Nutrition during Pregnancy and Lactation

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The mother’s food habits and nutritional status before conception, as well as during pregnancy, influence the outcome of the pregnancy.

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Mother needs more energy to:Supply the increased fuel demanded by

the fetus (increased metabolic workload)

Increase energy by 350 to 450 kcal/day (during 2nd & 3rd trimesters) Increased complex carbohydrates and

protein in the diet are the preferred sources of energy

The fetus requires glucose as its major source of fuel

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Protein serves as the building blocks for growth of body tissues during pregnancy.Rapid growth of the fetusDevelopment of the placenta Increased maternal blood volumeAmniotic fluid

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Protein intake should increase 25 g/day Increase by 50% Milk, eggs, cheese, soy products, meat Legumes, grains

Protein-rich foods contribute calcium, iron, B vitamins

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CalciumEssential for fetal development of bones

and teethSupplements might be needed in cases of

poor maternal stores or pregnancies involving more than one fetus

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Iron

*needed for Hemoglobin synthesis *consuming foods high in vit. C will help

with iron absorption *Iron supplements often needed during

pregnancy

Iodine Iodine essential to produce more

thyroxine Sources

Iodized salt7

FolateBuilds mature red blood cells during

pregnancyNeeded during early pregnancy (and prior

to conception)DRIs recommend daily folate intake of

600 mcg during pregnancy and 400 mcg/day for nonpregnant women during childbearing years

May require folate supplementsTO PREVENT NEURAL TUBE DEFECTS !!!

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Neural Tube Defects

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Vitamin DEnsures absorption and utilization of

calcium and phosphorus for fetal bone growth, including teeth

Daily intake of at least 3 cups fortified milk (low fat, skim)

Exposure to sunlight increases synthesis of vitamin D

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Set weight goals according to mother’s pregnancy nutritional status and body mass indexUnderweight women: 28 to 40 lbNormal-weight women: 25 to 35 lbOverweight women: 15 to 25 lbObese women: approximately 15 lbTeenage girls: 35 to 40 lbWomen carrying twins: 35 to 45 lbWomen carrying triplets: overall gain of 50

lbMinimum = 15 lb.

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Weight reduction should never be undertaken during pregnancy

Average amount of weight gain during first trimester: 2 to 4 lb

1 lb per week weight gain during remainder of pregnancy

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Pregnant women should avoid tobacco, alcohol and caffeine use during pregnancy and lactation

Less than 300mg caffeine/day may be acceptable, check with MD first !

Avoid: shark, swordfish, mackeral Higher levels of mercury Limit tuna (6 oz/wk), shrimp,salmon, catfish (12

oz/week)

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Undercooked meat, unwashed fruits/veget, Cat litter

Toxoplasmosis (infection) Mental retardation Blindness Epilepsy

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Nausea and vomitingMorning sickness occurs briefly during first

trimester. Is caused by hormonal changes.Small, frequent, dry, easily digested energy

foods may relieve symptoms.Toast, crackers

Severe and prolonged sickness requires medical treatment (hyperemesis gravidarum)

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ConstipationMay occur in latter part of pregnancyThe result of increased pressure of

enlarging uterus and reduced normal peristalsis

Remedies include exercise, increased fluid intake, high-fiber foods

HemorrhoidsCaused by increased weight of babyUsually controlled by dietary suggestions

used for constipation

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HeartburnCaused by pressure of enlarging uterus

crowding the stomachDividing day’s food intake into a series of

small meals usually relieves condition Effects of iron supplements:

Gray or black stool, nausea, constipation, diarrhea

Take iron supplements 1 hour before or 2 hours after a meal with water or orange juice

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Identifying risk factors and addressing them early are critical.

Identifying poor food patterns can prevent nutrition problems. Insufficient food intakePoor food selectionPoor food distribution throughout day

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Teenage pregnancySpecial care must be given to support

adequate growth of mother and fetus.Teens have higher rates of low-

birthweight infants & infant mortalityConcerns: still growing, no income, ?

Smoking, ? Drug use, dieting, wt. gain fears

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Fetal alcohol effects

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TobaccoAssociated with prematurity and low birth

weight Drugs

Potential addiction in unborn child Caffeine

Should avoid

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Special counseling needsVitamin abuse by megadosing also may

cause fetal damage.Caffeine used in extreme excess may result

in fetal injury.Poverty puts pregnant women in danger –

will need resources for financial assistance & food (ie, WIC)

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AnemiaDeficiency of iron or folate in mother’s

dietAdditional supplements may be required

(beyond prenatal vitamins) Neural tube defect

Caused by low folate intake Intrauterine growth failure

Caused by low pregnancy weight, inadequate weight gain, smoking

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Hypertensive disorders (preeclampsia)Related to diets low in appropriate

kilocalories, calciumOptimal nutrition important, medical

treatment required Gestational diabetes

Results from increased metabolic workload

Important to identify based on risk factors and treat with special diet or insulin

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Breastfeeding on rise since 1960 >70% of North American mothers

currently initiate breastfeeding.Goal = 75% in early post-partum period

(2010)More mothers are informed of benefits

Practitioners recognize human milk can meet unique infant needs.

Maternity wards and birth centers support lactation.

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Milk production requires an extra 330 to 400 kcal/day.

Need for protein during lactation is 25 g/day more than woman’s average need.

About 3 L/day of water, juices, milk, and soup contribute to necessary fluids.

Rest, moderate exercise, and relaxation are necessary.

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Fewer infections Fewer allergies and intolerances Ease of digestion Convenience and economy Improved cognitive development May protect against breast cancer

(mom)

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