Ch. 14 Pregnancy and Lactation (tegrity) Flashcards
Nutrition before pregnancy
Achieve and maintain a healthy weight (men and women) Choose an adequate balanced diet Be physically active Get regular medical checkups Manage chronic conditions Avoid harmful substances and behaviors
Growth and Development
Besides the fetus, there is also the placenta, amniotic sac, and umbilical cord
What factors can increase the risk for neural tube defects?
Family history of neural tube defect Maternal diabetes Certain medication use Folate deficiency or problem processing Maternal obesity
When did we start enriching grain products to reduce the risk for neural tube defects?
1995
Chronic Disease in Offspring
Maternal malnutrition = linked to offspring with type 2 diabetes and metabolic syndrome
Decreased growth during placental development = link to offspring with HTN
–placental development occurs extremely early, before women even know they’re pregnant
Fetal Programming
Mother’s nutrition may change gene expression in fetus
–ex: mother consumes a lot of added sugar, gene expression adapts to help baby deal with excess sugar
Maternal Weight
Birth weight is most reliable indicator of infant’s health
Maternal weight prior to conception:
- -influences fetal growth
- -underweight - increased rates of preterm births, infant deaths
- -overweight and obesity (medical complications and risks for infant)
Weight Gain
Indicates fetal growth and maternal health
Correlated with fetal birth weight
Weight Gain patterns
3.5 pounds in 1st trimester
1 pound per week after 1st trimester
–average birthweight in US = 7.5 pounds
–mother’s fat stores: varies in every pregnant woman
Large weight gain over short time
–preeclampsia
Weight loss after pregnancy
Retain a couple of pounds with each pregnancy
Seven or more pounds: BMI increases 1 unit
–diabetes and HTN
–chronic diseases later in life
Meeting energy and nutrient needs
Make careful selections - nutrient density
Body maximizes absorption [through gut]
Body minimizes losses [through kidneys]
Energy
NO INCREASE IN THE FIRST TRIMESTER
–you do NOT need to eat for two
15 to 20% more energy than before pregnancy
Macronutrients during Pregnancy
CHO:
–necessary for fuel of the developing fetus (fetus prefers to run on glucose)
PRO:
–additional 25 grams per day
Essential fatty acids:
–Omega-3 and Omega-6 fatty acids for brain development
Blood production and cell growth
Fetal growth and development Maternal RBC mass Need for synthesis of DNA and new cells Increases need for: --folate, vitamin B12, iron, zinc
Women who made good food choices typically do not require supplements. What is the exception to this statement?
Iron
Prenatal supplements
Great source of folate and iron
Poor source of calcium and vitamin D
Benefits of use
Decreased low birth weights and birth defects
Most effect seen in high risk mothers (substance abuse, multiple fetuses [twins, triplets…])
Low birth weight (LBW)
5.5 pounds or less
Risk of complications are much greater
Strong relationship with socioeconomic status (SES)
Gestational age: Preterm
Before 37 weeks gestation, but appropriate weight
Can “catch up” with growth and development
Most cause for concern if baby is delivered before lungs are adequately developed
Gestational age: Small-for-gestational-age
Growth failure in uterus
Typically do to “catch up” well
Malnutrition
Effects on early pregnancy
- -impaired placenta development
- -dysfunctional placenta = poorly nourished fetus (can lead to miscarriage)
Effects on fetal development
–growth retardation, birth defects, miscarriage, preterm birth, and LBW
Preexisting Diabetes
Preconception: unmanaged diabetes leads to infertility
Those with diabetes: extreme blood sugar fluctuations, preterm labor, pregnancy related to HTN
Gestational Diabetes
1 in 25 women develop it (very common)
Common consequences:
–high birth weight = macrosomia
–uncontrolled: birth defects
Dietary recommendations
- -first line of treatment
- -consistent CHO throughout the day
- ->minimizes blood sugar fluctuations
- -only use of insulin if necessary to control hyperglycemia
- ->extremely rare to use a pill for gestational diabetes
Chronic HTN
Risks to mother: stroke and heart attack
Risk to fetus: separation of placenta from uterus prior to delivery = fetal death
Gestational HTN
High BP in the 2nd trimester and on
Typically BP returns to normal following delivery
Can progress to preeclampsia
Preeclampsia
high BP and protein in urine
Risks for mother: decreased blood flow to organs
Risks for fetus:
- -decreased blood flow to placenta = decreased fetal growth
- -increased risk of miscarriage
Eclampsia
Sudden seizures or coma
Develops from preeclampsia
Treatment first includes decreasing BP and controlling seizure
Labor is induced, perhaps requiring a C-section
What is the highest cause for fetal and maternal deaths during childbirth?
BP issues
Maternal Age: Adolescents
Compete for nutritions for growth and fetal development
Decreased risk of pregnancy with early prenatal care
Weight gain = normal adolescent weight gain + pregnancy weight gain
–significantly greater weight gains
Maternal Age: Older women (≥ 35)
Complications often reflect chronic conditions
C-section rates 2x as high as younger women
Maternal death rates are higher
Risks for fetus
- -increased rate of preterm birth and children with genetic abnormalities
- -fetal death is twice as high
Lactation: A Physiological Process
Hormones promote growth and branching of duct system and milk-producing cells
Prolactin: milk production
Oxytocin: milk ejection
Triggered by infant demand for milk
99% of women are capable of lactation and milk production
Breastfeeding: a learned behavior
Lactation is an automatic, physiological process
Breastfeeding is a learned behavior
Factors influencing breastfeeding and its success:
- -partner’s support
- -adequate nutrition and rest
Who requires more energy: a lactating mother or a pregnant mother?
Lactating mother
It takes more energy to make breast milk than to make a baby and be pregnant
A lactating mother requires how much energy intake?
Almost 500 extra kcal per day
Lactation: energy nutrients
Recommendations increase for CHO and fiber
Protein and fats stay roughly the same as during pregnancy
Lactation: vitamins and minerals
Inadequacies reduce the quantity, not the quality of breast milk
Prolonged inadequate intakes lead to inadequacies
