Nutrition in the Life Stages

• Nutrition in the Life Stages 1 is presented by Cherly F. Dinglasa, RND, Instructor 1, Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Samar State University.

Life Stages and Nutrition

• Nutrition plays a vital role in various life stages, from infancy to old age, impacting health and well-being.
• Malnutrition at any stage can lead to impaired development and increased risk of disease.
• Adequate nutrition, along with health and care, are crucial at all stages of life.
• Adequate nutrition during pregnancy is vital for fetal development.
• Inadequate nutrition during pregnancy can lead to low birthweight and increased risk of mortality.
• Proper nutrition during childhood ensures adequate catch-up growth and reduces mental impairments.
• Overweight and obesity can arise if there is inadequate food, health, and care.
• Nutritional status also has an impact in adulthood and old age.

Maslow's Hierarchy of Needs

• Physiological needs: air, water, food, shelter, sleep, clothing, reproduction are the base of the pyramid
• Safety needs: personal security, employment, resources, health, property
• Love and belonging: friendship, intimacy, family, sense of connection
• Esteem: respect, self-esteem, status, recognition, strength, freedom
• Self-actualization: desire to become the most that one can be

DOHaD (Developmental Origins of Health and Disease)

• Epigenetics involves epigenetic adaptations that are made to fetal/neonatal DNA in response to environmental influences.
• Developmental programming involves the body responding to the environment and makes genetic changes (predictive adaptations) in anticipation of a presumed future environment.
• Environmental factors include maternal nutrition, smoking, infant feeding methods, maternal stress, and infection.

Preconception Care

• Preconception care refers to providing biomedical, behavioral, and social health interventions to women and couples before conception occurs.
• It aims to improve health status and reduce behaviors/environmental factors that may contribute to poor maternal and child health outcomes.
• The ultimate aim is to improve maternal and child health outcomes in the short and long term.

Preconception Period

• The preconception period is the time before or between pregnancies, often overlooked as a stage of the reproductive cycle.
• It's a critical period where nutritional and other exposures can impact conception, pregnancy maintenance, development, growth and future health of the offspring.

Areas Addressed by Preconception Care Package

• Nutritional conditions
• Infertility/subfertility
• Too early, unwanted, and rapid successive pregnancies
• Genetic conditions
• Vaccine-preventable diseases
• Environmental health
• Mental health
• Human immunodeficiency virus (HIV)
• Interpersonal violence
• Psychoactive substance use
• Tobacco use
• Female genital mutilation
• Sexually transmitted infections

Fertility, Infertility, Fecundity, and Subfertility

• Fertility refers to the actual production of children.
• Infertility is the lack of conception after one year of unprotected coitus.
• Fecundity addresses the biological capacity of bearing children.
• Infecundity is the biological inability to bear children after 1 year of unprotected coitus.
• Subfertility indicates a reduced level of fertility by either unusually long time for conception or repeated pregnancy losses.

Impact of Surplus Body Fat on Fertility

• Fat cells produce estrogen, testosterone, and leptin, altering their availability based on body fat content.
• Obese men and women, with a BMI greater than 29.99 kg/m², tend to be subfertile.
• Obesity in men is associated with lower testosterone and increased estrogen/leptin, reducing sperm production in 16% of obese males and increasing rates of erectile dysfunction.
• Obese women often have higher estrogen, androgen, and leptin levels compared to non-obese women leading to menstrual cycle irregularity, anovulatory cycles, and amenorrhea.

Impact of Inadequate Body Fat on Fertility

• A critical level of body fat, indicated by a body mass index above 20 kg/m2, is needed to trigger and sustain normal reproductive functions in women.
• Low levels of body fat during adolescence are related to delays in the age of onset of menstruation and later fertility.
• Impaired fertility in underweight women often takes the form of delayed time to conception and amenorrhea.
• Lowered libido and reduced sperm production have been identified in underweight men with low levels of body fat

Diet: Macronutrients and Fertility

• Carbohydrates: Insulin sensitivity and glucose metabolism affect ovulation and female fertility; glycemic index and load can increase insulin resistance, dyslipidemia, and oxidative stress, which negatively affects fertility and ovarian functions.
• Fats: A high-fat diet is associated with changes in menstrual cycle length, reproductive hormone concentrations, and embryo quality
• Protein: Emphasis on intake of animal and plant-based protein to promote fertility.

Diet: Micronutrients and Fertility

• Folic acid: Higher levels of dietary intakes of folate from food and supplements in healthy men have corresponded with fewer chromosomally abnormal sperm among men with lower folate.
• Iron deficiency: Iron deficiency prior to pregnancy has been shown to increase the risk of iron deficiency anemia during pregnancy and that infants will be born with low stores of iron, iron deficiency before pregnancy is also related to increased rates of preterm delivery.
• Vitamin D: Vitamin D has anti-inflammatory and immunomodulating properties; deficiency may be associated with endometriosis or cause reproductive hormone synthesis; Vitamin D is considered an essential nutrient for infertility treatment.
• Iodine: Preconception nutrition affects thyroid function and fertility; Women experiencing moderate/severe iodine deficiency may experience pregnancy delays: the chances of becoming pregnant in each cycle decreased by 46% compared to women who were not iodine deficient.
• Zinc, Selenium and Copper: Low serum concentrations of zinc and selenium corresponded with a 1-month longer period before achieving pregnancy; deficiency of selenium and copper was linked to a higher risk of infertility; Selenium affects thyroid gland function, acts as an antioxidant, and influences the growth and maturation of oocytes.
• Magnesium: Magnesium is important for glucose metabolism, and proper serum concentration of magnesium is associated in women with PCOS and metabolic disorders with increased insulin sensitivity in tissues.

Caffeine and Fertility

• Caffeine is a potential factor associated with prolonged time to achieving pregnancy and an increased risk of pregnancy loss.
• The European Food Safety Authority recommends up to 200 mg of caffeine/day is recommended for women trying or who are pregnant.
• The American College of Obstetricians and Gynecologists indicates that the intake of up to 200 mg of caffeine does not appear to be a main factor leading to miscarriage or preterm delivery.
• Sources: Caffeine is in coffee, tea, soft drinks, energy drinks, cocoa, or certain drugs like acetaminophen, aluminum hydroxide, aspirin, and magnesium hydroxide.

Definitions of Pregnancy

• Pregnancy, known as "gestation", extends from conception to delivery
• It is a condition of having a developing embryo and later a fetus within the uterine environment from the union of an ovum and sperm.
• Pregnancy lasts 266 days or 38 weeks (ovulation age) or 280 days or 40 weeks (menstrual age).

Definitions of Pregnancy: Trimesters

• Pregnancy is divided into three trimesters.
• The terms preterm and postterm are used to describe pregnancies lasting less than 37 weeks and greater than 42 weeks, respectively.

Menstrual Cycle

• Approximately a 4-week interval in which hormones direct a build up of blood and nutrient stores within the wall of the uterus and ovum maturation and release.
• Length of cycles vary from cycle-to-cycle and with increasing age.
• The first half of the cycle is called the follicular phase; the last 14 days is the luteal phase.
• Typically 26-29 days long with average of 28 days

Stages of the Menstrual Cycle

• Menstruation: Lining of the uterus is shed, resulting in the release of blood and tissue from the body through the vagina.
• Follicular Phase: When the pituitary gland releases hormones that stimulate the growth and development of ovarian follicles.
• Ovulation Phase: When a mature egg is released from the ovary and is ready for fertilization.
• Luteal Phase: Empty ovarian follicle becomes the corpus luteum, producing hormones that prepare the uterus for possible embryo implantation.

Hormonal Changes in the Menstrual Cycle

• Estrogen, secreted by the ovary, stimulates the hypothalamus to release GnRH
• GnRH stimulates the anterior pituitary gland to release FSH and LH.
• FSH causes growth of 6-20 follicles in the surface of the ovary.
• FSH also stimulates the production of estrogen by cells in the follicles.
• Rising LH levels cause cells within the follicles to secrete progesterone.
• Progesterone and estrogen prompts the uterine wall (endometrium) to store glycogen and other nutrients as well as expansion and growth of blood vessels and connective tissues
• On the 14th day, FSH and LH level peaks and an ovum from a follicle is released (OVULATION)
• The corpus luteum is a tissue formed from the follicle left after ovulation.

If Ovum is not Fertilized

• The tissue secretes large amounts of progesterone and little estrogen, which inhibits the production of GnRH
• The absence of GnRH prevent secretion of LH and FSH, so ova within follicles do not mature
• If ovum is not fertilized, corpus luteum activity declines, blood levels of progesterone/estrogen falls, blood vessels in the uterine walls constrict, its outer layer is then released with menstrual flow.

Physiological Stages of Pregnancy

• Implantation: 2 weeks after conception, the fertilized egg develops into a sphere (blastocyst) and embeds itself into the endometrium or lining of the uterus; the embryo is nourished from the uterine substances.
• Organogenesis: completed 60 days after conception with the differentiation continued in the 3rd month; nourishment comes from within the uterine environment and maternal tissues; maternal nutrition is crucial for fetal growth.
• Fetal growth: the remaining 7 months of pregnancy and includes the role of placenta is crucial for nourishing the developing fetus.

Physiological Changes During Pregnancy

• Blood Volume Expansion: Blood volume increases 20%, Plasma volume increases 50%, Edema occurs in 60-75% of pregnant women.
• Hemodilution: Decrease of most vitamins and minerals in the blood.
• Blood Lipid Levels and glucose levels: Increased concentrations of cholesterol, LDL cholesterol, triglycerides, HDL cholesterol, increased insulin resistance.
• Maternal Organ and Tissue Enlargement: Heart, thyroid, liver, kidneys, uterus, breasts, adipose tissues.
• Circulatory System: Increased cardiac output through increased heart rate (increased 16% or 6 beats per minute), decreased blood pressure in the first half of pregnancy (-9%) the followed by a return to non-pregnancy levels on the second half.
• Respiratory System: Increased tidal volume (30-40%), increased oxygen consumption (10%).
• Food Intake: Increased appetite and food intake; weight gain, taste and odor changes, modification in preference for some foods and increased thirst.
• Gastrointestinal Changes: Relaxed gastric tract muscle tone, increased gastric and intestinal transit time. nausea (70)%, vomiting (40%, heartburn, constipation.
• Kidney Changes: Increased GFr (50-60%), increased sodium conservation, increased nutrient spillage into urine; protein is conserved and increased risk of UTI.
• Immune System: Suppressed immunity, increased risk of urinary and reproductive tract infection.
• Basal Metabolism: Increased basal metabolic rate in the second half of pregnancy increased body temperature.
• Hormones: Placenta secretes large amounts of hormones needed to support physiological changes of pregnancy.

Hormones and Their Role in Pregnancy

• Progesterone promotes maternal fat deposition.
• Estrogen increases hydroscopic properties in connective tissue and affects thyroid function.
• Human placental lactogen (HPL) elevates blood glucose from the breakdown of glycogen.
• Human chorionic thyrotropin (HCT) stimulates thyroid hormone production.
• Human Growth Hormone (HGH) increases growth of long bones and nitrogen retention.

Placenta

• A tissue embedded on the wall of the uterus where maternal and fetal circulatory systems interact.
• Weighs 450-1000 gram at birth
• Supplies the fetus with nutrients and oxygen
• Stores nutrients such as vitamins
• Synthesizes hormones and removes fetal waste products

Transport Mechanisms in the Placenta

• Passive diffusion transports oxygen, carbon dioxide, fatty acids, steroids, nucleosides, electrolytes, and fat-soluble vitamins.
• Facilitated diffusion transports most monosaccharides.
• Active transport transports amino acids, some cations (calcium, iron), iodine, phosphate, and water-soluble vitamins.

Maternal Weight Gain

• Maternal weight gain during pregnancy varies based on pre-pregnancy BMI.
• Weight gain consists of fetus, placenta, amniotic fluid, uterus, breast tissue, blood, or fat.
• Underweight women (BMI less than 18.5 kg/m2) should gain 28-40 pounds.
• Normal weight women (BMI 18.5-24.9) should gain 25-35 pounds.
• Overweight women (BMI 25.0-29.9) should gain 15-25 pounds.
• Obese women (BMI greater than 30.0) should gain at least 15 pounds.

Nutritional Requirements During Pregnancy

• Energy: TER + 300 kcal per day for the 2nd and 3rd trimesters only; Supports growth of fetus, placenta and maternal tissues, increases BMR, better utilization of dietary protein and good for pregnancy outcome.
• Protein (g): 62 + 27; Meets the needs of the developing maternal tissues, supports growth of fetus and placenta and protects the course and outcome of pregnancy
• Water (ml): +300; Supports blood volume, amniotic fluid, fetal hydration.
• Vitamin A (mcg RE): 600 + 300;Essential for the health of the epithelial tissues including the skin and the glandless ducts and passages of Gl tract, urinary and respiratory tract and accounts for vitamin A storage int the fetal tissue
• Thiamin (mg), riboflavin, and niacin: Thiamin (mg): 1.1 + 0.3, Riboflavin (mg): 1.1 +0.7 and Niacin (mgNE): 14 +4, is for carbohydrate, protein, and lipid metabolism
• Vitamin b6 and b12: Vitamin b6 (mg): 2.4 +0.6, Vitamin b12 (mcg): 2.4 + 0.2 and prevents nausea and vomiting.
• Folate (mcgDFE): 400 +200; Supports fetal growth (DNA synthesis) and in erythrocyte maturation is preventing neural tube defects.
• Vitamin C (mg): 60 + 10 and maintain integral fetal tissue membrane and structure.
• Iron (mg): 28 +10; Supplementation replaces iron losses, supports red cell expansion and a healthy placenta/fetus.
• Zinc (mg): 4.6 +5.1 and important in protein, RNA, and DNA synthesis and in cell division differentiation.
• Selenium (mcg): 33 +4; Supports the fetal saturation of selenoproteins.
• Iodine (mcg): 150 +50 and to avoid compromising the development of the fetus.
• Calcium (mg): 750 + 50, for 3rd trimester is only a promote adequate mineralization of fetal skeleton and deciduous teeth of the fetus.

Pinggang Pinoy for Pregnant and Lactating Women (Visual Guide)

• Go (Energy Giving): Rice, root crops, pasta, bread
• Grow (Body Building): Fish, shellfish, lean meat, poultry, eggs, dried beans, nuts, milk, and dairy.
• Glow (Body Regulating): Fruits and vegetables for vitamins, minerals, and fiber.
• Water: Adequate hydration.

Harmful Substances to Avoid During Pregnancy

• Alcohol: No amount is safe for a developing baby; causes fetal alcohol syndrome (FAS).
• Cigarette smoking: Decreases infant birth weight and increases the risk of perinatal morbidity and mortality through the toxic effects of carbon monoxide and nicotine, which reduce blood flow to the fetus.
• Caffeine: Only moderate doses are recommended; limit to less than 4 cups per day.
• Narcotics: These can cross the placental barrier and damage the fetus.

Nausea and Vomiting

• Symptoms usually begin around week 5 of gestation and disappear by week 12; can occur any time of day. Loss of appetite usually accompanies nausea and vomiting.
• Interventions: Eat carbohydrate foods before rising, eat small feedings/fluids between meals, avoid odors and foods that trigger nausea, take Vitamin B6 (pyridoxine); multivitamin supplement including ginger.

Heartburn or Reflux

• Results from the backflow of stomach contents into the esophagus due to hypomotility.
• Interventions: Eat small meals, do not lay down for 1-2 hours after a meal, drink between meals, elevate the bed and remove foods, take supplements, and ingest calcium carbonate.

Constipation

• Decreased muscle tone and motility of the GIT and the pressure by the fetus on the digestive tract.
• Interventions: Eat liberal allowance of fruits and vegetables and adequate fluid intake, practice regular elimination and exercise, and get enough sleep.

Pica

• Compulsion for ingesting unnatural foods or nonfood items such as clay, starch, ice, or raw rice grains, which may limit and/or interfere with the intake of food and/or absorption of nutrients.
• Interventions: Women with amylophagia sometimes like powdered milk and or increase iron in their diets.

Health Complications During Pregnancy

• Hypertension before pregnancy.

Gestational Hypertension

• Elevated blood pressure levels are detected for the first time after mid-pregnancy and is not accompanied by proteinuria.

Preeclampsia-Eclampsia

• pregnancy-specific syndrome occurring after 20 weeks gestation with elevated BP and proteinuria.
• Preclampsia is if increased blood pressure is accompanied by headache, blurred vision, abdominal pain, low platelet count, and abnormal liver enzyme values
• Proteinuria: excretion of ≥0.3 grams of protein in a 24-hour urine specimen is considered elevated.
• Eclampsia is the occurrence of seizures that cannot be attributed to other causes in women with preeclampsia.

Gestational Diabetes

• Glucose intolerance that develops during pregnancy and diagnosed in the second or third trimester
• Risk factors can include advancing maternal age, BMI >25, history of GDM; a first degree relative with diabetes; and ethnicity
• Interventions include regular small snack/meals including abstinence from alcohol and participation in 30+ minutes of exercise daily.

Anemia

• Mostly due to iron and folic acid deficiencies
• There are two types of anemia which include, microcytic and megaloblastic
• Interventions are to encourage Iron and folic acid supplementation and foods that include leafy green vegetables, nuts, and citrus fruits.

Exercise During Pregnancy

• It is beneficial to the mother and fetus and it reduces backpain, eases constipation, decrease risk of gestational diabetes, preeclampsia and caesarean birth, promotes healthy weight gain, strengthens blood vessels and heart and aids in losing the baby weight after delivery.
• 150 minutes of moderate-intensity aerobic activity per week with examples being brisk walking, general gardening, swimming or water workouts, modified yoga, and pilates.
• Must be a discussed topic with the ob-gyn.
• Wear supportive clothes or loose-fitting clothes for ease with drinking enough water.
• Avoid standing still or lying flat on your back as much as possible.