K - 15 Nutrition During Pregnancy (Gizi)

7/31/2019 K - 15 Nutrition During Pregnancy (Gizi)

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NUTRITIONDURING

PREGNANCY

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Nutrition before conception

Risk assessment, healthpromotion, intervention

Weight

Maintain a healthy weight Vitamins

Folic acid/day

Avoid high doses of retinol

Substance use Eliminate prior to

pregnancy

Photo PhotoDisc


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Effect of nutritional status on

pregnancy outcome

1. Maternal size

- maternal size ~ placental size indicator of placental health

determines the amount of nutrient

available to the fetus

birth weight-prepregnancy weight


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2. Weight Gain

During Pregnancy


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Recommended weight gain during

pregnancy based on BMI

Total 1st 2nd & 3rd

weight gain trim weekly gain

Underweight 12.5 18 2.3 0.49

(BMI < 19.8)

Normal weight 11.5 16.0 1.6 0.44

(BMI 19.8 26)

Overweight 7.0 11.5 0.9 0.3

(BMI 26 29)Obese 6.0

(BMI > 29)

Twins 15.9 20.4

Triplets/multiples >22.7


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Normal components of maternal

weight gain during pregnancyOrgan, tissue or fluid (g)

Uterus 970

Breasts 450

Blood 1250

Water 1680

Fat 3350

Maternal components = 7700

Fetus 3400Placenta 650

Amniotic fluid 800

Non-maternal components = 4850

Total = 12550


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3. Obesity

risk

- Gestational DM

- Pregnancy induced hypertension

- Cesarean section

- IUFD

Hesitant to gain weight during pregnancy

Should be told that pregnancy is not a time forweight loss


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4. AdolescenceRisk factor for poor pregnancy outcome in teenagers

- Maternal age 15 yrs

- Pregnancy < 2 yrs afteronset of menarche

- Poor nutrition & lowprepregnancy weight

- Poor weight gain

- Infection

-

STD infection- preexisting anemia

- Substance abuse :smoking, drinking, drugs

- Poverty

- Lack of social support- Lack of education

- Rapid repeat pregnancies

- Lack of access to age-appropriate prenatalcare

- Late entry into thehealth care system


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Deficiencies of :

- folic acid

- other vitamins

- calcium

- vitamin D

- energy

- micronutrients


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Clinical findings :

- poor weight gain during pregnancy

- LBW- premature birth


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Physiologic changes in the GI tract

Primarily as a result of the relaxation of

smooth muscle

Esophageal regurgitation, emptying timeof the stomach, reverse peristalsis heartburn

water absorption from the colon

constipation

Hormonal changes nausea & vomiting


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Nutritional requirements

Energy

- additional energy is required

- metabolism by 15%

- 2002 DRI :

- 1st trim : = not pregnant

- 2nd trim : + 340 360 kcal/day- 3rd trim : + 112kcal/day


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Protein

Additional protein is required support the

synthesis of maternal & fetal tissues

RDA : 71 g (> 25 g than not pregnant)

Deficiency adverse consequences


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Specific nutrients to consider

Folic acid

Calcium

Iron

Zinc


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Folic acid

req, for - maternal erythropoiesis- fetal & placental growth

- prevention of NTD

RDA : 600 g 400 g from fortified foods orsupplement & 200 g fromfoods

Deficiency :

- megaloblastic anemia

- congenital malformations


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The Centers for Disease Control &

Prevention :

all female of childbearing age their intake of

folic acid, because :- 50% of all pregnancies in US are unplanned

- neural tube closed by 28 days of gestation

Supplementation should begin before

conception


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US Public Health Service :

- all women of childbearing age capable ofbecoming pregnant should consume 400 gfolic acid /day

The American College of OG :

- women who are planning a pregnancy & have

previously had a child with NTD take 4 mg of

folic acid/day beginning 1 mo prior to

conception 3 mo of pregnancy


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Three major type of Neural Tube Defects

Anencephaly Spina bifida Encephalocele


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PHYSICAL IMPACT

Spina bifida often

causes lifelongdisabilities:

paralysis


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NTDs can require complex medicalmanagement, often including multiple

surgeries.


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Orange juice, oranges

Liver

Avocado

Dried beans and peas; lentils Dark green leafy vegetables

(spinach, mustard, turnip,

collard greens)

Broccoli Asparagus

Folate-rich Foods


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Fortified Foods

Good way to get synthetic

folic acid with minimalbehavior change

Blood levels are increasing


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Folicacid 30%

Pasta fortified with 140 micrograms per 100 grams flour(FDA, January 1998)


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Iron

RDA 27 mg/day (18 mg for non pregnant)

Many women start pregnancy with poor iron

stores & target iron intake is often not achieved

from diet alone supplementation is oftennecessary

30 mg in divided doses of ferrous iron

supplements daily during the 2nd & 3rd trim


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Calcium

AI 1000 1300 mg

Supplementation is necessary for those

who do not drink milk or eat dairyproducts

Daily intake < AI calcium loss from

maternal skeleton

Increased Requirements


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Increased Requirements


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Nonnutritive substances in food

Caffeine

- risk of 1st trimspontaneous abortion

as consumption from 100

mg to > 500 mg /day


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Pica

Consumption of substance with little or no

nutritional value (dirt, clay, ice, chalk, baking

soda, hair, stone, cigarette ashes)

Some reasons :

- relief of nausea or nervous tension

- a deficiency of an essential nutrient

- pleasant sensation when chewing

Possible risks : gastrointestinal disorders


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Nausea & Vomiting

Common during 1st trim, resolves 13th 14th wk

Vomit excessively

deficit in protein, energy,vitamins & minerals

Fluid & electrolyte imbalance (+) hospitalized

for rehydration & prevent ketosis


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Recommendation for nausea &

vomiting

Eat crackers or dry cereal before getting out of

bed in the morning Eat small, frequent meals

Liquids are best consumed between meals

Avoid drinking coffee and tea Avoid or limit intake of fatty and spicy foods


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Heartburn

Common during the latter part of

pregnancy

Often occurs at night

Effect of pressure from the enlarged

uterus on the intestine & stomach,

relaxation of the esophageal sphincter

regurgitation


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Recommendation for heartburn

Eat small low-fat meals, slowly

Drink fluids between meals

Avoid spices

Avoid lying down for 1 to 2 hours after eating

or drinking Wear loose-fitting clothing


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Constipation & hemorrhoids

Usually occurs in the 3rd trim

Causes :

- gut motility

- physical inactivity

- pressure exerted on the bowel by the

enlarged uterus


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Recommendation for constipation

Drink 2 to 3 quarts of fluids daily

Eat high-fiber foods, including cereals,whole grains, legumes and fresh fruits and

vegetables

Be physically active Avoid taking laxatives


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Gestational DM

Goal :

- provide all required nutrients

- prevent hyperglycemia & ketosis

- insure appropriate weight gain

Meal plan is individualized & expert care is

needed


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Summary

Energy intake to meet nutritional needs andallow for about 0.4kg weight gain /wk duringthe last 30 wk of pregnancy

Protein intake to meet nutritional needs

Mineral & vitamin intakes to meet RDA

( For folic acid requires supplementation and

for iron it is also likely that is required) Alcohol omitted

Caffeine in moderation


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HEALTHY BABIES

START WITHHEALTHY MOMS


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K - 15 Nutrition During Pregnancy (Gizi)

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