Pregnancy Infancy HLTH 120 N Lecture 16 Identify

Pregnancy & Infancy HLTH 120 N; Lecture 16

�Identify optimal weight gain ranges during pregnancy �Recognize factors that increase risk of complications during pregnancy and through the life of the infant �Understand lactation and nutrient needs associated with it �Identify advantages and disadvantages of breastfeeding & formula feeding Objectives

�Pre-Conception ◦ Avoid Nutrient Deficiency / Toxicity ◦ Avoid substances that cause defect ◦ Maintain a healthful body weight & diet � �Adequate nutrition is essential for tissue formation, neurological development, bone growth, and modeling Nutrition before & during pregnancy

�Must support mothers functions plus normal fetal growth & development �Full ◦ � 3 term / Gestation: weeks trimesters ◦ 13 -14 weeks each Nutrition During Pregnancy

�Begins when the egg is fertilized �At day 10 implants in uterine lining ◦ Cell growth, multiplication & differentiation ◦ Which nutrients? �Next 6 weeks structure of body forms �Placenta is formed by week 4 ◦ Becomes a fully functioning organ � 1 st Trimester

�Week 8 ◦ Organs & tissues dramatically differentiated ◦ � 3 rd Month ◦ Embryo is now a fetus ◦ Many nutrients needed for dramatic growth ◦ Irreversible damage can occur �Blood supply 1 st Trimester

Second �Fetus grows & matures �Some pre-mature can survive Third �Important organs mature �Gains nearly ½ length & ¾ weight! �Average 7. 5 lbs; 18 -22 inches 2 nd & 3 rd Trimesters

�Likely �Low with: birth weight: �Pre-term: �SGA: ◦ Not pre-term, just low weight �Risks: Low birth weight

�Large gains can be risky �Pattern of weight gain is important: ◦ First trimester: ◦ Second & third trimesters: per week �Overweight: 0. 6/wk Obese: 0. 5 lb/wk �Weight loss during pregnancy may deprive the fetus of critical nutrients Weight Gain during pregnancy

What about pregnant adolescents? With twins, gain should be 37 -54 lbs

What is all the weight?

�Requirements for nearly all nutrients increase during pregnancy �Select foods �My. Pyramid �Monitor Plan for Moms is a useful tool intake of: ◦ ◦ ◦ Nutrition During Pregnancy

�Energy Balance ◦ 2 nd and 3 rd trimester: + ◦ Safe, moderate physical activity kcal/day �Carbohydrates ◦ g/day minimum �Protein ◦ g/kg/day �Fats ◦ Help newborns regulate body temperature ◦ Omega-3 (DHA) ◦ Limit ; avoid fats Macronutrients

�Calcium �Folate �Iron �Vitamin B 12 �Zinc �Vitamin C �Sodium �Vitamin A �Iodine �Vitamin D Micronutrients – most critical

Folate B 12 � Required for cell � Regenerates active division & development folate of � RDA ↑ � Deficiency � � Absorption more �macrocytic anemia efficient (immature blood cells) � RDA increases � Who should supplement?

Vitamin C � Synthesis of _______ � Decreased concentration in maternal blood � Deficiency: preterm births, complications � RDA: 85 mg/day; ◦ more if _____ Vitamin A � 10% increased need � Deficiency ◦ ↑ risk of low birth weight, growth problems, preterm delivery � Excess?

� RDA = same as for non-pregnant women � RDA = 1, 300 mg/day for adolescents � Absorption is efficient � Pregnant lactoseintolerant women? Calcium � AI does not increase � Supplements recommended: ◦ Darkly pigmented skin ◦ Limited sun exposure/ not regular milk drinker � Excessive vitamin ◦ Developmental disabilities Vitamin D D

� Infant (3 rd need increases trimester) � Iron-deficiency anemia � Deficiency increases rate of low birth weight, preterm, stillbirth, and death � RDA = 27 mg per day � Sources? Iron � Need increases 38% � Critical for DNA, RNA, protein synthesis � Deficiency ◦ malformations, premature birth, decreased birth size � Absorption from supplements low � Sources? Zinc

�RDA not altered �Excess? �Maintain balance �Needs ↑ significantly �Sprinkling salt onto food unnecessary fluid ◦ ↑ body fluid a normal and necessary part of pregnancy Sodium �Balanced, healthful diet will provide all the iodine needed during pregnancy Iodine

�Are prenatal supplements required? �Meeting all nutrient needs requires careful and complex dietary planning �Good insurance for �“supplement” defined? Supplements During Pregnancy

�Fluid need increases to �Body temperature regulation �Amniotic liters per day fluid – function? �Combat fluid retention, constipation, and dehydration (morning sickness/vomiting) �Prevent UTI Fluids During Pregnancy

�Morning �Cravings sickness and aversions �Heartburn �Constipation �Gestational and hemorrhoids diabetes �Preeclampsia Nutrition-Related Concerns

�Nausea/vomiting pregnancy �Only associated with in the morning? �Symptoms can be reduced ◦ ◦ ◦ Well-tolerated: popsicles, jello, watermelon, and mild broths Morning Sickness

�Crave salty) a certain type of food (sweet, �Some evidence supports that cravings indicate a deficiency ◦ Pica: �Aversions are common Cravings and Aversions

�Hormones relax smooth muscles ◦ Slow colonic movement of food residue �Fiber needs: �Consume �Be - g/day adequate fluids physically active Constipation

�Insufficient insulin production or insulin resistance increases blood glucose levels �Requires strict diet, physical activity, and/or medication �Risks ◦ ◦ Gestational Diabetes

�Gestational hypertension: no symptoms �Pre-eclampsia: sudden increase in maternal blood pressure �↑ Risk with deficiency ◦ Vitamins C and E, calcium, magnesium �Treatment: �The bed rest, medical oversight only cure is childbirth Hypertensive Disorders

�Full physical stature not yet attained �Require more energy and bone-related nutrients ◦ Often inadequate weight gain �Higher rates of prenatal alcohol & drugs �Risks: Adolescent Pregnancy

�Caffeine is a stimulant ◦ Crosses the placenta � 1 or 2 cups of coffee (200 mg of caffeine) per day is not likely to harm the fetus �Higher amounts ◦ Increase risk of miscarriage, impair growth Consumption of Caffeine

�Alcohol crosses the placenta �Immature liver cannot metabolize alcohol �Condition: �Risks: ◦ spontaneous abortion, delivery complications, low birth weight, sudden infant death syndrome �Abstain: no known safe level Consumption of Alcohol

�Exposes infant to toxins ◦ lead, cadmium, cyanide, nicotine, carbon monoxide etc. �Fetal blood flow reduced �Risks: ◦ miscarriage, stillbirth, placental abnormalities, growth retardation, preterm, low birth weight ◦ Higher rates of sudden infant death syndrome, and. Smoking

�Avoid raw or undercooked. . ◦ Eggs, meat/fish/poultry, sprouts, and unpasteurized juices and milk �Avoid large fish ◦ Shark, swordfish, and king mackerel and limit canned albacore tuna ◦ Be mindful of marine toxins/preparation Food Safety

� �Helps to feel in control of changing body �Reduces �Lowers risk of blood pressure; ↓ �Lessens lower back pain �Shortens the duration of active labor Exercise

�Lactation: production of breast milk � : first milk produced ◦ Rich in proteins, antibodies, vitamins, minerals ◦ Good bacteria in the infant’s GI tract Hormones �Synthesize milk & stimulate “let down” Breastfeeding

�Milk production requires - cal/day �Consume 300− 400 kcal/day above pre-pregnancy needs �Gradual weight loss �Increased needs: protein, carbohydrates, DHA, vitamins, minerals (calcium), fluid Nutrient Needs w/ breastfeeding

�High-quality nutrition: protein, DHA �Absorbable iron, calcium, magnesium � prevent allergies & infections �Assists mother in �Suppresses �Convenient, ovulation cost-efficient Advantages of Breastfeeding

�Requires patience and practice �Harmful substances are passed into breast milk: drugs, caffeine, alcohol, pesticides, mercury �HIV is transmitted through breast milk �Social concerns Challenges to Breastfeeding