Nutrition In Pregnancy
-
Upload
drmcbansal -
Category
Education
-
view
13.967 -
download
2
Transcript of Nutrition In Pregnancy
BY- PROF. DR. MC BANSAL
DR. RIDHI KATHURIA
LET THY KITCHEN BE THY APOTHECARY, LET THY KITCHEN BE THY APOTHECARY, AND LET FOODS BE THY MEDICINEAND LET FOODS BE THY MEDICINE
Good nutrition is an important component of a healthy lifestyle and a healthy baby.
The best time to review the nutritional status to make appropriate changes is prior to conception.
A very important time of fetal development is during the first several weeks of pregnancy as all of the major fetal body systems are undergoing formation and rapid development.
Many women may not even realize they are pregnant at this time.
Therefore it is prudent to make your lifestyle and nutritional changes several months before conception occurs.
Pregnancy is the only time in life of women when weight gain is not only desirable, but also encouraged.
Weight gain should not be confused with being obese.
There are multiple growth spurts of multiple organ systems that contribute to the normal weight gain.
Placenta (avg) at term = 650gms *
Amniotic fluid = 800gms*
Breast enlargement = 405gms*
Uterine mass = 900gms*
Fat & fluid = 1200gms*
Maternal blood = 1800gms*
Average weighing baby = 2500 – 3000gms*
It is easy to see that the recommended weight gain of about 11,000gms (11-14 kg) is very appropriate.
* Weights are shown as approx values
Extra 11-14kgs recommended translate into an additional 200-300 calories/day.
This increases the average daily caloric intake from 2200 calories per day to approximately 2400-2700 calories per day.
Total extra energy cost of a pregnancy is 77,000kcal.
1st Trimester 85kcal/day
2nd Trimester 285kcal/day
3rd Trimester 475kcal/day
Pre pregnancy BMI Weight for Height Category
Recommended gain in body weight (kg)
<18.5 Underweight 12.5 – 18
18.5 – 24.9 Normal Weight 11.5 – 16
25 – 29.9 Overweight 7.0 – 11.5
About 75% of pregnant females in India are underweight & anaemic.
Anaemia thus remains a major cause of maternal & fetal morbidity, mortality and low birth weight.
Too early, Too close, Too many, Too late conception also adversely affect the health status (nutritional status) of the females.
Another indirect important factor is Gastro-intestinal Infections, Infestations, which are heralded further with under-nutrition, setting up a vicious cycle.
IMPORTANT NUTRIENTS FOR PREGNANCY
Folate
Iron
Calcium
Vitamin D
Vitamin A
Omega Fatty Acids
Essential Amino Acids from protein sources
Calorie providing Food (Carbohydrate and Fats in proper ratios)
• Why is it important in pregnancy– Needed to reduce risk of :- Neural tube defects Congenital heart defects, Cleft lips, Limb defects Urinary tract anomalies Preterm delivery Infant low birth weight Fetal growth retardation
400 micrograms of synthetic folic acid daily from fortified foods and/or supplements has been suggested for all non-pregnant women, in order to have adequate folic acid intake even in case of unplanned pregnancies.
Ideal to start before conception occurs.
It is hypothesized that the insulin-like growth factor 2 gene is differentially methylated and these changes in IGF2 result in improved intrauterine growth and development.
RICH SOURCES OF FOLATERICH SOURCES OF FOLATE
Certain foods are very high in folate:
Leafy vegetables - spinach, asparagus, turnip greens, lettuce.
Legumes - dried or fresh beans, peas and lentils
Egg yolks
Baker's yeast
Fortified grain products (pasta, cereal, bread)
Breakfast cereals (ready-to-eat and others)
Sunflower seeds
Liver and liver products
Kidney
Moderate amounts:
Fruit Juices (Orange Juice, Canned Pineapple Juice, Cantaloupe, Melon, Grapefruit Juice, Banana, Raspberry, Grapefruit And Strawberry)
Vegetables (Beets, Corn, Tomato Juice, Vegetable Juice, Broccoli, Brussels Sprouts)
• Why is it important in pregnancy
– Pregnancy causes a surge in the volume of blood in the body; the expanded volume may go up by 50%.
– To meet the demands of the increased blood volume, iron requirements go up significantly.
– Iron is also required for the normal development of the growing baby and the Placenta.
On an average, the iron requirement during pregnancy is as follows:-
Basal iron = 280 mgExpansion of red cell mass = 570 mgFetal transfer = 200-350 mgPlacental development = 50-150 mgBlood loss at delivery (normal) = 100-250 mg
After deducting iron conserved by amenorrhoea (240-480mg), additional 500-600 mg iron is required in pregnancy.
If the patient is chronically anaemic, then her iron stores also stand to be depleted. This necessitates an extra supplementation of 500 mg is needed.
Thus Total Iron Supplementation Stands At 1000 Mg.
• Iron requirements in pregnancy go up from 18 to 27-30 mg per day.
• Because iron is not easily absorbed from the diet, it is recommended to take an iron supplement
• Risk profile of an anaemic mother includes- a)Preterm birth.b)Low birth weight.c)Increased blood loss during and after labour.d)Depleted stores.
oCooking In An Iron Skillet
o Red Meat
o Poultry
o Lentils
o Beans
o Leafy Vegetables
o Pistachios
o Tofu
o Fortified Bread & Breakfast Cereals
o Soybean
o Spinach
o Beetroot
o Jaggery
RICH SOURCES OF IRONRICH SOURCES OF IRON
IRON PREPARATION
ELEMENAL IRON CONTENT
(mg%)DOSE (mg)
Ferrous Fumerate
30 200
Ferrous Gluconate
11 550
Ferrous Sulphate
20 300
Ferrous Penta-CarbonylFerrous Penta-Carbonyl Has Not Yet Been Approved By The FDA For Use During Pregnancy And Lactation.
However, If No Other Preparations Cant Be Used And Benefits Out Weigh The Risks, Then It Can Be Used With
High Degree Of Vigilance.
• Why is it important during pregnancy? 1. Total calcium concentration falls because of physiologic
hypoalbuminemia
2. Free ionized calcium concentration does not change (9-11gm%)
3. The placental produces 1,25-dihydroxyvitamin D, which results in increased intestinal absorption of calcium
4. Calcium is actively transported across the placenta to the fetus, facilitated by parathyroid hormone-related peptide
This increased demand if not met in the diet – Will lead to excessive calcium resorbtion from the maternal bones –
Osteoporosis.
Involved in mineralization of bones and teeth, energy and cell production and electrolyte acid-base buffering.
Fetal bone and teeth calcification primarily occurs in last 2-3 months.(total fetal requirement=)
2 cup full of milk daily or equivalent to supply 1200 mg calcium/1200mg phosphorous daily
Excess phosphorous can be a problem. Avoid snack foods, processed meats and cola drinks.
Therapeutic calcium supplementation (1200mg/day) should Be in the form of calcium citrate/ calcium gluconateSupplemented with vit -d
RICH SOURCES OF CALCIUMRICH SOURCES OF CALCIUM
Dairy foods - Milk, yogurt, Cheese, Cottage Cheese, Rasgullas.
Leafy & Green vegetables - Broccoli, Spinach, Okra, Horseradish, Watercress
Fruits - Oranges, Bananas.
Beans and Peas – Red kidney beans, Soyabean, Cabbage, Celery.
Tofu, Peanuts, Peas, Black Beans, Baked Beans
Fish - Salmon, Sardines
Miscellaneous - Sesame Seeds, Blackstrap Molasses, Corn, Almonds, Brown Sugar.
Fortified foods
Why is it important in pregnancy?
• It helps the body to use calcium that is consumed.• Maintain blood calcium & phosphorous levels.• Anti proliferative action.
RECENT STUDIES RECENT STUDIES INDICATE INDICATE
INCREASED RISK INCREASED RISK OF AUTISM IN OF AUTISM IN INFANTS WITH INFANTS WITH
VIT. D VIT. D DEFICIENCYDEFICIENCY
ᴥ Sunlight exposure
ᴥ Fish - Salmon, Tuna, Flounder, Sole.
ᴥ Milk
ᴥ Cereal
ᴥ Pork
ᴥ Mushrooms
ᴥ Riccota Cheese
ᴥ cod liver oil
Why is it important in pregnancy?
Need enough for healthy growth
Too much can cause birth defects
Formation of Rhodopsin, essential for normal vision
Glycoprotein synthesis (epithelial cell function)
Maintain normal skin health by switching on genes and differentiating keratinocytes (immature skin cells) into mature epidermal cells.
Regulates gene transcription.
Anti Oxidant action.
One of the rare entities which cause adverse effects if taken in excessive amounts.
Since vitamin A is fat-soluble, disposing of any excesses taken in through diet takes much longer than with water-soluble B vitamins and vitamin C.
This allows for toxic levels of vitamin A to accumulate.
ToxicityToxicity
Nausea
Irritability
Anorexia
Vomiting
Blurry vision
Headaches
Hair loss
Muscle & Abdominal pain
Drowsiness
Altered mental status.
Hair loss
Dry skin
Drying of the mucous membranes
Fever
Insomnia
Fatigue
Weight loss
Bone fractures
Anemia
Diarrhea
Liver (Beef, Pork, Chicken, Turkey, Fish)
Cod Liver Oil
Dandelion Greens
Carrot
Broccoli Leaf
Sweet Potato
Butter
Spinach
Pumpkin
Cheddar Cheese
Melon
Egg
Apricot
Papaya
Mango
Pea
Broccoli
Milk
Tomatoes
Why are they important in pregnancy?
• They serve as building blocks of proteins.• Used in production of DNA, Cell membrane, Haemoglobin, Receptors, Enzymes, Neurotransmitters, Hormones, Antibodies & other Bioactive molecules .• Serve as body store of energy after fat stored in adipose tissue.
INDISPENSABLE INDISPENSABLE AMINO ACIDSAMINO ACIDS
DISPENSABLE AMINO ACIDS
CONDITIONALLY INDISPENSABLE
PRECURSORS OF CONDITIONALLY INDISPENSABLE
HISTIDINE ALANINE ARGININE GLUTAMINE/GLUTAMATE
ISOLEUCINE ASPARTIC ACID
CYSTEINE ASPARTATE
LEUCINE ASPARAGINE GLUTAMINE METHIONINE
LYSINE GLUTAMIC ACID GLYCINE SERINE
METHIONINE SERINE PROLINE GLUTAMIC ACID/AMMONIA
PHENYLALANIME TYROSINE SERINE
THREONINE CHOLINE
TRYPTOPHAN GLUTAMATE
VALINE PHENYLALANINE
According to the American College of Nurse-Midwives, pregnant women require 71 grams of complete protein each day.
Some types of amino acid protein supplements contain only certain essential amino acids required by the body.
If consuming amino acid protein supplements during pregnancy, choose those that contain all nine essential amino acids.
Many types of amino acid protein supplements contain added ingredients such as Creatine, Herbs, Caffeine, Artificial Sweeteners and Preservatives.
A pregnancy diet has more restrictions than a non-pregnant person. Not all herbs and artificial sweeteners are safe for pregnant women.
In fact, according to the American Pregnancy Association, the FDA encourages pregnant women to consult with their healthcare provider before taking any types of herbal products. This includes amino acid protein supplements that contain herbs.
COMPLETE
COMPLETE
PROTEINS
PROTEINS
Proteins from- Meat, Poultry,
Fish, Eggs, Milk, Cheese,
Yoghurt.
Provide all nine essential
amino acids
INCOMPLETE
INCOMPLETE PROTEINS
PROTEINSProteins from- Legumes,
Grains, Nuts, Seeds,
Vegetables.Lack one or more
essential amino acids.
SITE OF PROTEIN
DEPOSITION
DEPOSITION (g) BY WEEKS OF GESTATION
Fetus 0.3 27 160 440
Placenta 2 16 60 100
Amniotic Fluid
0 0.5 2 3
Uterus 24 55 102 166
Breasts 9 36 72 81
Blood 0 30 102 135
TOTAL 35 165 498 925
10 20 30 40
Deposition Of Protein In The Deposition Of Protein In The Fetus & Maternal Tissues Fetus & Maternal Tissues
During PregnancyDuring Pregnancy
Omega-3 fatty acids are fats commonly found in marine and plant oils.
They are considered essential fatty acids, meaning that they cannot be synthesized by the human body but are vital for normal metabolism.
Though mammals cannot synthesize omega−3 fatty acids, they have a limited ability to form the long-chain omega−3 fatty acids including Eicosapentaenoic AcidEicosapentaenoic Acid Docosahexaenoic AcidDocosahexaenoic Acid α-Linolenic Acidα-Linolenic Acid
DHA is important for development of the central nervous system in all mammals.
There is an enormous growth spurt in the human brain during the last trimester of pregnancy and the first postnatal months, with a large increase in the cerebral content of Arachidonic Acid (AA) and DHA.
The fetus and the newborn infant depend on a continual maternal The fetus and the newborn infant depend on a continual maternal supply of DHA and AA.supply of DHA and AA.
CARBOHYDRATESCARBOHYDRATES
Principle energy yielding food.
‘Digestible CarbsDigestible Carbs’ – Sugars & Starches.
‘Indigestible CarbsIndigestible Carbs’ – Cellulose, Hemicellulose, Gum, Pectin, Lignin.
Foods with carbohydrates in them have a wide range of effect on the blood glucose levels, during
digestion.
This is known as the This is known as the ‘Glycaemic Response’‘Glycaemic Response’
‘‘Glycaemic Index’Glycaemic Index’ is the effect of carbs on the blood glucose levels.
Rapidly breaking down carbs have high GI, and vice versa.
BASED ON NUMBER OF SUGAR UNITS
NAMENUMBER OF SUGAR
UNITSEXAMPLES
Monosaccharides 1 Glucose, Fructose
Disaccharides 2Sucrose, Lactose,
Maltose
Oligosaccharides 3-10 Raffinose, Stachyose
Polysaccharides >10Starch (plant food), Glycogen (animal
food)
Should Pregnant Women Go on Should Pregnant Women Go on Low-Carb Diets?Low-Carb Diets?
Pregnant women should not go on low-carb diets, let alone carb-free diets.
In fact, it is recommended that at least half of the calories that pregnant women consume should be carbohydrates.
The main reason is because carbs are known to turn to glucose, which is necessary for the unborn baby.
Carbs are known to provide the baby with nutrients, protein and healthy fats. All of these are quite essential to the proper
development of the baby.
Can a Carb-Free Diet Harm an Can a Carb-Free Diet Harm an Unborn Baby?Unborn Baby?
What many people do not realize is that a carb-free diet can actually harm an unborn baby.
It is highly likely that the baby will not get the nutrients that he or she needs for healthy development when one puts oneself on a
carb-free, high-protein diet.
When women choose to go on a diet that is high in protein when they are pregnant, their cortisol levels are known to increase.
When an unborn baby is exposed to higher cortisol levels, the chances that he or she will have high blood pressure later on in
childhood or adulthood increases.
Although a low-carb diet may not be as bad, it is important to keep in mind that these same side effects may also affect your
unborn baby when you restrict your carbs too much.
Are There Any Types of Carbs Are There Any Types of Carbs Pregnant Women Should Eat?Pregnant Women Should Eat?
There are various types of carbs that pregnant women should eat while they are pregnant in order to ensure the ultimate health
and development of their baby.
Some of these carbs include fruits, vegetables and whole grains.
These are what most people refer to as "GOOD CARBSGOOD CARBS" and ultimately, are what will provide the baby with the nutrients
needed for healthy development.
What Types of Carbs Should What Types of Carbs Should Pregnant Women Avoid?Pregnant Women Avoid?
There are many carbs that pregnant women should avoid, or only eat in moderation.
These are what most people call "BAD CARBSBAD CARBS." Some of these types of carbs include donuts, candy, fast food etc.
These carbs and known to cause weight gain and gestational diabetes among pregnant women.
Although eating bad carbs will not necessarily cause any harm to the baby, they will not provide any health benefits.
Eating bad carbs in moderation may not be harmful, but when it comes down to it, one should not eat them too frequently during
pregnancy.
WHY THE DEVELOPING BABY NEEDS FATSWHY THE DEVELOPING BABY NEEDS FATS
Babies need a diet high in beneficial fats, as these are their main source of energy.
A baby’s brain, which is around 60% fat, uses nearly three quarters of total dietary energy for growth, whereas an adult's uses only a fifth.
Once born, they’ll get a lot of essential fats from breastmilk, which contains over 50% of its calories as fat.
But while still in the womb, they rely on maternal fat supply.
FAT IS ESSENTIAL FOR VITAMIN FAT IS ESSENTIAL FOR VITAMIN ABSORPTIONABSORPTION
Fats act as carriers for fat-soluble Fats act as carriers for fat-soluble Vitamins such as A, D, E and K.Vitamins such as A, D, E and K.
Vitamin D Helps Keep Bones And Teeth Vitamin D Helps Keep Bones And Teeth Healthy.Healthy.
Vitamin E Protects Cell Membranes By Vitamin E Protects Cell Membranes By Acting As An AntioxidantActing As An Antioxidant
Vitamin K Helps Wounds Heal Properly As Vitamin K Helps Wounds Heal Properly As It Helps With Blood Clotting And Also It Helps With Blood Clotting And Also
Helps Build Strong BonesHelps Build Strong Bones
BUTTER & OTHER COOKING MEDIA FAT (g/unit)
Butter 100 g 81
Ghee 100 g 100
Vegetable Oil 100 g 100
Vegetable Hydrogenated Oil 100 g 100
BREADS AND CEREALS FAT (g/unit)
Chapati (one) 0.4
Puri (one) 2.8
Paratha (one) 4.1
Aloo ka Paratha (one) 3.5
Cooked Rice (3/4th katori) 0.1
Khicheri (1 katori) 7.3
Dosa 3.5
Bread large sized (1 slice) 0.7
Dry Cereal (3/4th katori) 0.3
LEGUMES (1 katori cooked dal including veg oil used) FAT (g/unit)
Bengal Gram (Channe ki dal) 4.1
Black Gram (Urad ki dal) 4.5
Green Gram (Moong ki dal) 5.6
Lentil (Masoor ki dal) 4.1
Red Gram (Arhar ki dal) 2.0
Sambar 2.1
Chickpea (Kabuli Channa) 6.6
Green Gram (Saboot Moong ki dal) 3.3
Lentil whole (Saboot Masoor ki dal) 2.5
Rajma 5.7
VEGETABLE PREPARATIONS (1 katori incld oil used) FAT (g/unit)
Matar Paneer (Cottage Cheese with Peas) 10.4
Aloo Matar (Potatoes with Peas) 6.4
Potato curry 6.2
Veg Kofta 13.7
Veg Korma 7.9
Aloo Baingan (Potatoes with Brinjal) 6.7
Carrots 6.0
Pumpkin 6.3
Cabbage 10.3
Ridge Gourd 7.3
Okra 15.0
Bhurtha 8.2
Stuffed Tomatoe 3.4
RAW VEGETABLES & FRUITS FAT (g/unit)
Green Peas 100 g 0.1
Brinjal 100 g 0.3
Sweet Potatoes 100 g 0.3
Beams 100 g 1.0
All other Vegetables 100 g < 0.3
Apple 100 g 0.5
Pear 100 g 0.2
Most other 100 g 0.3
SNACKS FAT (g/unit)
1 Samosa 12.6
1 -1/4th Upma 11.3
French Fries 90 g 11.3
Palora (4 pieces) 11.0
Besan ka Pura 11.7
Dahi Vada (1) 9.6
Masala Vada (2) 4.6
Poha 1-1/2 katori 13.1
Potato cutlet (1) 5.4
Chaat 10.0
MILK PRODUCTS FAT (g/unit)
Milk (1 cup) 8.6
2% Milk (1 cup) 4.9
Skimmed Milk (1 cup) 0.2
Buttermilk (1 cup) 2.4
Ice Cream regular (1 cup) 14.1
Yoghurt (1 cup) 9.8
Cottage Cheese (30 g) 1.2
Swiss Cheese (30 g) 7.9
Cheddar Cheese (30 g) 9.1
MEAT, FISH & POULTRY FAT (g/unit)
Lamb Leg (90 g) 9.4
Lamb Chop (90 g) 15.8
Chicken, white, no skin (90 g) 2.9
Fried Chicken (90 g) 7.9
Fried Liver (90 g) 9.8
Fried Fish (90 g) 12.5
Fish Jhol (1 katori) 2.5
Mutton ball curry (1 katori) 17.6
Prawn curry (1 katori) 6.5
Boiled Egg (1) 5-6
Fried Egg (1) 7-9
DESSERTS FAT (g/unit)
Halwa (100 g) 15.9
Jelly & Custards (100 g) 1.2
Kheer (150 g) 13.4
Sevian (100 g) 10.0
Suji Kheer (150 g) 14.2
Sriikhand (100 g) 19.7
Sandesh (2 pieces) 9.0
Besan ki Barfi (60 g) 25.4
Chikki (60 g) 12.0
Fruit Cake (50 g – 1 piece) 15.1
Jam Tart (35 g – 1 piece) 9.1
Lemon Tart (55 g – 1 piece) 9.2
Nutty Biscuits (40 g – 2 pieces) 13.8
MINERAL DIEARY SOURCES
RDA’S CLINICAL MANIFESTATION
SODIUMSODIUM Table salt, Dairy products
Adults = 1.5 g/dl Only excess loss can produce deficiency – Muscular cramps, Weakness, Hypovolemia
POTASSIUMPOTASSIUM Bananas, Muskmelon, Bael fruit, Citrus fruit, Leafy veg, Milk, Meat
Adults = 4.7 g/dlPreg = 4.7 g/dlLactation = 5.1 g/dl
Weakness, Paraesthesia, Arrhythmias.
MAGNESIUMMAGNESIUM Whole grains, Leafy veg
Men = 400 mg/dlWomen = 310 mg/dlPreg = 350 mg/dlLactation = 310 mg/dl
Muscle weakness, Twitching, Tremors, Numbness, Apathy.
PHOSPHORUSPHOSPHORUS Milk, Cheese, Yoghurt, Fish, Poultry, Meat, Grains.
Adults = 700 mg/dlPreg & Lactation = 700 mg/dl
Weakness, Fatigue, Leukocyte & Platelet dysfunction, Heart failure, Haemolysis
IODINE Seaweeds, Salt water fish, Shell fish, Iodised salt
Preg = 220 micro g/dlLactation = 290 micro g/dlWomen = 150 micro g/dl
Thyroid enlargement
Manganese Nuts, Dry fruits, Cereals, Unrefined grains, Tea
Women = 1.8 mg/dlPreg = 2.0 mg/dlLactation = 2.6 mg/dl
Impaired growth & skeletal development, Decline in reproductive function
Selenium Seafood, Muscle meat, Cereals
Women = 55 micro g/dlPreg = 60 micro g/dlLactation = 65 micro g/dl
Cardiomyopathy, CHF, Striated muscle degeneration
Zinc Nuts, Legumes, Meats, Shellfish
Women = 8 mg/dlPreg = 11 mg/dlLactation = 12 mg/dl
Growth retardation, Poor wound healing,Hypogonadism
TRIMESTERTRIMESTER EXTRA ENERGY EXTRA ENERGY NEEDSNEEDS
EXAMPLES OF FOODSEXAMPLES OF FOODS
1st trimester 100 extra calories each day
•A large apple OR•A slice of cheese OR•A glass of milk OR•A piece of bannock
2nd and 3rd trimester
300 extra calories each day
•A piece of toast with peanut butter and a glass of milk OR•A small piece of meat or fish with bannock OR•A bowl of vegetable soup with crackers and cheese
NOT ENOUGH WEIGHT GAINNOT ENOUGH WEIGHT GAIN
• Low birth weight baby
• Early birth
• Baby may not develop properly
• Baby may have life-long health problems
• Higher perinatal mortality
•Baby may have mental and behavioural problems
TOO MUCH WEIGHT GAINTOO MUCH WEIGHT GAIN
• High birth weight baby
• Difficult birth (Feto pelvic disproportion)
• Higher perinatal mortality
• Mother may develop gestational diabetes
• Baby may develop diabetes & cardiac problems in later life
• Too much caffeine is not good during pregnancy
• Coffee, tea and some pop has caffeine
• 3 small cups of coffee per day (400-450 mg of caffeine) is safe.
• Switch to decaf or try half decaf, half regular
• Smoking is harmful to the baby
• Passive smoking is dangerous
• Nicotine causes vasospasm leading toPlacental insufficiency.
• IUGR
• Preterm Birth.