Pregnancy And Lactation Nutrition PDF

PREGNANCY AND LACTATION Pregnancy or Gestation  Pregnancy or Gestation - The period when the fertilized ovum implants itself in the uterus, undergoes differentiation and grows until it can support extra-uterine life - The whole pregnancy period 266 to 280 days (37-...

PREGNANCY AND LACTATION Pregnancy or Gestation  Pregnancy or Gestation - The period when the fertilized ovum implants itself in the uterus, undergoes differentiation and grows until it can support extra-uterine life - The whole pregnancy period 266 to 280 days (37-40 weeks) - Consist of 3 trimester (1st, 2nd, 3rd) - Phases: implantation, organogenesis and growth  Nutritional Objectives Ensure optimum nutrition before, during and after pregnancy and during lactation Provide adequate nutrition to meet increased maternal and fetal nutrient demands  Nutrition in Pregnancy Calorie allowances Weight gain Maternal weight Protein allowances Calcium allowances Iron allowances Iodine allowances Vitamin allowances  Calorie allowances - 80,000 kcal – the total energy cost of storage + maintenance (work for maternal heart and uterus and a steady rise in basal metabolism) - 300 kcal/day - energy cost of pregnancy - 36 kcal/kg – energy intake per kg/day  Weight gain * 1st trimester – small wt. gain *2nd trimester – rapid wt. gain * 3rd trimester – slower wt. gain * 24 lbs – average wt. gain during pregnancy - * 1.5lbs to 3.0lbs wt. gain during 1st trimester then a gain of 0.8lb per week thereafter * sudden wt. gain after 20th week – indicate water retention and possible onset of pre-eclampsia. (refer to page 198, table 50 for maternal wt. gain)  Maternal Weight 1. Underweight 2. Overweight and obese  Maternal Weight Underweight - high risk of having low-birth wt. infants - higher rates of pre-term deaths and infant deaths  Maternal Weight Overweight and obese a. High risk of complications like hypertension, gestational diabetes, and postpartum infections b. Complications of labor and delivery c. Increases likelihood of a difficult labor and delivery, birth trauma and cesarean section for large babies d. Doubled risk of neural tube defects (refer to page 199, table 51 for recommended wt. gain during pregnancy)  Protein Allowances - 9.5g/day or 900 to 950 g – recommended protein needs for a normal pregnant for the 9 mos. gestation period - pregnant adolescent – should receive: 59g for ages 16-19 (non pregnant) 14g/day (pregnant) 73g - total  Protein Allowances Reason for additional protein: 1. To provide for the storage of nitrogen, 2. To protect the other 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.  Protein Allowances Sources: - meat - eggs - milk - cheese - poultry - fish  Nutritional needs during pregnancy: - The normal requirements of the mother - Those of the developing fetus (including the uterus and placenta) - Building up reserves in the preparation for the and lactation Nutritional needs during pregnancy:  Nutritional needs during pregnancy: Calcium Allowances - calcium and phosphorus are deposited early in pregnancy in small amount. - adequate supply of vitamin D is essential in the use of calcium and phosphorus to calcify the fetal bones and teeth. - inadequate calcium – calcium stored for mother’s used will be provided to the baby  Nutritional needs during pregnancy: Calcium Allowances - fetus on the 1st trimester (2mos.) retain calcium and phosphorus for about 65% - full term fetus – 64% - daily intake of calcium 0.5 (non- pregnant) to 0.9 (pregnant)  Nutritional needs during pregnancy: Iron allowances - 700 to 1,000 mg of iron must be absorbed and utilized by the mother throughout her pregnancy - 3rd trimester increases the need for iron for the fetus  Nutritional needs during pregnancy: Iodine Allowances - important during pregnancy - inadequate intake may result in goiter for the mother or the child. - advise regular use of iodized salt in food  Nutritional needs during pregnancy: Vitamin Allowances - thiamine, niacin, riboflavin, Vitamin D, calcium and phosphorus, ascorbic acid, vitamin A, vitamin B6 are needed for the developing fetus.  Nutritional needs during pregnancy: Food Allowances - 1oz or 30g of meat or its equivalent and an extra pint of milk to the normal diet - Daily consumption of whole-grain cereals, enriched bread; rice; leafy green and yellow vegetables; and fresh and dried fruits - Liver at least once a week - Fortified milk with vitamin D or fish liver oil - Six to 8 glasses of water daily  COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS  COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS Conditions that complicate the pregnancy: - nausea - vomiting - improper body weight - toxemia - may influence the following: * intake * digestion * absorption and utilization - more serious on adolescents  COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS - Rapid weight gain or loss - Toxemia - Anemia - Diabetes - Constipation - Socio-economic and Cultural Factors - Alcohol, Caffeine, Nicotine  COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS Rapid weight gain or loss - eating for two – may lead to overweight, toxemia, difficult labor, large sickly baby - sudden increase in weight after 20th week may suspect fld. retention that serves as a warning sign for impending eclampsia.  COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS Toxemia clinical manifestations - rapid wt. gain - edema - high blood pressure - excretion of albumin in the urine - convulsions  COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS Classifications 1. Acute toxemia: onset after 24th week - pre-eclampsia – hypertension with proteinuria and/or edema - eclampsia – convulsions or coma; usually both when associated with hypertension, proteinuria and edema  COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS Classifications 2. Chronic hypertensive (vascular) disease - without superimposed acute toxemia - with superimposed acute toxemia  COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS Anemia - combined deficiency of iron and folic acid - increases chances of premature birth - can no longer be corrected during this period - enhance absorption thru ascorbic acid rich foods and foods rich in iron  COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS Diabetes - prone to develop: - pre-eclampsia - pyelonephritis - inflammation of the kidney, typically due to a bacterial infection - polyhydramios - presence of excess amniotic fluid in the uterus - higher risk of the baby to die in the uterus or at birth  COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS Constipation - caused by: - pressure exerted in the developing fetus on the digestive tract - lack of exercise - insufficient bulk in the diet - intervention: - fresh fruits, - vegetables, - fluids and regular exercise  COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS Socio-economic and Cultural Factors - big families with low economic status may have difficulty in complying with nutritional needs of a pregnant mother. - eating habit is also affected as well as the choice of food to eat.  COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS Alcohol, Caffeine, Nicotine - smoking – can lower the mean birth weight of the baby - increases the risk of perinatal mortality - alcohol ingestion may lead to Fetal Alcohol Syndrome (FAS) - may develop: CNS disorders, mental retardation, growth deficiencies, and facial deformities. Mother’s age and associated health concerns and risks  Mother’s age and associated health concerns and risks Pregnancy in Adolescents (1 out of 20) a. Iron deficiency anemia b. Prolonged labor c. Higher rates of stillbirths, pre-term births and low-birth weight infants  Mother’s age and associated health concerns and risks Pregnancy in older women a. Hypertension and diabetes b. Higher rates of premature births and low birth weight c. Birth defects d. Fetal death  Mother’s age and associated health concerns and risks Repeated pregnancies - close interval depletes the maternal reserves of nutrients (refer to page 208, table 52 for the dietary guide for a pregnant/lactating woman) Lactation Lactation Lactation - the preparation for assuring adequate supply of good quality breast milk – begins during pregnancy - increase dietary essentials such as: - calories, protein, calcium, vitamin A, thiamin, roboflavin, niacin and ascorbic acid Nutrition in lactation Nutrition in lactation Calorie Allowances Protein Allowances Calcium, Phosphorus, and Vitamin D Allowances Iron Allowances Vitamin Allowances Nutrition in lactation Calorie Allowances - no accurate food requirement – it depends on the demands of the infant. - suggested – 700 to 1,500 calories of food for 500 to 1,000 ml of milk - FNRI – an increase by 1,000 calories above the normal requirement in an average milk production of 850ml – energy value (600 calories) - human milk – 0.70 calories/ml or 20 calories /oz – contains 1.2 g protein per 100ml Nutrition in lactation Protein Allowances - an additional of 20.2 g protein for lactating mother Nutrition in lactation Calcium, Phosphorus, and Vitamin D Allowances - calcium allowance – 1.0g daily for good milk production - phosphorus – adequate intake of protein - vitamin D – 400 IU Nutrition in lactation Iron Allowances - during lactation the loss of iron is similar to the loss during menstrual flow - baby when born have adequate reserve of iron Nutrition in lactation Vitamin Allowances - increase demand on: vitamin A, niacin, riboflavin, thiamin, ascorbic acid Food needs in lactation Food needs in lactation Mother’s milk - the best food for the baby - easily digested - economical - has the right temperature - free from harmful bacteria - contains colostrum (has high protein content, acts as laxative, contains antibodies that help resist infection) Food needs in lactation Nutritional Requirements Calories Protein Calcium and Phosphorus Iron Vitamin A Vitamin B1 Riboflavin, Vitamin C Fluids Food needs in lactation Calories - an additional of 1,000 calories from the normal (300-400 bf, 700 lunch, 700 dinner) - 120 calories is required to produce 100ml of milk thus if daily milk production of 850 it requires 1000 calories in the diet. - energy giving food are good source of calories. Food needs in lactation Protein - additional of 20g to the normal allowance - 2g of food protein required to produce 1g of milk protein (conversion of milk to protein is only 50% efficient) - sources: milk, eggs, animal proteins and legumes Food needs in lactation Calcium and Phosphorus - an increase of 0.5mg needed to prevent severe depletion of maternal calcium reserve being used for milk production - sources: milk and milk products, eggs, etc. Food needs in lactation Iron - additional iron intake is recommended due to blood loss during parturition (childbirth), milk iron and basal losses. Food needs in lactation Vitamin A - an additional of 2,000 IU to provide adequate amount for milk production - sources: green leafy and yellow vegetables, milk, eggs, etc. Food needs in lactation Vitamin B1 - additional allowance is needed - diet with very low thiamin may secrete toxic substance called glyoxaline – it is associated with infantile beriberi - sources: unpolished rice, legumes, vegetables, milk, etc. Food needs in lactation Riboflavin, Vitamin C - an additional allowance is needed for milk production Food needs in lactation Fluids - take 8 glasses or more to increase milk production Food needs in lactation Food to avoid for a lactating mother - Too much fried foods - Pickles - Highly seasoned food - Stimulants (drugs, nicotine, caffeine, theobromine, morphine and alcohol) a bitter, volatile compound obtained from cacao seeds (Refer to page 213 for dietary allowance for lactating mother’s) Breast Feeding Misconception Breast Feeding Misconception A mother with TB cannot breastfeed. Breast milk is not good if the mother has stayed long under the sun. A mother cannot breastfeed during pregnancy. A mother cannot breastfeed with only one breast if the other breast is painful. A mother cannot breastfeed if she has a cold, flu or diarrhea Breast milk is not good if the mother has been caught in a sudden shower. Advantages of Breastfeeding Advantages of Breastfeeding Provides passive antibody (immunity of the baby to some children’s diseases) Higher in lactose than in cow’s milk Easy regulation of calcium and phosphorus Prevents dental defects/malformation Protects from allergies Beneficial to the mother - prevent breast cancer - less incidence of thrombophlebitis - rapid return of uterus to its original size Factors Affecting Milk Secretion  Factors Affecting Milk Secretion Diet Nutritional State of mothers Emotional and physical state Suckling Use of Contraceptives and drugs  Factors Affecting Milk Secretion Diet - galactagogues(a food or drug that promotes or increases the flow of a mother's milk.) - meat and vegetable soups (tahong, tulya, malunggay), milk and fruit juices - drink water regularly and occasionally (do not wait to feel thirsty to drink water, it suppresses milk secretion)  Factors Affecting Milk Secretion Nutritional State of mothers - sufficient nutrients must be provided to the mother - quality and quantity of milk flow is affected due to these diseases: - malnutrition - cardiac and kidney diseases - anemia - beriberi - TB - infections  Factors Affecting Milk Secretion Emotional and physical state - worries can affect milk production - to enhance milk secretion, surrounding must be: - pleasant - relax - conducive to rest - conducive to good sleep  Factors Affecting Milk Secretion Suckling - stimulate milk production - supply of milk increases if babies are feed for longer period  Factors Affecting Milk Secretion Use of Contraceptives and drugs - using contraceptives can decrease milk flow and may lead to osteria (cessation of lactation) - alcohol and nicotine from smoking can affects the quality of milk