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Maternal Nutrition

Preconception
» Lifestyle issues
» Preexisting conditions

Physiological changes
during pregnancy
» Nutritional implications

Nutrient requirements
during pregnancy

Recommended weight gain

Lifestyle choices
Preconception
______
 _________
 _________
 medical conditions
 psychological
readiness/stress
 ________, e.g.

» restrictions, eating disorders
» folic acid intake
_________________________
______________
 previous __________

Preexisting Medical
Conditions/
Pregnancy related
Conditions
1) Inborn Errors of
Metabolism
2) Other conditions
Phenylketonuria
(PKU)

______________________
» Lack of _________ to convert
phenylalanine (phe) to
tyrosine (tyr) leads to
__________________
– mental retardation, death

Risk for:
PKU treatment
maintain __________ as
low as possible
 maintain serum ________
 control ____________

» special low-phe foods are
necessary

maintain ______________
________ during
pregnancy

People with PKU should
not use aspartame
Celiac Disease
Sensitivity to ______ (in
wheat, rye, barley…)
 Causes malabsorption of
___ and ______________


general _____________

general nutrient _________

___________
Often undiagnosed!
 Must follow _________ diet

Type I Diabetes
pregnancy will make
____________ even harder
 increased need for ________
 uncontrolled blood glucose
can cause damage to fetus as
well as stress on mother


____________ fairly common
during pregnancy
»
»
blood _________,
glomerular filtration rate
(GFR)
Gestational Diabetes

Risk factors:

Risk for:
» _______________
» spontaneous __________
» perinatal ___________
» later development of Type II
diabetes (_________)
Pregnancy-induced
hypertension (PIH)

[preeclampsia

Characterized by:

Risk for:
eclampsia]
» ______________________
» HBP, _______________, type II
diabetes
PIH risk factors
preexisting ____________
 ____________
 PIH history
 dietary deficiencies:


age extremes

Do not restrict ________!
Physiological
Changes during
Pregnancy
Glossary






___________ = protein to which
oxygen bind in RBC
___________ = volume of packed
red blood cells (RBC)
__________ = physiological
(normal) anemia of pregnancy
_______________ = waves of
involuntary muscle contractions
in the GI system
_____ = Urinary tract infections
Glomerular filtration rate (GFR) =
rate at which fluid passes through
the kidneys
GI system



changed ___________
increased __________
decreased __________
» hypoperistalsis



enhanced ____________
heartburn
nausea, vomiting, constipation
» avoid strong smells or fried, greasy
foods; eat dry crackers before
getting out of bed; try small,
frequent meals; megadoses of
vitamin B6?

_____________
Fluids

Blood
»
blood __________: 150%
»
blood ____________
– 12-50 ml/min to 500-600 ml/min
» RBC increase less than BV =
________________ aka
“physiological anemia of
pregnancy”

Body ________content
increases as much as 20%
Blood pressure
drops early, then prone to
rise in later pregnancy
 _________________
increases due to increased
efficiency of gas exchange
in the lungs
 shift of diaphragm position
leads to ____________

Clinical Blood Values
Normal
Hematocrit
35%
Pregnancy
29-31%
Hemoglobin 13-14 g/dl 10-11 g/dl
Cholesterol
<200
mg/dl
200-325
mg/dl
Folacin
5-21
mcg/dl
3 mcg/dl
Iron
>50
mcg/dl
>40
mcg/dl
TIBC
250-400
mcg/dl
300-450
mcg/dl
Table 4-10, p. 95
Renal function

growth of uterus causes
______________
» greater need to ____________
» susceptibility to __________

renal ________ and ____ increase
» greater capacity to __________
» greater amounts of nutrients are
___________, perhaps more than
healthy kidneys can ________


_____uria and ______uria
are fairly common
increased need for _____________

Basal metabolic rate (BMR)
___________

____________ nitrogen
balance
Fuel Usage

Fetus: needs mostly ________
» 50-70%CHO, 20%aa, rest from fat
» hoards __________ for tissue
building

Mother: _____ becomes more
important
» _______________ decreases
because of relative lack of
____________
» more ____ is stored for future
needs, including _________
» (with less GNG and more
lipolysis, __________ may occur)
Hormones (proteins,
steroids)
1) _____________
» relaxes smooth muscle cells
–
»
»
»
GI motility
maternal ________ stores
capillary tension
renal _____ excretion
2) ____________
» promotes _____ growth/function
» alters _______________
structure
–
–
flexibility
water
______ = normal if
without HBP and proteinuria
The Placenta



Organ that supports __________
» ___________ to the uterus
» site of ________ synthesis
–establish pregnancy
–provide for fetal metabolism
and glandular systems
–suppress ______________
» ______ of oxygen, nutrients, and
______________
Mother and fetal blood supplies are
always ____________
Affected by ____________,
insufficient blood supply,
inappropriate _____________
Placental Nutrient
Exchange

Simple (passive) diffusion
» oxygen, CO2, fatty acids, fatsoluble vitamins, electrolytes

Facilitative diffusion
» CHO

Active ________
» amino acids, water-soluble
vitamins, minerals

Pinocytosis
» immunoglobulin G (IgG)
Stages of Fetal
Growth
1) _________________(~ 2 weeks)
» rapid ______________
» early placenta
» implantation of ____________
2) __________ stage (to 2 months)
» ____derm
CNS, hair, ____
» ____derm
voluntary
muscles, _____, cardiovascular
system, ______ systems
» ____derm
digestive and
________ systems,
glandular organs
3) ____ stage (to 38-40 weeks)
» ______ from 6 g to 3000-3500 g
Stages of Fetal
Growth

Blastogenesis and embryonic
» Hyperplasia occurs
» ____________ status important
» only serious general
malnutrition would cause harm
» certain deficiencies/exposures
could cause __________
– _______ is closed by day ____

_____ stage
» hyper_____ and hyper____,
then just _____________
» malnutrition now probably not
teratogenic, but could easily
affect __________
Illustration 4-11, p. 105
Terminology for
pteroylglutamic acid

________ = term for synthetic
form used in supplements and in
food fortification

________ = term for naturally
occurring form found in foods;
generic term

________ = generic term

Tetrahydrofolate (THF) =
__________
Functions of Folate
Co-enzyme in transfer of one-carbon units

_________ and _________
» synthesis of

formation of
DRIs for Folate

Dietary Folate Equivalents
(DFEs)
1 DFE = 1 mcg food folate =
0.6 mcg synthetic folic acid
in combination with food =
0.5 mcg synthetic folic acid
taken on empty stomach
DRIs for Folate
Life stage group
RDA (mcg/day)
Adults
400#
Pregnant women
600#
#All women capable of becoming
pregnant are recommended to
consume 400 mcg of folic acid
Growth Retardation





Severity, timing, and duration of
deficiencies matter
If only hyper______ affected, later
rehabilitation might reverse effects
Other effects might persist
Fetus does not always act as an
efficient “___________”
Growth failure
low __________
(____) baby = <_____ g
»
postnatal risk of
» tissue changes: placental cells,
brain cell #, _________, organ
size, altered ___________
Table 4-15, p. 103
Correlates of fetal
birth weight
_____________
(prepregnancy height, weight)

» ______weight (____ healthy wt)
–
risk for ____, premature birth,
____, pregnancy complications
(caesarian birth), low Apgar score
» _______ (~____ healthy wt)
–
risk for
________________________,
prolonged labor, pregnancy
complications (caesarian)
– baby:
______, difficulty
regulating blood glucose

Maternal weight gain
» _______ pound gain
recommended
Maternal Weight Gain
Depends on prepregnancy
weight and health
BMI
Low
(<18.5)
Recommended gain:
kg
lb
12.5-18
28-40
Normal
(18.5-24.9)
11.5-16
25-35
High
(25 to 29.9)
7-11.5
15-25
Obese
(30+)
5-9.1
11-20
Twins
15.9-20.5
35-45
Nutrient Needs during
Pregnancy
Dietary Guidelines for
Americans, 2005
Executive Summary
http://www.health.gov/dietaryg
uidelines/dga2005/document/ht
ml/executivesummary.htm
Nutrient Needs
during Pregnancy
Nutrient
Why change?

BMR, physical
activity

tissue growth

DNA synthesis

DNA synthesis,
neurological function

Bone

Bone
Bone
Teeth
Calcium metabolism



Nutrient Needs
during Pregnancy
Nutrient
Why change?






kcal needs
kcal needs
kcal needs
protein needs
Cell differentiation
oxygen transport

DNA synthesis,
enzyme co-factor...

Thyroid function

Connective tissue
No change!

Bioavailability of
Calcium in Foods
Food
Total Ca
(mg)
Milk
Juice w/ Ca
Tofu, Ca-set
Spinach
Beans, white
Turnip greens
Kale
Broccoli
Cabbage
Soy milk
300
300
258
122
113
99
47
35
25
5
Available
Ca (mg)
Servings
to = milk
96
150
80
6
20
51
28
18
16
2
1.0
0.6
1.2
15.5
5.0
2.0
3.5
5.0
5.0
60.5
Table 4-29, p. 122
Food Beliefs, Cravings,
Aversions, Avoidances

Cultural beliefs and attitudes
» perhaps restrict food intake in
order to have a smaller baby

____________ = compulsions
for or against certain foods
» very _________
» ____ = compulsion to consume
non-food items
– displace nutrients
– lead, heavy metal poisoning
– __________
– __________
__________ = conscious
decisions about food

__________: No known safe
level of intake
» Fetal Alcohol Spectrum,
including Fetal Alcohol ________
» primary cause of preventable
mental retardation in the U.S.

_______:possible _______
» < moderate use recommended

food ____________
» saccharin?
» aspartame: not for PKU

_______: O2 to fetus
____
Update: Trends in Fetal Alcohol Syndrome -- United States,
1979-1993
MMWR Weekly April 07, 1995 / 44(13);249-251
http://www.cdc.gov/ncbddd/fasd/data.html; accessed February 2, 2012
Food Safety
Concerns

Listeriosis
» L. monocytogenes thrives at
refrigerator temperatures

Toxoplasmosis
» T. gondii transmitted from
cat litter (not house cats)

Mercury contamination
» predator fish

SO…don’t eat
undercooked fish or meat,
poorly stored processed
meat, unpasteurized milk
or cheese, predator fish
Physiological Effects of
Smoking
BMR, blood pressure

need for V.C, folate
 damages platelets
blood clots

bone density

nitrosamine exposure

Health Effects of
Smoking
 Risk
factor for chronic
diseases:
»lung cancer
»coronary heart disease
»stroke
»hypertension
»osteoporosis
 Multiplies
risks from alcohol
Effects during pregnancy:

placental blood flow
– nutrient delivery
– waste removal
» oxygen delivery to fetus
» birth weight
Health Effects of
Smoking during
Pregnancy

Smoking correlates with:
»
intellectual and
behavioral development
» SIDS
» earlier menopause
 Smoking decreases volume of
breast milk
Exercise during
Pregnancy
Vigorous exercisers:
» fewer spontaneous
abortions
» “easier” labor and delivery
» higher Apgar scores
» no greater preterm
complications
 BUT babies were of lower
birth weight (lower body fat
reserves)
 So…moderate exercise
during third trimester is
recommended

Eating Pattern
Messages
Eat 3 meals and 2
snacks a day
 Eat a fruit or vegetable
at each meal and snack
 Drink 3 glasses of milk
each day
 Take a vitamin supplement
with folic acid each day
 Walk at least 30 total
minutes a day
 Visualize breastfeeding
your baby
