrient Recommendations For Nonpregnant, Pregnant, And Lactating Women Copyright 2005 Wadsworth Group,

Nutrient needs in pregnancy continued n n Folate and B 12 – needed for rapid cell proliferation both in the foetus and the increase in mother’s red blood cells. Folate 600 ug/day. Folate critical during first 6 weeks of pregnancy when neural tube forms and closes. Failure to close at upper end causes anencephaly; at lower end –spina bifida

Vitamin B 12 n n n Requirements: B 12: 2. 6 ug/day Assists folate in manufacture of new cells. High intakes of folate can mask B 12 deficiency and diagnosis. Non vegetarians consume adequate amounts of B 12 with meat, eggs and dairy products. Vegetarian women who exclude dairy and eggs must take a supplement.

Calcium, Phosphorus, Magnesium n n All 3 have a significant role in development of skeletal structure of foetus. Intestinal absorption of calcium doubles early in pregnancy and is stored in the mother’s bones. When foetal bones begin to calcify, there is a dramatic shift in calcium across the placenta. In last trimester, over 300 mgs calcium per day are transferred to the foetus.

Recommendations for Calcium and Magnesium n n Calcium recommendation same as for non-pregnant female. Magnesium for bone and tissue growth is needed during pregnancy in amounts slightly more in pregnancy. Recommendation is 40 mg more than nonpregnant women.

Iron n n Body conserves iron during pregnancy but huge demand can deplete maternal reserves. Foetus draws on mother’s supply to create reserves of its own for the first 3 to 6 months of life. Mother also loses iron through blood loss with delivery Recommendation is 30 mg iron daily (Canadian) 27 mg/day DRI

Nutrient Supplements n n n Prenatal vitamins typically contain greater amounts of folate, iron, and calcium than regular vitamin/mineral supplements. Vitamin/mineral supplements recommended for high-risk groups: mothers carrying multiple fetuses, smokers, alcohol and drug users, teens, obese women, women with inadequate nutrient intakes. Building Blocks for Better Babies provincial program supplies supplements and nutritional counseling to high-risk and low-income women.

Nutritional problems during pregnancy n “Morning Sickness” – nausea and vomiting caused by hormonal changes. It can occur any time during the day, but common in morning. Can be a nuisance to a severe problem. Can lead to dehydration and acid-base imbalance, weight loss.

Food Cravings and Aversions n n Fairly common but don’t reflect real physiological needs. Most likely due to hormone-induced changes in sensitivity to taste and smell.

Nonfood Cravings n Pica – desire to eat non-nutritious foods or non-food substances e. g. , ice, cornstarch, clay. More common in women whose diets are deficient in iron, zinc or other nutrients, but deficiency does not cause craving.

Heartburn n n Hormones relax digestive muscles, and the growing fetus puts increasing pressure on mom’s stomach. This allows stomach acid to back up into the lower esophagus and create a burning sensation near the heart.

High-Risk Pregnancies Copyright 2005 Wadsworth Group, a division of Thomson Learning

Gestational Diabetes n n Blood glucose becomes abnormal during pregnancy, but it usually returns to normal after pregnancy. In 1/3 of cases, diabetes is permanent. If untreated or poorly managed, gestational diabetes can lead to foetal or infant sickness or death. Pregnant women are screened for gestational diabetes around 24 -28 weeks gestation.

Preeclampsia n n n A potentially dangerous condition characterized by edema, hypertension, and protein in the urine. Edema is widespread – face, hands, feet and ankles. All organs are affected – circulation, liver, kidneys and brain. If condition progresses –develops into eclampsia, which can result in convulsions and death. Treatment is prevention of convulsions and regulation of blood pressure, emergency caesarean section if necessary.

Pregnancy in Adolescents n n Challenge: to nourish a growing fetus as well as a growing teen. Common complications: iron-deficiency anemia and prolonged labor. High rate of stillbirths, preterm births, and low birthweight infants. Encourage high weight gain. (35 lbs)

Pregnancy in Older Women n n Number of first births at 35 or older has increased. Complications: hypertension, diabetes and may result in cesarean section. High rate of premature births and low birthweight. Risk of having child with Down syndrome is increased.

Behaviours to avoid during pregnancy n n n Cigarette (cigar/pipe) smoking. Smokers have lower intakes of dietary fibre, vitamin A, Beta carotene, folate and vitamin C. Oxidants in smoke accelerate vitamin C metabolism - depletes vitamin C Smoking restricts blood supply to foetus, slows growth, leads to low-birthweight. Environmental Tobacco Smoke (nicotine and cyanide & others) in smoke directly toxic to foetus and to infant; increases risk of SIDs

Behaviours to Avoid continued n n n Medications and illegal drugs: can cause serious birth defects. Herbal preparations, over-the-counter drugs, and high-dose vitamins are not recommended during pregnancy. Prescription drugs may need to be altered or discontinued (if possible ) during pregnancy. Caffeine: 1 cup per day of coffee per day Dieting to be avoided at all costs during pregnancy

Foetal Alcohol Syndrome n n n Alcohol during pregnancy can result in FAS which causes irreversible mental retardation, growth retardation, facial abnormalities, vision abnormalities, low APGAR scores and 40 other identifiable health problems. Foetal brain is very susceptible to glucose or oxygen deficit and alcohol causes both by disrupting placental functioning. Alcohol also crosses placental barrier and is toxic to brain and nervous system of developing foetus.

Fetal Alcohol Syndrome Copyright 2005 Wadsworth Group, a division of Thomson Learning

Foetal Alcohol Effect n n In animal research, 1/5 of amount of alcohol needed to produce outwardly visible effects can produce a learning impairment. Children with this reduced syndrome, perform poorly in school and social interactions, may be short in stature, or have subtle face abnormalities. Recommendation is no alcohol during pregnancy and preferably pre-pregnancy if planning a pregnancy.

Lactation n n n Production of about 25 oz of milk/day. Requires an extra 330 kcalories of food each day. Protein and fatty acids = same as pregnancy. Need additional carbohydrate to replace glucose used to make the lactose in breast milk. Fibre is 1 gram higher due to increased calories needed. Fluids need to be increased to protect from dehydration.

Behaviours to avoid n n n Alcohol Medicinal drugs Illicit drugs Smoking Caffeine

Nutrient needs of infant n n n Infant’s rate of growth in first year greater than at any other time in life. Birth weight doubles by 4 months of age and triples by age 1. A newborn requires 100 – 120 kilocalories per kg of body weight per day.

Infancy Copyright 2005 Wadsworth Group, a division of Thomson Learning

Nutrient needs of infant continued n n 13 g protein per day for first 6 months and 14 g for the second 6 months of life. 30 – 55% of calories from fat. Infant’s small stomach capacity requires high fat to meet energy requirements High fat also needed for developing nervous system.

Recommended Intakes Of An Infant And An Adult Compared On The Basis Of Body

Breast milk is best n n Breast milk contains antiviral and antibacterial agents which reduces incidence of infection in newborn. Colostrum produced in first 3 days of lactation contains antibodies and white cells from the mother’s blood. Infections which she has developed an immunity to are thereby passed to her infant.

Breast milk is best continued n n n Protein in breast milk consists of 70% whey and 30% casein. Cow’s milk protein contains 18% whey and 82% casein. Whey portion of breast milk contains soluble proteins which are easily digested.

Breast versus cow’s milk n n Breast is more easily and completely digested than formula. Major whey protein of breast milk is alphalactalbumin which is efficiently digested and absorbed. Major whey protein in cow’s milk is betalactoglobulin, the protein often blamed for milk allergy and colic. Lactoferrin – another protein in breast milk assists with iron absorption in the infant and acts as an antibacterial agent.

Breast milk continued n n n Breast milk contains lipase to assist with fat absorption, therefore 95 -98% of fat in breast milk is absorbed by infant. The 2 -1 calcium to phosphorus ratio of breast milk enhances absorption of calcium. Vitamin C is higher in breast milk than in cow’s milk, but vitamin D is lower. Breastfed Infants need exposure to sunlight or supplementation of vitamin D.

Breast Milk

Breast milk versus cow’s milk n n n Breastfed baby does not require iron supplementation until 4 months of age. Breast milk higher in water than cow’s milk, therefore provides adequate hydration even in dessert climate. Breast milk varies in nutritional content according to time of day and infant’s needs.

Breast milk versus cow’s milk n n B 12 is 9 times higher in cow’s milk than in breast milk of women consuming a mixed diet. Vegans produced only ¼ to 1/3 as much B 12 as mothers consuming a mixed diet. Breastfed babies require injection of Vitamin K at birth to prevent bleeding.

Breast milk versus cow’s milk continued n n n Breast milk contains 1/3 of the sodium, potassium and chloride and 1/8 of the phosphorus of cow’s milk which is best for the infant’s kidneys. Breast milk contains 1/6 of calcium of cow’s milk but 67% absorbed versus 25% of calcium Zinc is absorbed 60% from breast milk and 43% from cow’s milk

Breast milk versus cow’s milk continued n n n Breastfed baby does not require iron supplementation until 4 months of age. Breast milk higher in water than cow’s milk, therefore provides adequate hydration even in dessert climate. Breast milk varies in nutritional content according to time of day and infant’s needs.

Infant Formula Copyright 2005 Wadsworth Group, a division of Thomson Learning

Formula feeding n Formula preparation n n Sterilize bottles Water selection Dilution Storage

Formula feeding continued n Types of formula n n n Iron fortified cow’s based Special formulas Follow-up formula Nucleotides Essential fatty acids

Other beverages n n n n Goats’ milk Soy milk Rice beverage Herbal teas Juice Pop, drink crystals Nursing bottle syndrome

Introducing Solid Foods Copyright 2005 Wadsworth Group, a division of Thomson Learning

When to start solids n n Between ages 4 months to 6 months Earlier introduction of solids may cause allergies due to immature gut. Infant can support and control head movements – can move toward or away from food offered Baby shows interest in solid foods

Introducing solids continued n n Increased saliva present Tongue can move food to the back of the mouth Extrusion reflex disappearing ( movement of tongue to push food out of mouth) Baby’s iron stores are getting low

Solid foods Given one at a time n Try a food for 4 -5 days before trying a new food n Feed after breast milk or formula First foods: cereals: rice, barley, oats, wheat n 1 tsp at first then increase n

Solids continued Second foods: n Vegetables: squash, peas, sweet potato, green or yellow beans, zucchini, asparagus, broccoli, cabbage, etc. n Give separately then mix Third foods: Fruits: apple, pear, peach, apricots, plum, banana etc.

Solids continued Delay strawberries, pineapple and grapes until 12 months Fourth foods: n Meats: chicken, turkey, fish, beef, pork and lam. Moisten well. Avoid cold cuts, sausage n Egg yolk only n Milk products n Legumes n

Food textures and feeding capabilities n n n Puree Mashed Chunky Finger foods Table food

Other feeding issues n n no sugar, salt or seasonings No honey No raw egg Weight gain Fat

Choking n Caused by foods that are not well controlled in the mouth: n n n Hard Round/cylindrical (e. g. , grapes) Chewy Sticky Child also needs to sit quietly when eating