Nutrition and Lactation in Pregnancy

Question 1

What are some of the metabolic changes that happen in early pregnancy?

Answer 1

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

Question 2

What are some metabolic changes in late pregnancy?

Answer 2

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)

Question 3

What nutrition preconception questions should be asked?

Answer 3

weight status
dietary practices
use of harmful substances

Question 4

What is birthweight influenced by?

Answer 4

mother’s pre-pregnancy weight and overall weight gain. base recommendations for weight gain are based on pre pregnancy weight.

Question 5

Why is weight gain important for pregnancy?

Answer 5

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.

Question 6

should you gain more or less weight than normal if you are already low weight? obese?

Answer 6

low weight = gain more weight

obese = gain less weight

Question 7

How much should you gain for twin pregnancies? triplets?

Answer 7

Twin pregnancies:
34-45 lb recommended weight gain
Weight gain/wk after 12th wk = 1.5 lb

Triplets:
Overall gain of 50 lb

Question 8

What are the risks of excessive maternal weight gain?

Answer 8

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

Question 9

How do the energy needs change in the 2nd and 3rd trimester?

Answer 9

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

Question 10

Why is folic acid needed during pregnancy? How much do you need?

Answer 10

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

Question 11

What food sources have folate?

Answer 11

Food sources of folate: legumes, green leafy vegetables, liver, citrus fruits, whole-wheat bread, fortified foods and supplements

Question 12

What are the mineral needs during pregnancy?

Answer 12

1. iron
2. calcium
3. vitamin D
4. choline

Question 13

Describe the iron needs during pregnancy?

Answer 13

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

Question 14

Describe calcium needs during pregnancy:

Answer 14

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

Question 15

describe vitamin d requirement during pregnancy:

Answer 15

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.

Question 16

Why is choline needed in pregnancy?

Answer 16

plays an essential role in fetal brain development

Question 17

What are the needs for choline. What are the food sources for choline?

Answer 17

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

Question 18

What is the prenatal vitamin and mineral supplement recommendations?

Answer 18

come back to me

Question 19

mega doses of what vitamin can cause defects?

Answer 19

vit A during early pregnancy

Question 20

should herbal teas be consumed during pregnancy?

Answer 20

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

Question 21

Are there sodium restrictions?

Answer 21

No restrictions recommended unless on low sodium diet prior to pregnancy for hypertension

Question 22

Are there caffeine restrictions in pregnancy?

Answer 22

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

Question 23

Are artificial sweeteners okay to drink?

Answer 23

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

Question 24

Are mercury and fish okay during pregnancy?

Answer 24

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)

Question 25

how can nausea and vomitting be avoided during pregnancy?

Answer 25

Consume small meals frequently, avoid offensive odors, drink enough fluids and getting adequate fresh air

Choose higher CHO foods such as crackers

Individualize food choices

Question 26

What bacteria may result in stillbirth?

Answer 26

May result in stillbirth, septicemia or meningitis
Can cause a serious bacterial infection
Avoid:
Mexican style cheese, feta, Brie, Camembert and blue cheese
lunch meat, deli meat or hot dogs unless reheated
refrigerated pate or meat spreads
smoked seafood unless reheated
Unpasteurized milk

Question 27

Why does heartburn occur during pregnancy?

Answer 27

Result of slowing movement of food through GI tract

Avoid lying down after eating, sleep with head slightly elevated, consume small frequent meals, avoid known irritants such as caffeine, chocolate, highly seasoned foods

Question 28

Why does constipation occur during pregnancy?

Answer 28

May be due to high doses of iron or as part of normal digestive changes
Include more high fiber food, increase fluid intake, get regular exercise

Question 29

Describe some of the benefits of great milk for baby?

Answer 29

• Tailored precisely for fetal growth & development
• Amino acid profile is ideal for neonatal brain
• Contains lipases that aid in fat digestion
• Adequate vitamin content
• Immunologic protection (IgA and digestive disorders)
• Decreased likelihood of overfeeding

Question 30

how long can you store breast milk for and have it be safe?

Answer 30

Can safely store breast milk in the refrigerator for 2-5 days and in the freezer up to 6 months

Question 31

What are some benefits of breast feeding for mom?

Answer 31

Reduction of breast cancer 
Control of postpartum blood loss
Postpartum wt. loss (from 3-6 months)
Convenience
Economic benefits
Mother/baby bonding

Question 32

When does gestational diabetes most often occur?

Answer 32

weeks 24-28

Question 33

How do we screen for gestation diabetes?

Answer 33

50 gram glucose tolerance
– positive screen serum value > 130

100 gram glucose tolerance
– 2 or more values exceed threshold (fasting <153)

Question 34

high blood sugars could cause what in the baby early and late in pregnancy?

Answer 34

congenital abnormalities and spontaneous abortions can occur in early pregnancy

late:
Hypoglycemia in the neonate
Macrosomia
Stillbirth
Respiratory distress syndrome
Increased rates obesity and diabetes in the neonate
Hypocalcemia, hyperbilirubinemia and polycythemia

Question 35

what are the pregnancy glucose goals?

Answer 35

Home glucose monitoring
Pregnancy blood glucose goals: fasting <120mg/dl
I
nsulin
Ongoing follow-up and monitoring

Question 36

What are the nutritional guidelines for diabetes?

Answer 36

Adequate calories for normal prenatal weight gain
40-45% calories from CHO (35-40% if obese)
Distribute CHO evenly between 3 meals and 2-4 snacks. Breakfast <45 g.
Evening snack to prevent ketosis
Match insulin to food
Consistent CHO vs. CHO to insulin ratio
3 meals/day with snacks based off individual schedule and types of insulin
Bedtime snack to prevent starvation ketosis.