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Nutrition Through the Life Cycle: Pregnancy and the First Year of Life

16. Nutrition Through the Life Cycle: Pregnancy and the First Year of Life. Nutrition Before Conception. Adequate nutrition is essential for tissue formation, neurological development, bone growth, modeling, and remodeling Helps to achieve peak physical and intellectual potential in adult life.

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Nutrition Through the Life Cycle: Pregnancy and the First Year of Life

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  1. 16 Nutrition Through the Life Cycle: Pregnancy and the First Year of Life

  2. Nutrition Before Conception • Adequate nutrition is essential for tissue formation, neurological development, bone growth, modeling, and remodeling • Helps to achieve peak physical and intellectual potential in adult life

  3. Nutrition Before Conception • Problems related to nutrient deficiency develop early • Neural tube defects: • Related to inadequate folate status • Effects the embryo in the first few weeks • Adequate folate (400 µg daily) before conception can reduce the risks

  4. Nutrition Before Conception • Avoid teratogens that cause birth defects: alcohol and illegal drugs • Consult physician about consumption of caffeine, medications, herbs, supplements • Quit smoking

  5. Nutrition Before Conception • A healthful diet and appropriate levels of physical activity before conception • Promote optimal body weight • BMI 19.8 to 26.0: best chance of uncomplicated pregnancy and delivery • Lower risk of negative outcomes such as prolonged labor, cesarean section, gestational diabetes, and hypertension

  6. Nutrition Before Conception • A man’s nutrition before conception is also important • Sperm number and motility (ability to move) are reduced by alcohol consumption and certain prescription and illegal drugs • Adequate nutrition keeps the immune system strong and promotes fertility

  7. Nutrition During Pregnancy • A balanced, nourishing diet throughout pregnancy provides the nutrients needed and: • Supports fetal growth and development • Provides the mother with the nutrients she needs • Minimizes the risks of excess energy intake

  8. Nutrition During Pregnancy • Full-term pregnancy (gestation) lasts 38 to 42 weeks: • Three trimesters lasting 13 to 14 weeks each • Zygote: a single, fertilized cell • Embryo: weeks 3 to 8 after fertilization • Fetus: week 9 to birth

  9. First Trimester • Zygote travels through the fallopian tube and implants in the wall of the uterus • Development of organs, limb buds, facial features, placenta • Vulnerable to teratogens during this time • Spontaneous abortion (miscarriage) • Placenta provides nutrients via the umbilical cord

  10. Second Trimester • Continued growth and maturation • Growth from ~3 inches to over a foot long by the end of the second trimester • Some babies born prematurely (the end of second trimester) survive with intensive neonatal care

  11. Third Trimester • Time of intense growth and maturation • Fetus gains ½ to ¾ of its weight • Brain growth is also extensive • Lungs become fully mature • A balanced, adequate diet for the mother continues to be critical

  12. Low-Birth-Weight Infants • Likely among undernourished mothers • Low birth weight: baby born weighing <5.5 lb • Increased risk of infections, learning disabilities, impaired physical development, and death in the first year of life • Preterm babies are born before 38 weeks • Infants that are small for gestational age (SGA) are full-term but weigh less than expected for age

  13. Weight Gain During Pregnancy • Typically 25−35 lb • Too much weight gain is also risky • Pattern of weight gain is important: • First trimester: 3−5 lb • Second and third trimesters: average 1 lb per week • Weight loss during pregnancy may deprive the fetus of critical nutrients

  14. Nutrition During Pregnancy • The requirement for nearly all nutrients increases during pregnancy • Select foods high in nutrient density • MyPyramid Plan for Moms is a useful tool • Pay attention to intakes of: • Macronutrients (energy) • Micronutrients • Fluids

  15. Macronutrients • Energy • Second and third trimesters: add 350−450 calories/day • Maximize nutrient density • Safe and physician-approved program of regular moderate physical activity • Proteins and Carbohydrates • 1.1 gm/kg body weight/day of protein • 175 grams/day minimum of carbohydrates

  16. Macronutrients • Fat • Same percentage of calories as in non-pregnancy • Limit saturated fat; avoid trans fats • Fat helps newborn regulate body temperature • Omega-3 polyunsaturated fatty acid docosahexaenoic acid (DHA) is critical for neurologic and eye development

  17. Folate Vitamin B12 Vitamin C Vitamin A Vitamin D Calcium Iron Zinc Sodium Iodine Micronutrients • Micronutrients that are most critical during pregnancy include:

  18. Folate • Required for cell division • Critical for development of the neural tube (future brain and spinal cord) • Deficiency is associated with neural tube defects (spina bifida, anencephaly) and macrocytic anemia (immature blood cells) • RDA = 400 µg/day for sexually active women • RDA = 600 µg/day for pregnant women

  19. Vitamin B12 • Regenerates the active form of folate • RDA = 2.6 µg/day during pregnancy • Absorption more efficient during pregnancy • Sources: animal foods • Fortified foods or supplementation for women on vegan diets

  20. Vitamin C • Synthesis of collagen (connective tissues) • Decreased concentration in maternal blood: increased blood volume, vitamin transferred to fetus • Deficiency: preterm births, complications • RDA: 85 mg/day; more if smoking (lowers serum and amniotic fluid levels of vitamin C)

  21. Vitamin A • Needs increased by 10% in pregnancy • Deficiency linked to an increased risk of low birth weight, growth problems, preterm delivery • Excess preformed vitamin A exerts teratogenic effects

  22. Vitamin D • AI does not increase during pregnancy • Supplements recommended for pregnant women with darkly pigmented skin and/or limited sun exposure who do not regularly drink milk • Excessive vitamin D can cause developmental disabilities in newborns

  23. Calcium • RDA = 1,000 mg/day, same as for non-pregnant women • RDA = 1,300 mg/day for pregnant adolescents • Pregnant women absorb calcium more efficiently • Pregnant lactose-intolerant women: calcium-fortified or low-lactose foods

  24. Iron • Increased demand for red blood cells • Need increases (third trimester): stores iron in the liver for use during the first few months of life • Iron-deficiency anemia: fetus takes maternal iron • Deficiency increases rate of low birth weight, preterm birth, stillbirth, and death • Heme-rich foods (meat, fish, and poultry), iron-rich legumes, iron-fortified foods with vitamin-C rich foods, iron and vitamin C supplements • RDA for iron during pregnancy: 27 mg per day

  25. Zinc • Need increases 38% during pregnancy • Critical for DNA, RNA, protein synthesis • Deficiency: fetal malformations, premature birth, decreased birth size, extended labor • Absorption of zinc from supplements is inhibited by high intakes of non-heme iron (found in iron supplements) • Sources: red meats, shellfish, fortified cereals

  26. Sodium • RDA = 1,500 mg/day, same as for non-pregnant women • Excess: fluid retention, bloating, high blood pressure • Increased body fluids are a normal and necessary part of pregnancy • Some sodium needed for fluid balance

  27. Iodine • Need for iodine increases significantly • 220 µg/day can be obtained from iodized salt • Sprinkling salt onto food at the table is unnecessary • Balanced, healthful diet will provide all the iodine needed during pregnancy

  28. Supplements During Pregnancy • Prenatal multivitamin-mineral supplements are not strictly necessary • Recommended by most doctors • Meeting all nutrient needs requires careful and complex dietary planning • Good insurance for vegans, adolescents • Supplements: to be taken in addition to, not as a substitute for, a nutrient-rich diet

  29. Fluids During Pregnancy • Fluid need increases to 3 liters per day • Increased blood volume of mother • Body temperature regulation • Amniotic fluid: protects and cushions fetus • Combat fluid retention, constipation, and dehydration (morning sickness/vomiting) • Prevent urinary tract infections

  30. Nutrition-Related Concerns • Morning sickness • Cravings and aversions • Heartburn • Constipation and hemorrhoids • Gestational diabetes • Preeclampsia

  31. Morning Sickness • Nausea and vomiting associated with pregnancy • Can occur at any time; often lasts all day • No cure, but symptoms can be reduced • Eat small, frequent meals and snacks • Consume fluids between meals • Well-tolerated: frozen ice pops, gelatin desserts, watermelon, and mild broths

  32. Cravings and Aversions • Most crave a certain type of food (sweet, salty) rather than a particular food • Little evidence supports the claim that cravings indicate a deficiency • Pica: craving non-foods (chalk, clay) • Food aversions are common • Strongly woven into family’s belief system

  33. Heartburn • Pregnancy hormones relax lower esophageal smooth muscle • Enlarged uterus pushes on the stomach • Avoid excessive weight gain • Eat small, frequent meals; chew food slowly • Wait 1 hour after eating before lying down • Sleep with your head elevated

  34. Constipation • Pregnancy hormones cause smooth muscle to relax • Slow colonic movement of food residue • Eat 25−35 g/day of fiber • Drink plenty of fluids • Keep physically active

  35. Gestational Diabetes • Insufficient insulin production or insulin resistance increases blood glucose levels • Requires strict diet, physical activity, and/or medication • Risk of delivering a large baby; risk of type 2 diabetes and overweight later in life

  36. Hypertensive Disorders • Gestational hypertension: no symptoms • Preeclampsia: sudden increase in maternal blood pressure • Can be fatal if left untreated • Deficiencies in vitamins C and E, calcium, magnesium increase the risk • Treatment: bed rest, medical oversight • The only cure is childbirth

  37. Adolescent pregnancy Vegetarianism Caffeine Alcohol Smoking Illegal drugs Food safety Exercise Nutrition-Related Concerns

  38. Adolescent Pregnancy • Full physical stature: not yet attained • Higher needs for calories and bone-related nutrients (calcium, phosphorus, magnesium) • Inadequate maternal weight gain • Poor prenatal care; higher rates of prenatal alcohol and drug use • Higher rates of preterm births, low-birth-weight babies, and other complications

  39. Vegetarianism • Vegans need more attention to: • Vitamin D (unless regularly exposed to sunlight throughout the pregnancy) • Vitamins B6 and B12 • Calcium, iron, zinc • Supplements containing these nutrients are usually necessary

  40. Consumption of Caffeine • Caffeine is a stimulant that crosses the placenta and reaches the fetus • 1 or 2 cups of coffee (200 mg of caffeine) per day is not likely to harm the fetus • Higher amounts may slightly increase the risk of miscarriage and impair fetal growth • Can make one feel full • Considerable calories (if sweetened)

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