Nutrition for Childbearing

Question 1

Many women do not understand the nutritional needs of pregnancy

Answer 1

Nutrition changes per trimester & in the postpartum phase

Question 2

Weight Gain During Pregnancy

* Too little or too much weight gain can have negative effects

* Caution w/women who are over- or under-weight (a psychiatric component) pre-pregnancy

• Based on BMI; be cautious w/conversations

Answer 2

* Obese women are at an increased risk for spontaneous abortion

* Risk for gestational DM & HTN, preeclampsia, prolonged labor, cesarean births w/associated wound complications, postpartum hemorrhages, macrosomia (a newborn who’s much larger than average), & congenital anomalies

Question 3

Distribution of Weight Gain

* To maternal reserves, extravascular fluids, breasts, uterus, fetus, placenta, amniotic fluid

Answer 3

Question 4

Women at Risk for Inadequate Weight Gain

* Young

* Low income

* Less educated

* Poor general health

* Insufficient prenatal care

* Smoker (connected to low birth weight infants)

* Substance abuser

Question 5

Nutritional Requirements During Pregnancy: Terms to Know

* Dietary Reference Intakes

* Recommended Daily Allowance

* Adequate Intake

* Tolerable Upper Intake Level

* Estimated Average Requirement

Question 6

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Is the nutrient intake that is assumed to be sufficient when the RDA can’t be determined

Answer 6

Adequate Intake

Question 7

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Are all the terms that estimate our nutrient needs

Answer 7

Dietary Reference Intakes

Question 8

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Is the highest amount of a nutrient that can be taken without probable adverse health effects

Answer 8

Tolerable Upper Intake Level

Question 9

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Is the amount of a nutrient estimated to meet the needs of half the healthy people in that age group

Answer 9

Estimated Average Requirement

Question 10

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Is the amount of nutrients that meets almost all healthy people in an age group

Answer 10

Recommended Dietary Allowance

Question 11

Nutritional Requirements: Energy

Carbohydrates

> Simple carbs (i.e. table sugar, candy, fruits, vegetables)

> Complex carbs (the better choice; e.g. vitamins, minerals, & fiber in starchy veggies, cereal, & pasta)

Fats

> Fat-soluble vitamins (linoleic acid, alpha-linoleic acid, or DHA)

Answer 11

Calories

> Approximately 80,000 additional calories needed over the course of a pregnancy

> Most women need a daily intake of 2200-2900 during pregnancy

• Aim for calories to be from nutrient-dense foods
• Avoid empty calories

! If fats & carbs provide insufficient calories, body starts to use proteins to meet energy needs

• Protein then won’t be available for building tissues → fetus

Question 12

Nutritional Requirements: Protein

* Daily recommended dietary allowance for females: 46g

* Daily recommended dietary allowance in pregnancy: 71g

* Diets low in caloric intake may be low in protein

* Encourage high protein foods over protein substitutes

Answer 12

Nutritional Requirements: Vitamins

* True deficiencies are unlikely to occur in North America

> Fat-soluble vitamins (don’t need to consume everyday)

A, D, E, K

Stored in the liver

> Water-soluble vitamins (do need to put in daily diet)

B6, B12, C, folic acid, niacin

Not stored in the body; should be a part of the daily diet

Question 13

Nutritional Requirements: Folic Acid

* Decreases the occurrence of neural tube defects (e.g. spina bifida, anencephaly)

* Also helps prevent cleft lip, cleft palate, & some heart defects

* All women of childbearing age should consume adequate amounts of folic acid every day

* 400-800mcg daily for all women of childbearing age

* 600mcg daily for pregnant women

* 4mg daily for women taking anticonvulsant rx’s or w/a history of an infant w/neural tube defects

Question 14

Nutritional Requirements: Minerals

Iron

Calcium

Sodium

Answer 14

Sodium

• More needed b/c of increased blood volume & fetal needs

Question 15

Calcium

• Girls 18 years & younger may need more calcium (their bones are still developing)
• Whole fat, low-fat, & non-dairy fat products contain the same amounts of calcium
• Caffeine increases the excretion of calcium
• Consume with ___ to increase absorption

Answer 15

Vitamin D

Question 16

Iron

• Only nutrient that cannot be supplied completely & easily from the diet
• Transfers to the fetus even if the mother is anemic
• 25% of heme-iron is absorbed (animal proteins); 5% of nonheme-iron (from plants) is absorbed
• Consume with ___ to increase absorption

Answer 16

Vitamin C

! Iron can have undesirable side effects including nausea, vomiting, heartburn, and black, tarry stools (which is normal)

Question 17

Vitamin & Mineral Supplementation

* Is no standardization of regulation for the amounts of ingredients contained in supplements is available at this time

* Each woman should be assessed individually to determine if supplementation is needed

* Large quantities of some supplements can have negative effects on the fetus

Question 18

Nutritional Requirements: Fluid Intake

Recommendation: ___ to ___ cups of fluid each day

Water should constitute most of the fluid intake

Limit fluids low in nutrients (e.g. soda; teas & coffees that have diuretic effects)

Answer 18

8-10

Question 19

Food Plan

Answer 19

Food Safety During Pregnancy & Lactation

* NO shark, swordfish, king mackerel, or tilefish (large fish have high levels of mercury that can cause damage to the fetal CNS)

* Eat up to 6oz canned albacore weekly

* Eat up to 12oz shrimp, canned light tuna, salmon, pollack, & catfish each week

* Do not eat raw or undercooked fish, meat, poultry, or eggs; no sushi

Question 20

Food Safety During Pregnancy & Lactation cont’d

* Avoid luncheon meats & hot dogs unless reheated to steaming hot (can be contaminated w/L. monocytogenes = listeriosis ⇒ premature labor, death of infant, spontaneous abortion)

* Avoid soft cheeses unless made w/pasteurized milk

* Do not consume refrigerated pate or meat spreads, refrigerated smoked seafood, raw or undercooked eggs or meat, or raw milk products (causative of toxoplasmosis)

Question 21

Moderate daily exercise during pregnancy is encouraged

> Monitor diet

> Modifications to meet the increased nutritional needs of pregnancy

Question 22

Nutritional Risk Factors

* Socioeconomic status (TANF, WIC)

* Adolescence (need more calcium, zinc, magnesium, phosphate)

* Vegetarianism (combine incomplete w/complete proteins)

* Lactose intolerance

* Pregnancy-related nausea & vomiting (eat dry carbs, e.g. toast, crackers in the AM)

* Anemia (ferritin <10ng)

Answer 22

Nutritional Risk Factors cont’d

* Abnormal pre-pregnancy weight

* Eating disorders

* Food cravings & aversions

* Pica (eating non-foods or some food components that are not considered a part of the normal diet, e.g. ice, clay, corn starch; puts at risk for iron deficiency)

* Multifetal pregnancy (extra 300 cal/day per fetus)

* Substance use & abuse (smoking decreases appetite, causes low birth weight infants, fetal-alcohol syndrome; more research needed on caffeine)

Question 23

Women, Infant, and Children (WIC)

* Provides nutritional assessment, counseling, & education to low-income women & children

* Provides food vouchers for approved foods only

* Applicable throughout pregnancy & for 6-12 months postpartum for women

* Applicable for up to age 5 for children

Answer 23

Nutrition for Postpartum Mothers

If Breastfeeding:

* Additional 500 calories needed per day for the first 6 months

* Additional 400 calories needed per day for subsequent 6 months

* Do not breastfeed for at least 2 hours after consuming alcohol

* Excessive caffeine intake can cause irritability in the infant

For all Postpartum Mothers

* Dieting should be postponed for at least 3 weeks to allow healing

* Avoid appetite suppressants as these can pass on to the infant