EAT RIGHT IN PREGNANCY Dr Renu Chawla , Dr Sharda Jain

1. EAT RIGHT IN
PREGNANCY
DR RENU CHAWLA
DR SHARDA JAIN

2. DR RENU CHAWLA
She is graduate and post graduate from
LHMC and SSKH DELHI.
She has been practicing as Obstetrician and
Gynecologist since 1991 with keen interest
in high risk obstetrics.
She has been joint secretary EDGF. Currently
she is treasurer of EDGF.

5. Eat right in pregnancy
FIRST 1000 DAYS
• The first 1000 days of life is the time spanning between
conception and second birthday is a period when
foundation of optimum health , growth and
neurodevelopment are established
• Period of rapid physical growth and accelerated mental
development
• Nutrition is a key modifiable factor that affects birth
outcomes and has long-term effects on the health of
offspring

6. According to the WHO, the ideal
weight gain during pregnancy for
four BMI categories for Asians
• Underweight (BMI <18.5), weight gain 12.5to18 .0 kg
• Normal weight (BMI 18.5-24.9kg), weight gain 11.5to16 .0 kg
• Overweight (bmi 25- 29.9), weight gain 7.0to11 .5 kg
• Obese (BMI ≥30), weight gain 5.0to9 .0 kg
The incidence of pregnancy complications is higher at the
upper and lower extremes of weight gain

7. History taking and its relevance
• Past history of nutrition-what was she eating?
• Use of supplements
• Food avoidances/special diets/skipping meals
• Eating disorders
• Lack of resources for adequate nutrition
• Low intake of nutrient-dense foods (fruits and vegetables)
• High intake of added sugars and fats (fried foods, processed
foods, desserts)
• Overweight or obesity
• Medical history of bariatric surgery or other conditions that
cause malabsorption
• Substance misuse

8. Nutrition in pregnancy
• Women should be counseled to eat a healthy diet during pregnancy.
• This includes plenty of fruits and vegetables, whole grains, low-fat
dairy, and a variety of proteins.
• Nutrient-dense foods should be encouraged, and empty calories
should be minimized or avoided
• Optimum nutrition is of great importance for women, due to their
special nutritional needs associated with physiological changes such as
menstruation, pregnancy, lactation and menopause.

9. Women IN Developing Countries
• Women in Africa and Asia between the ages of 15
& 45 spent 50% of their life time in being
pregnant or lactating
J NursWomens Health 2017: J119

10. Nutrition in Critical period of
Development
• Neurological development is extremely rapid during the first 1000 days
of life

12. Essential Fatty Acids
• Essential as not synthesized by body
• There are two families of EFAs
Omega 6-Fatty acids e.g. Linoleic acid
Omega 3-Fatty acids e.g. DHA
• Adequate intake of omega 3 fatty acid is essential in maintaining the
balance production of hormone like substances called Prostaglandins
• During pregnancy and breastfeeding the benefits of EPA and DHA
include
-Healthy development of foetal brain , eye and nervous system,
-Healthy birth weight and gestational length
-Healthy immune system
-Mood elevation in postpartum period
• This rapid growth of the fetus is mainly sustained by the release of free
fatty acids and glycerol from maternal adipose tissue
12

13. 13

14. DHA during Pregnancy and
Lactation
• Fetus depends completely on maternal sources of DHA
• Placenta selectively and substantially transport fatty acid
from mother to the fetus
• During 3rd trimester – there is an avid accretion of DHA in
the liver, brain & retina of fetus ( at rate 0.59gm/day)
• Pregnancy leads to progressive depletion in maternal DHA
status
• After delivery maternal stores are replaced slowly or
incompletely over a period of 6 months
14
Ind J Pediatr. 2005;72(3):239-242

15. DHA & Pregnant Mother
15
• In the last three months of pregnancy, there is rapid accumulation of
DHA in the eyes & brain of the foetus
• Fetus accrues up to 70 mg DHA per day during the last trimester
• At term (40 weeks)
o21% in skeletal muscle
o23% in brain tissue
o50% fetal adipose tissue
• DHA adipose content serves as a
reservoir for DHA that can be
utilized in infant development
DHA accumulation in foetal brain
Proc Nutr Soc 2008;67:19–27
Nutrients. 2012;4:799-840
Nancy L. Morse et al. Nutrients 2012, 4
Journal of Nutrition & Intermediary Metabolism. 5;2016, Pages 23-33

16. DHA for Fetal Growth and
Development
• Fetal DHA demand increases exponentially with increasing
gestational age
• Fetus requires approximately 50 mg/kg/d of omega-3 fatty
acids
16
Eur J Nutr. 2014;53(5):1147–54.
DHA plays an important role:
 Birth Weight & fetal development
 Neural & retinal development
 Central nervous system, improve
cognitive and spatial memory
development
 Child’s pre and postnatal growth

17. DHA for Fetal Growth and
Development
• DHA make up around 30% of brain and 50% of retina’s structure
• DHA is critically important for optimal development of dopaminergic
signaling and once the window for development is past deficits are not
later reversible
17
Rev Obstet Gynecol. 2008 Fall; 1(4): 162–169.
Nutritional Health 2.4 (2018): 43-50.

18. 18
IN PREGNANCY
Pregnancy leads to
progressive
depletion in
maternal DHA status
LAST TRIMESTER
Accretion of DHA in
the liver, brain &
retina of fetus
POST-PARTUM
Breast milk provides
DHA to baby
Maternal stores are
replaced slowly or
incompletely over a
period of 6 months
Ind J Pediatr. 2005;72(3):239-242

19. DHA & Lactating Mother
• There is linear correlation between the dietary
intake of DHA by nursing mother and DHA
content of her breast milk
• DHA supplementation with at least
300mg/day is associated with ↑ breast milk
content by 0.20-0.34 wt%
• A daily intake up to 3 gm/day during
pregnancy has been demonstrated to be safe
19
Proc Nutr Soc 2008;67:19–27
Ind J Pediatr. 2005;72(3):239-242
Prostaglandins Leukot Essent Fatty Acids. 81:171-174

20. MATERNAL AND FETAL
BENEFTIS OF LCFA
• Mothers who have healthy intakes of DHA give birth to infants
with more bloodstream DHA and better visual function as
measured by visual evoked potentials
• The continued intake of EPA and DHA are also important for the
maintenance of the mother’s cardiovascular health
• The level of omega-3 fatty acids in the mother’s bloodstream
during pregnancy has been shown to correlate with insulin levels
and adiposity
Nutrients 2019, 11, 2891;doi:10.3390/nu11122891

21. Cognitive Development
• All meta-analyses in this area are limited by a large degree
of heterogeneity
• There is a trend toward a greater likelihood of benefit with
higher dosages (DHA ≥0.32% and AA ≥0.66%) and a longer
duration of a higher postnatal LC-PUFA supplementation (up
to 1 year of age)
Ann Nutr Metab. 2014;65(1):49-80

22. effect of maternal and fetal DHA
status on general health
• Higher cord plasma DHA was associated with lower body mass
index (BMI) scores, waist circumference, and leptin levels
• Prenatal DHA status may also contribute to improved sustained
attention in preschool children
Mun JG et al. Nutrients. 2019;11(5):1125.

23. Maternal DHA
status during fetal
development can
have lasting
impacts on brain
and eye health
throughout life as
evident by key
recommendations
for DHA intakes
during the first
1000 days of life