Nutrition During Pregnancy PDF

Chapter 4-2 Nutrition During Pregnancy Copyright © 2017 Cengage Learning. All Rights Reserved.  The need for vitamins and minerals during pregnancy – Folate: inadequate intake is associated with anemia and reduced...

Chapter 4-2 Nutrition During Pregnancy Copyright © 2017 Cengage Learning. All Rights Reserved.  The need for vitamins and minerals during pregnancy – Folate: inadequate intake is associated with anemia and reduced fetal growth Functions of folate: metabolic reactions Deficiencies lead to congenital abnormalities Folate status: assessed by serum and red cell folate levels Dietary sources: vegetables and fruits Recommended intake: 600 mcg DFE Copyright © 2017 Cengage Learning. All Rights Reserved. Neural Tube Defects (NTDs) Failure of neural tube to close early in gestation 300,000 worldwide and 3,000 in the States Diagnosis: alpha-fetoprotein and fetal ultrasound Interaction of genetic and environmental factors Protective effect of folic acid (4mg per day) Copyright © 2017 Cengage Learning. All Rights Reserved.  Neural Tube Defects (NTDs) Anencephaly Copyright © 2017 Cengage Learning. All Rights Reserved. Early Pregnancy and Other Nutritionally Relevant Diseases Neural tube defects (NTDs) - Ectoderm folds and eventually forms a tube - Tube closes day 22-29 of gestation - Forms spinal cord and brain Some Causes of NTD Lack of folic acid or other nutrients (vitamin B12, magnesium, zinc, etc.) Obesity Glucose intolerance/diabetes Genetic – MTHFR genotype and others – Methylenetetrahydrofolate reductase (DRI adequate) Copyright © 2017 Cengage Learning. All Rights Reserved.  Periconceptional Folate Status (cont’d.) Remaining risk group for neural tube defects – Hispanic Americans – Women who take the anti-seizure drug valproate without appropriate folic acid supplementation – Women who have previously delivered an infant with a neural tube defect Copyright © 2017 Cengage Learning. All Rights Reserved.  Dietary folate equivalents(DFE) 1mcg food folate 0.6 mcg folic acid consumed in fortified food or a supplement taken with food 0.5 mcg of folic acid taken as a supplement on an empty stomach Copyright © 2017 Cengage Learning. All Rights Reserved. Alcohol’s effects on homocysteine/methionine metabolism and DNA methylation. Effect of increased folate - fortification JAMA 285:2981, 2001 - Live births – NTDs/100,000 live births – 1990-1999 = 37.8 – 1998-2001 = 30.5 REDUCTION OF 19% NTD’S  The need for vitamins and minerals during pregnancy Choline: B-complex vitamin – RDA: 450 mg Copyright © 2017 Cengage Learning. All Rights Reserved.  The need for vitamins and minerals during pregnancy-Vitamin A For baby's embryonic growth, including the development of the heart, lungs, kidneys, eyes, and bones as well as the circulatory, respiratory, and central nervous systems. Helps with postpartum tissue repair. Helps maintain normal vision, fights infections, supports your immune system, and helps with fat metabolism. A healthy daily intake of vitamin A for pregnant women is approximately 4000 IUs (no more than 8000 IUs). Copyright © 2017 Cengage Learning. All Rights Reserved. Vitamin A deficiency and birth defects Niederreither et al., Development, 2001 Copyright © 2017 Cengage Learning. All Rights Reserved.  The need for vitamins and minerals during pregnancy Vitamin D: supports fetal growth – RDA: 15 mcg (600IU) – Upper limit: 4000IU Calcium: needed for fetal skeletal mineralization and maternal bones – Needs can be met with three cups of milk or calcium-fortified soymilk or other adequate sources Copyright © 2017 Cengage Learning. All Rights Reserved.  Vitamin D metabolism Copyright © 2017 Cengage Learning. All Rights Reserved.  Vitamin D deficiency and pregnancy Smaller size, poorly calcified bones and abnormal enamel, dental cavities Higher risk for miscarriage, preeclampsia, preterm birth, maternal infection… Difference in different racial and ethnic groups Obese increase the risk of Vitamin D deficiency Vegan women are at risk for Vitamin D deficiency Copyright © 2017 Cengage Learning. All Rights Reserved. Copyright © 2017 Cengage Learning. All Rights Reserved.  The need for vitamins and minerals during pregnancy Iron: need increases substantially – 300 mg for fetus and placenta – 250 mg lost at delivery – 450 mg for increased red blood cell mass Copyright © 2017 Cengage Learning. All Rights Reserved.  The need for vitamins and minerals during pregnancy Iron deficiency – Condition marked by depleted iron stores Characterized by weakness, fatigue, short attention span, poor appetite, increased susceptibility to infection and irritability Iron-deficiency anemia – Condition marked by low hemoglobin Characterized by signs of iron deficiency plus paleness, exhaustion, and rapid heart rate Copyright © 2017 Cengage Learning. All Rights Reserved.  The need for vitamins and minerals during pregnancy Iron-deficiency anemia in pregnancy – Early pregnancy-risk of preterm delivery and low birth weight – Related to lower scores on intelligence, language, gross motor, and attention tests Copyright © 2017 Cengage Learning. All Rights Reserved.  Periconceptional Iron Status Iron deficiency: most common nutritional deficiency – Women who take iron supplements have, on average, 40 percent less risk of ovulatory infertility than those who don’t take iron supplements. – Prior to pregnancy increases the risk that iron-deficiency anemia – Iron status can generally be improved by regular consumption of vitamin C Copyright © 2017 Cengage Learning. All Rights Reserved.  Why does pregnancy make a woman more likely to become anemic? Iron requirements go up significantly when pregnant—need to prepare more… most women start pregnancy without sufficient stores of iron The amount of iron needed during pregnancy: 18 to 27 milligrams (mg) per day. a daily supplement of 30 mg of elemental iron as a preventive dose. Copyright © 2017 Cengage Learning. All Rights Reserved.  How does iron-deficiency anemia affect mother's health? Mild, anemia may not have any effect on pregnancy and labor. Moderate anemia may cause increased weakness, lack of energy, fatigue and poor work performance. Severe anemia, palpitations, tachycardia, breathlessness, increased cardiac output leading on to cardiac stress which can cause de-compensation and cardiac failure which may be fatal Copyright © 2017 Cengage Learning. All Rights Reserved.  How does iron-deficiency anemia affect baby's health? an increased risk of preterm delivery and low birth weight. a higher risk of stillbirth or newborn death maternal anemia can affect a baby's iron stores at birth, increasing his risk for future anemia Copyright © 2017 Cengage Learning. All Rights Reserved. Copyright © 2017 Cengage Learning. All Rights Reserved.  Energy and Nutrient Needs During Pregnancy (cont’d.) Recommendations for iron supplementation in pregnancy (prevention) – 30-mg iron supplement daily Copyright © 2017 Cengage Learning. All Rights Reserved.  The need for vitamins and minerals during pregnancy Iodine – Required for thyroid function and energy production and for fetal brain development Sodium – Critical role in maintaining body’s water balance – Restriction not indicated in normal pregnancy or for control of edema or high blood pressure Copyright © 2017 Cengage Learning. All Rights Reserved.  Energy and Nutrient Needs During Pregnancy (cont’d.) Coffee/caffeine – Moderate amounts of coffee intake, such as three cups daily, do not appear to pose a risk The need for water – Met by increased levels of thirst – Average consumption: nine cups of fluid per day Copyright © 2017 Cengage Learning. All Rights Reserved.