Pregnancy Nutrition Lecture Notes PDF

Nutrition during Pregnancy Part 1 Done by : Dr. Reham Shawky Updated by: Ms. Lena Bogari Lecture 2 3/09/2024 Physiological Changes During Pregnancy  Physiological Changes during Pregnancy P...

Nutrition during Pregnancy Part 1 Done by : Dr. Reham Shawky Updated by: Ms. Lena Bogari Lecture 2 3/09/2024 Physiological Changes During Pregnancy  Physiological Changes during Pregnancy Physiological changes Placental and fetal Metabolic changes Different Body systems Hormones development Hematological system Respiratory system Placenta growth. Metabolism is increased Oestrogen Cardiovascular system Progesterone Gastrointestinal system (GI system) Fetal growth: Oxytocin Renal system 1. Zygote. Relaxin 2. Embryo. human Chorionic Nervous system 3. Fetus. Endocrine system Gonadotropin (hCG) Musculoskeletal system Human Dermatological system Placental Lactogen (hPG) Prostaglandin Hematological System. The increase of clotting factors is to prevent bleeding at time of delivery, but it causes high risk of thromboembolic phenomena The increase of RBC 20-30%, coupled with disproportionate increase of plasma causes the risk of anemia.  Respiratory System. The increase of tidal volume, causes hyperventilation, in which it leads to respiratory alkalosis. During labor hyperventilation is augmented, that could cause marked alkalosis, reducing the release of O2 to the fetus Respiratory Alkalosis signs and symptoms: Dizziness Fatigue Causes decease in Fainting the total lung Chest Discomfort capacity. Shortness Of Breath SOB Confusion Numbness  Cardiovascular System. Cardiac output (CO) ↑ 30–40% higher levels, than in the non-pregnant state in the 1st trimester. This increase can be attributed to ↑ in both the stroke volume (35%) and heart rate (15%). After delivery there is further ↑blood volume causing ↑CO, which makes this a hazardous time for patient’s with heart disease.  Gastrointestinal System. ↑ hCG→ estrogen production → nausea and vomiting, 1st trimester up to 70% of patients. 60% of it would be over by the end of the 1st trimester, and 90% by 20 weeks of gestation. What’s hyperemesis gravidarum? Progesterone ↑relaxation of lower esophageal sphincter and upward displacement of the stomach because of enlarging uterus causing ↑ heart burn. Intestinal emptying time ↑, which might cause constipation.  Renal System. After 12th week of gestation, progesterone ↑ relaxation leads to dilation renal calyces and ureters. This → urinary stasis, ↑ risk of urinary tract infections UTI  Nervous System ↑ sensitivity to the anesthetic agent.  Endocrine System Corticosteroid hormones is ↑ by the adrenal gland, and there is adrenal cortical hyperplasia → insulin resistance and ↑ skin pigmentation.  Musculoskeletal System Relaxin and estrogen are responsible for ↑ ligamentous laxity, especially in the pelvis, enabling the fetus to be accommodated easily. It can also contribute → musculoskeletal pain and poses ↑ risk of subluxation or dislocation.  Dermatological System Melanocyte-stimulating hormone → hyperpigmentation of the face, neck, middle of abdomen.  Placental and Fetal Development Placental Development Fetal Growth and Development Placenta: Organ develops inside the uterus 1- Zygote: A newly fertilized ovum. Size =. during early days of pregnancy, through ↓week rapidly divide multiple times to become blastocyte ready for which fetus receives nutrients and O2 and implementation. returns CO2 and other waste products. Placenta is metabolically active organ. Structure, function, and development of 2- Embryo: Developing infant from 2-8 weeks after conception. placenta At first number of cells in embryo doubles every 24 hour, later on the rate slows. Healthy placenta is important for full fetus At 5 weeks size of embryo: 0.5 inch long. development and growth. At 8 weeks size of embryo: 1.25 inch long, and has a complete central nervous system, digestive system, beating heart, well defined fingers, and the beginning of facial features. 3- Fetus: Developing infant from 8 weeks after conception – term. Each organ grows to maturity on it’s own schedule. The infant grows during this period 20 times longer, and 50 times heavier.  Hormones Name of hormone Increase or Function decrease Oestrogen Increase 1-To support your baby until the placenta takes over. 2- Helps the development of your baby’s organs and the correct function of the placenta. Progesterone Increase Progesterone causes an increase in blood flow to the womb. Oxytocin Increase Eases the pain during labour, and encourages the cervix to open Relaxin Increase Makes your ligaments softer human Chorionic Increase Support you and your baby. It’s often an indicator of pregnancy in Gonadotropin (hCG) over-the-counter tests as well. Human Increase Helps the baby to get the nutrients they need while you’re pregnant Placental Lactogen (hPG) Increase Help to get the cervix ready for labour Prostaglandin  Metabolic changes During the last two trimesters of pregnancy , energy needs increase by about 350-450 kcal/day Energy is increased to support…  Basal energy expenditure (BEE),  Physical activity,  The thermic effect of food,  Growth of the fetus  Deposition of maternal tissues. BEE increases because of the enhanced metabolism of the uterus and fetus and the increased work of the heart and lungs. All macronutrients requirements ↑  Fluid Fluid play many vital roles during pregnancy:- 1-Increase in the mother's blood volume. 2- Acts as a lubricants. 3- Aids in regulating body temperature. 4- Necessary for many metabolic reactions. 5-Helps maintain the amniotic fluid that surrounds , cushions , and protects the fetus in the uterus. 18 Estimated Energy Requirements (EER), Recommended Dietary Allowances (RDA), and Adequate Intakes (AI) for Water, Energy, and the Energy Nutrients Why? Common Nutrition-Related Concerns of Pregnancy.  Nutrition Related Pregnancy Problems 1. Morning Sickness (Nausea and Vomiting of Pregnancy NVP) 2. Heartburn. 3. Constipation. 4. Dizziness. 5. Gestational Diabetes. 6. Fluid Retention. 7. Hypertension. 8. Edema and Leg Cramps. 9. Anemia. 10. UTI 9/3/2024 24  NVP Small, frequent meals. Drink fluid between meals, not with meals. Eat high amount of protein. Avoid high fat foods. Nutritional Eat dry food or carbohydrate before rising from bed in the morning. strategies Try sour food. Avoid spicy food. Ginger has been shown to be beneficial (250 mg 2- 4/day. Vitamin B6 + doxylamine. Medical Therapy 25 Heartburn Nutritional tips to reduce the heartburn: Eat small meals instead of 3 main meals. Avoid eating right before bed. Minimize caffeinated drinks and spicy or fatty foods. Sit upright when eating, as it relieves pressure on the stomach. Avoid eating and drinking at the same time; Which may make the stomach full. Support the head and shoulder together with pillows when sleeping; To prevent stomach acid. Stop smoking. 9/3/2024 26 3. Constipation  4.Dizziness during Pregnancy Dizziness and nutrition: Eat regularly. Avoid long periods between meals; it is better to snack throughout the day 9/3/2024 28  5. Gestational Diabetes GDM Some women have diabetes when they become pregnant. Others may develop gestational diabetes during pregnancy. In most cases, this latter type disappears after the infant is born; however, there is a 40% increased risk of developing type 2 diabetes later in life. Every pregnant woman should be tested for diabetes between 16 and 28 weeks of gestation. Those found to have the disease must learn to monitor their diets to maintain normal blood glucose levels and to avoid both hypoglycemia and Dietary Measures for GDM hyperglycemia. -Recommend a minimum of: 175gm of carbohydrate, 1.1 g/kg/day of protein, 28 gm of fiber. -Space carbohydrate evenly throughout the day. -Eat several meals and snacks instead of large meals without snack. 9/3/2024 29  During pregnancy, the body produces approximately 50% more blood and body fluids to meet the needs of the developing baby. 6. Fluid Retention Swelling is a normal part of pregnancy that is caused by this additional blood and fluid. Normal swelling, which is also called edema, Reasons related to nutrition: is experienced in the hands, face, legs, ankles, and Low potassium diet. feet. High sodium diet. High level of caffeine consumption. Swelling may be experienced at any point during pregnancy, but it tends to be noticed around the fifth month and can increase while you are in the third trimester. 7. Pregnancy-Induced Hypertension (PIH)  PIH was formerly called Toxemia or Preeclampsia.  It is a condition that sometimes occurs during the third trimester.  Increased intake of fiber and calcium has been positively associated with reduced risk in several studies. 31 8. Edema and Leg Cramps  Mild, physiologic edema is usually in the third trimester and should not be confused with the edema associated with pregnancy induced hypertension. Calcium supplementation for leg cramps during pregnancy has been used extensively.  Magnesium supplementation may relieve leg cramps because pregnancy and lactation can lead to a secondary magnesium deficiency as evidenced by low serum magnesium levels. 32  9. Anemia  The patient suffering from anemia:  Consequently feels weak and tired.  Poor appetite.  Appears pale. Note: high amounts of supplemented iron are associated with constipation and upset stomach for many pregnant women. 33  10- UTI Cranberry Juice: Some evidence suggests that daily consumption of 100% pure cranberry juice with no added sugar may prevent UTIs. Because of a possible infection-fighting property contained in the juice. It is unclear how much and how often one should drink cranberry juice to prevent UTIs. You should not drink cranberry juice if you are taking the blood-thinning medication, warfarin, as it may lead to bleeding. 34 Unusual Complications of Pregnancy  Food Cravings and Aversions Food cravings: strong desires to eat particular foods. Food aversions: strong desires to avoid particular foods.  Due to hormone-induced changes in sensitivity to taste and smell. 36  Pica  Pica is a craving for and consumption of nonfood substances.  Pica is known as: