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Reproductive Fitness and
Prenatal Nutrition
By Jennifer Turley and Joan Thompson
© 2013 Cengage
Introduction
• PRE-CONCEPTUAL
NUTRITION
• Nutrition and Fertility
• Building the Blue
Ribbon Baby
• Energy and Nutrient
Needs
• PRENATAL NUTRITION
• Monitoring Good
Nutrition during
Pregnancy
• Energy and Nutrient
Needs
• Diet and Health Issues in
Pregnancy
• MyPlate for Pregnant
Women
• Prenatal Fitness and
Lifestyle Management
Pre-Conceptual Nutrition
• Nutrition affects fertility, conception,
implantation and embryonic
development
• Normal healthy body weight
• An antioxidant-rich nutritionally
adequate diet is needed; especially
important is sufficient folic acid and iron
– Genetic mutations, MTRR or MTHFR,
prevent the conversion of folate to folic acid
Nutrition and Fertility
Male & Female Fertility
Females: Low body fat inhibits ovulation, excess
body fat inhibits conception. A diet low in TFAs,
and SFAs, with higher MUFAs, vegetable proteins,
fiber, low GI carbohydrate sources and adequate
vitamins and minerals is a fertility diet.
Males: An organic diet free of pesticides supports
fertility.
Nutrition and Fertility
Celiac Disease and Infertility
• Celiac disease is an autoimmune disease
causing intestinal damage
• Dietary gluten from wheat, barley, and rye
trigger the autoimmunity and malnutrition
• Breastfeeding, delaying introduction of gluten
and amount of gluten exposure in infancy may
reduce disease risk
• Female reproduction: Delayed menarche,
amenorrhea, early menopause, infertility,
hypogonadism, recurrent abortions, and lowbirth-weight or preterm deliveries
• Male reproduction: Impotence
Nutrition and Fertility
Polycystic Ovarian Syndrome
• Endocrine disorder affecting 5-10% of women
• Caused by insulin resistance
• 60% have weight management issues,
increased risk of diabetes and gender cancers
• Irregular or no menstrual periods or irregular
ovulation, with or without monthly bleeding.
• Painful un-ruptured follicles on the periphery
of the ovaries
• Acne and excess hair growth on the face and
body with thinning scalp hair
Building the Blue
Ribbon Baby
• Healthy baby born at term from an
uncomplicated pregnancy
• 7 lb, 8 oz, 20 “ long
The Menstrual
Cycle
Follicular Phase: Days 114, ovum development,
estrogen domination,
stable emotions,
increased synthesis of
serotonin and
endorphin (feel good
neurochemicals)
Luteal Phase: Increasing
progesterone,
diminishing estrogen,
serotonin and
endorphin;
inflammation, craving
sweet-fat treats.
A balanced diet helps
transition through the cycle
Basics of Conception and Genetics
• 48 hour conception window , just prior to or at
ovulation
• Building the baby requires meiosis and mitosis.
• Typical body (somatic) cells reproduce or divide by
mitosis
• Gametes: egg and sperm with ½ the chromosomes,
23 each
• Zygote: produced from 2 fused gametes, has 46
chromosomes; 23 sets of 2, 1 set determines gender
• Cellular division (mitosis) and cellular differentiation
continue to occur through embryonic and fetal
development
Energy and Nutrient Needs
• Energy and nutrient needs pre-conceptually are the
same as a non-pregnant woman by life stage group
• Nutrient stores to sponsor a pregnancy and to
prevent maternal nutrient store depletion
• Calories: Gender and age specific EER formula
• Carbohydrate: 130 gm/day minimum; 45-65% of
Calories; ≤25% Calories from sugars; 1.4 grams/100
Calories for fiber
• Protein: 0.8 grams/Kg; 10-35% of Calories
• Fat: Adequate EFAs, 20-35% of Calories
Vitamins, Minerals, Water
•
•
•
•
Adult female values
Need adequate iron stores
Water DRI of 2.7 liters per day
Need adequate folic acid to prevent neural tube
defects; supplements and/or fortified foods in the
form of folic acid (400 µg/day) for 1 year prior.
Prenatal Nutrition
• Nutritional recommendations for mother and fetus
to stay alive, and to support the tissue changes.
• Increases in heart and respiratory rate, cardiac
output, red blood cell and plasma volume, and
oxygen consumption.
• Enlarged heart.
• Increase in appetite, thirst, metabolism, and body
temperature.
• More rapid kidney waste filtration, sodium and thus
body water retention.
Maternal Weight Gain
• Increased body water, fat, and lean body mass
Maternal Weight Gain
Pre-Pregnancy
BMI1
Underweight (BMI
Pregnancy
BMI2
Underweight
<18.5)
(BMI <19.8)
Normal weight (BMI Normal weight
Recommended
Weight Gain
28-40 pounds
25-35 pounds
<25)
(BMI <26)
Overweight
Overweight (BMI 15-25 pounds
(BMI 25-29.9)
26-29)
Obese
Obese
(BMI > 30)
(BMI > 29)
11-20 pounds
Food and Nutrition Board, subcommittee on nutrition status during pregnancy and
lactation.
2 National Heart Lung and Blood Institute expert panel on identification, evaluation,
and treatment of overweight and obesity in adults.
1
Fetal Growth and Development
•
•
•
•
•
•
•
•
1st 8 weeks, embryonic development
Week 9 to birth, fetal development
Full term, 38 week gestation
Weeks 17-20, gender determination
Placenta forms from the endometrium
Rapid cellular differentiation occurs
Critical period, high risk of teratogenic effects
Fetal growth and development is monitored by
measuring the uterus and listening to fetal heart
• Genetic testing for conditions like Down Syndrome
or Cystic Fibrosis when indicated
Fetal Growth and Development
Birth Size, Nutrition and Health
Outcomes
• Birth weight, newborns 1st weight immediately after
birth.
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–
–
–
Low birth weight, <5.5 lbs
Small for gestational age if born at term
Preemie if born > 3 weeks early
Low birth weight from maternal alcohol and/or tobacco
use, low prenatal weight gain, and exposure to lead,
solvents, pesticides, polycyclic aromatic hydrocarbons, and
air pollution
– Low birth weight and preemie increases risk for health
problems
Energy and Nutrient Needs
• Macronutrient recommendations are generally
made for pregnancy
• Micronutrient recommendations are made
depending on the trimester
• Energy (Calories)
–
–
–
–
1st trimester = EER
2nd trimester = EER + 340 Calories
3rd trimester = EER + 452 Calories
Too few or too many Calories consumed causes negative
health consequences for the baby and mother
– A woman should be healthy, have a healthy body weight,
and be nourished prior to becoming pregnant
Carbohydrate, Protein, and Fat
• Carbohydrate: 175 gm/day minimum; 45-65% of
Calories; ≤25% Calories from sugars; 1.4 grams/100
Calories for fiber
• Protein: 1.1 grams/Kg; 10-35% of Calories
• Fat: DRI for the EFAs increase, 20-35% of Calories
– Linoleic acid → arachidonic acid (AA)
– alpha-linolenic acid → eicosapentaenoic acid (EPA) →
docosahexaenoic acid (DHA)
– DHA supports CNS growth and development and cognition
– Eat low mercury fish or take a supplement
Vitamins, Minerals
and Water
• Consume a healthy diet.
• Take a prenatal vitamin and
mineral supplement during
the entire pregnancy
• Most of the DRIs for the
vitamins and minerals are
higher during pregnancy
and lactation
• Adequate water is
important
Vitamins, Minerals and Water
• Iron and folate for new cell synthesis
• Vitamin A for gene expression, growth, and
development
• Calcium absorption increases and kidney excretion
decreases
• Iodine for thyroxin a major metabolic hormone;
Inadequate levels cause mental retardation
• Zinc for catalytic, structural, and regulatory roles that
support growth and development
• Adequate water to support metabolic waste
removal, blood volume expansion, cardiovascular
function, thermal regulation and metabolism
Diet and Health Issues
Nausea and Vomiting
• Common and normal in the 1st trimester
• Likely from hormonal changes
• May occur in the morning or all day
• Control by avoiding foods and beverages that are
triggers and separating solid and liquid intake
Constipation and Heartburn
• Fiber and fluid promote regularity
• Small more frequent iron supplements to prevent
constipation from taking iron
• Small, frequent low fat meals to prevent heartburn;
also avoid foods that relax the lower esophageal
sphincter and sit up-right after eating for an hour
Diet and Health Issues
Pica
• Intake of non-nutritional foods like starch and clay
• Culturally based, familial factors, underlying
deficiencies of iron or zinc, or lead toxicity
Gestational Diabetes
• Transient type of diabetes, usually goes away after
pregnancy, can increase risk for type 2 diabetes
• Modified fasting glucose tolerance test given at the
beginning of the 3rd trimester
• Proper diet (with low glycemic index foods) and
exercise are the best treatment
Diet and Health Issues
Preeclampsia
• Very serious hypertension during pregnancy
• Healthy lifestyle with adequate rest, exercise and
consuming a well-balanced, antioxidant-rich for
prevention.
• Calcium and fish oil supplementation, reducing
sodium, and taking daily aspirin for prevention.
• Medication for treatment.
• If untreated, increased risk for heart disease, stroke
and type 2 diabetes for the mother and restricted
growth and respiratory distress for the baby.
• Symptoms include nausea, headache, blurred vision,
and certain abnormal urine and blood tests though
hypertension can be asymptomatic
Diet and Health Issues
Fetal Alcohol Syndrome
• Children born to mothers
who drank alcohol during
their pregnancy
• Preventable by not drinking
alcohol during pregnancy
• Visible characteristics of the
head, forehead, nose, jaw,
eyes, ears and lips
• Cognitive and behavioral
delays
• Ages 3-8 years is when
diagnosis is best made
Diet and Health Issues
Fish and Methylmercury
• Bacteria metabolically convert inorganic mercury to
methylmercury
• Contaminates waterways and bioaccumulates
• Crosses the placenta and causes small head size,
cerebral palsy, developmental delay and/or mental
retardation, blindness, muscle weakness, and
seizures
• Fish that are large and have long life spans have
higher levels; especially avoid shark, swordfish, king
mackerel, and tilefish
• Consume 2-6oz servings of low methylmercury fish
MyPlate for Pregnant Women
Prenatal Fitness and Lifestyle
Management
• Exercising will reduce; the loss of muscular and
cardiovascular fitness; excessive maternal weight
gain, the risk of gestational diabetes, preeclampsia,
the development of varicose veins, deep vein
thrombosis, and the complaints about low back pain
and the poor psychological adjustment to physical
changes of pregnancy
• 30 minutes or more of moderate-intensity physical
activity everyday is safe unless medical conditions
• It’s best to consultation with a healthcare provider
• Avoid activities with a high risk of falling, causing
abdominal trauma or putting stress on the joints
• Protect the breasts and avoid overheating
Summary
• Pre-conceptual nutrition affects fertility, conception,
implantation and the development of the embryo
and so does celiac disease and PCOS – taking a folic
acid supplement is recommended.
• The “fertility diet” is low in TFAs, SFAs, higher in
MUFAs, vegetable proteins, fiber, low glycemic index
carbohydrate sources, and adequate in all of the
essential vitamins, minerals, amino acids, fatty acids,
and water.
• The prenatal DRIs include increased maternal and
fetal nutritional needs for proper growth,
development, and function.
Summary
• Prenatal weight gain and healthcare monitoring
determines risk for developing medical conditions of
pregnancy such as preeclampsia and gestational
diabetes and promotes good nutrition.
• Prenatal fitness includes; following the eating plan
provided by MyPlate, taking a prenatal multivitamin
and mineral supplement, engaging in regular
exercise, getting plenty of rest, and being wise about
lifestyle choices.
References for this presentation are the same as those for this topic found in module 7 of the textbook