Transcript Basic Human Nutrition lecture pregnancy mine

Basic Human Nutrition
Nutrition for a Healthy Pregnancy
Nutrition for Healthy Infants
Prior To Pregnancy
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Goals
 Achieve and maintain a healthy
body weight
 Choose an adequate and
balanced diet
 Be physically active
 Avoid harmful influences
Pre-conceptual Nutrition
Issues
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Maternal nutrient stores:
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Development of a healthy placenta
Prevention of neural tube defects
Placenta
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Stages of Pregnancy
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Ovum (fertilized) implants in uterine wall–
placenta begins to grow
Zygote divides into many cells, these cells
sort themselves into 3 layers.
Embryo – 1st month- organs start to form,
spine and primitive brain form, arm & leg
buds
Foetus- nervous system, digestive tract,
liver, kidney & spleen form.
Stages of Embryonic And Fetal
Development
Critical Periods
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Neural tube defects
 Anencephaly
 Spina bifida
Folate supplementation
Critical
Periods
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Chronic Disease
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Nutrition is a primary determinant of
beta cell growth, and infants who have
suffered prenatal malnutrition have
significantly fewer beta cells than wellnourished infants.
They are also more likely to be low
birthweight infants.
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Weight Prior To Conception
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Underweight
 Preterm births and infant deaths are higher.
 High risk of having low-birthweight infant.
Overweight and obesity
 Infants are more likely to be born post
term.
 High risk of medical complications.
 Increased likelihood of difficult labor and
delivery, birth, trauma and cesarean
section.
Recommended Weight Gain
During Pregnancy
BMI Category
 < 20
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20 - 25
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> 27
Recommended Gain
 12.5 – 18.0 kg
(28-40 pounds)
 11.5 - 16.0 kg
( 25 – 35 pounds)
 7.0 - 11.5 kg
(15 – 25 pounds)
Weight Gain
Weight Gain
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Weight Gain continued
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Normal –weight woman: 2 to 4 pounds
in first trimester, 1 pound/week
thereafter.
Teenager: if normal BMI for age, should
gain about 35 pounds
Multiple pregnancy e.g., twins, should
gain about 35 to 40 pounds.
Weight Gain
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Exercise During
Pregnancy
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Energy And Nutrient Needs
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Nutrient Needs During Pregnancy
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Energy: 300 additional calories n 2nd and 3rd
trimesters only (Canadian)
340 additional calories n 2nd and 451 kcal in
the 3rd trimester.(DRI)
Protein: 5g additional protein 1st trimester
20 g additional protein – 2nd trimester
24 g additional protein – 3rd trimester
Fat: no lower than 30% calories from fat
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Fatty acids necessary to development of foetal
brain
Carbohydrate: about 50% of calories
Comparison Of Nutrient Recommendations For
Nonpregnant, Pregnant, And Lactating Women
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Nutrient needs in pregnancy
continued
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Folate and B12 – needed for rapid cell
proliferation both in the foetus and the
increase in mother’s red blood cells.
Folate 600 ug/day.
Folate critical during first 6 weeks of
pregnancy when neural tube forms and
closes.
Failure to close at upper end causes
anencephaly; at lower end –spina bifida
Vitamin B12
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Requirements: B12: 2.6 ug/day
Assists folate in manufacture of new
cells.
High intakes of folate can mask B12
deficiency and diagnosis.
Non vegetarians consume adequate
amounts of B12 with meat, eggs and
dairy products.
Vegetarian women who exclude dairy
and eggs must take a supplement.
Calcium, Phosphorus,
Magnesium
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All 3 have a significant role in
development of skeletal structure of
foetus.
Intestinal absorption of calcium doubles
early in pregnancy and is stored in the
mother’s bones.
When foetal bones begin to calcify,
there is a dramatic shift in calcium
across the placenta.
In last trimester, over 300 mgs calcium
per day are transferred to the foetus.
Recommendations for Calcium
and Magnesium
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Calcium recommendation same as for
non-pregnant female.
Magnesium for bone and tissue growth
is needed during pregnancy in amounts
slightly more in pregnancy.
Recommendation is 40 mg more than
nonpregnant women.
Iron
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Body conserves iron during pregnancy but
huge demand can deplete maternal reserves.
Foetus draws on mother’s supply to create
reserves of its own for the first 3 to 6 months
of life.
Mother also loses iron through blood loss with
delivery
Recommendation is 30mg iron daily
(Canadian) 27mg/day DRI
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Nutrient Supplements
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Prenatal vitamins typically contain greater
amounts of folate, iron, and calcium than
regular vitamin/mineral supplements.
Vitamin/mineral supplements recommended
for high-risk groups: mothers carrying
multiple fetuses, smokers, alcohol and drug
users, teens, obese women, women with
inadequate nutrient intakes.
Building Blocks for Better Babies provincial
program supplies supplements and nutritional
counseling to high-risk and low-income
women.
Nutritional problems during
pregnancy
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“Morning Sickness” – nausea and vomiting caused by
hormonal changes. It can occur any time during the day, but
common in morning. Can be a nuisance to a severe
problem. Can lead to dehydration and acid-base imbalance,
weight loss.
Food Cravings and Aversions
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Fairly common but don’t reflect real
physiological needs.
Most likely due to hormone-induced
changes in sensitivity to taste and
smell.
Nonfood Cravings
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Pica – desire to eat non-nutritious foods
or non-food substances e.g., ice,
cornstarch, clay. More common in
women whose diets are deficient in
iron, zinc or other nutrients, but
deficiency does not cause craving.
Heartburn
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Hormones relax digestive muscles, and the growing fetus
puts increasing pressure on mom’s stomach.
This allows stomach acid to back up into the lower
esophagus and create a burning sensation near the heart.
High-Risk Pregnancies
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High-Risk Pregnancies
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Gestational Diabetes
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Blood glucose becomes abnormal during
pregnancy, but it usually returns to normal
after pregnancy.
In 1/3 of cases, diabetes is permanent.
If untreated or poorly managed, gestational
diabetes can lead to foetal or infant sickness
or death.
Pregnant women are screened for gestational
diabetes around 24-28 weeks gestation.
Preeclampsia
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A potentially dangerous condition characterized by
edema, hypertension, and protein in the urine.
Edema is widespread – face, hands, feet and ankles.
All organs are affected – circulation, liver, kidneys
and brain.
If condition progresses –develops into eclampsia,
which can result in convulsions and death.
Treatment is prevention of convulsions and regulation
of blood pressure, emergency caesarean section if
necessary.
Pregnancy in Adolescents
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Challenge: to nourish a growing fetus
as well as a growing teen.
Common complications: iron-deficiency
anemia and prolonged labor.
High rate of stillbirths, preterm births,
and low birthweight infants.
Encourage high weight gain. (35lbs)
Pregnancy in Older Women
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Number of first births at 35 or older has
increased.
Complications: hypertension, diabetes
and may result in cesarean section.
High rate of premature births and low
birthweight.
Risk of having child with Down
syndrome is increased.
Behaviours to avoid during
pregnancy
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Cigarette (cigar/pipe) smoking.
Smokers have lower intakes of dietary fibre,
vitamin A, Beta carotene, folate and vitamin
C.
Oxidants in smoke accelerate vitamin C
metabolism - depletes vitamin C
Smoking restricts blood supply to foetus,
slows growth, leads to low-birthweight.
Environmental Tobacco Smoke (nicotine and
cyanide & others) in smoke directly toxic to
foetus and to infant; increases risk of SIDs
Behaviours to Avoid continued
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Medications and illegal drugs: can cause
serious birth defects.
Herbal preparations, over-the-counter drugs,
and high-dose vitamins are not recommended
during pregnancy.
Prescription drugs may need to be altered or
discontinued (if possible ) during pregnancy.
Caffeine: 1 cup per day of coffee per day
Dieting to be avoided at all costs during
pregnancy
Foetal Alcohol Syndrome
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Alcohol during pregnancy can result in FAS
which causes irreversible mental retardation,
growth retardation, facial abnormalities,
vision abnormalities, low APGAR scores and
40 other identifiable health problems.
Foetal brain is very susceptible to glucose or
oxygen deficit and alcohol causes both by
disrupting placental functioning.
Alcohol also crosses placental barrier and is
toxic to brain and nervous system of
developing foetus.
Fetal Alcohol Syndrome
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Foetal Alcohol Effect
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In animal research, 1/5 of amount of alcohol
needed to produce outwardly visible effects
can produce a learning impairment. Children
with this reduced syndrome, perform poorly
in school and social interactions, may be
short in stature, or have subtle face
abnormalities.
Recommendation is no alcohol during
pregnancy and preferably pre-pregnancy if
planning a pregnancy.
Lactation
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Production of about 25 oz of milk/day.
Requires an extra 330 kcalories of food each day.
Protein and fatty acids = same as pregnancy.
Need additional carbohydrate to replace glucose used
to make the lactose in breast milk.
Fibre is 1 gram higher due to increased calories
needed.
Fluids need to be increased to protect from
dehydration.
Behaviours to avoid
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Alcohol
Medicinal drugs
Illicit drugs
Smoking
Caffeine
Nutrient needs of infant
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Infant’s rate of growth in first year
greater than at any other time in life.
Birth weight doubles by 4 months of
age and triples by age 1.
A newborn requires 100 – 120
kilocalories per kg of body weight per
day.
Infancy
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Nutrient needs of infant
continued
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13g protein per day for first 6 months
and 14g for the second 6 months of life.
30 – 55% of calories from fat.
Infant’s small stomach capacity requires
high fat to meet energy requirements
High fat also needed for developing
nervous system.
Recommended Intakes Of An Infant And An Adult
Compared On The Basis Of Body Weight
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Breast milk is best
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Breast milk contains antiviral and antibacterial
agents which reduces incidence of infection in
newborn.
Colostrum produced in first 3 days of
lactation contains antibodies and white cells
from the mother’s blood. Infections which she
has developed an immunity to are thereby
passed to her infant.
Breast milk is best continued
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Protein in breast milk consists of 70%
whey and 30% casein.
Cow’s milk protein contains 18% whey
and 82% casein.
Whey portion of breast milk contains
soluble proteins which are easily
digested.
Breast versus cow’s milk
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Breast is more easily and completely digested
than formula.
Major whey protein of breast milk is alphalactalbumin which is efficiently digested and
absorbed.
Major whey protein in cow’s milk is betalactoglobulin, the protein often blamed for
milk allergy and colic.
Lactoferrin – another protein in breast milk
assists with iron absorption in the infant and
acts as an antibacterial agent.
Breast milk continued
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Breast milk contains lipase to assist with fat
absorption, therefore 95-98% of fat in breast
milk is absorbed by infant.
The 2-1 calcium to phosphorus ratio of breast
milk enhances absorption of calcium.
Vitamin C is higher in breast milk than in
cow’s milk, but vitamin D is lower. Breastfed
Infants need exposure to sunlight or
supplementation of vitamin D.
Breast Milk
Breast milk versus cow’s milk
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Breastfed baby does not require iron
supplementation until 4 months of age.
Breast milk higher in water than cow’s
milk, therefore provides adequate
hydration even in dessert climate.
Breast milk varies in nutritional content
according to time of day and infant’s
needs.
Breast milk versus cow’s milk
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B12 is 9 times higher in cow’s milk than
in breast milk of women consuming a
mixed diet. Vegans produced only ¼ to
1/3 as much B12 as mothers consuming
a mixed diet.
Breastfed babies require injection of
Vitamin K at birth to prevent bleeding.
Breast milk versus cow’s milk
continued
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Breast milk contains 1/3 of the sodium,
potassium and chloride and 1/8 of the
phosphorus of cow’s milk which is best for the
infant’s kidneys.
Breast milk contains 1/6 of calcium of cow’s
milk but 67% absorbed versus 25% of
calcium
Zinc is absorbed 60% from breast milk and
43% from cow’s milk
Breast milk versus cow’s milk
continued
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Breastfed baby does not require iron
supplementation until 4 months of age.
Breast milk higher in water than cow’s
milk, therefore provides adequate
hydration even in dessert climate.
Breast milk varies in nutritional content
according to time of day and infant’s
needs.
Infant Formula
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Formula feeding
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Formula preparation
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Sterilize bottles
Water selection
Dilution
Storage
Formula feeding continued
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Types of formula
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Iron fortified cow’s based
Special formulas
Follow-up formula
Nucleotides
Essential fatty acids
Other beverages
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Goats’ milk
Soy milk
Rice beverage
Herbal teas
Juice
Pop, drink crystals
Nursing bottle syndrome
Introducing
Solid Foods
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When to start solids
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Between ages 4 months to 6 months
Earlier introduction of solids may cause
allergies due to immature gut.
Infant can support and control head
movements – can move toward or away
from food offered
Baby shows interest in solid foods
Introducing solids continued
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Increased saliva present
Tongue can move food to the back of
the mouth
Extrusion reflex disappearing (
movement of tongue to push food out
of mouth)
Baby’s iron stores are getting low
Solid foods
Given one at a time
 Try a food for 4-5 days before trying a
new food
 Feed after breast milk or formula
First foods: cereals: rice, barley, oats,
wheat
 1 tsp at first then increase
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Solids continued
Second foods:
 Vegetables: squash, peas, sweet
potato, green or yellow beans, zucchini,
asparagus, broccoli, cabbage, etc.
 Give separately then mix
Third foods: Fruits: apple, pear, peach,
apricots, plum, banana etc.
Solids continued
Delay strawberries, pineapple and grapes
until 12 months
Fourth foods:
 Meats: chicken, turkey, fish, beef, pork and
lam. Moisten well. Avoid cold cuts, sausage
 Egg yolk only
 Milk products
 Legumes
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Food textures and feeding
capabilities
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Puree
Mashed
Chunky
Finger foods
Table food
Other feeding issues
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no sugar, salt or seasonings
No honey
No raw egg
Weight gain
Fat
Choking
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Caused by foods that are not well
controlled in the mouth:
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Hard
Round/cylindrical (e.g., grapes)
Chewy
Sticky
Child also needs to sit quietly when eating