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• Chapter 4 discusses nutrition through the lifecycle, specifically during pregnancy

Status of Pregnancy Outcomes

• Table 4.1 presents natality statistics, rates, definitions, and trends in the United States
• Maternal mortality rate increased from 7.1 in 1995 to 18.5 in 2013 per 100,000 live births
• Preterm births slightly increased from 11.0% in 1995 to 11.4% in 2013
• Very preterm births saw a notable increase from 1.9% in 1995 to 3.5% in 2013
• Low birthweight births increased from 7.3% in 1995 to 8.0% in 2013
• Infant mortality reflects the general health and socioeconomic status of a population
• Decreases in mortality are related to improved social circumstances, infectious disease control, and availability of safe and nutritious food
• Low birthweight (LBW), preterm delivery, and infant mortality result in a high risk of dying in the first year of life
• 8% of births are LBW, yet they account for 66% of infant deaths
• 11.4% of births are preterm and account for a large number of infant deaths
• Neonatal and infant mortality rates are lowest for newborns weighing between 3,000 and 3,800 grams (6.6–8.4 lbs)
• Newborns with these weights are less likely to develop heart and lung diseases, diabetes, and hypertension

Physiology of Pregnancy

• Gestational age is assessed starting from the date of conception; average pregnancy is 38 weeks
• Menstrual age is assessed from the onset of the last menstrual period; average pregnancy is 40 weeks
• Maternal physiology involves changes in body composition and functions that occur in a specific sequence
• Maternal plasma volume peaks at week 20, followed by maternal nutrient stores at week 20, placental weight at week 31, and uterine blood flow and fetal weight at week 37

Physiology of Pregnancy & Dietary Intake Factors

• Key notes on normal physiological changes during pregnancy
• Maternal anabolic phase occurs during the first 20 weeks
• Mother's body builds the capacity to deliver all of the blood, oxygen, and nutrients the fetus requires during the second half of pregnancy
• Mother experiences increased appetite, increased anabolic hormones, and decreased exercise tolerance
• Catabolic phase occurs during the last 20 weeks of pregnancy
• Mobilization of stored nutrients occurs, the mother experiences increased catabolic hormones, and increased exercise tolerance
• Blood volume expansion and increased cardiac output occur during the maternal anabolic phase (0-20 weeks), while mobilization of fat and nutrient stores occurs during the maternal catabolic phase (20+ weeks)
• The placenta is a large endocrine organ that develops in the uterus within the first several weeks of conception and is responsible for secreting vital hormones
• It fights internal infections, acts as a barrier to harmful substances, exchanges nutrients and oxygen from the mother to the fetus, and removes waste products
• Placenta nutrient transfer is affected by the size and charge of molecules, lipid solubility of particles, and the concentration of nutrients in maternal and fetal blood
• Nutrients are first used for maternal needs, then for the placenta, and lastly for fetal needs
• The fetus is harmed more than the mother by poor maternal nutrition
• Hormonal changes during pregnancy result from increased secretion of hormones by the placenta
• The expecting mother relies on hormones such as progesterone, estrogen, human chorionic gonadotropic (hCG), leptin, and human chorionic somatomammotropin
• Body water increases by 7–10 L during pregnancy
• This increase primarily builds blood and tissues during the first trimester
• Plasma volume starts to increase in the first few weeks of pregnancy, from ~50 mL at the 10th week of gestation to ~800 mL at the 20th week
• Increased levels of body water and tissue synthesis require additional sodium and other minerals during pregnancy
• Calcium metabolism is linked with bone turnover and reformation

Embryonic & Fetal Growth/Development

• Four periods of growth and development: hyperplasia, hyperplasia and hypertrophy, hypertrophy, and maturation
• Variations in fetal growth are linked to energy, nutrient, and oxygen availability, conditions that interfere with genetically programmed growth and development etc
• Insulin-like growth factor (IGF-1) is a main fetal growth stimulator

Pregnancy Weight Gain

• The rate of pregnancy weight gain matters less than the total amount of weight gained
• Most weight gain occurs during the second and third trimesters
• Women may experience slow rates of weight gain and possibly weight loss throughout pregnancy
• Normal-weight women should aim to gain 25-35 lb during pregnancy
• Approximately one-third of the weight gained in women goes to the fetus and increased body fat helps meet the nutritional needs of the mother and fetus
• Body fat stores provide an average reserve of 30,000 calories for pregnancy and lactation
• Fat storage increases significantly during the early part of the second trimester and decreases later in pregnancy

Nutrition & Pregnancy Course/Outcome

• The Dutch hunger winter (1943-1944) saw declined pregnancy rates and lower birth weights
• The siege of Leningrad (1942) led to increased infertility, infant death rates, and low birth weights
• Food shortages In Japan (in other areas) and Famine in China had the same outcomes

Key Energy & Nutrient Needs

• Nutrient needs vary during the course of pregnancy and can be met with healthful diets
• Increased energy and protein intake is needed
• Carbohydrate intake should be 45-65 percent of diet.
• Fat intake should be 33 percent
• Omega-3 fatty acids EPA and DHA are needed to bring several added health benefits
• There is no safe level of alcohol when pregnant or expecting.
• Glucose is the fetus's preferred fuel
• High estrogen and progesterone levels stimulate insulin, which increases glucose conversion to glycogen and fat during early pregnancy
• Human chorionic somatotropin (hCS) and prolactin inhibit the conversion of glucose to glycogen and fat during late pregnancy
• The diabetogenic effect of pregnancy results from maternal insulin resistance
• 50-80% of fetal energy needs are provided by glucose
• The fetus receives adequate levels of glucose intake even if the maternal intake is not adequate
• Glucose crosses the placenta more readily than other macronutrients
• During the final months of pregnancy; a 50–70% decrease in insulin sensitivity causes insulin resistance in the mother occurs.
• During pregnancy. maternal protein accumulates in the blood, uterus, breasts, fetus, placenta, and amniotic fluid
• Protein is needed to support the fast growth of maternal of fetal tissue
• Requires increased doses during the second and third trimesters
• Amnio acids such as Plasma amino acids/use of branched chain amino acids decrease during pregnancy
• Fat stores accumulate in first half, than enhance fat mobilization in second half
• Cholesterol increases use for hormone production and baby membrane formation

VItamins & Minerals During Pregnancy

• Folate, iron, VitA, VitD, calcium, and sodiums are key needs during pregnancy
• Increased risk for dehydration, needs around ~300 mL/day, fluid can decrease risk of edema
• Women that exercise need additional fluids
• Urine color determine if you are dehydrated or not

Sweeteners

• Acesulfame, aspartame, saccharin are fine to used at FDA approved
• Artificial sweetener are safe and non nutritious

Common Nutrition Considerations

• Caffeine passes to baby, can increase low weight or preterm
• Should be 200mg per day
• Lead has impact in Coginitive functions
• Elevated lead level is toxic
• Lead limits calcium and iron
• Slow grow of lead
• Gasto issues are a huge issue during pregancy
• Causes nauesa , diarreha , and vomitting
• Nauesea is normal and stops at 12 the week
• Diarhera is common, so increase hydrations and electrolytes
• Heartburn issues rise from estrogen
• Increase of progesterone
• Lax is not recommed in pregnancy
• Food saftey is nesscary

Promoting Healthy Lifestyles

• Exercise is important
• Can promote healthy lifestyle
• Mod to heavy cardio is good to do
• 30 min 5 times a week is key , 150min a week
• Mental health is key
• Depression , anxitety is a common factors
• Causes bad health out come
• Proper diet can limit depression
• Food insecure / hunger