Download Fundamentals of Nutrition

Chapter 11
Diet during Pregnancy and Lactation
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Facts
• Good nutrition in pregnancy essential for
mother and child
• Relationship between mothers’ diet and health
of baby at birth
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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)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Concerns during Pregnancy
•
•
•
•
Nausea
Constipation
Heartburn
Excessive weight gain
• Pregnancy-induced
hypertension
• Pica
• Anemia
• Alcohol, caffeine,
drugs, and tobacco
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Nausea
• Hyperemesis gravidarum:
– Occurs when nausea becomes so severe that it is lifethreatening
– May require hospitalization and parenteral nutrition
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Anemia
• Condition caused by insufficiency of RBCs,
hemoglobin, or blood volume
• Causes weakness, fatigue, poor appetite, and
pallor
(continues)
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Anemia
• Iron-deficiency anemia
– Most common form
• Folate deficiency may lead to megaloblastic
anemia
– Prevented by folate supplement
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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)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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)
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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
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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)
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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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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)
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Pregnancy during Adolescence
• Inadequate nutrition of mother related to both
mental and physical birth defects
• Much counseling and emotional support
needed
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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
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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)
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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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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)
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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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Conclusion
• Pregnant woman most likely to remain healthy
and bear healthy infant if following wellbalanced 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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.