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Life Cycle Nutrition: Pregnancy and Lactation
Chapter 15
Nutrition Prior to Pregnancy
Nutrition may affect fertility Preparation before pregnancy
Achieve and maintain healthy body weight Choose an adequate and balanced diet Be physically active Receive regular medical care Manage chronic conditions Avoid harmful influences
Growth and Development During Pregnancy
Placental development
Develops in uterus
Amniotic sac and umbilical cord
Expelled during childbirth Interweaving of fetal and maternal blood vessels Metabolically active organ
Requires energy and nutrients Produces hormones
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The Placenta and Associated Structures
Growth and Development During Pregnancy
Fetal growth and development
Fertilization of an ovum by a sperm Zygote
Rapidly divides to become blastocyst Implantation
Embryo
Eight weeks
Fetus
Full-term
Stages of Embryonic and Fetal Development
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Growth and Development During Pregnancy
Critical periods
Times of intense development
Cellular activities can occur only during these times
Adverse influences on organ and tissue development
The Concept of Critical Periods in Fetal Development
Critical Periods of Development
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Growth and Development During Pregnancy
Neural tube defects
Anacephaly
Brain either missing or fails to develop
Spina bifida
Incomplete closure of spinal cord & its bony encasement
Cause is unknown Risk factors Folate supplementation
Spina Bifida
Growth and Development During Pregnancy
Chronic diseases
Adverse influences at critical times during fetal development
Malnutrition type 2 diabetes Inadequate growth during placental & gestational development hypertension
Fetal programming
Mothers nutrition may change gene expression in fetus
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Maternal Weight
Birthweight is most reliable indicator of infants health Weight prior to conception
Influences fetal growth Underweight
Rates of preterm births and infant deaths
Overweight & obesity
Medical complications Risks for infant
Maternal Weight
Weight gain during pregnancy
Fetal growth and maternal health Correlates closely with infant birthweight
Predictor of health and development
Recommended weight gains
Number of fetuses Beginning weight
Recommended Weight Gains
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Maternal Weight
Weight gain patterns
3.5 pounds in first trimester 1 pound per week thereafter Large weight gain over short time
Preeclampsia
Components of weight gain
Placenta, uterus, blood, breasts, fluid volume, baby
Maternal fat stores
Recommended Prenatal Weight Gain Based on Prepregnancy Weight
Components of Weight Gain During Pregnancy
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Weight gain (lb) Increase in breast size Increase mother's fluid volume Placenta Increase in blood supply to the placenta Amniotic fluid Infant at birth Increase in size of uterus and supporting muscles Mother's necessary fat stores 2 4
1 1/2 4
2 7 1/2 2
7 30
Stepped Art
1st trimester
2nd trimester
3rd trimester
Figure 15-7 p478
Maternal Weight
Weight loss after pregnancy
Return to prepregnancy weight
Not typical
Retain a couple of pounds with each pregnancy Seven or more pounds; BMI increase 1 unit
Diabetes and hypertension Chronic diseases later in life
Exercise During Pregnancy
Can continue exercise throughout pregnancy
Adjust duration and intensity
Benefits Low-impact activities Fetal development
Excessively high internal body temperature Dehydration
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Exercise Guidelines during Pregnancy
Nutrition during Pregnancy
Dramatic changes Guidelines for a healthy pregnancy
Good nutrition Healthy weight gain Physical activity Prenatal supplements Avoiding harmful substances
Energy & Nutrient Needs During Pregnancy
Needs tend to be higher than any other time in life To meet needs
Make careful selections Body maximizes absorption Body minimizes losses
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Comparison of Nutrient Recommendations
Energy & Nutrient Needs During Pregnancy
Energy
Increase in basal metabolic rate
Second and third trimester
Food energy
15 to 20% more energy than before pregnancy Nutrient-dense foods
Daily Food Choices for Pregnancy & Lactation
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Energy & Nutrient Needs During Pregnancy
Carbohydrate
Ample carbohydrate is necessary
Protein
RDA additional 25 grams per day
Supplements are discouraged
Essential fatty acids
Omega-3 and omega-6 fatty acids for brain material
Energy & Nutrient Needs During Pregnancy
Blood production and cell growth
Fetal growth and development Maternal red blood cell mass Needs for synthesis of DNA and new cells
Folate Vitamin B12 Iron Zinc
Energy & Nutrient Needs During Pregnancy
Nutrients for bone development
Vitamin D
Deficiency interferes with calcium metabolism
Calcium
Absorption and retention increase Intake usually falls below recommendations
Other nutrients
Optimal interval between pregnancies
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Energy & Nutrient Needs During Pregnancy
Prenatal supplements
Calcium Folate Iron
Benefits of use
Vegetarian Diets During Pregnancy & Lactation
Can support healthy pregnancy and lactation
Well planned Food sources
Vegan diets
Additional supplementation Risks
Common Nutrition-Related Concerns of Pregnancy
Nausea
Morning sickness Hormonal changes
Constipation and hemorrhoids Heartburn Food cravings and aversions
Hormone-induced changes
Nonfood cravings
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Strategies to Alleviate Maternal Discomforts
High-Risk Pregnancies
Infants birthweight
Low birthweight (LBW)
5 pounds or less Risk of complications Relationship with socioeconomic status
Gestational age
Preterm Small-for-gestational age
High-Risk Pregnancy Factors
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High-Risk Pregnancies
Malnutrition and pregnancy
Fertility
Viable sperm Sexual interest Amenorrhea
Early pregnancy
Placenta development
Fetal development
Consequences
High-Risk Pregnancies
Food Assistance Programs
WIC
Nutrition education and nutritious foods Vulnerable populations who qualify for help Cost-benefit Remedial and preventive services
High-Risk Pregnancies
Maternal health
Preexisting diabetes
Risks associated with unmanaged diabetes
Gestational diabetes
Common consequences Dietary recommendations
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High-Risk Pregnancies
Maternal health
Chronic hypertension
Risks
Gestational hypertension Preeclampsia
Cause is unclear Risks for mother Risks for fetus
Eclampsia
High-Risk Pregnancies
Mothers age
Ideal childbearing age Adolescents
Risk of pregnancy complications Higher rates of stillbirths, preterm births, and LBW infants Weight gain recommendations Need to seek prenatal care
High-Risk Pregnancies
Maternal age
Older women
Complications often reflect chronic conditions Cesarean section rates increase Maternal death rates are higher Risks for fetus
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High-Risk Pregnancies
Alcohol consumption
Irreversible mental and physical retardation
Fetal alcohol syndrome (FAS)
Medicinal drugs
No medication use without consulting physician
Herbal supplements
Seek physician advice
High-Risk Pregnancies
Illicit drugs
Many drugs easily cross the placenta
Impair fetal growth and development
Other risks to fetus, infant, and child
Smoking and chewing tobacco
Harmful effects magnified during pregnancy Risks for mother and infant
SIDS
High-Risk Pregnancies
Environmental contaminants
Lead Mercury
Foods to avoid Supplements
Foodborne illness
Increased risk of listeriosis Risks associated with illness
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High-Risk Pregnancies
Vitamin-mineral megadoses
Excessive vitamin A
Fetal malformations
Caffeine
Miscarriage and fetal death Fetal growth
Restrictive dieting Sugar-substitutes
Lactation: A Physiological Process
Health benefits of breastfeeding Hormones promote growth and branching of duct system & milk-producing cells
Prolactin
Milk production
Oxytocin
Cause mammary glands to eject milk into ducts
Benefits of Breastfeeding
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Breastfeeding: A Learned Behavior
Lactation is an automatic, physiological process Breastfeeding is a learned behavior
Some decide not to breastfeed
Factors influencing breastfeeding and its success
Partner Adequate nutrition and rest
Tips for Successful Breastfeeding
Maternal Energy & Nutrient Needs During Lactation
Energy intake and exercise
Almost 500 extra kcalories per day Exercise is compatible with breastfeeding
Energy nutrients
Recommendations increase for carbohydrates and fibers
Water
Prevent dehydration
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Maternal Energy & Nutrient Needs During Lactation
Vitamins and minerals
Inadequacies reduce the quantity, not quality of breast milk
Quality maintained at expense of maternal stores
Prolonged inadequate intakes
Impacts several nutrients
Supplements
Iron
Maternal Energy & Nutrient Needs During Lactation
Food assistance programs
Participants are less likely to breastfeed WIC incentives to encourage breastfeeding
Particular foods
Flavors Allergies
Maternal Health
HIV infection and AIDS
Transmission through breastmilk
Medications
Diabetes type I Postpartum amenorrhea
Does not protect from pregnancy
Breast health
Breast cancer
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Practices Incompatible With Lactation
Alcohol
Easily enters breast milk Infants eat less when mother consumes alcohol
Medical drugs
Physician consultation
Illicit drugs
Risks
Practices Incompatible With Lactation
Smoking
Reduces milk volume Sleep less Passive smoking and SIDS
Environmental contaminants
DDT, PCBs, and dioxin
Caffeine
Iron bioavailability
Fetal Alcohol Syndrome
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Introduction
Alcohol readily crosses the placenta
Deprives fetus of nutrients and oxygen
Fetal alcohol spectrum disorder
Fetal alcohol syndrome (FAS)
Cluster of physical, mental, and neurobehavioral symptoms
Alcohol-related neurodevelopmental disorder (ARND) Alcohol-related birth defects (ARBD)
Introduction
Abstinence from alcohol during pregnancy is recommended
Severe consequences FAS can only be prevented not treated
Abstinence is recommended for those who may become pregnant
Typical Facial Characteristics of FAS
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Drinking During Pregnancy
Direct damage
Intoxication
Indirect damage
Malnutrition
Alcohol interferes with tissue development during critical periods Fetal blood alcohol concentration (BAC) increase until even with maternal BAC levels
How Much Is Too Much?
Even one drink a day may threaten neurological development and behaviors Total alcohol intake
Average intakes
Drinking patterns
Frequency of consumption Quantity consumed Stage of fetal development
When Is the Damage Done?
First one to two months of pregnancy Critical periods and alcohol exposure Male alcohol ingestion
May affect fertility and fetal development Association with low infant birthweight
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