Nutrition during pregnancy Flashcards
Pregravid Weight
- Obese: HPN, gestational diabetes, induced labor, C/S
–↑ neural tube defects, macrosomia, low Apgars, shoulder dystocia, childhood obesity
– Difficulty initiating breastfeeding - Underweight: premature delivery, LBW, IUGR ( intrauterine growth restriction)
–“programs” for adult heart disease,
Type II diabetes, hypertension, hyperlipidemia
Weight Gain: BMI
BMI Rec. Weight Gain
<18.5 28-40 lbs.
18.5-24.9 25-35 lbs.
25-29.9 15-25 lbs.
30 and > 11-20 lbs
Pattern of Weight Gain
1.1 – 4.4 lb total first trimester
• Then, slightly <1 lb/week
• Gaining too fast: watch portion size; avoid 2nd helpings; lower-fat dairy; lower-fat foods;
avoid sugary foods & drinks; increase exercise
• Gaining too slow: eat 5-6 x/day; nutrient & calorie dense foods; add cheese, honey,
margarine, sugar to foods already eating
Calorie Requirements
• Energy needs increase
• about 300 cal/day
–Total 2300 – 2400/day
• 4 cal/gram from carbohydrates & protein; 9 cal/gram from fats
Water
• Major component of fetus, placenta, breast tissue, blood
• Need 1 liter/1000 calories consumed
Protein
• RDA = 60 grams/day
–10 more than pregravid
–Meat-eaters exceed this
–1 qt.( 4 cups) milk/day = RDA
• Tissue growth & maintenance
• Water balance
• Nitrogen balance
• Antibody formation
• Nutrient transport
Iron
• RDA = 30 mg/day
– Double pregravid RDA
• Prevent anemia
• Emphasize dietary sources 1st
–Red meat, whole grains, dark green leafy vegetables
* Vitamins take 3-4 weeks to respond
Avoid Iron-deficiency Anemia
• RBCs microcytic (lack Fe for optimal formation)
– Depleted RBC mass, leads to lower Hgb concentration
–Low HCT (32%), low Hbg (11 g/dl)
• Fatigue, pallor, irritability, SOB, anorexia, susceptibility to infection and PPH (postpartum hemorrhage)
–**Pica - eating non foods **
• Treatment: 200 mg elemental Fe
Iron Supplementation
- Ferrous sulfate, ferrous gluconate, ferrous fumerate
• All poorly absorbed (30% at most) E: 325 mg TIB
– GI upset
– Give with Vitamin C source ( glass of orange juice)
–Avoid giving with milk
• Risk of iron overdose in children
Folic Acid (Folacin)
RDA = 600 mcg/day dietary folacin equivalents
• All women of childbearing age + pregnant
• Deficiency linked to neural tube defects (spine)
Dietary sources - beans, legumes, poultry, dark green leafy vegetables, whole grains, citrus fruits, shelfish
Avoid Folic Acid Deficiency
Folic Acid Deficiency Anemia
• Body uses folic acid to break down & use proteins & to form nucleic acids & heme
–Immature RBCs fail to divide (megaloblasts or macrocytes)
–Low Hgb
• Similar S/S to Fe-deficiency
• Treatment: 1 mg/TID
Studies: Benefits of Folic Acid
(1/08): supplement x 1 year, ↓ premature deliveries 50-70%
• (10/11): supplementation ↓ severe language delays in children age 3
Calcium
• RDA = 1000 mg/day; adolescents +300
–Risk for PIH may benefit with additional Ca+
• Dairy foods, tofu, fish packed with bones, dark green leafy vegetables, fortified juice
Fiber
• RDA pregnancy = 28 grams
• Study, July 2008
–21.2 g/day fiber 1st TM = 72% ↓ pre-eclampsia than < 11.9 g/day
• Foods
–Fruits, vegetables, whole grains, beans, legumes
Omega 3 Fats
Polyunsaturated fatty acids (DHA, EPA, ALA)
–Fish, fish oils, seeds, vegetable oils, leafy greens
–Brain, retina, nervous system development
–↓ PP depression, PTL, preeclampsia
• 300 mg/day RDA
–Oily fish
–Fish oil supplements
–Eggs, bread, juice
–Canola, sunflower, flaxseed oils
–Walnuts
