Nutrition during pregnancy Flashcards
Pregravid Weight
- Obese: HPN, gestational diabetes, induced labor, C/S
–↑ neural tube defects, macrosomia, low Apgars, shoulder dystocia, childhood obesity
– Difficulty initiating breastfeeding - Underweight: premature delivery, LBW, IUGR ( intrauterine growth restriction)
–“programs” for adult heart disease,
Type II diabetes, hypertension, hyperlipidemia
Weight Gain: BMI
BMI Rec. Weight Gain
<18.5 28-40 lbs.
18.5-24.9 25-35 lbs.
25-29.9 15-25 lbs.
30 and > 11-20 lbs
Pattern of Weight Gain
1.1 – 4.4 lb total first trimester
• Then, slightly <1 lb/week
• Gaining too fast: watch portion size; avoid 2nd helpings; lower-fat dairy; lower-fat foods;
avoid sugary foods & drinks; increase exercise
• Gaining too slow: eat 5-6 x/day; nutrient & calorie dense foods; add cheese, honey,
margarine, sugar to foods already eating
Calorie Requirements
• Energy needs increase
• about 300 cal/day
–Total 2300 – 2400/day
• 4 cal/gram from carbohydrates & protein; 9 cal/gram from fats
Water
• Major component of fetus, placenta, breast tissue, blood
• Need 1 liter/1000 calories consumed
Protein
• RDA = 60 grams/day
–10 more than pregravid
–Meat-eaters exceed this
–1 qt.( 4 cups) milk/day = RDA
• Tissue growth & maintenance
• Water balance
• Nitrogen balance
• Antibody formation
• Nutrient transport
Iron
• RDA = 30 mg/day
– Double pregravid RDA
• Prevent anemia
• Emphasize dietary sources 1st
–Red meat, whole grains, dark green leafy vegetables
* Vitamins take 3-4 weeks to respond
Avoid Iron-deficiency Anemia
• RBCs microcytic (lack Fe for optimal formation)
– Depleted RBC mass, leads to lower Hgb concentration
–Low HCT (32%), low Hbg (11 g/dl)
• Fatigue, pallor, irritability, SOB, anorexia, susceptibility to infection and PPH (postpartum hemorrhage)
–**Pica - eating non foods **
• Treatment: 200 mg elemental Fe
Iron Supplementation
- Ferrous sulfate, ferrous gluconate, ferrous fumerate
• All poorly absorbed (30% at most) E: 325 mg TIB
– GI upset
– Give with Vitamin C source ( glass of orange juice)
–Avoid giving with milk
• Risk of iron overdose in children
Folic Acid (Folacin)
RDA = 600 mcg/day dietary folacin equivalents
• All women of childbearing age + pregnant
• Deficiency linked to neural tube defects (spine)
Dietary sources - beans, legumes, poultry, dark green leafy vegetables, whole grains, citrus fruits, shelfish
Avoid Folic Acid Deficiency
Folic Acid Deficiency Anemia
• Body uses folic acid to break down & use proteins & to form nucleic acids & heme
–Immature RBCs fail to divide (megaloblasts or macrocytes)
–Low Hgb
• Similar S/S to Fe-deficiency
• Treatment: 1 mg/TID
Studies: Benefits of Folic Acid
(1/08): supplement x 1 year, ↓ premature deliveries 50-70%
• (10/11): supplementation ↓ severe language delays in children age 3
Calcium
• RDA = 1000 mg/day; adolescents +300
–Risk for PIH may benefit with additional Ca+
• Dairy foods, tofu, fish packed with bones, dark green leafy vegetables, fortified juice
Fiber
• RDA pregnancy = 28 grams
• Study, July 2008
–21.2 g/day fiber 1st TM = 72% ↓ pre-eclampsia than < 11.9 g/day
• Foods
–Fruits, vegetables, whole grains, beans, legumes
Omega 3 Fats
Polyunsaturated fatty acids (DHA, EPA, ALA)
–Fish, fish oils, seeds, vegetable oils, leafy greens
–Brain, retina, nervous system development
–↓ PP depression, PTL, preeclampsia
• 300 mg/day RDA
–Oily fish
–Fish oil supplements
–Eggs, bread, juice
–Canola, sunflower, flaxseed oils
–Walnuts
Vitamin C
• RDA = 85 mg/day
• Antioxidant
• Tissue repair/healing
• Collagen formation
–Bones, cartilage, tendons, skin
• Brain development (animal studies)
Pica
- Craving substances with little or no nutritional value
- Cause unclear: vitamin/mineral need vs. physical or mental disorder
- Cultural component: spirituality, treatment for morning sickness, physical/emotional traits
- All races, all socioeconomic groups
• Common substances: dirt, clay, laundry starch, ice, burnt matches, cigarette ashes,
mothballs, soap, cornstarch, stones, charcoal, plaster, sand, coffee grounds, baking soda,
hair
Pica
• Potential harm (maternal)
–Toxic substances (i.e., lead poisoning)
–Parasite ingestion
–Interference with nutrient absorption
–Iron deficiency anemia link
–Bowel obstruction
– Dental injury
• Potential harm (fetal)
–LBW, preterm birth, stillbirth
Pica TX
Treatment
–Monitor Fe levels
–Psychological counseling
– Nutritional supplements
–Medications to control stress & depression
–“Buddy system” most successful !!!
–Substitutions (i.e., gum or mints)
Caffeine Intake
• March of Dimes: no >200 mg/day
• Crosses placenta, ↓ blood flow to fetus
• ? ↑ risk miscarriage, infertility
Caffeine, cont’d…
• Other issues
–? ↑ risk miscarriage & infertility
–Stillbirth: Denmark 2003, ↑ risk if 4 or > cups
– Newborns: slight ↓ birthweight, VS changes, sleeplessness
–Breastfeeding: small amount crosses into breastmilk; babies more irritable
Fish Intake: Mercury
- Limit 12 oz./wk. of salmon, shrimp, canned light tuna 4 oz / week, pollock, sardines, tilapia, catfish
- Consider source: farmed vs. wild, pollutants
- www.seafoodwatch.org
Food Safety in Pregnancy
- Avoid raw fish and shellfish
- Do not undercook meat, poultry & eggs ( salmonella )
- Avoid deli meats ( bacteria)
- Avoid soft cheeses & foods made with unpasteurized milk (listeriosis)
- Avoid unpasteurized juices & raw sprouts ( E coli)
- Avoid herbal supplements & teas: GRAS ( generally recognized and safe) only
WIC: Women, Infants & Children - not a welfare
• USDA program, unrelated to food stamps
• Pregnant ♀, postpartum 6-12 months, infants to age 1 (53%), children to age 5
• Supplemental foods, education, counseling, screening, referrals
• Income/nutrition risk requirement
–$27,991/family of 2
• Vouchers, EBT card, food delivery
WIC Benefits
• ~9,100,000/year: Ohio 2012, ~275,401
–~50% employed
• Iron-fortified formula & cereal, juice, adult cereal, fruit, juice, eggs, milk, cheese, peanut
butter, dried beans & peas, tuna fish, carrots
–Some organic foods allowed
• ↓ infant mortality, better birth outcomes
–Saves Medicaid $ (1:1.77-4.21)
WIC Updates 10/01/09
• Meet needs of culturally diverse groups
–Brown rice, tortillas, whole grains
• Cash-value vouchers
–Fruits, vegetables, tofu
–Baby food
• Mother & child’s packages combined
• Breastfeeding: 2x food
• New programs
–Recipes, food preparation tips
