DIET DURING PREGNANCY LACTATION Different stages of human

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DIET DURING PREGNANCY, LACTATION & Different stages of human life

DIET DURING PREGNANCY, LACTATION & Different stages of human life

OBJECTIVES After studying this chapter, you should be able to: �Identify nutritional needs during

OBJECTIVES After studying this chapter, you should be able to: �Identify nutritional needs during pregnancy and lactation � Describe nutritional needs of pregnant adolescents � Modify the normal diet to meet the needs of pregnant and lactating women. �Identify nutritional needs during infancy.

Introduction �Good nutrition during the 38 to 40 weeks of a normal pregnancy is

Introduction �Good nutrition during the 38 to 40 weeks of a normal pregnancy is essential for both mother and child. �The pregnant woman must provide nutrients and calories for the fetus, the amniotic fluid, the placenta, and the increased blood volume and breast, uterine, and fat tissue. � woman who consumed a nutritious diet before pregnancy is more apt to bear a healthy infant than one who did not. � Malnutrition of the mother is believed to cause decreased growth and mental retardation in the fetus. �Low-birth-weight infants (less than 2. 3 kg ) have a higher mortality (death) rate than those of normal birth weight.

WEIGHT GAIN DURING PREGNANCY �Weight gain during pregnancy is natural and necessary for the

WEIGHT GAIN DURING PREGNANCY �Weight gain during pregnancy is natural and necessary for the infant to develop normally and the mother to retain her health. �The average weight gain during pregnancy is 5 to 7 kg. � A pregnant adolescent who is still growing should gain more weight than a mature woman of the same size. �Women of average weight should avoid excessive weight gain �Underweight women should gain 6 to 8 kg.

NUTRITIONAL NEEDS DURING PREPREGNANCY �Ideally when couples decide to have a child, they should

NUTRITIONAL NEEDS DURING PREPREGNANCY �Ideally when couples decide to have a child, they should make an appointment with their physician to discuss any health concerns or needed changes to the woman’s diet. � At that time the physician needs to emphasize the importance of the woman taking a folic acid supplement at least 1 month prior to conception. �Lifestyle and habits also need to be taken into consideration before becoming pregnant. Certain medications, smoking, illegal drugs, and alcohol can all be detrimental to the embryo. �Good nutrition is essential before becoming pregnant and during pregnancy.

NUTRITIONAL NEEDS DURING PREGNANCY �Some specific nutrient requirements are increased dramatically during pregnancy, based

NUTRITIONAL NEEDS DURING PREGNANCY �Some specific nutrient requirements are increased dramatically during pregnancy, based on the client’s nutritional status, age, and activities. - protein requirement is increased. Proteins are essential for tissue building, and protein-rich foods are excellent sources of many other essential nutrients, especially iron, copper, zinc, and the B vitamins.

NUTRITIONAL NEEDS DURING PREGNANCY……… - no need for increased vitamin A during pregnancy. Excess

NUTRITIONAL NEEDS DURING PREGNANCY……… - no need for increased vitamin A during pregnancy. Excess vitamin A has been known to cause birth defects such as hydrocephaly (enlargement of the fluid-filled spaces of the brain), microcephaly (small head), mental retardation, ear and eye abnormalities, cleft lip and palate, and heart defects. - The required amount of vitamin D is 10 g, vitamin E is 15 mg, vitamin K is 75 to 90 g depending upon age. - water-soluble vitamins are increased during pregnancy. - Additional vitamin C is needed to develop collagen and to increase the absorption of iron. �The B vitamins are needed in greater amounts because of their roles in metabolism and the development of red blood cells.

NUTRITIONAL NEEDS DURING PREGNANCY………… - Need for minerals calcium, iron, zinc, iodine, and selenium

NUTRITIONAL NEEDS DURING PREGNANCY………… - Need for minerals calcium, iron, zinc, iodine, and selenium are all increased - Calcium is essential for the development of the infant’s bones and teeth as well as for blood clotting and muscle action. - If the mother is not consuming adequate calcium in her diet, the baby will get its calcium from her bones.

FULFILLMENT OF NUTRITIONAL NEEDS DURING PREGNANCY �To meet the nutritional requirements of pregnancy, the

FULFILLMENT OF NUTRITIONAL NEEDS DURING PREGNANCY �To meet the nutritional requirements of pregnancy, the woman should base her diet on healthy plan �One of the best ways of providing these nutrients is by : - drinking additional milk each day or using appropriate substitutes. - To be sure that the vitamin requirements of pregnancy are met, vitamin supplement in addition to an iron supplement should be prescribed. �The unusual cravings for certain foods during pregnancy do no harm unless eating them interferes with the normal balanced diet or causes excessive weight gain.

CONCERNS DURING PREGNANCY Nausea � occurs during the first trimester of pregnancy. This type

CONCERNS DURING PREGNANCY Nausea � occurs during the first trimester of pregnancy. This type of nausea is commonly known as morning sickness, but it can occur at any time. �Suggestions can help relieve - Eat dry crackers or dry toast before rising. - Eat small, frequent meals. - Avoid foods with offensive odors. - Avoid liquids at mealtime. �If persists and becomes so severe is called hyperemesis gravidarum. The mother may be hospitalized and given parenteral nutrition.

CONCERNS DURING PREGNANCY… Constipation and hemorrhoids - can be relieved by eating high-fiber foods,

CONCERNS DURING PREGNANCY… Constipation and hemorrhoids - can be relieved by eating high-fiber foods, - getting daily exercise, - drinking at least 8 glasses of liquid each day, and - responding immediately to the urge to defecate. Heartburn - result from relaxation of the cardiac sphincter and smooth muscles related to progesterone. - is a common complaint during pregnancy. - As the fetus grows, it pushes on the mother’s stomach, which may cause stomach acid to move into the lower esophagus and create a burning sensation there. Relieved by: - eating small, frequent meals; avoiding spicy or greasy foods; - avoiding liquids with meals; - waiting at least an hour after eating before lying down; and waiting at least 2 hours before exercising.

CONCERNS DURING PREGNANCY… �Excessive Weight Gain � the pregnant woman should reevaluate her diet

CONCERNS DURING PREGNANCY… �Excessive Weight Gain � the pregnant woman should reevaluate her diet and eliminate foods (except for the extra pint of milk) that cause weight gain - drink fat-free milk - substitute calcium pills in some cases - vegetables such as broccoli or cauliflower tips, carrots, celery, cucumber, zucchini sticks, or radishes - Fruits and custards made with fat-free milk make nutritious, satisfying desserts that are not high in calories. - Broiling, baking, or boiling foods instead of frying can further reduce the caloric intake.

CONCERNS DURING PREGNANCY… �Pregnancy-induced hypertension (PIH) - was formerly called toxemia or preeclampsia -

CONCERNS DURING PREGNANCY… �Pregnancy-induced hypertension (PIH) - was formerly called toxemia or preeclampsia - characterized by high blood pressure, the presence of albumin in the urine (proteinuria), and edema. - occurs more frequently in first-time pregnancies, in multifetal pregnancies, in those women with morbid obesity, and among pregnant women on inadequate diets, especially protein-deficient diets. - Pregnant adolescents have a higher rate of PIH than do pregnant adults.

CONCERNS DURING PREGNANCY… �Pica - is the craving for nonfood substances such as starch,

CONCERNS DURING PREGNANCY… �Pica - is the craving for nonfood substances such as starch, clay (soil), or ice. - is most common among pregnant women. - The consumption of soil should be highly discouraged. Soil contains bacteria that would contaminate both mother and fetus. - Ingesting soil can lead to an intestinal blockage, and substances in the soil would bind with minerals, preventing absorption by the body and thus leading to nutrient deficiencies. - Eating laundry starch, in addition to a regular diet, will add unneeded calories and carbohydrates.

CONCERNS DURING PREGNANCY… � Anemia - is a condition caused by an insufficiency of

CONCERNS DURING PREGNANCY… � Anemia - is a condition caused by an insufficiency of red blood cells, hemoglobin, or blood volume. - The patient receive insufficient oxygen from the blood and consequently feels weak and tired, has a poor appetite, and appears pale. - Iron deficiency is its most common form. During pregnancy, the increased volume of blood creates the need for additional iron. - When this need is not met by the diet or by the iron stores in the mother’s body, iron deficiency anemia develops. - This may be treated with a daily iron supplement. - Folate deficiency can result in a form of megaloblastic anemia that can occur during pregnancy. - It is characterized by too few red blood cells and by large immature red blood cells. - The body’s requirement for folic acid increases dramatically when new red blood cells are being formed. Consequently, the obstetrician might prescribe a folate supplement of 400 to 600 g a day during pregnancy.

CONCERNS DURING PREGNANCY… �Caffeine is known to cross the placenta, and it enters the

CONCERNS DURING PREGNANCY… �Caffeine is known to cross the placenta, and it enters the fetal bloodstream. - Birth defects if large doses consumed - it is suggested that pregnant women limit their caffeine intake to 2 cups of caffeine-containing beverages each day, or less than 300 mg/day. �Drugs vary in their effects, but self-prescribed drugs, including vitamins and mineral supplements and dangerous illegal drugs, can all damage the fetus. �Drugs derived from vitamin A can cause fetal malformations and spontaneous abortion. Illegal drugs can cause the infant to be born addicted to whatever substance the mother used and, possibly, to be born with the

CONCERNS DURING PREGNANCY… �Tobacco risks include: - Reduced birth weight. The more the mother

CONCERNS DURING PREGNANCY… �Tobacco risks include: - Reduced birth weight. The more the mother smokes, the smaller her baby will be because smoking reduces the oxygen and nutrients carried by the blood. - SIDS (sudden infant death syndrome), fetal death, spontaneous abortion, and complications at birth. - affect the intellectual and behavioral development of the baby as it grows up. - it is advisable that pregnant women avoid them.

DIET FOR THE PREGNANT WOMAN WITH DIABETES � Diabetes mellitus is a group of

DIET FOR THE PREGNANT WOMAN WITH DIABETES � Diabetes mellitus is a group of diseases in which one cannot use or store glucose normally because of inadequate production or use of insulin. This impaired metabolism causes glucose to accumulate in the blood, where it causes numerous problems if not controlled. � Some women have diabetes when they become pregnant. Others may develop gestational diabetes during pregnancy. In most cases, this latter type disappears after the infant is born; however, there is a 40% increased risk of developing type 2 diabetes later in life � Either type increases the risks of physical or mental defects in the infant, stillbirth, and macrosomia (birth weight over 9 pounds unless blood glucose levels are carefully monitored and maintained within normal limits. � Every pregnant woman should be tested for diabetes between 16 and 28 weeks of gestation. Those found to have the disease must learn to monitor their diets to maintain normal blood glucose levels and to avoid both hypoglycemiaand hyperglycemia.

DIET FOR THE PREGNANT WOMAN WITH DIABETES…. �In general, the nutrient requirements of the

DIET FOR THE PREGNANT WOMAN WITH DIABETES…. �In general, the nutrient requirements of the pregnant woman with diabetes are the same as for the normal pregnant woman. The diet should be planned with a registered dietitian or a certified diabetes educator because it will depend on the type of insulin and the time and number of injections. �Clients with gestational diabetes and diabetic clients who do not normally require insulin to control their diabetes may require insulin during pregnancy to control blood glucose levels.

LACTATION �Lactation, the production and secretion of breast milk for the purpose of nourishing

LACTATION �Lactation, the production and secretion of breast milk for the purpose of nourishing an infant, is facilitated Oxytocin and prolactin. Prolactin is responsible for milk production, and oxytocin is involved in milk ejection from the breast. �It will take 2 to 3 weeks to fully establish a feeding routine; therefore, it is recommended that no supplemental feedings be given during this time. �Human milk is formulated to meet the nutrient needs of infants for the first 6 months of life. Iron content in breast milk is very low, but it is very well absorbed; therefore, no iron supplement is needed for breastfed babies.

Calorie Requirements during Lactation - The mother’s calorie requirement increases during lactation. - The

Calorie Requirements during Lactation - The mother’s calorie requirement increases during lactation. - The caloric requirement depends on the amount of milk produced. - Approximately 85 calories are required to produce 100 mlof milk. - During the first 6 months, average daily milk production is 750 ml, and for this the mother requires approximately an extra 640 calories a day. �During the second 6 months, when the baby begins to eat food in addition to breast milk, average daily milk production slows to 600 ml, and the caloric requirement is reduced to approximately 510 extra calories a day.

Lactation �In general, most nutrient requirements are increased during lactation. The amounts depend on

Lactation �In general, most nutrient requirements are increased during lactation. The amounts depend on the age of the mother. �Protein is of particular importance because it is estimated that 10 grams of protein are secreted in the milk each day. � sufficient fruits and vegetables, especially those rich in vitamin C. �Extra fat-free milk will provide many of the additional nutrients and calories required during lactation. Chips, sodas, candies, and desserts provide little more than calories. � sufficient fluids to replace those lost in the infant’s milk. Water and real fruit juice are the best choices. �The mother must reduce her caloric intake at the end of the nursing period to avoid adding unwanted weight

Medicines, Caffeine, Alcohol, and Tobacco - Most chemicals enter the mother’s milk, so it

Medicines, Caffeine, Alcohol, and Tobacco - Most chemicals enter the mother’s milk, so it is essential that the mother check with her obstetrician before using any medicines or nutritional supplements. - Caffeine can cause the infant to be irritable. - Alcohol in excess, tobacco, and illegal drugs can be very harmful. - The biggest concern is addiction of the mother and baby.

DIET DURING INFANCY �Food and its presentation are extremely important during the baby’s first

DIET DURING INFANCY �Food and its presentation are extremely important during the baby’s first year. �Physical and mental development are dependent on the food itself, and psychosocial development is affected by the time and manner in which the food is offered. � it is preferable to feed infants on demand. Feeding on demand prevents the frustrations that hunger can bring and helps the child develop trust in people. �The newborn may require more frequent feedings, but normally the demand schedule averages approximately every 4 hours by the time the baby is 2 or 3 months old.

NUTRITIONAL REQUIREMENTSINFANCY �The first year of life is a period of the most rapid

NUTRITIONAL REQUIREMENTSINFANCY �The first year of life is a period of the most rapid growth in one’s life. �A baby doubles its birth weight by 6 months of age and triples it within the first year. �This explains why the infant’s energy, vitamin, mineral, and protein requirements are higher per unit of body weight than those of older children or adults. � Nutritional needs depend largely on a child’s growth rate.

NUTRITIONAL REQUIREMENTSINFANCY… � During the first year, the normal child needs 98 to 108

NUTRITIONAL REQUIREMENTSINFANCY… � During the first year, the normal child needs 98 to 108 calories per kilogram of body weight each day. This is approximately two to three times the adult requirement. � Low-birth-weight infants and infants who have suffered from malnutrition or illness require more than the normal number of calories per kilogram of body weight. � The basis of the infant’s diet is breast milk or formula. Either one is a highly nutritious, digestible food containing proteins, fats, carbohydrates, vitamins, minerals, and water. � It is recommended that infants up to 6 months of age have 2. 2 grams of protein per kilogram of weight each day, and from 6 to 12 months, 1. 56 grams of protein per kilogram of weight each day. This is satisfactorily supplied by human milk or by infant formulas. � Infants have more water pound of body weight than do adults. Thus, they usually need 1. 5 ml of water per calorie. This is the same ratio of water to calories as is found in human milk and in most infant formulas. � Essential vitamins and minerals can be supplied in breast milk, formula, and food. Except for vitamin D, breast milk provides all the nutrients an infant needs for the first 4 to 6 months of life.

NUTRITIONAL REQUIREMENTSINFANCY… � An infant is born with a 3 - to 6 -month

NUTRITIONAL REQUIREMENTSINFANCY… � An infant is born with a 3 - to 6 -month supply of iron. When the infant reaches 6 months of age, the pediatrician usually starts the infant on iron-fortified cereal. � Human milk usually supplies the infant with sufficient vitamin C. � Academy of Pediatricians if the baby is not being breastfed. � Newborns lack intestinal bacteriato synthesize vitamin K, so they are routinely given a vitamin K supplement shortly after birth. � Care must be taken that infants do not receive excessive amounts of either vitamins A or D because both can be toxic in excessive amounts. � Vitamin A can damage the liver and cause bone abnormalities, and vitamin D can damage the cardiovascular system and kidneys.

Breastfeeding Advantages - Provides the infant with temporary immunity to many infectious diseases -

Breastfeeding Advantages - Provides the infant with temporary immunity to many infectious diseases - Sterile - Economic - Enhance bonding

BOTTLE FEEDING � Some women fear they will be unable to produce enough breast

BOTTLE FEEDING � Some women fear they will be unable to produce enough breast milk. � Some lack emotional support from their families, and some simply find breastfeeding foreign to their culture. � Others who are employed or involved in many activities outside the home find bottle feeding more convenient � Either way of feeding is acceptable provided the infant is given love and attention during the feeding. � The infant should be cuddled and held in a semi-upright position during the feeding It appears that babies fed this way are less inclined to develop middle ear infections than those fed lying down � During and after the feeding, the infant should be burped to release gas in the stomach, just as the breast-fed infant should be burped. Burping helps prevent regurgitation.

BOTTLE FEEDING…. �If the baby is to be bottle-fed, the pediatrician will provide information

BOTTLE FEEDING…. �If the baby is to be bottle-fed, the pediatrician will provide information on commercial formulas and feeding instructions. �Formulas are usually based on cow’s milk because it is abundant and easily modified to resemble human milk. �It must be modified because it has more protein and mineral salts and less milk sugar (lactose) than human milk. �Formulas, such as soy formula, are developed so that they are similar to human milk in nutrient and caloric values.

SUPPLEMENTARY FOODS � Children to be fed only breast milk during their first 12

SUPPLEMENTARY FOODS � Children to be fed only breast milk during their first 12 months. � The general recommendation is that the infant’s diet be limited to breast milk or formula until the age of 4 to 6 months and that breast milk or formula remain the major food source until the child is 1 year old. � With the appropriate supplements of iron and vitamin D and possibly vitamin C and fluoride, breast milk or formula � Solid foods must be introduced gradually and individually. � One food is introduced and then no other new food for 4 or 5 days. If there is no allergic reaction, another food can be introduced, a waiting period allowed, then another, and so on.

DIET DURING CHILDHOOD AND ADOLESCENCE � Children’s nutritional needs vary as they grow and

DIET DURING CHILDHOOD AND ADOLESCENCE � Children’s nutritional needs vary as they grow and develop. � The rate of growth slows between the ages of 1 and 10, and the child’s calorie requirement per pound of body weight slows accordingly. � However, nutrient needs gradually increase during these years. � During adolescence, growth is rapid, and nutritional and calorie requirements increase substantially. � Anorexia nervosa, bulimia, and obesity are problems of weight control that can occur during adolescence. � Fast foods are acceptable when used with discretion in a balanced diet. � Alcohol can be a serious problem for adolescents, and it is essential that adolescents understand its potential dangers. � The nutritional needs of athletes are similar to those of nonathletes except for increased needs for calories, B vitamins, sodium, potassium, and iron.

DIET DURING YOUNG AND MIDDLE ADULTHOOD �calorie requirements diminish after the age of 25,

DIET DURING YOUNG AND MIDDLE ADULTHOOD �calorie requirements diminish after the age of 25, most nutrient requirements do not. �food must be selected with increasing care as one ages to ensure that nutrient requirements are met without exceeding the calorie requirement. �Overweight can cause health problems. If it is caused by energy imbalance, a program of weight loss, which includes exercise, should be undertaken. �The diet should be based health plan, and eating habits should be taught so that the lost weight will not be regained later.

DIET DURING LATE ADULTHOOD �The rate of aging varies. Each person is affected by

DIET DURING LATE ADULTHOOD �The rate of aging varies. Each person is affected by heredity, emotional and physical stress, and nutrition. �The elderly are becoming an increasingly large segment and their nutritional needs are of growing concern. � Many of the chronic diseases of the elderly could be delayed or avoided by maintaining good nutrition throughout life. �Most nutrient requirements do not decrease with age, but calorie requirements do. �Older people are easily attracted to food fads that promise good health and prolonged life.

CONSIDERATIONS FOR THE HEALTH CARE PROFESSIONAL � Good nutrition during pregnancy can make the

CONSIDERATIONS FOR THE HEALTH CARE PROFESSIONAL � Good nutrition during pregnancy can make the difference between a healthy, productive life and one shattered by health and economic problems—for both mother and child. � Most pregnant women will want the best nutrition for themselves and their children. They also will be concerned about their weight during and after pregnancy. � It is essential that they receive advice from a properly trained health care professional. � As always, the health care professional must use great patience in reeducating those clients who may require it. � The pregnant teenager can present the greatest challenge. Her needs are vast, but her experience, and thus her perspective, is limited. � Teaching pregnant adolescents about good nutrition may be difficult but, if successful, can help not only that particular client but also her child and her friends.