nutrition for all

1. Maternal Nutrition

2. Objectives
• Define Maternal nutrient requirements. (calories, proteins, vitamins and minerals).
• Explain the importance of pre conceptual nutrition
• Discuss Nutritional risk factors at onset of pregnancy:
• Adolescents
• Multiple pregnancies
• Poor reproductive performance
• Poverty
• Food faddists
• Substance abuse (caffeine, smoking, alcohol)
• Chronic systemic disease (gestational diabetes)
• Pre-pregnant weight
• Anemia
• Describe development of Common symptoms in pregnancy and interventions to alleviate them.
(nausea, heart burn, constipation, Pica)
• Explain lactation and the nutritional requirement

3. Daily Food Plan for Pregnant Women

4. Nutrient requirements
• PROTEIN Complete protein foods of high biologic value include eggs, milk, beef,
poultry, fish, pork, cheese, soy products, and other animal products (e.g., lamb, venison, and
so on). Other incomplete proteins from plant sources such as legumes and grains contribute
additional valuable amounts of amino acids. Protein-rich foods also contribute other
nutrients, such as calcium, iron, zinc, and fat-soluble vitamins.
• Minerals
• The physiologic and metabolic changes that take place during pregnancy are vast and will
vary greatly between women. But in all cases, the nutrient needs of the mother must be met
before the nutrient needs of the placenta will be met and finally, before the needs of the
fetus are fulfilled. As such, all nutrients are of great importance in the mother’s diet.
Teratogenic effects may develop as a result of a maternal diet that is deficient in many of the
minerals (e.g., goiter, fetal growth restriction).

5. Cont. . . .
• Vitamins
for pregnant women are slightly higher for most vitamins. As total
energy intake increases, so do the nutrients contained in the foods
consumed. Therefore, the recommended intake for most nutrients is
achieved through a selection of nutrient dense foods. As with the
mineral section, we will limit the discussion here to those vitamins that
are of specific concern during pregnancy because of inadequate dietary
intake

6. Nutritional risk factor of pregnancy
• Pre pregnancy BMI is less than 18.5 or higher than 25
• Inadequate intake of nutrients
• Smoking
• Alcohol
• Teenagers
• Age more than 35 years
• Multiple births

7. Substance abuse
• Alcohol.
• Alcohol use during pregnancy can lead to fetal alcohol spectrum disorders
(FASDs), of which fetal alcohol syndrome (FAS) is the most severe form
(Figure 10-1). Fetal alcohol spectrum disorders comprise the leading causes
of preventable mental retardation and birth defects in the United States. It is
difficult to determine the exact prevalence of FAS; however, one study
estimated that between 2 and 7 per 1000 live births in the United States are
affected by FAS. Alcohol is a potent and well-documented teratogen. There
are no safe amounts, types, or times during pregnancy that are acceptable for
the consumption of alcohol. FAS is 100% preventable by abstaining from
alcohol during pregnancy

8. Conti. . . .
• Caffeine.
• Caffeine use is common during pregnancy. Caffeine crosses the placenta and
enters fetal circulation. Studies on caffeine use and pregnancy risks have been
controversial with conflicting results over the past several decades. Three
large-scale reviews of the available literature did not find consistent evidence
that either normal or high intakes (defined as ≥300 mg/d) of caffeine during
pregnancy posed a risk for congenital malformations, growth restriction, or
spontaneous abortion (miscarriage). The use of caffeine and safety during
pregnancy is difficult to study; however, it will continue to be a hot topic of
research for years to come.

9. Common symptoms in pregnancy
• Pica.
• Pica is the craving for and the purposeful consumption of nonfood items (e.g.,
chalk, laundry starch, clay). It is a practice that is sometimes seen in pregnant or
malnourished individuals. Although the etiology is unknown, pica is significantly
associated with iron deficiency anemia as well as other contributing factors, such
as poor zinc status, hunger, and psychological stress. Although pica may occur in
any population group, worldwide it is most common among pregnant women. The
practice of eating nonfood substances can introduce pathogens (e.g., bacteria,
worms) and inhibit micronutrient absorption, thereby resulting in various
deficiencies. Most patients do not readily report the practice of pica; therefore,
practitioners should always ask patients directly about their consumption of any
nonfood substance.

10. Conti. . . .
• Heartburn
• Pregnant women sometimes have heartburn or a “full” feeling. These discomforts
occur especially after meals, and they are caused by the pressure of the enlarging
uterus crowding the stomach. Gastric reflux may occur in the lower esophagus,
thereby causing irritation and a burning sensation. The full feeling comes from
general gastric pressure, the lack of normal space in the area, a large meal, or the
formation of gas. Dividing the day’s food intake into a series of small meals and
avoiding large meals at any time usually help to relieve these issues. Comfort is
sometimes improved by the wearing of loose-fitting clothing.
• Constipation Although it is usually a minor complaint, constipation may occur
during the latter part of pregnancy as a result of the increasing pressure of the
enlarging uterus and the muscle-relaxing effect of progesterone on the
gastrointestinal tract, thereby reducing normal peristalsis. Helpful remedies include
adequate exercise, increased fluid intake, and consumption of high-fiber foods such
as whole grains, vegetables, dried fruits (especially prunes and figs), and other fruits
and juices.

11. Conti. . . .
• Nausea and Vomiting
• Nausea and vomiting affect 69% of women during early pregnancy. It can be distressing
and disruptive to daily life. For the majority of women experiencing nausea and vomiting, it
will persist throughout the entire day. As a matter of fact, less than 2% of women experience
“morning sickness” (i.e., nausea and vomiting limited to the morning hours). It is likely
caused by hormonal adaptations to human chorionic gonadotropin (hCG) during the first
trimester, and it generally peaks at about 9 to 11 weeks’ gestation. For about half of the
women with nausea and vomiting, it will resolve around 14 weeks; and 90% of women will
have no additional symptoms after 22 weeks’ gestation. In most cases it is self-limiting and
does not indicate further complication.
• Avoid an empty stomach by eating small, frequent meals and snacks that are fairly dry and
bland with low-fat and low-fiber.
• Drink liquids between (rather than with) meals.
• Avoid odors, foods, or supplements that trigger nausea
hyperemesis gravidarum a condition that involves prolonged and severe vomiting in pregnant
women, with a loss of more than 5% of body weight and the presence of ketonuria, electrolyte
disturbances, and dehydration.

12. Anemia
• Iron-deficiency anemia is the most common nutritional deficiency worldwide
and is a risk factor for delivering low birth weight infants. Approximately
42% of pregnant women worldwide experience iron-deficiency anemia (Hb <
110 g/L). Although a disproportionate amount of these cases occur in
underdeveloped countries, the prevalence ranges greatly, from about 6%.
Anemia is more prevalent among poor women, many of whom live on
marginal diets that lack iron-rich foods, but it is by no means restricted to
lower socioeconomic groups. Dietary intake must be improved and
supplements used as necessary to avoid the long-term detrimental effects on
the fetus of iron deficiency during gestation.
• Organization currently recommends an intermittent (once, twice, or three
times weekly on nonconsecutive days) iron and folic acid dietary supplement
as a safe, effective, and inexpensive way to prevent anemia during pregnancy
for women living in areas with a high risk for anemia.

13. Chronic systemic disease (gestational diabetes)
• Gestational diabetes is defined as glucose intolerance with onset during
pregnancy, and the definition applies regardless of whether medication (e.g.,
oral hypoglycemic agents, insulin) or only diet modification is used for
treatment. Women found to have diabetes at their initial prenatal visit (usually
by fasting or random blood glucose test) are assumed to have had
undiagnosed diabetes before becoming pregnant and are therefore diagnosed
with overt diabetes and not gestational diabetes.

14. CONT.
• lactation production and secretion of breast milk for the purpose of
nourishing an infant.