Nutrition during pregnancy Flashcards Preview

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Flashcards in Nutrition during pregnancy Deck (25):
1

Pregravid Weight

1. Obese: HPN, gestational diabetes, induced labor, C/S
–↑ neural tube defects, macrosomia, low Apgars, shoulder dystocia, childhood obesity
– Difficulty initiating breastfeeding
2. Underweight: premature delivery, LBW, IUGR ( intrauterine growth restriction) 
–“programs” for adult heart disease,
Type II diabetes, hypertension, hyperlipidemia 

2

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

3

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

4

Calorie Requirements

• Energy needs increase
•  about 300 cal/day
–Total 2300 – 2400/day


• 4 cal/gram from carbohydrates & protein; 9 cal/gram from fats

 

5

Water 

• Major component of fetus, placenta, breast tissue, blood

• Need 1 liter/1000 calories consumed

6

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

7

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 

8

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

9

Iron Supplementation

1. 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

10

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 

11

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

12

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

13

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

14

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

15

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

16

Vitamin C

• RDA = 85 mg/day
• Antioxidant
• Tissue repair/healing
• Collagen formation

–Bones, cartilage, tendons, skin
• Brain development (animal studies)

17

Pica

• Craving substances with little or no nutritional value
• Cause unclear: vitamin/mineral need vs. physical or mental disorder
• Cultural component: spirituality, treatment for morning sickness, physical/emotional traits
• All races, all socioeconomic groups

• Common substances: dirt, clay, laundry starch, ice, burnt matches, cigarette ashes,
mothballs, soap, cornstarch, stones, charcoal, plaster, sand, coffee grounds, baking soda,
hair

18

Pica 

• Potential harm (maternal)
–Toxic substances (i.e., lead poisoning)
–Parasite ingestion
–Interference with nutrient absorption
–Iron deficiency anemia link
–Bowel obstruction
– Dental injury
• Potential harm (fetal)
–LBW, preterm birth, stillbirth

19

Pica TX

Treatment
–Monitor Fe levels
–Psychological counseling
– Nutritional supplements
–Medications to control stress & depression
–“Buddy system” most successful !!!
–Substitutions (i.e., gum or mints)

20

Caffeine Intake

• March of Dimes: no >200 mg/day
• Crosses placenta, ↓ blood flow to fetus
• ? ↑ risk miscarriage, infertility
Caffeine, cont’d…
• Other issues
–? ↑ risk miscarriage & infertility
–Stillbirth: Denmark 2003, ↑ risk if 4 or > cups
– Newborns: slight ↓ birthweight, VS changes, sleeplessness
–Breastfeeding: small amount crosses into breastmilk; babies more irritable

21

Fish Intake: Mercury

• Limit 12 oz./wk. of salmon, shrimp, canned light tuna 4 oz / week, pollock, sardines, tilapia, catfish
• Consider source: farmed vs. wild, pollutants
• www.seafoodwatch.org

22

Food Safety in Pregnancy

• Avoid raw fish and shellfish
• Do not undercook meat, poultry & eggs ( salmonella ) 
• Avoid deli meats ( bacteria) 
• Avoid soft cheeses & foods made with unpasteurized milk (listeriosis)
• Avoid unpasteurized juices & raw sprouts ( E coli)
• Avoid herbal supplements & teas: GRAS ( generally recognized and safe)  only

23

WIC: Women, Infants & Children - not a welfare 

• USDA program, unrelated to food stamps
• Pregnant ♀, postpartum 6-12 months, infants to age 1 (53%), children to age 5
• Supplemental foods, education, counseling, screening, referrals
• Income/nutrition risk requirement
–$27,991/family of 2
• Vouchers, EBT card, food delivery

24

WIC Benefits

• ~9,100,000/year: Ohio 2012, ~275,401
–~50% employed
• Iron-fortified formula & cereal, juice, adult cereal, fruit, juice, eggs, milk, cheese, peanut
butter, dried beans & peas, tuna fish, carrots

–Some organic foods allowed
• ↓ infant mortality, better birth outcomes
–Saves Medicaid $ (1:1.77-4.21)

25

WIC Updates 10/01/09

• Meet needs of culturally diverse groups
–Brown rice, tortillas, whole grains
• Cash-value vouchers
–Fruits, vegetables, tofu
–Baby food
• Mother & child’s packages combined
• Breastfeeding: 2x food
• New programs
–Recipes, food preparation tips