Pregnancy And Lactation Nutrition PDF

**PREGNANCY AND LACTATION** **Objectives** At the end of the chapter, the students should be able to: 1\. identify the nutritional requirements for pregnant and lactating mothers; and 2\. plan a whole-day menu considering these nutritional requirements. **PREGNANCY** Pregnancy or gestation is...

**PREGNANCY AND LACTATION** **Objectives** At the end of the chapter, the students should be able to: 1\. identify the nutritional requirements for pregnant and lactating mothers; and 2\. plan a whole-day menu considering these nutritional requirements. **PREGNANCY** Pregnancy or gestation is the period when the fertilized ovum implants itself in the uterus, undergoes differentiation, and grows until it can support extra-uterine life. Human pregnancy lasts for a period of 266 to 280 days (37-40 weeks). It consists of 3 trimesters: first, second, and third trimesters which correspond to the three main phases: implantation, organogenesis, and growth. **Nutritional Objectives** 1\. Ensure optimum nutrition before, during, and after pregnancy and during lactation 2\. Provide adequate nutrition to meet increased maternal and fetal nutrient demands **NUTRITION IN PREGNANCY** **Calorie Allowances** During the course e of pregnancy, the total energy cost of plus maintenance (additional work for maternal heart and uterus and a steady rise in basal metabolism) amounts to approximately 80,000 kcal. The energy cost of pregnancy then is about 300 kcal per day. The energy intake should be 36 kcal per kg of pregnant weight per day. **Weight Gain** The components of maternal weight gain is shown in Table 50. The weight of the blood volume and the enlargement of the reproductive organs are fairly constant. If the weight gain is less than the weight if the maternal components in pregnancy, the growth of the fetus calls on the reserve of the mother. Although weight gain varies is generally agreed that the normal curve of weight gain is sigmoid in shape. A small weight gain is observed during the first trimester A more rapid weight gain happens in the second trimester, and a slower weight gain is recorded during the third trimester. An average weight gain during pregnancy is 24 lbs which is commensurate with a better-than-average course and outcome of pregnancy. A gain of 15 to 3.0 lbs during the first trimester and a gain of 0.8 lb per week during the remainder of the pregnancy should be the guideline. The pattern of weight gain is more important than the total amount gained. A sudden gain in weight after the 20th week of pregnancy may indicate water retention and the possible onset of pre-eclampsia. **Table 50** **Maternal Weight Gain** **Tissue** **Weight (Pounds)** ---------------- --------------------- Fetus 7.5 Uterus 2.0 Placenta 1.5 Amniotic fluid 2.0 **Tissue** **Weight (Pounds)** ------------------------------- --------------------- Blood Volume 3.0 Extracellular fluid Accretion 2.0 Breast Tissue 1.0 Fat 9.0 Total 28.0 **Maternal Weight** **1. Underweight** **2. Overweight and Obese** **Table 51** **Recommended Weight Gain during Pregnancy** During the total pregnancy period, the basal metabolic rate increases from 6% to 14% and the calorie requirements proportionately Increase. Because the appetite is usually lessened during the first trimester, it may be difficult to maintain calorie requirements almost negligible. The chief concern during lactation is the loss of the food material in the milk and the storage of a certain amount of food which cannot be entirely accounted for by the chemical composition of the milk. Also, extra calories may be needed for additional activity necessitated by the care of the infant. The extra energy required for lactation depends on the amount of milk produced. The food requirements are not uniform during the entire period of lactation; nevertheless, they depend on the demands of the infant. It is generally suggested that the extra food calories should be about twice those secreted in the milk of approximately 700 to 1,500 calories of food for 500 to 1,000 mL of the milk. The FNRI recommends an increase by 1,000 calories above the normal requirement for an average production of 850 mL of milk, with an energy value of about 600 calories. Human milk is approximately 0.70 calories per ml. or approximately 20 calories per ounce, and it contains 1.2 g protein per 100 ml.. **Protein Allowances** An adequate protein intake of HBV foods during pregnancy is essential in preparation for lactation. The need for protein is greatest when lactation has reached its maximum, but it is a need which should be anticipated and planned for during pregnancy. Lactation makes large demands on the human stores. The food intake of a nursing mother must contain sufficient proteins to supply both the maternal needs and the essential amino acids to be transferred through her breast for the baby\'s growth. Additional protein in the diet tends to increase the yield of breast milk while a decrease of protein lowers the amount of milk secreted. If the amount of protein in the mother\'s diet does not meet the body maintenance needs and the necessary protein content of the milk secreted, a loss of maternal body tissues will result. The average protein allowance for the lactating mother is an additional 20.2 g protein to her normal requirement. In such a case, a 20 g factor may be used. **Reasons for the additional protein:** 1\. to provide for the storage of nitrogen 2\. to protect the mother against many of the complications of pregnancy 3\. for the growth of the woman\'s uterus, placenta, and associated tissues 4\. to meet the needs for the fetal growth and repair 5\. for the growth of the mammary tissues 6\. for the hormonal preparation for lactation Two-thirds of the proteins should be of animal origin of the highest biologic value such as meat, milk, eggs, cheese, poultry, and fish. A factor of 10 g added to the normal protein allowance may be used for simplicity. **Nutritional needs during pregnancy include:** 1\. the normal requirements of the mother 2\. those of the developing fetus (including also the uterus and placenta) 3\. building up reserves in preparation for labor and lactation **Calcium Allowances** Some calcium and phosphorus deposition takes place early in pregnancy, but the amounts are small. During the latter half of pregnancy, the intake and retention of calcium are considerably increased. The quantity retained is more than what can be accounted for by the fetal utilization, and it perhaps represents the establishment of a reserve supply which may be availed of during subsequent emergencies. An adequate supply of vitamin D is essential in the use of calcium and phosphorus needed to calcify the fetal bones and teeth. If the diet of the pregnant woman is inadequate in calcium, she will have to sacrifice the calcium of her bones in favor of the developing fetus. It has been shown that the calcium and phosphorus retained in the fetus during the last two months of pregnancy are 65% and 64%, respectively, of the total body content of the full-term fetus. To satisfy these additional needs, the daily intake of calcium must be increased from 0.5 to 0.9 to that of the non-pregnant adult\'s daily allowance. Phosphorus is less likely to be deficient in the average diet. If the protein requirements and other dietary principles are observed, the need for phosphorus will be met. **Iron Allowances** At least 700 to 1,000 mg of iron must be absorbed and utilized by the mother throughout her pregnancy. Of this total, about 240 mg is spared by the cessation of the menstrual flow. The remainder must be made available from the diet. The rate of absorption is increased therefore, in the third trimester when the needs of the fetus are highest. **Iodine Allowances** Iodine is especially important during pregnancy to meet the needs for fetal development. An inadequate intake of iodine may result in goiter in the mother or the child. The increased need for iodine can be met by the regular use of iodized salt in food. **Vitamin Allowances** Thiamine and niacin allowances are increased in proportion to the calorie increase while riboflavin allowances are increased according to the higher protein level. The need for vitamin D is increased during pregnancy to make easier the utilization of greater amounts of calcium and phosphorus. Ascorbic acid, vital in tissue structure, is required in considerably increased amounts. Vitamin A is important in the epithelial cells during organogenesis and is necessary to ensure good vision. Folic acid and vitamin B12 are important in the synthesis of RBC. Vitamin B6 or pyridoxine requirement has been observed to be greater during pregnancy. It has been found to have much value in preventing severe nausea and vomiting associated with childbearing. During the early days of life, the infant often has low blood prothrombin levels until intestinal synthesis of vitamin K is fully established. Vitamin K may be given to the mother at 2 mg to 5 mg parenterally before the birth of the baby to stabilize the prothrombin level of the infant until synthesis can take place. Otherwise 1 mg to 2 mg can be given to the infant after birth. The use of vitamin K supplement during the course of pregnancy is, therefore, not necessary. **Food Allowances** 1\. One ounce or 30 g of meat or its equivalent and an extra pint of milk to the normal diet 2\. Daily consumption of whole-grain cereals; enriched bread; rice; leafy green and yellow vegetables; and fresh and dried fruits 3\. Liver at least once a week 4\. Egg in the daily diet 5\. Fortified milk with vitamin D or fish liver oil 6\. Six to 8 glasses of water daily **COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS** Nausea, vomiting, improper body weight, and toxemia are among the many conditions that complicate the normal course of pregnancy. They influence the intake, digestion, absorption, and utilization of essential nutrients. They become even more serious when gestation occurs during adolescence. During the early part of pregnancy, the most common discomfort is \"morning sickness,\" so called because nausea and vomiting usually occur immediately after getting up in the morning. When accompanied by lack of appetite, such condition leads to malnutrition and loss of weight. A longitudinal study on pregnant women reveals nausea to affect frequency of food intake, resulting in a decrease in calorie intake. Increased hormone secretion is in some way responsible for this phenomenon. Nutrition experts recommend small frequent feedings instead of three large meals, and high-carbohydrate, low-fat foods such as crackers and jelly to overcome the above complications. Liquids are better taken between meals rather than at mealtime. **Rapid Weight Gain or Loss** The popular concept of \"eating for two\" is not valid among well-nourished mothers. It may lead to overweight with consequent toxemia, difficulties of labor, and birth of large sickly babies Excessive weight gain during pregnancy is defined as an increase of three kilograms or more per month in the second and third trimesters. A sudden increase in weight after about the 20th week of gestation is a cause for suspecting that water is being retained at an inordinate rate and should be regarded as a warning sign of an impending eclampsia. Proper management of obese pregnant patients is a matter of controversy. Some obstetricians advocate moderate calorie restriction with limited weight loss. Nutrition experts generally oppose severe calorie restriction because aside from the probability that restriction of calories results in deficiency of some essential nutrients, the susceptibility to starvation ketosis during pregnancy endangers fetal and maternal health. It is advised that the overweight and obese women should consciously avoid severe calorie restriction as well as prevention of excessive weight gain. On the other hand, a gain of less than 500 g/month during the first trimester of pregnancy and 250 g during the second trimester is considered a maternal risk factor. Those who are seriously underweight entering pregnancy (\