Applied Nutrition

Maternal Nutrition unit(I)

Subia Naz
Lecturer,
ION&M
 Objectives

• Nutritional need in pregnancy and lactation.

• Pre-pregnancy diet.
• Pregnancy and Adolescents.
• Nutritional Risk factor of Pregnancy.
• Concern during pregnancy/weight gain/ feeding/DM
in Pregnancy.
• 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.
Conti..
• 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.
Pre-pregnancy diet
 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.
 Conti…

• 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

• Energy:
– First Trimester - no change
– Second Trimester - increases 340 kcal/day
– Third Trimester - increases 452 kcal/day

• Protein:
– Increases from 46 g/day to 71 g/day
Vitamin and Mineral Requirements in
Pregnancy
• Pregnant women are at increased risk for
folic acid, iron, and calcium deficiencies.

• Recommendations are:
– Iron – increases to 5 mg/day
– Folate – increases to 0.6 mg/day
– Calcium - 1000 mg/day
– Magnesium - increases to 360 mg/day
– Vitamin C - increases to 85 mg/day
 Calcium Requirements

• Daily Calcium Recommendations

– 1300 mg/day
– 1000 mg/day (adults, pregnant and lactating)
– >51 y/o: 1200 mg/day

– Increased requirements during the third trimester

– Supplementation shown to reduce hypertension during

pregnancy

• Dietary sources
– Milk, yogurt , cheese.

– Orange juice- fortified (1 cup = 300 mg) .

 Folate Requirements in Pregnancy

• DRI=600 g pregnancy or 500 g lactating female,

400 g for non-pregnant woman.

• Beans, peas, orange juice, green leafy vegetables,

fortified cereals are good sources.
 Iron in Pregnancy

• Iron is an essential element in all cells of the body.

• During pregnancy, maternal blood volume

increases 20-30%.

• Iron needs increase from 0.8 mg to 1 mg/day for

first trimester, 4 to 5 mg/day for 2nd trimester and
6 to 10 mg/day for last trimester of pregnancy.

• Deficiency increases risk of maternal and infant

death, preterm delivery, and low birth weight
babies.
 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.
• 1 lbs in first three months and about 1 lbs /week.
• Average weight gain is 25—35 lbs.
• Teen pregnant gains more weight than a mature
woman.
 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
Nutrition Risk Factors for Pregnant Women

• Pre- pregnancy weight below BMI of 18.5 or a BMI of 25 or higher.

• Inadequate kcalories intake.
• Inadequate intake of nutrient(s).
• Smoking.
• Alcohol use
• Drug use
• Teenager
• Woman over 35
• Chronic disease such as diabetes or high blood pressure
• Poverty and/or food insecurity
• Multiple Births (twins, triplets, etc.)
Importance of Nutrition during Lactation
 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.
 Physiologic factors that influence nutrient
requirements:
Developmental considerations
Throughout the life cycle, nutrient needs change in
relation to growth , development , activity and age –
related changes in metabolism and body composition
.period of intense growth and development such as
•Infant (birth to 1 year)
•Toddlers and preschoolers. (2 to 5 years)
•School Age.
•Teenage
 Adolescents:
This is period of rapid physical, emotional, social and
sexual maturation. It is also marked by intense
psychological growth, family conflict , social and peer
pressure.
The growth spurt begins at different ages among
individuals.
Girls begin menstruation and experience fat deposition,
where as males experience and an increase in muscle
mass ,lean body tissue , and bones.
Adolescents:

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Academic performance increases….

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 Issues in Adolescent Nutrition
• “Adolescence is a time of rapid physiologic, psychological, and
social development influencing nutrient needs as well as the
individual’s ability to supply those needs.
• Disruptions in the balance between nutrient requirements and
intake during adolescence impact on such major health
problems as atherosclerosis, hypertension, obesity, anorexia
nervosa, and bulemia nervosa.
• Dietary and exercise habits formed as the adolescent achieves
increased independence have the potential to enhance or
undermine health throughout life.
• Dietary indiscretion as another form of risk-taking behavior is a
new concept worthy of scientific inquiry.”
Marc. S. Jacobson, M.D. LIJ, Schneider Children's Hospital (ref.1)

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 Nutritional requirements are significantly
increased during adolescence to meet the
physiologic demands of rapid growth and
development.

• Body fat content doubles in females (from 10 to

20%)
• Adult eating habits are established
• 12% of adolescents between the ages of 12 and
17 are overweight, but
• 60% of girls and 20% of boys are trying to lose
weight
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 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
• Susceptible Population:
• Pregnant women who have not been taking iron supplements
• Infants and children
• Menstruating females
• Teens
• Low income women
Nutritional Risk Factors in Pregnancy that Require Observation.

• Risk factors at the onset of pregnancy.

• (a) Adolescence. Many adolescents are nutritionally
at risk due to a
• variety of complex and interrelated emotions and
social and economic factors that may adversely affect
dietary intake. Their nutritional needs are greater
and attitude much concern from nurses and
physicians.
Cont.…..
• (b) Frequent pregnancies. These pregnancies may
have depleted nutrient stores. This situation can
compromise maternal and fetal health and well-being.
• (c)  Poor reproductive history. Previous poor weight
gain, pregnancy-induced hypertension (PIH), previous
stillbirth or small for gestational age baby, premature
delivery, and prenatal infection are all common in
women who are or have been poorly nourished in the
past. These women may need more than the usual
nutrition guidance.
 Cont.…
• (d)  Economic deprivation. This refers to the
pregnant patient who is not able to afford proper
food. There are several programs that help with
the purchase of food or that offer supplements.

• (e)  Bizarre food patterns. This includes faddish

diets. A woman may enter pregnancy either
having or continuing to be on a faddish or
otherwise nutritionally inadequate diet.
Cont.….
• (f)  Vegetarian diets. This diet may not contain any or
enough protein or vitamins for a developing fetus.
Intense nutritional counseling will be required to
work out a diet pattern during the prenatal period.
• (g) Smoking, drug addiction, and alcoholism.
Physiologic problems may have been present.
Pregnant patients who indulge in this category may
have major physiologic problems. There is the
possibility that the patient may not consume
sufficient quantities of nutritious foods and, in
addition, can cause major problems to the fetus.
Cont.….

• (h) Chronic systemic disease. There may have been

medical problems, which may have interfered with
ingestion, absorption, or utilization of nutrients.
Drugs used to treat these conditions may also affect
nutrition by similar interference. Counseling should
include general nutrition guidelines for prenatal care
and diet therapy.
• (i)  Pre-pregnant weight. This may be at risk if the
patient is fifteen percent or more below or twenty
percent or more above the standard weight for
health
Iron deficiency Anemia among Children under
five & their Mothers

• Moderate Severe
• Children
• 33.0% 2.6%

• Mothers
• 23.7% 1.8%
Nutritional Status of Pakistani population:

• Low Birth Weight babies 25-30%

• Iron Deficiency Anaemia
– Pregnant mothers 50-58%
– Girls 60-70%
– Children 40-50%
• Iodine Deficiency Disorders 3%
• Vitamin A Deficiency 1%
 References:
Enkin M et al. 2000. A Guide to Effective Care in Pregnancy and Childbirth,
3rd ed. Oxford University Press: Oxford.
Kulier R et al. 1998. Nutritional interventions for the prevention of maternal
morbidity. Int J Gyn Obstet 63: 231–246.
Lopez-Jaramillo P et al. 1997. Calcium supplementation and the risk of
preeclampsia in Ecuadorian pregnant teenagers. Obstet Gynecol 90(2):162–
167.
Mahomed K. 2000a. Iron supplementation in pregnancy (Cochrane Review),
in The Cochrane Library. Issue 4. Update Software: Oxford.
Mahomed K. 2000b. Iron and folate supplementation in pregnancy
(Cochrane Review), in The Cochrane Library.Issue 4. Update Software:
Oxford.
Mahomed K and A Gülmezoglu. 2000. Maternal iodine supplements in areas
of deficiency (Cochrane Review), in The Cochrane Library. Issue 4. Update
Software: Oxford.
Nutrition and Micronutrients in Pregnancy 34
THANK YOU
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