Maternal Nutrition

SHAFAAT ULLAHKhyber Medical University

Peshawer,Pakistan

Applied Nutrition Unit-I

Objectives

By the end of this unit, the students will be able to:• Define key terms• Identify nutritional need in pregnancy and Lactation• Identify pre-pregnancy diet• Discuss the nutritional need in pregnancy and adolescents• Identify nutritional risk factors of pregnancy• Discuss concerns during pregnancy / weight gain/feeding

twins/DM in pregnancy.• Identify prevalence of Iron deficiency anemia in Pakistani

women.

Introduction to Applied Nutrition

• Nutrition at optimal levels is fundamental in the

maintenance of positive health. Maternal nutrition is very

important for the course and outcome of pregnancy.

• Lactation represents a stage where health and nutritional

status of the infant are dependent on the mother.

• Successful pregnancy and lactation require adjustments

in maternal body composition, metabolism and function

of various physiological systems.

Cont…

• Thus improving the nutrition and health of girls

and younger women and of mothers during

pregnancy and lactation will derive benefits in

terms of improved health of their children

throughout their lives.

Pregnancy

• Pregnancy is a period of great physiological stress for women as they nurture a growing fetus in their body.

• Some changes occur in mother’s body which influence the need for nutrients and their use as:

• A. Increased Basal metabolic rate (BMR): Fetal growth and development increases the BMR by 5 % during 1st trimester and 12 % during 2nd & 3rd trimester. This increases the total energy requirement of mother.

Pregnancy Cont…

• B. Changes in Body fluid: Mother’s blood volume increases so as to carry the appropriate amount of nutrients to the fetus and metabolic wastes away from the fetus. Increased blood volume decreases the concentration ratio of plasma protein, hemoglobin and other blood constituents.

• C. Gastrointestinal Changes: Alteration in GI functions includes nausea, vomiting and constipation. In the later trimester the absorption of vit B12, iron and calcium increases in order to meet the increased needs of mother and fetus.

Importance of Good Nutrition During Pregnancy

• Good health of fetus and newborn depends upon the nutritional status of the mother during and prior to conception.

• A well nourished woman prior to conception enters pregnancy with nutrients reserve to meet the nutritional needs of the fetus without affecting her own tissue s and health.

• A well nourished mother minimizes complications during pregnancy and premature delivery.

• Poor mother nutrition put the fetus on the risk of developing complications , congenital defects and even death.

• Low nourished mother results in the delay of baby’s milestones.

Nutritional Needs During Pregnancy

Nutrients need increases:• To develop maternal organs like uterus, placenta,

and breast tissues.• To build up body nutrients reserve.• During 1st trimester qualitative improvement of

nutrients is needed.• During 2nd and 3rd trimester both qualitative and

quantitative improvement of nutrients is needed.

Energy Requirement During Pregnancy

• Additional energy is required during pregnancy.• Additional 300 Kcal is required

Group Energy requirement (Kcal)

Sedentary worker

1875 + 300 = 2175

Moderate worker

2225 + 300 = 2525

Heavy worker 2925 + 300 = 3225

Weight Gain During Pregnancy

• It is natural and necessary to gain weight during pregnancy as uterus, placenta, breast, blood volume, body fluids and fat increases.

• Average weight gain is 25—35 lbs • Teen pregnant gains more weight than a

mature woman.

Nutritional Demands

• Energy Needs• Mothers need more Kcal for two reasons:• To supply the increased fuel demanded by the

increased BMR• To spare protein for the newly added tissues

Protein Requirement during Pregnancy

Protein is a primary need during pregnancyAdditional 15 g protein is required for:• Enlargement of maternal tissues• Growth of placenta• Growth of fetus• Increased maternal blood volume• Formation of amniotic fluid• Preparation for labour and lactation

Calcium Requirement During Pregnancy

• Fetal bone, teeth development and growth. • Decreases the risk of low birth weight and

maternal hypertension and pre-eclampsia.• Helps in muscle contraction.• Helps in blood clotting.RDA during pregnancy is 1g.

Iron during Pregnancy

• Fetal growth• Increases RBC production in mothers• Building iron stores in fetal liver• RDA: 3 g/day

Folic Acid

• Folic acid (RDA 400 mcg/d)• Needed for maternal blood formation• Prevents fetal neural tube defects and improves

birth weight.

• Pregnant women: 600 mcg (RDA)Breastfeeding women: 500 mcg (RDA)

Other considerations during Pregnancy

• Avoid caffeine as it crosses placenta and enters fetal blood circulation and increases the risk of premature delivery.

• Avoid smoking as it results in placental abnormalities and low birth weight (LBW).

• Avoid Alcohol as it causes LBW, growth retardation, and mental retardation

Importance of Nutrition during Lactation

• Mother needs extra nutrition to baby’s nutritional needs.

• Inadequate maternal nutrition affects the normal growth of the baby and ultimately mother herself.

During Lactation

• Protein Requirement:• Protein need increases in lactation as mother’s

milk contains 1.15g of protein/100 ml.• During first 6 months of lactation 75. g/d is

required.• During 6—12 months of lactation 65 g/d is

required.

During Lactation

• Calcium: • Additional calcium is required for breast milk

secretion as 30—40 mg/100 ml is secreted per day.

• Iron:• Iron intake should be increased to 30 mg/d to

make up the iron secreted milk.• Note: 1 mg of iron/d is lost during menstrual

period.

During Lactation

• Vit A (950mcg/d):• Breast milk is rich in vit A.• About 350 mcg /d of vit A is secreted in mother’s

milk.

Nutrients requirementNutrient Non-pregnant pregnant increase

Energy (kcal 2100 2400 300

Protein (g) 44 74 30

Retinol (μg) 800 1000 200

Vitamin D (μg) 7.5 12.5 5

Vitamin E (mg) 8 10 2

Vitamin C (mg) 60 80 20

Riboflavin (mg) 1.3 1.6 0.3

Nicotinic acid mg) 14 16 2

Vitamin B6 (mg) 2 2.6 0.6

Folic acid (μg) 400 800 400

Thiamin (mg) 1.1 1.5 0.4

Calcium (mg) 800 1200 400

Iron (mg) 18 -(S) -(S)

Zinc (mg) 15 20 5

Obstetrical History

• Past medical history (wt gained in pregnancy)• Current dietary intake patterns • Vitamin, mineral and herbal intake• Caffeine and other fluids• Nausea, vomiting, and heartburn• Constipation

Obstetrical Physical Exam

• Low pre-pregnancy weight and low maternal weight gain are risk factors for:– Intrauterine growth retardation– Low birth weight baby– Increased incidence of perinatal death

• Need to asses:– Pre-pregnancy weight (BMI)– Current weight (BMI)– Weight gain from previous visit

Recommended Weight Gain

<156.8Obese BMI > 30.0

15-256-11Overweight BMI 25-29.9

25-3511-15Normal Weight BMI 19-24.9

28-4012-18Underweight BMI < 18.5

Weight Gain (lbs)

Weight Gain (kg)

BMI Weight (kg) Height (m2)

Concerns during Pregnancy

Nausea and Vomiting Strategies for managing morning sickness:

– Eat small, low-fat meals and snacks – Drink fluids between meals, avoid caffeine– Limit spicy and high-fat foods – Avoid lying down after eating or drinking– Take a walk after meals– Wear loose-fitting clothes

Constipation:– Increase fluid and fiber intake to reduce constipation.

Iron Deficiency Anemia

• A pathological condition in which oxygen carrying capacity of RBCs is insufficient to meet the needs of the body.

• WHO recommends the HB %age should not fall below 11 g/dl throughout pregnancy.

• CDC refers the value of 10.5 g/dl

Iron Deficiency Anemia

• Susceptible Population:– Pregnant women who have not been taking iron

supplements– Infants and children– Menstruating females– Teens– Low income women

Iron Deficiency Anemia

• Weakness, fatigue, poor work performance, and changes in behavior.

• Physical signs include pallor, fatigue, coldness and paresthesia (a sensation of tingling, burning,or numbness) of the extremities, greater susceptibility to infections.

• Infants and young children with iron deficiency may have low IQ levels, poor cognitive and motor development, learning, and behavioral problems.

Iron Treatment Recommendations

• Iron-rich foods:– Meat, fish, poultry, eggs– Organ meats– Peas and beans– Dried fruit– Whole grain and cereal

Prevalence of Anemia in Pregnancy in Pakistan

• The prevalence of anemia in pregnancy is 56 % in Pakistan Factors:• Dietary and socioeconomic factors.• Likes and dislikes in food• Pica, tea consumption, and low intake of eggs and red

meat are associated with anemia.Recommendations: • Women of childbearing age should be provided nutritional

education regarding food sources of iron, especially prior to becoming pregnant, and taught how food choices can either enhance or interfere with iron absorption.