Diet During Pregnancy and Lactation PDF

Diet During Pregnancy and Lactation  Objectives  Identify nutritional needs during pregnancy and lactation  Describe nutritional needs of pregnant adolescents  Modify the normal diet to meet the needs of pregnant and lactating women  Weight Gain During Preg...

Diet During Pregnancy and Lactation  Objectives  Identify nutritional needs during pregnancy and lactation  Describe nutritional needs of pregnant adolescents  Modify the normal diet to meet the needs of pregnant and lactating women  Weight Gain During Pregnancy Average weight gain is 25 to 35 pounds. Average weight gain during the first trimester is 2-4 pounds. The second and third trimester average one pound per week. 3  Maternal Weight Gain TISSUE WEIGHT (POUNDS) FETUS 7.5 UTERUS 2.0 PLACENTA 1.5 AMNIOTIC FLUID 2.0 BLOOD VOLUME 3.0 EXTRACELLULAR 2.0 FLUID BREAST TISSUE 1.0 FAT 9.0  MATERNAL WEIGHT UNDERWEIGHT 1. Low birth-weight infant – 2.5 kg or less 2. High pre-term deaths & infant deaths  MATERNAL WEIGHT OVERWEIGHT 1. Risk for birth complications – hypertension, gestational diabetes, postpartum infections 2. Labor and delivery complications- difficult labor/delivery, birth trauma cesarean section for large babies 3. Risk for neural tube birth defects  Pregnancy Weight Gain Distributions Pre- Pregnancy Weight Recommended Status Gain Underweight 28 to 40 lbs. (BMI less than 18.5) 25 to 35 lbs. Normal Weight (BMI 18.5- 15 to 25 lbs 24.9) At least 15 lbs. Overweight (BMI 25-29.9) Obese (BMI ≥ 30) 35 to 45 lbs. Twin Pregnancy Weight Gain Pattern 1st TRIMESTER: 1 lb per month ( 1 kg= 2nd TRIMESTER: 2.2pounds) 0.9 to 1 lb per 3 TRIMESTER: rd week 0.5 to 1 lb per Weight Gain During Pregnancy Generally, no additional kcal are required during the first trimester. An additional 300 kcal is needed during the second and third trimesters. Pre-pregnancy Nutritional Needs Research has shown that adequate pre-pregnancy nutrition is critical for the prevention of neural tube defects such as spina bifida.  Importance of Good Nutrition during Pregnancy A. Important before, during and after pregnancy B. Good control of weight, blood pressure and blood glucose increase chances of healthy, normal weight, term infant C. Affects fetal and placental  Importance of Good Nutrition during Pregnancy D. Affects maternal well being and maternal outcomes E. Not getting enough micronutrients causes low birth weight, premature birth, and other fetal problems Micronutrients include: folic acid, iron, omega-3 fatty acids, Vitamin A, calcium, Vitamin D and iodine  NUTRITIONAL NEEDS DURING PREGNANCY Energy No one should lose weight during pregnancy, because it could cause nutrient deficiencies for both mother and infant. A balance must be struck regarding weight gain during NUTRITIONAL NEEDS DURING PREGNANCY Overweight and obese women should gain enough weight to support the fetus maternal support tissues without increasing body fat. There are increased risk for: Operative Delivery (CS) Increased maternal postpartum weight Gestational diabetes And other long-term health consequences when maternal weight goes beyond the guidelines, particularly women who are  Energy Requirement On average, a pregnant adult requires no additional kcal during the 1st trimester of pregnancy and only additional of 300 kcal a day during the 2nd and 3rd trimesters for: 1. growth of the fetus, placenta and the maternal tissues and their maintenance; 2. for the increase of the BMR and 3. for better utilization of dietary protein. Additional 300 kcal per day can be met by eating an additional of the following:  1 cup low fat milk  1 serving fruit  1 cup vegetables  1 serving meat Protein Additional Protein is required for: 1. Growth and repair of maternal tissues, breasts, uterus and placenta 2. Increased maternal blood volume 3. Growth and development of the fetus.  Additional Protein 4. Nitrogen storage 5. Protection against pregnancy complications 6. Fetal growth and repair 7. Mammary tissue growth 8. Hormonal preparation for lactation Protein Requirement during pregnancy is: 1st trimester = + 2 grams/day or ¼ serving Meat/Fish 2nd trimester = +9 grams/day or 1 serving Meat/Fish 3rd trimester = +15 grams/day or 2 servings Meat/Fish Sample Menu for Pregnant Woman BREAKFAS AM PM T LUNCH DINNER SNACKS SNACKS Toasted Tulya with Pork Fried Cheese Dilis Malunggay Sinigang Yellow Sandwich Fried Egg Leaves with Kamote Orange Fried Rice Grilled fish Vegetables with juice Coffee with Fresh Steamed Brown with sugar Tomato Rice Sugar and whole Steamed Banana milk Rice Ripe Mango Fulfillment of Nutritional Needs During Pregnancy Vitamin supplements may be prescribed. No unprescribed nutrient supplements should be taken because they may be harmful to the fetus. INCREASE MAJOR MINERALS AND VITAMINS  Folic Acid Reduces risk of having a baby with neural tube defects Reduces the risk of premature birth Recommended amount of folic acid is 0.4 milligrams (400 micrograms) per day Neural Tube Defects  Folic Acid Supplement should be started at least one month before getting pregnant –It is recommended that any woman of childbearing age should be taking folic acid supplements because they may not know they are pregnant until it is too late. Good Sources of Folic Acid Green leafy vegetable Fortified cereals  Iron Reduces the risk of premature birth and low birth weight Not getting enough iron could cause anemia –Could contribute to developmental delays and behavioral disturbances in the infant and poor health in the mother –Contributes to death and other disease development  Iron Essential for normal infant brain development Iron helps create blood that is necessary for fetal demands and blood loss during delivery.  Good Sources of Iron Lean red meat Green leafy vegetables Fortified breakfast cereals  Omega-3 Fatty Acids Important for brain development and preventing preterm birth Essential for visual development Reduces the incidence of heart disease and heart related death of the infant  Good Sources of Omega-3 Fatty Acids Fish oil capsules Certain fish such as salmon, trout, mackerel, sardines, and fresh tuna Vegetable oils such as sunflower, rapeseed, flaxseed, and walnut oils  Calcium and Vitamin D Calcium and vitamin D are needed for strong bones and teeth Vitamin D is needed for the formation of the fetal bones Recommended 10 micrograms of Vitamin D per day Good Sources of Calcium and Vitamin D Milk and other dairy products Eggs Meat Certain fish such as salmon, trout, mackerel, sardines, and fresh tuna  Vitamin A and Iodine Vitamin A is needed in small amounts to protect the fetus from immune system problems, blindness, infections, and death –Can cause birth defects in high doses Lack of iodine could contribute to stillbirth, birth defects, and decreased brain development Iodine is important for brain No Alcohol and Limited Caffeine Protect the infant from fetal alcohol syndrome and other birth defects –Avoid alcohol, including all wines, beers, hard liquor, and wine coolers High caffeine intake linked to low birth weight and spontaneous fetal death –Avoid food and beverages such Weight Gain and Caloric Intake Pattern of weight gain during pregnancy is more important than the total amount of weight gained It is better to gain the majority of your pregnancy weight during the last two trimesters Weight Gain Pattern 1st TRIMESTER: 1 lb per month ( 1 kg= 2nd TRIMESTER: 2.2pounds) 0.9 to 1 lb per 3 TRIMESTER: rd week 0.5 to 1 lb per Concerns During Pregnancy Nausea Pregnancy- Constipatio induced hypertension n Pica Heartburn Anemia Excessive Alcohol, weight gain caffeine, drugs, and tobacco 1. Create a Meal Plan for Pregnant Mothers 2. Enumerate / Present the Nutritional Concerns during Pregnancy  Nausea “Morning sickness” occurs most commonly in first trimester. Suggestions: –Eat dry crackers or dry toast before rising –Small, frequent meals –Avoid food with offensive odors –Avoid liquids at mealtime Hyperemesis Gravidarum Occurs when the nausea becomes so severe that it is life-threatening. This may require hospitalization and parenteral nutrition.  Constipation Constipation is common during the first and third trimesters of pregnancy. During the first trimester, progesterone (which slows GI motility) may be responsible. In the third trimester, the growing fetus crowds the other internal organs again possible slowing GI motility.  Constipation Eat high fiber diet. Participate in daily exercise. Responding immediately on the urge to defecate Drink eight glasses of water per day. –Over the counter laxatives or enemas should NOT be used unless prescribed by a physician. 44  Heartburn Caused by pressure on the mother’s stomach as the fetus develops. Eat small, frequent meals. Avoid spicy or greasy foods. Avoid liquids with meals. Wait at least one hour after eating to lay down and two hours  Excessive Weight Gain Reevaluate diet and eliminate food that does not fit within the Food Guide Pyramid. Drink fat-free milk. Eat clean, crisp, raw vegetables as a snack. Eat fruits and custards made with fat-free milk as desserts. Broil, bake, or boil instead of frying.  Pregnancy-induced Hypertension (PIH) Formerly called “preeclampsia” or “toxemia.” Characterized by high blood pressure, presence of protein in the urine, and edema.  Pregnancy-induced Hypertension If condition persists, it may result in convulsions, coma, and death of the mother. There is a higher incidence of this disorder among mothers with inadequate diets.  Pica Pica is the craving for nonfood substances such as starch, clay (soil), or ice. Soil binds with minerals making it impossible for the body to absorb them. If these substances take the place of nutrient rich foods in the diet, there can be multiple nutritional deficiencies.  Anemia Anemia is a condition caused by an insufficiency of red blood cells, hemoglobin, or blood volume. Often the client with anemia feels weak and tired, has a poor appetite, and appears pale.  Anemia Iron deficiency anemia is the most common form of anemia. Folate deficiency may lead to megaloblastic anemia, another form of anemia. Supplements may be prescribed. Alcohol, Caffeine, Drugs, and Tobacco Fetal alcohol syndrome (FAS) is characterized by a growth deficiency, central nervous system dysfunction, and microcephaly (small head). Alcohol, Caffeine, Drugs, and Tobacco Caffeine has been shown to cause birth defects in rats, but no data exists for humans. Illegal drugs can cause the infant to be born addicted. Drugs derived from vitamin A can cause fetal malformations and spontaneous abortions. Alcohol, Caffeine, Drugs, and Tobacco Tobacco smoking is associated with:  low birth weights, sudden infant death syndrome (SIDS), fetal death, spontaneous abortions, and Diet for the Pregnant Woman with Diabetes Nutrient requirements of the pregnant woman with diabetes are the same as for the nondiabetic pregnant woman. Dietitian should plan the diet depending on the type and number of insulin injections required. Diet for the Pregnant Woman with Diabetes Gestational diabetics may require insulin during pregnancy. Oral hypoglycemic agents may be harmful to the fetus and should not be used. Artificial sweeteners have been found to be safe during pregnancy. Pregnancy During Adolescence Nutritional, physical, psychological, social, and economic demands on pregnant adolescents are tremendous. High risk for pregnancy- induced hypertension and premature delivery. Pregnancy During Adolescence Inadequate nutrition of the mother is related to both mental and physical birth defects. Much counseling and emotional support is needed. LACTATION  Lactation The production and secretion of breast milk for the purpose of nourishing an  Lactation 2 to 3 weeks to establish a feeding routine. Recommended that no supplemental feedings be given during this time. Human milk is formulated to meet the nutrient needs of infants for the first 6 months of life.  Lactation Kcal requirements during breastfeeding increase. The Food and Nutrition Board suggests an increase of 500 - 1000 kcal a day for an average milk production of 850ml of milk = 600 calories. NUTRITIONAL NEEDS IN LACTATION 1. Additional 500 – 1,000 calories above normal requirement 2. Additional 20gms of protein above normal allowance 3. Calcium and phosphorus – to prevent severe depletion of maternal calcium reserve 4. Iron for blood loess 5. Vitamin A – additional 2000 IU 6. Vitamin B1 - needed for thiamine secreted in milk; prevent thiamine deficiency due to secretion of toxic substance “glyoxaline” 7. Riboflavin 8. Fluids  ACTIVITY: 1. Create a Meal Plan for Lactating Mother 2. Enumerate/ present the Factors affecting Milk Secretion 3. What are the advantages of Breastfeeding? Benefits of Breastfeeding for the Infant Nutritional benefits: contains just the right amount of lactose, water, fatty acids, and amino acids. No babies are allergic to their mother’s milk. Human milk contains at least 100 ingredients not found in formula milk. Benefits of Breastfeeding for the Infant Lower incidence of ear infections, diarrhea, allergies, and hospital admissions. Breast-fed babies receive antibodies from breast milk (COLOSTRUM) Benefits of Breastfeeding for the Infant Promotes good jaw development. Encourages growth of straight, healthy teeth. May have psychological benefits. Benefits of Breastfeeding for the Mother Ability to quickly lose the pounds gained during pregnancy. Stimulates uterus to contract back to its original size. Breastfeeding is economical. Provides opportunity for resting. Milk is always at the right temperature and is readily available. Nutrient Requirements during Lactation Most nutrient requirements are increased. Depends on age of the mother. Protein is the most important because it is secreted in the milk each day. Important to include fruits and vegetables rich in vitamin C. Nutrient Requirements during Lactation Extra fat-free milk is beneficial. Increase fluid intake to replace loss. Check with obstetrician before using any medication or nutrient supplement. Caffeine may make infant  Conclusion A pregnant woman is most likely to remain healthy and bear a healthy infant if she follows a well-balanced diet. Anemia and PIH are two conditions that can be caused by inadequate nutrition. Caloric and most nutrient requirements increase for pregnant