Nutrition for Pregnancy and Athletes

Nutrition Essentials

• The risk of dietary deficiency or overdose reactions correlated to nutrient intake levels can be illustrated on a U-shaped curve
• The curve indicates the Estimated Average Requirement (EAR), Recommended Dietary Allowance (RDA), Adequate Intake (AI), and Tolerable Upper Intake Level (UL).

Carbohydrates

• Simple sugars include monosaccharides like glucose, fructose, and galactose.
• Disaccharides include sucrose, maltose, and lactose.
• Complex carbohydrates include starches and fiber.
• Starches are the plant form
• Glycogen is the animal form.
• Alcohol sugars include alcohol (ethanol).
• The recommended intake level for carbohydrates is 45-65% of daily calories.
• Women need 21-25 grams of fiber daily
• Men need 30-38 grams.

Protein

• High-quality protein sources include milk, cheese, meat, and eggs.
• The recommended protein intake is 10-35% of daily calories.

Fats

• Lipids include fats, which are solid at room temperature, and oils, which are liquid at room temperature.
• Triglycerides consist of 3 fatty acids attached to glycerol.
• Essential fatty acids include linoleic acid (parent omega-6 found in seed oils)
• Alpha-linolenic acid (parent omega-3 found in sea fish and flax seeds).
• Hydrogenation is the process of adding hydrogen to unsaturated fatty acids, creating trans fats.
• This alters the fatty acid structure
• Dietary cholesterol is a fat-like, clear liquid found in animal products.
• Dietary Cholesterol is a precursor to vitamin D, estrogen, and testosterone.
• Egg yolks, meat, milk, milk products, and fats like butter are sources.
• Recommended fat intake is 20-35% of daily calories, with no trans fats.

Vitamins and Minerals

• Fat-soluble vitamins include A, D, E, and K.
• Water-soluble vitamins include thiamin, riboflavin, niacin, B6, folate, B12, biotin, pantothenic acid, choline, and vitamin C.
• There are 15 essential minerals, including calcium, phosphorus, magnesium, iron, zinc, fluoride, iodine, selenium, copper, manganese, chromium, molybdenum, sodium, potassium, and chloride.

Water

• Adults are 60-70% water.
• The recommended intake is 15-16 cups daily for males and 11 cups for females.

Nutrition Assessment

• ABCDs of nutrition assessment include:
• Anthropometric measures
• Biochemical tests
• Clinical observations
• Dietary intake

Preconception Nutrition

• Start preparing for pregnancy three months in advance.
• Infertility affects 15% of couples.
• 44% of infertile couples eventually conceive and 20-25% of healthy couples conceive.
• Miscarriage: loss of conceptus within the first 20 weeks of pregnancy.
• Miscarriage may be due to defects in the fetus, maternal infection, structural abnormalities of the uterus, or endocrine/immunological disturbances.
• Subfertility: Reduced fertility with an unusually long conception time, affecting 18% of couples.
• Subfertility can be caused by sperm abnormalities, multiple miscarriages, or infrequent ovulation.
• The female reproductive system and hormones involved are critical to conception.
• The menstrual cycle lasts ~28 days and includes the follicular (1st) and luteal (2nd) phases.

Hormones and Menstrual Cycle

• Four key hormones: follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone.
• Gonadotropin-releasing hormone (GnRH) stimulates the pituitary gland to release LH and FSH.
• Follicle-stimulating hormone (FSH) stimulates the growth of ova.
• Luteinizing hormone (LH) stimulates the secretion of progesterone.
• The anterior pituitary releases FSH and LH, which travel to the ovaries
• 15-20 eggs begin to grow, in own follicle
• In the Follicular Stage estrogen levels rise with FSH increase
• Enough estrogen turns off FSH, limiting the number of maturing follicles.
• Just one follicle becomes dominant and mature.
• The Luteal Stage occurs 14 days after the follicular stage.
• Estrogen stimulates the release of LH, causing the follicle to release its egg (ovulation).
• The empty follicle becomes the corpus luteum, which secretes progesterone.
• Progesterone prepares the uterus for a fertilized egg and if egg isn't fertilized, menstruation occurs
• Contraceptives contain forms of estrogen and block both LH and FSH stopping ovulation
• Progestin induces a barrier to sperm by making cervical mucus thick and sticky.

Preconception Nutrition: Conditions and Interventions

• Losing 5-10% of body weight in overweight/obese women can restore ovulation.
• PCOS and insulin resistance can cause issues with menstruation and ovulation.
• Increased fat tissue increases endogenous and exogenous steroidal hormones and lipid soluble steroids, altering hormone metabolism and steroid binding proteins (SHBG).
• Too much estrogen can be produced from adrenal androgens, causing excessive feedback to the HPO axis and inhibiting ovary function.
• High blood glucose levels impact hormone levels and carbohydrate counting is important.

Polycystic Ovary Syndrome (PCOS)

• Insulin resistance is the leading cause
• Insulin acts with LH to enhance androgen production in the ovary.
• Hyperinsulinemia is linked to hyperandrogenemia.
• Insulin decreases hepatic synthesis and secretion of sex hormone-binding globulin, increasing free testosterone.
• Insulin-sensitizing drugs can increase insulin sensitivity.
• It is recommended to eat lean proteins, whole grains, fruits and veggies, regular meals, non-fat dairy, low-glycemic index carbohydrates

Causes of Underweight

• Low BMIs may develop anovulation and amenorrhea.
• Reduced hypothalamic production of gonadotropic releasing hormone levels
• To increase BMI, should to eat more food.
• Hypothalamic amenorrhea causes can cause a loss of periods and nutritional deficits.
• Anorexia nervosa and bulimia nervosa can cause hypothalamic amenorrhea.
• Individuals with eating disorders are more likely to miscarry, have preterm delivery, and deliver low birth weight infants.
• Nutritional infertility causes low fuel detection by neuron cells.
• Release of neuropeptide Y and catecholamines
• Hypothalamus blocks GnRH, preventing ovum or sperm growth.

Energy Balance and Deficiencies

• A negative energy balance includes the female athlete triad, with energy intake 30% less than required, decreasing LH, FSH, and estrogen.
• Treatment restores energy balance, ovulation, and bone mass.
• Vitamin/mineral deficiencies from untreated celiac disease include folate (lactose maldigestion), B12 (weight loss), vitamin A (anemia), vitamin D (osteoporosis), vitamin E (subfertility), and vitamin K (growth failure and irritable bowel disease).
• Celiac can be treated by eliminating foods with gluten and replacing them with rice, soy, or corn.
• During conception Women need folate, iodine, DHA, and multivitamins.
• Men need zinc and antioxidants.
• It’s important to have 27 mg of Iron daily.
• Coffee should be limited to no more than 200 mg.
• Caffeine contributes to miscarriage and low birth weight

Nutrition During Pregnancy: Outcomes and Physiology

• Low birth weight (2500 g), preterm delivery, and infant mortality are key concerns.
• 8% of infants have a low birth weight (LBW); 66% of infant deaths are LBW and 11.4% are preterm.
• The goal is to reduce infant mortality and morbidity and to have babies with a desirable birth weight of 3500-4500 grams (7lbs 12oz- 10lbs).
• Ideal birthweight reduces risk of heart and lung diseases, diabetes, and hypertension later
• Gestational age is calculated from the date of conception (38 weeks)
• Menstrual age is assessed from the last period (40 weeks).
• The maternal anabolic phase occurs in the first 20 weeks of pregnancy when the body builds capacity to deliver oxygen, nutrients, and blood for the fetus.
• Mothers experience increased appetite, increased anabolic hormones, and decreased exercise tolerance.
• The maternal catabolic phase occurs in the last 20 weeks, characterized by mobilization of stored nutrients
• Mothers symptoms: increased catabolic hormones, increase in exercise tolerance

Physiological Changes During Pregnancy

• Increased insulin ↑glucose Adipose tissue: Glucose uptake, Lipogenesis, and Lipolysis Adipose tissue: breaks down lipids Striated muscle: glucose uptake, glycogen, synthesis, and protein synthesis Liver: Gluconeogenesis and Glycogen synthesis
• The placenta develops in the uterus in early conception where nutrients and oxygen is exchanged: Removes waste from fetus to mothers blood
• Change in hormones. The body Uses: progesterone, estrogen, human chorionic gonadotropic (hCG), leptin, and human chorionic somatomammotropin
• Body water increases 7-10 L and building blood in first trimester
• First week: body water levels Increases: 50 ml during 10th to 800 mL 20 week of gestation.

Maternal Metabolism, Embryonic Development, and Weight Gain

• Maternal nutrition: Calcium metabolism occurs with bone turnover and reformation
• Increased levels of body water require sodium and other minerals.
• Development: Hyperplasia & Hypertrophy occurs
• Insulin-like growth factor (IGF-1) is growth stimulator.
• It’s normal gain 25-35 lb and 1/3 of gained fetal weight
• Body fat increases, and calories increases to 30,000

Nutrition Needs and Metabolism

• Needs
• Carb intake: 45-65%
• Alcohol: none
• Protein: increase
• Fat: 33%
• Glucose: need more to conversion to glycogen and fat
• Human chorionic somatotropin promotes conversion to glycogen and fat Maternal protein blood: uterus, breasts, fetus, placenta, and amniotic are high Fat stores: accumulate in first half and enhance fat mobilization in last half
• Blood and Lipid increase increase cholesterol and used in steroid
• Hormone increase for the fetus and normal cells VItamins: Folate Iron Vitamin A Vitamin D Calcium Sodium
• Water: 300 mL/day Help with prevention of edema

Other Nutritional Factors During Pregnancy

• Sweeteners approved include: acesulfame K, aspartame, saccharin, sucralose/Consuming Moderation
• Lead can impact children's cognitive function
• High bloods Lead levels/Brain problems
• Nausea, vomiting, diarrhea, and constipation as well as gestational disturbances
• Diarrhea can be causes by; infections, food medicine/medications, IBS
• Relax Gl muscles occur with high estrogen can treat with with high-fiber diets, and fluids
• GERD occurs because of; Uterus pressure high esterogen

More on Pregnancy

• Should Increase fiber and fluid
• No laxatitives
• Should Still do 30min of exercise five times per week
• Experiencing Anxiety and depression

Nutrition During Pregnancy Pt.2

• Deficiencies lead to congenital abnormalities
• Check folate status in blood
• Vegetables and fruit: normal levels are 600 mcg
• NTB (Nueral tube Defects) can be prevented with fetal ultrasounds
• 4 mg folic acid prevents Anecephally and spina bifida
• Tube closes day 22-28 of gestation
• Lack of folic acid or vitamin B12, magnesium, zinc/Obesity
• MTHFR genotype (methylenetetrahydrofolate reductase)
• Glucose intolerance/diabetes Vitamine Intake: 1 mcg food folate .6 mcg folic acid/supplement food .5 mcg folic taken as a supplement on empty stomach
• Choline: B-complex vitamin/ RDA: 450 mg Vitamin A/Help postpartum tissue repair Immure supports fatty acid vision and decreases problems 4000 IUS – no more than 8000 IUS
• For Fetal vitamin D growth: RDA: 15 mcg (600IU

Fetal Development pt.2

• Upper limit: 4000IU

• Deficiency leads to: small or dental cavity in bone/ high Preeclampsia high chance of preterm
• To Help Calcium support both bones should drink Three cups of milk or calcium-fortified soymilk and other resources
• 300mg for the Fetus
• 250 lose during normal
• 450 mg increase red blood Deficiency if: Iron store increase/anemia
• Iron: Pregnancy problems can lead to early early and low birth weight
• Vitamin C is good
• The intake is 18-27 mg
• Anemia has none
• Med can increase if severe fatigue and problem breathing: palpitations, tachycardia, breathlessness
• Low stillborn can increase it

Supplements and Minerals

• 30-mg should be recommended
• lodine: for function for energy and for fetal development,
• No restriction to balance diet increase
• Do not drink Coffe: 3 Cups
• Body should have 9 cups

Conditions during Pregnancy that may occur

• High Blood in glucose, Insilon, and increase levels of HDL:Cholesterol can occur/Physical activity
• Mothers gain weight but not more then 30lb Pregnancy weight gain increase: Underweighed Normal, Overweight, Obese, and with Twins is more
• Increase many nutrients and Thiamin B12

Eating Disorders

• Balanced died to increase physical health
• Diabetes in Pregnancy can: Impaired insulin Production, spontaneous abortion
• Diabetes can be Diagnosis; A1 C> 6.5%, glucose> 126 mg/dL, Glucose <200 mg/dL Impacts of GMD can be: Stillbirth, birth trauma, cesarean section, and the child’s growth cycle and diet can avoid by: eating carbs grains and decrease sugary foods

Complications during pregnancy

• Test in 6 weeks by: measuring the Blood glucose: 140 mg/dL
• Blood can increase with :Impared>140 <200 mg/dL Type 1 diabetes
• More hazardous and Kidney problems occur, can gain hypoglycemia
• 5-10% pregnancy can harm or affect vessels with Clots
• High protein levels, high blood pressure complications in organ, and more
• A poor placenta can cause high blood vessel problems with
• Characteristics of preeclampsia can cause high blood and harm more the the: Oxidative stress inflammation endothelial dysfunction, Platelet aggregation and blood coagulation
• High fiber, exercise is need

Lactation Physiology

• Rounded,Oblong shape Alveoli/ Secreting milk cells Myoepithelial

Horomones that support

Prolactin increases Progesterone: Mammary gland Letdown ejaculation of milk Lactogenesis occurs with before/after birth. In the form of milk Lactoferrin 65 calories less then human milk substitute Help in lactose level intake

Lipds,Protein,Vitamine

• Provide of calories vitamin (a) + (d) DHA; retinol development
• Lower can intake and main in protein/ Casein
• Lactoes- Increase nonessential acid for Immune and calcium system/Vitamin A: with colostrum yellow beta cartone/ D Most -25

Problems During pregnancy

Content can effect and zinc if can increase and cause: Rare if not caused other problems

• All can alter cause harm: High, protein,Immunoglobin IgA, Oligosaccharides, Lysozyme
• No bottles and Dymmies

Common Issues That Occur

• Infections can increase with infection and can lead to
• Increased oxytocin, Physical benefits: help with infections
• Meet protein needs without overloading kidneys
• Provides generous amounts of the right lipids
• Long-chain polyunsaturated fatty acids are present
• Enhanced availability of minerals
• Infection protection

Problems With Brestfeeding

• Can affect in few days: Prevent infant food/ fluids more in Diapers
• 3-4 day should see results day 5-7: See Months after first tooth erupts need increase in Breast Supplements for Vitamine D needs

Problems In Detail

• Positioning of baby, Letdown ejaculation from breastfeeding Decrease
• High Milk level of of milk (volume) : increase of breast volume/milk
• Supply and demand: process if not increase
• Breast blockage: Massage with high pressure and massage

The Risk Of Brestfeeding

• No feed due to: complete dry dry-mastitis/Inflammation
• Milk that is or and infective that can: missing milk that causes, 30%
• Real or have a galactagoge: The breast
• Most effect and expose index/drug intake: high and affect to breast if: low milk intake Drugs that cause: Breastfeeding, affect and no result: high risk
• High risk for Brestvolume/ Herbs cause risk: no intake or not safe and cause more problems

More On BreastFeeding

• GOat mill or alchol; passes and if same can pass effect.
• Interfere: Baby Pattern or decrease smell when milk cause
• High risks of; Infections (medium) (ear) or respiratory
• Nicotine should take for.5 increase: blood increase problems
• Marijuana can high and form neurotransmitter
• Caffeine (low in small level for months: can cause less or high Durg, Steroids,
• Jaundice for babies not in a normal order

Issues After Born

• BIIrubin; metabolism + after to can lead to: Low blood or transport problems/physiologic rise in; bilburn rises,
• Usually less 5
• Resolves; with in days
• Jaundice breastfeeding causes: nursing and
• Inefficient are at levels in increase milk

Breastfeed with Milk

• Increase in; problems increase with Bilirubin
• AAP guidelines recommend phototherapy using fluorescent lights -Light is absorbed in bilirubin changing it to a water soluble product
• Encourage continuing breastfeeding -Only some jaundice causes will develop into hyperbilirubinemia and kernicterus

Infant Alliegies

• Not the first:4 months
• No high chance and for dermatitis: more and wheat and soy with fish