Maternal Nutritiyon During Pregnancy And Lactation Flashcards
What is recommend folic acid supplementation during pregnancy
400 mcg folic acid daily
How much weight should a pregnant women gain to be healthy
Underweight (BMI <18.5) = 28-40lbs during pregnancy
- 1 lb/wk roughly
Normal weight (BMI 18.5-24.9) = 25-35 lbs during pregnancy - 0.8-1 lb/wk roughly
Overweight (BMI 25-29.9) = 15-25 lbs during pregnancy
- 0.6 lb/wk roughly
Obese (BMI >30) = 11-20 lbs
-0.5 lb/wk roughly
Women during pregnancy should NEVER engage in weight loss diets
Not increasing enough weight. However can increase risk for
- preterm birth
- small for gestational age babies
Excessive weight gain increases risks for
- macrosomia
- neonatal obesity
- maternal obesity after pregnancy
How much extra Kcals per day are needed roughly in the 2nd and 3rd trimester
340 kcals in second trimester per day
450 kcals in third trimester per day
Macronutrient increases required for pregnancy
Protein = increased by 25g/day -> 71 g/day
- should be lean protein sources
- DONT use protein supplements
- ** too much protien = slower growth of baby, increased risk for gestation diabetes
Carbohydrates = at least 175 of CHO is recommended for pregnant women
- avoid refined CHO and focus on complex
- is required for fetal and maternal brain to sue so that proteins can be used for growth of fetus and not ketone bodies
Fat = 20-35% of all energy intake
- make sure to add adequate intake of omega-3 and omega-6 FAs
- 1.4g/day ACEIs is recommended
Plant-based diets in pregnancy
Not usually recommended without careful planning since protein needs are harder to meet
Micro vitamin intake recommend levels for pregnancy
The following are elevated in pregnancy:
1) Folic acid = 600 mcg/day (higher than normal 400)
- **this needs to be 4 mg/day total in women with history of neural tube defect births
- sources = green leafy vegetables, citrus foods, legumes
2) Iron = 27 mg/day
- 30 mg iron supplementation starting 2nd trimester is common
- this needs to be 60-180 mg if anemic
- this is required for maternal and fetal hemoglobin production
- not getting enough = increased risk of preterm birth, low birth weight, fatigue, decreased resistance to infection
- **to much can cause GI distress Tom other and fetus
3) Vitamin B12 = 2.6 mcg/day
- increased in pregnancy and is required to prevent NTDs and homocystinuria
NO changes in vitamin D or calcium intake
- need to get enough of both though since bone turnover increases during pregnancy for mom and fetus needs to both to grow
Hemoglobin criteria for diagnosis of anemia during pregnancy
1st trimester Hgb <11 g/dL
2nd/3rd trimester Hgb <10.5 g/dL
Vitamin A in pregnancy
While the levels of vitmain A do slightly increase with needs in pregnancy (700 -> 770), Excess vitamin A is a concern during pregnancy
- upper limit is 2800-3000 mcg/day
Excess amounts are known to cause birth defects
- MUST avoid supplements containing more than 1500 mcg (5000 IU)
Vitamin A derivative medications must be discontinued during pregnancy for risk of teratogenic effects
B-carotene in pregnancy
Precursor form of vitamin A found in plant foods and is not teratogenic
- this is an acceptable replace for vitamin A supplementation in pregnancy
Morning sickness in pregnancy
Common complaint and typically occurs from 4th week -> 16th week of pregnancy
- sometimes extends beyond 16th week
can get so bad can lead to hyperemesis gravida
Ways to limit this
- eating 6 meals a day
- eat easy digestible foods
- drinking water and caffeine free beverages
- drinking natural ginger fluids helps (not artificial though)
- low fat foods are easier to digest and can help with nausea (high fat foods make this worse)
Food borne illness in pregnancy
Are a serous issue
Common ways to prevent
- good personal hygiene
- only cook fully cooked meats and fish and poultry
- avoid unpasteurized dairy products
- rinse fruits and vegetables under water for 30 seconds minimum
- raw sprouts need to be avoided
Common food borne illness
- toxoplasmosis = ingestion of undercooked or cured meat, fruits, vegetables and contained water
- listeria = unprocessed foods, especially cold dairy, hot dogs, soft cheeses, smoked seafood, meat spreads, etc. Hot cooked foods prevents this
- brucellosis = is caused by ingestion of contained food such as raw milk, cheeses and raw meat
Fish intake during pregnancy
Fish is an excellent source of protein, however too much can increase mercury levels and be teratogenic
- 1-3 serves of fish or shell fish that are high in omega-3 FAs and low in mercury are okay per week (no more than 12 oz)
- *avoid shark, swordfish, king mackerel, orange roughly, tilefish and bigeye tuna**
- all are high in mercury
sushi grade raw fish is okay as long as its not any of the fish listed above to avoid
Caffeine in pregnancy
Should not consume more than 200 mg/day
12 oz Soft drinks = 40 caffeine
8 ozCoffee = 100 mg caffeine**
8 oz Green/black tea = 5o mg caffeine
8 oz Energy drinks = 100-250 mg caffeine**
Herbal products in pregnancy
All should be avoided except for ginger used to control morning sickness
- MUST ask abitut his if a pregnant patient comes to see you
Issues that can arise
- strength and purity concerns
- interact with commonly prescribed medications = dangerous ADRs
- potentially harmful effects by themselves
- post market regulation by FDA is required
Artificial sweeteners in pregnancy
Isn’t by itself, but has been found to increase infant BMI, childhood obesity and altered childhood preference for sweets have been seen
should avoid saccharin though altogether since it is the only one that can cross the placenta
