Nutrition and Lactation in Pregnancy Flashcards
What are some of the metabolic changes that happen in early pregnancy?
Increased glycogen storage Increased glucose utilization Increased insulin response to glucose Hypoglycemia can be a problem in pregnancies complicated by diabetes Hyperemesis and food intolerance related to HCG Increased nutrient absorption Increased fat deposition Increase of blood volume (2nd trimester) Elevation of basal metabolic rate
What are some metabolic changes in late pregnancy?
Increased insulin resistance related to HPL and estrogen
Accelerated growth of the fetus
More rapid diversion to fat metabolism in fasting state (accelerated starvation)
Higher free fatty acids and ketone production (increased DKA)
What nutrition preconception questions should be asked?
weight status
dietary practices
use of harmful substances
What is birthweight influenced by?
mother’s pre-pregnancy weight and overall weight gain. base recommendations for weight gain are based on pre pregnancy weight.
Why is weight gain important for pregnancy?
Influences fetal growth and length of gestation.
Inadequate wt. gain is associated with increased prematurity rate and LBW
LBW is major determinant for infant mortality and morbidity.
LBW related to increased risk CVD, DM, HTN and obesity later in life.
should you gain more or less weight than normal if you are already low weight? obese?
low weight = gain more weight
obese = gain less weight
How much should you gain for twin pregnancies? triplets?
Twin pregnancies:
34-45 lb recommended weight gain
Weight gain/wk after 12th wk = 1.5 lb
Triplets:
Overall gain of 50 lb
What are the risks of excessive maternal weight gain?
Can lead to increased risk of gestational diabetes, hypertension and type 2 diabetes.
Increases risk of fetal macrosomia, shoulder dystocia and childhood obesity
Obesity increases risk of neural tube defects independently of folate intakes
Bringing weight into a healthy range before pregnancy makes conception easier, improves pregnancy outcomes and may enhance lactation productivity
How do the energy needs change in the 2nd and 3rd trimester?
ENERGY needs - 2nd & 3rd trimester
Additional 100-300 kcal/day in adults and older adolescents
500 kcal/day in young adolescents (<14yr)
Protein needs:
Additional 10-12 grams
Approx. 71 gms/day
Why is folic acid needed during pregnancy? How much do you need?
Folic acid helps prevent neural tube defects (NTDs)—serious birth defects of the spinal cord (such as spina bifida) and the brain (such as anencephaly). Neural tube defects occur at a very early stage of development, before many women even know they’re pregnant.
RDA – 600 mcg during pregnancy
RDA – 500 mcg during lactation
400 mcg recommend supplementation prepregnancy to prevent neural tube defects
4.0-5.0 mg recommended for women in high risk category (insulin dependent diabetes)
Vegans should also take B12 – low folate and B12 are independent risk factors for neural tube defects
What food sources have folate?
Food sources of folate: legumes, green leafy vegetables, liver, citrus fruits, whole-wheat bread, fortified foods and supplements
What are the mineral needs during pregnancy?
- iron
- calcium
- vitamin D
- choline
Describe the iron needs during pregnancy?
27 mg/day recommended during 2nd and 3rd trimester of elemental iron
10 mg/day during lactation
Food sources: lean red meat, fish, poultry, dried fruits, iron fortified cereals
Improves iron status during pregnancy and postpartum
Describe calcium needs during pregnancy:
Requirements during pregnancy 1300 mg for ages 14 – 18 years 1000 mg for ages 19 - 50 years (elemental calcium) 3-4 servings milk products/day If no milk products or calcium-fortified foods, a calcium/vitamin D supplement is indicated
describe vitamin d requirement during pregnancy:
Current recommendations for women during pregnancy is 600 IU
Dietary vitamin D absorption is low compared to endogenous production (sunlight)
5-50% of women in the U.S. are deficient in vitamin D during pregnancy
Studies show that Vitamin D is important for fetal development, can prevent congenital rickets and may be a predictor of infant size.
Question whether 600 IU is adequate.
Why is choline needed in pregnancy?
plays an essential role in fetal brain development
What are the needs for choline. What are the food sources for choline?
Essential nutrient (B-like vitamin)
Plays key role in fetal brain development
Influences neurotransmission with effects on the brain,
heart, muscle, G.I. tract
Adequate levels were developed by the Institute of Medicine
nonpregnant: 425 mg/day
pregnant: 450 mg/day
Nursing: 550 mg/day
NHANES 2003-04 average intake during pergnancy is 339 mg/day
Foods to enhance choline:
eggs, beef steak, salmon, lean ground beef, tilapia, pork chops, ham, shrimp, chicken, legumes, green leafy vegetables, wheat germ, low-fat milk
What is the prenatal vitamin and mineral supplement recommendations?
come back to me
mega doses of what vitamin can cause defects?
vit A during early pregnancy
should herbal teas be consumed during pregnancy?
The American Academy of Pediatrics recommend limited consumption of herbal teas
Very few randomized studies have examined the safety of herbal supplements during pregnancy
Women should be suspect of herbal supplements until safety can be ascertained
Are there sodium restrictions?
No restrictions recommended unless on low sodium diet prior to pregnancy for hypertension
Are there caffeine restrictions in pregnancy?
Crosses the placenta and can affect fetal heart rate and breathing
May increase risk of spontaneous abortion and low birth weight
Recommend <300 mg/day
Are artificial sweeteners okay to drink?
Recognized as safe
Saccharin does cross the placenta and may remain in fetal tissues. Should use moderate amounts in foods
Women with PKU need to limit use of aspartame due to phenylalanine content
Limit use to less than 4 servings per day
Are mercury and fish okay during pregnancy?
Can damage the nervous system, lungs, kidneys, vision and hearing
Avoid high mercury fish (i.e. shark, swordfish, king mackerel, tilefish)
Limit consumption of light tuna and other fish to 12 oz./week or albacore tuna to 6 oz./week (good source of DHA)
