Nutrition for Childbearing Flashcards
Many women do not understand the nutritional needs of pregnancy
Nutrition changes per trimester & in the postpartum phase
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
* 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
Distribution of Weight Gain
* To maternal reserves, extravascular fluids, breasts, uterus, fetus, placenta, amniotic fluid
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
Nutritional Requirements During Pregnancy: Terms to Know
* Dietary Reference Intakes
* Recommended Daily Allowance
* Adequate Intake
* Tolerable Upper Intake Level
* Estimated Average Requirement
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Is the nutrient intake that is assumed to be sufficient when the RDA can’t be determined
Adequate Intake
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Are all the terms that estimate our nutrient needs
Dietary Reference Intakes
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Is the highest amount of a nutrient that can be taken without probable adverse health effects
Tolerable Upper Intake Level
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Is the amount of a nutrient estimated to meet the needs of half the healthy people in that age group
Estimated Average Requirement
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Is the amount of nutrients that meets almost all healthy people in an age group
Recommended Dietary Allowance
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)
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
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
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
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
Nutritional Requirements: Minerals
Iron
Calcium
Sodium
Sodium
- More needed b/c of increased blood volume & fetal needs
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
Vitamin D
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
Vitamin C
! Iron can have undesirable side effects including nausea, vomiting, heartburn, and black, tarry stools (which is normal)
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
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)
8-10
Food Plan
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
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)
Moderate daily exercise during pregnancy is encouraged
> Monitor diet
> Modifications to meet the increased nutritional needs of pregnancy
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)
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)
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
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
