Nutrition: A Life Span Approach: Dr. Hajra Ahmad Aiou
Nutrition: A Life Span Approach: Dr. Hajra Ahmad Aiou
Contents :
• 3.1 Physiological demands of pregnancy
• 3.2 Nutrient requirements in pregnancy.
• 3.3 Diet in relation to pregnancy outcomes.
• 3.4 Nausea and vomiting of pregnancy (NVP).
• 3.5 High-risk pregnancies.
Learning objectives
By the end of this chapter, the reader should be able to:
• Describe the physiological adaptations during pregnancy and their
role in maintaining the fetus health.
• Learn about increased maternal demand for energy, protein, and
micronutrients during pregnancy.
• Describe the nutrition-related factors that determine the risk of
miscarriage and stillbirth.
Learning objectives
• Respiratory system:
• Increased amount of air inhaled and exhaled (30-40%).
• Increased Oxygen consumption (10%).
• Food Intake:
• Increased appetite and food intake; weight gain.
• Taste and odor changes
• Increased thirst
Normal changes in maternal physiology during pregnancy
• Gastrointestinal changes:
• Relaxed gastrointestinal muscle tone
• Increased gastric and intestinal transit time
• Nausea (70%), Vomiting (40%)
• Heartburns
• Constipation
Normal changes in maternal physiology during pregnancy
• Kidney Changes:
• Increase Glomerular filtration rate
• Increased sodium conservation
• Increased nutrient spoilage into urine; protein is conserved
• Increased risk of urinary and reproductive tract infection.
Normal changes in maternal physiology during pregnancy
• Immune system:
• Suppressed Immunity
• Increased risk of urinary and reproductive tract
infections
• Basal Metabolism:
• Increased BMR in 2nd half of the pregnancy
• Increased body temperature .
Physiological demands of pregnancy
Fetus 3550
Placenta 670
Uterus 1120
Amniotic Fluid 896
Breasts 448
Blood supply 1344
Extracellular fluid 3200
Maternal fat stores 3500
Total weight gain at term 14.7 kg or 32-Ib
Recommended Weight Gain
BMI Weight
Weight Gain Weight Gain
(kg)
(kg) (lbs)
Height (m2)
Underweight
12.7-18.2 28-40
BMI < 18.5
Normal Weight
11.4-15.9 25-35
BMI 19-24.9
Overweight
6.8-11.4 15-25
BMI 25-29.9
Obese
6.8 <15
BMI > 30.0
Rate of Weight Gain
• Pattern of weight gain in pregnancy as important as
total weight gain.
17
Nutrient requirements in pregnancy
• Energy, protein, and lipids
• Pregnancy considerably increases the maternal demand for energy
for:
a) Growth of the fetus and placenta,
b) The deposition of fat reserves for lactation,
c) and the expansion of maternal tissues.
Nutrient requirements in pregnancy
• Micronutrients:
• Iron : High iron requirements , with the fetus taking up as much as 400 mg
over full gestation, with up to 175 mg accumulating in the placenta
• Calcium and other minerals
a) The fetus accumulates large quantities of most minerals during late
gestation.
b) The fetal skeleton deposits Ca, mg, and phosphorus in the last trimester,
c) High uptakes of zinc, copper, and other trace metals are also noted.
• Vitamin D : Pregnant women have increased requirements for vitamin D. It is
associated with changes in the metabolism of vitamin D.
Basics of a good diet during pregnancy
21
Protein and Energy Requirements
• Energy • Protein
• Sustains metabolic activity • Expansion of maternal
• Supports protein synthesis blood volume
• Reflects fat and • Growth of breast and
carbohydrate intakes after uterine tissues
increased protein • Growth of fetal tissues
requirement is included
+10 g/day
+300 kcal/day
22
Energy and Nutrient Needs during Pregnancy
1. Energy
• +300 calories in 2nd and 3rd trimester
• how much extra food is 300 kcals?
2. Protein
• +10 grams; how much extra food?
3. Essential Fatty Acids
• omega 6 f.a.: vegetable oils, poultry, meats
• omega 3 f.a.: oils, nuts, seeds, soybeans, shellfish and fish
4. Nutrients for Blood Production/Cell Growth
• key roles in synthesis of DNA and new cells
• folate
• vitamin B-12
• iron: to support enlarged blood volume and provide for placental and fetal needs;
supplement needed;
• zinc
5. Nutrients for Bone Development
• vitamin D
• calcium
Folic Acid
• Nausea
• Keep crackers by bedside; arise slowly; eat bland foods;
eat whatever sounds good; include protein; eat regularly
• Constipation and Hemorrhoids
• Eat high fiber; exercise; drink fluids; go when need to;
• Heartburn
• Eat slowly; relax; small frequent meals; avoid food
offenders; don’t lie down after eating;
Nutrition-Related Concerns during Pregnancy
• Food Cravings
• Strong desires to eat particular foods
• Don’t reflect real physiological needs
• Due to hormone-induced changes in sensitivity to taste
and smell
• Food Aversions
• Strong desires to avoid particular foods
• Nonfood Cravings
• Pica: cravings for nonfood items such as laundry starch,
clay, dirt, ice
• Cultural phenomenon not a response to nutrient need
Critical periods During Pregnancy
37
Diet in relation to pregnancy outcomes
• Human gestation is long and has evolved to maximize the growth of the
brain and produce an infant.
• In this period the developing infant is vulnerable to adverse factors that
impact upon the mother.
• Miscarriage and stillbirth
• Miscarriage, also is defined as the natural end of pregnancy at a stage
of fetal development prior to the fetus being capable of survival.
• With modern medical technology, fetuses of 23–24 weeks gestation
may be considered viable, so miscarriage refers to loss of pregnancy
prior to this stage.
Diet in relation to pregnancy outcomes
• Pre-pregnancy BMI and pregnancy weight gain
• The relationship between pre-pregnancy BMI and weight gain in
pregnancy is important.
• Obesity and overweight are widely regarded as risk factors for
preterm delivery.
• Results in increased prevalence of complications of pregnancy due to
high BP and relative insulin resistance that accompany obesity.
• Results in increased medical interventions and premature induction
of labor.
Nausea and vomiting of pregnancy (NVP)
• NVP as a normal physiological process
• NVP is a commonly reported symptom associated with early pregnancy.
• Most studies show the prevalence of NVP is between 60% and 80%.
• Hyperemesis gravidarum:
• The severity of NVP symptoms varies enormously between women
• Rarely the extent of those symptoms become so great that there is a threat
to the health of the pregnant woman or her child.
• The severity of HG symptoms will generally result in hospitalization for
treatment using vitamin supplements, and intravenous infusion of fluids and
electrolytes.
Cravings and aversions
• Pica :
• Pica represents an extreme form of craving behavior.
• Pica is the ingestion of substances that have no nutritive value and pica
behaviors include:
a) The consumption of clay or soil (geophagia),
b) Ice (pagophagia),
c) laundry starch (amylophagia), or other substances such as soap or chalk.
• Pica in pregnancy appears to be a behavior that is most commonly
associated with women of low socioeconomic status
Dietary Quality and Timing: The First Trimester
43
Energy Needs During Pregnancy
• Maternal weight
• Maternal nutrition
• Socioeconomic status
• Lifestyle habits
• Age
• Previous pregnancies
• number; interval; outcomes; birthweight; multiples
• Maternal health
• high blood pressure; diabetes; chronic disease
Conditions occurring in extremes of weight
48
Conditions occurring in extremes of weight
49
Conditions That May Result in Inadequate Nutrient Intake and
Weight Gain During Pregnancy
50
What to Avoid
51
What to Avoid
• Illegal drugs
• Environmental contaminants: mercury and lead (some
large ocean fish).
• Mega vitamins/minerals: especially vitamin A. Prenatal
vitamins – YES.
• Dieting: NO
• Sugar substitutes and caffeine – avoid or limit.
52
Summary
• Pregnancy is accompanied by major maternal adaptations that support
the development of the placenta and allow fetal growth and development.
• These adaptations, and the growth of the fetus, greatly increase the
demand for energy and nutrients.
• Changes to maternal physiology, behavior, and the mobilization of pre-
pregnancy stores are often sufficient to meet requirements for nutrients
without changes to intake.
• Optimal maternal weight gain in pregnancy is a key determinant of
pregnancy outcome.
• Advised weight gains vary depending upon pre-pregnancy BMI.
Summary
• Nutrition-related factors are predictive of a number of adverse pregnancy
outcomes, including miscarriage and stillbirth, GDM, preterm delivery, and the
hypertensive disorders of pregnancy.
• Maternal obesity is a major risk factor for most of the adverse pregnancy
outcomes.
• NVP is a normal feature of the early stages of most pregnancies.
• These symptoms may be protective and are associated with a lower risk of early
miscarriage.
• HG is the most extreme form of nausea and vomiting in pregnancy.
• This condition requires robust intervention as it is associated with greater risk of
both maternal fetal deaths.