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NUTRITION CHPT 11 Diet During Pregnancy & Lactation How long is a pregnancy • 38-40 weeks long During pregnancy, who/what does mom provide nutrients to? • Fetus - the growing baby • Amniotic fluid – the fluid that surrounds the fetus in the womb • Placenta – organ in the uterus that links blood supply from mom to fetus • Mom also provides nutrients to cause an increase in blood volume, breast and uterine and fat tissue • She is not just eating for herself any more Mental Retardation • Is believed to be caused in part by malnutrition on the mother’s part Low birth weight • Babies weighing less than 5.5 pounds Weight gain with 1 baby during pregnancy • 25-35 pounds over the 38-40 weeks • Mom should increase her calories by 300 calories per day along with what she was used to eating Trimesters • A trimester consists of 3 months • In pregnancy, there are 3 trimesters • Usually, women only gain 2-4 pounds in the 1st trimester however… • Weight gain should occur at a rate of 1 pound a week during the 2nd and 3rd trimester • This wt gain is to aid in the growth of the increase in maternal tissue and in the growth of the fetus Adolescent and weight gain • A pregnant adolescent who is still growing needs more nutrients • Adolescents already don’t have healthy diets, probs occur d/t this • Offer help from agencies like WIC, Birthright or other organizations • Their weight gain depends on the size they are before pregnancy Weight loss during pregnancy • NO ONE SHOULD LOSE WEIGHT DURING PREGNANCY • Malnutrition side effects could be worse than gaining weight Folic Acid • BEFORE a couple decides to become pregnant, they should visit the Dr. to discuss… • Folic acid – it’s a water soluble vitamin, it aids in protein metabolism and formation of hemoglobin • 400 mcg of Folic acid should be taken daily. Folic acid should be started 1 month before conception • Folic acid deficiency causes spinal cord and brain defects, megablastic anemia where large immature RBCs don’t carry O2 well Megablastic anemia • It’s JUST LIKE ALL THE OTHER ANEMIAS: • SOB • Fatigue • Weakness • Pallor • Bad RBCs which can’t carry good O2 DIET DURING PREGNANCY • Food pyramid should be followed • NO HOLLOW CALORIES or EMPTY CALORIES Vitamins & Supplements • • • • • • Folic acid – (member of the vit B complex) Vitamin A – fat soluble Vitamin D – fat soluble Vitamin E – fat soluble Vitamin K – fat soluble Iron (Fe)- to aid in the increase of blood volume during pregnancy • Vitamin C is an iron enhancer and increase absorption of iron • Vitamin B’s they aid in metabolism and development of RBC’s, water soluble • Calcium to build bone and teeth, needed for blood clotting and muscle action How important is iron? • Due to increase blood volume, more iron is therefore needed. Doubled during pregnancy • The fetus increases its hemoglobin level to twice its normal level while in the womb. After birth, the infant’s hemoglobin level is reduced back to normal as the extra hemoglobin breaks down. The resulting iron is stored in the liver and is available when needed • Iron deficiency causes dizziness, weakness, S.O.B. • Drinking additional milk each day while pregnant provides: • Protein • Phosphorus • Calcium • And other nutrients Problems During Pregnancy • NAUSEA – the feeling of a need to vomit, usually lasts through to the end of the 1st trimester • A.K.A morning sickness although, nausea comes on at any time Suggestions to help relieve morning sickness • Eat dry crackers or dry toast before rising • Eat small, frequent meals • Avoid foods with an offensive odor • Avoid liquids at mealtime Hyperemesis Gravidarum • Nausea so severe as to be life threatening • Mother may need to be hospitalized for IV and food – parenteral nutrition • Zofran given for nausea P.O. or I.V. • Phenergan I.V or P.R. or P.O. Parenteral Nutrition • Nutrition provided through a vein called TPN (total parenteral nutrition) • Parenteral – any med route other than the alimentary (mouth) canal such as I.V, SQ, IM • Pt usually must be in the hospital for this type • If home care nurse available and insurance, pt may get this at home CONSTIPATION • Progesterone is increased during the 3rd trimester to get ready for baby to be born • This causes relaxation of the cardiac sphincter and smooth muscle • Can’t push as strong, stool doesn’t come out Treatment of pregnancy related constipation • Eating high fiber diet • Daily exercise • Drink plenty of fluids 8 glasses of water per day • Respond immediately to the the urge to deficate HEARTBURN • As the fetus grows, it pushes on the mom’s stomach, this causes stomach acid to move into the lower esophagus causing heartburn Relief of heartburn • Eating small frequent meals vs. large meals • Avoid spicy or greasy foods • Avoid liquids with meals, you get too full • Wait at least 1 hour before laying down after eating Obesity • Stay away from low nutrient dense foods like chips, sodas, candy • Follow the food pyramid, drink lots of lowfat or fat-free milk • Eat raw, crisp veggies, fruits and low-fat items PIH • Pregnancy induced hypertension • (High blood pressure caused by pregnancy) • A.K.A toxemia or preeclampsia • Occurs in the 3rd trimester • S&S: HTN, proteinuria – albumin in the urine and edema PIH • The edema = wt gain • This early stage can progress to the eclamptic state= seizures or convulsions and death PIH, who gets it • Adolescents • Obese woman • Women on inadequate protein sufficient diets • First time pregnancies • Multiple birth pregnancy PICA • Abnormal cravings for non-food substances such as: • Starch like laundry detergent • Clay or soil • ice Causes of PICA • Unknown • Believed to stop nausea • More common in pregnant women • Can be cultural Anemia • A condition caused by insufficient numbers of red blood cells, hemoglobin or blood volume • Hemoglobin – the iron-containing pigment of the RBC that carries O2 • Pt does not receive enough O2 from the blood and feels weak and tired During pregnancy… • The increased volume of blood creates the need for additional iron • Baby takes what it needs from mom, mom is tired and deficient = anemia • Can be treated with daily iron supplements Folate Deficiency • Results from a form of anemia • There are too few RBCs and very large immature RBCs • When new RBCs are being formed, the body needs more folic acid • Supplement is given of folate = folic acid Fetal Alcohol Syndrome • Mental retardation or subnormal physical and mental developmental delays • These infants are of low birth wt • When mom drinks, it enters the fetal bloodstream but baby cannot metabolize the alcohol out Physical Characteristics of FAS • • • • • • • Small head (microcephaly) Short eye slits Flat midface Thin upper lip Ht and wt deficiency ADD or ADHD seizures Caffeine • Crosses the placenta and enters the baby’s bloodstream and causes fetus in womb or baby, to become irritable or hyperactive • Pregnant rats who were given caffeine, showed that it caused birth defects in baby rats • No data shows this in humans, mom should still limit caffeine to 2 cups/day Tobacco and pregnancy • Causes low birth wt • Smoking reduces the O2 and nutrients carried by the blood and then baby can’t get what it needs • SIDS, spontaneous abortion (miscarriage occurring naturally), intellectual and behavioral problems can occur Gestational Diabetes • Diabetes that occurs during pregnancy and disappears after the delivery of baby • Remember, Diabetes Mellitus is when one cannot use or store glucose normally d/t the inadequate production of insulin What happens to baby if mom has gestational diabetes? • • • • Physical or mental defect in baby Stillborn Macrosomia – birth wt over 9 lbs Every woman is tested for diabetes btwn weeks 16-28 • Insulin may be needed oral hypoglycemics are not recommended • Mom will see a dietician Lactation • The period during which the mother is nursing the baby • Breast milk is most nutritional for baby • Breast milk contains the right amts of lactose, H2O, fatty acids and amino acids for brain development growth and digestion • Human milk contain at least 100 ingredients not found in formula How is mom’s milk made and released to baby • Prolactin is responsible for milk production • Oxytocin is responsible for milk ejection from the breast • Baby sucking initiates the release of oxytocin, causing the “let-down reflex” to occur (this is a supply and demand mechanism) Calorie requirements during lactation • Increase of 500 calories per day while breastfeeding • Must drink lots of water • Increase in Vitamin C is needed • Increase in milk to gain protein • Natural wt loss occurs for mom by the burning of the stored fat for milk production during lactation Medicine, caffeine, alcohol, tobacco • Most chemicals enter the mom’s milk • Mom’s diet can cause irritability in baby such as gas • Check with Dr. as to what meds cross mom’s breast milk and into baby • Mom may take drugs that cause addiction to her and baby The End