Chapter 11

1. Chapter 11 Diet during Pregnancy and Lactation

2. Objectives • Identify nutritional needs during pregnancy and lactation • Describe nutritional needs of pregnant adolescents • Modify normal diet to meet needs of pregnant and lactating women

3. Facts • Good nutrition in pregnancy essential for mother and child • Relationship between mothers’ diet and health of baby at birth

4. Weight Gain during Pregnancy • Average: • 25 to 35 pounds for normal-weight woman • 28 to 40 pounds for underweight woman • At least 15 pounds for overweight woman • But less than normal-weight woman • No one should lose weight (continues)

5. Weight Gain during Pregnancy • First trimester: • 2- to 4-pound weight gain • No additional calories usually required • Second and third trimesters: • 1-pound weight gain per week • Additional 300 calories required

6. Nutritional Needs during Pregnancy • Folic acid supplementation prior to conception decreases risk of brain and spinal cord defects • Protein requirement increased by 20 percent for pregnant woman over age 25 • 25 percent for pregnant adolescent • Excess vitamin A can cause birth defects (continues)

7. Nutritional Needs during Pregnancy • Requirements for the following increased: • All water-soluble vitamins • Vitamin B and vitamin C • Calcium, iron, zinc, iodine, and selenium • Iron supplements commonly prescribed due to drastic increase in needs

8. Fulfillment of Nutritional Needs during Pregnancy • Base diet on MyPyramid • Drink additional fat-free milk or appropriate substitute • Prenatal vitamins and iron supplement may be prescribed • Over-the-counter nutrient supplements may be harmful to fetus

9. Concerns during Pregnancy • Nausea • Constipation • Heartburn • Excessive weight gain • Pregnancy-induced hypertension • Pica • Anemia • Alcohol, caffeine, drugs, and tobacco

10. Nausea • Also known as morning sickness • Occurs most commonly during first trimester • Suggestions: • Eat dry crackers or dry toast before rising • Eat small, frequent meals • Avoid food with offensive odors • Avoid liquids at mealtime (continues)

11. Nausea • Hyperemesis gravidarum: • Occurs when nausea becomes so severe that it is life-threatening • May require hospitalization and parenteral nutrition

12. Constipation • Constipation and hemorrhoids can occur during pregnancy. • Suggestions: • Eat high-fiber diet • Participate in daily exercise • Drink at least 8 glasses of water per day • Respond promptly to urge to defecate

13. Heartburn • Can result from pressure on stomach by growing fetus and relaxation of cardiac sphincter and smooth muscles related to progesterone. • Suggestions: • Eat small, frequent meals • Avoid spicy or greasy foods • Avoid liquids at mealtime • Wait at least one hour after eating to lie down and two hours before exercising

14. Excessive Weight Gain • Re-evaluate diet and eliminate foods that do not fit within MyPyramid • Suggestions: • Drink fat-free milk • Eat clean, crisp, raw vegetables as snack • Eat fruits and custards made with fat-free milk as desserts • Broil, bake, or boil instead of fry

15. Pregnancy-Induced Hypertension • Formerly known as pre-eclampsia or toxemia • Characterized by high blood pressure, presence of protein in urine, and edema in third trimester • May progress into eclamptic stage with convulsions, coma, and possible death of mother and infant (continues)

16. Pregnancy-Induced Hypertension • Higher incidence with first pregnancy, multifetal pregnancies, morbidly obese women, or women with inadequate diets • Especially protein-deficient • More frequent in pregnant adolescents

17. Pica • Craving for nonfood substances • E.g., starch, clay (soil), or ice • Discourage ingestion of soil due to possible contamination and nutrient deficiencies • Multiple nutritional deficiencies can result

18. Anemia • Condition caused by insufficiency of RBCs, hemoglobin, or blood volume • Causes weakness, fatigue, poor appetite, and pallor (continues)

19. Anemia • Iron-deficiency anemia • Most common form • Folate deficiency may lead to megaloblastic anemia • Prevented by folate supplement

20. Alcohol, Caffeine, Drugs, and Tobacco • Alcohol • Fetal alcohol syndrome (FAS) • Characterized by growth deficiency, central nervous system dysfunction, microcephaly, and other physical characteristics • Fetal alcohol effect (FAE) • Causes fewer physical defects but many behavioral and psychosocial problems • Abstinence recommended (continues)

21. Alcohol, Caffeine, Drugs, and Tobacco • Caffeine • Causes birth defects in rats, but no data exist for humans • Limit intake to < 300 mg per day • Drugs • Effect of prescription or self-prescribed drugs varies but includes possible damage to fetus • Vitamin A and its derivatives can cause fetal malformations and spontaneous abortions (continues)

22. Alcohol, Caffeine, Drugs, and Tobacco • Drugs • Illegal drugs can cause infant to be born addicted or born with human immunodeficiency virus (HIV) • Tobacco • Smoking associated with low birth weights, sudden infant death syndrome, fetal death, spontaneous abortions, and complications at birth

23. Diet for the Pregnant Woman with Diabetes • Some women have diabetes before pregnancy • Gestational diabetes • Occurs during pregnancy and disappears after birth • Routine screening part of prenatal care • Between 16 and 28 weeks • Insulin often used during pregnancy to control any type of diabetes (continues)

24. Diet for the Pregnant Woman with Diabetes • Nutrient requirements of pregnant woman with diabetes same as non-diabetic pregnant woman • Diet plan depends on type and number of insulin injections required • Artificial sweeteners found to be safe during pregnancy

25. Pregnancy during Adolescence • Nutritional, physical, psychological, social, and economic demands on pregnant adolescents tremendous • Nutrition must meet needs of adolescent’s growing body and needs of fetus • High risk for pregnancy-induced hypertension and premature delivery (continues)

26. Pregnancy during Adolescence • Inadequate nutrition of mother related to both mental and physical birth defects • Much counseling and emotional support needed

27. Lactation • Production and secretion of breast milk for purpose of nourishing infant • Supply and demand mechanism • No supplemental feedings should be given until feeding routine established • Human milk formulated to meet nutrient needs of infants for first six months of life

28. Benefits of Breastfeeding for the Infant • Breast milk has perfect composition for baby’s needs • No babies allergic to mother’s milk • Human milk contains at least 100 ingredients not found in formula • Breast milk provides antibodies (continues)

29. Benefits of Breastfeeding for the Infant • Lower incidence of ear infections, diarrhea, allergies, and hospital admissions • Promotion of good jaw development • Decreased risk of obesity later in life • Facilitation of bonding

30. Benefits of Breastfeeding for the Mother • Helps lose weight gained during pregnancy • Stimulates uterus to contract back to original size • Is economical • Provides opportunity for resting • Is always right temperature and readily available

31. Nutrient Requirements during Lactation • Food and Nutrition Board suggests increase of 500 calories per day • Most nutrient requirements increased • Especially protein • Base nutrition on MyPyramid • Fluid intake should replace fluids used for milk production (continues)

32. Nutrient Requirements during Lactation • Most chemicals can pass into mother’s milk • Avoid alcohol, tobacco, and illegal drugs • Check with obstetrician before using any medication or nutrient supplement • Caffeine may make infant irritable

33. Considerations for the Health Care Professional • Articles in newspapers and magazines may be inaccurate • Re-education may be necessary • Teaching pregnant teenagers presents biggest challenge

34. Conclusion • Pregnant woman most likely to remain healthy and bear healthy infant if following well-balanced diet • Anemia and pregnancy-induced hypertension • Two conditions that can be caused by inadequate nutrition • Caloric and most nutrient requirements increase for pregnant and lactating women