1. The document discusses maternal nutrition during pregnancy, outlining nutrient requirements and dietary guidelines. It covers topics like pre-pregnancy nutrition, ideal weight gain, increased needs for calories, protein, iron and other nutrients during pregnancy. 2. Nutritional concerns during pregnancy like nausea, constipation and heartburn are addressed, along with interventions like eating small frequent meals and staying hydrated. 3. Inadequate or excessive weight gain is also covered, noting the risks and recommended rates of gain depending on pre-pregnancy BMI. Maintaining a balanced diet according to daily food group guidelines is emphasized.

1. UNIT-1
MATERNAL NUTRITION
By : Muhammad Awais M.Phil. Human Nutrition And
Dietetics (UAF) Nutritionist DHQ Hospital Hafizabad

2. Outline
• Pre-pregnancy nutrition
– Conditions and interventions
• Pregnancy in adolescents
• Pregnancy physiology that alters nutritional needs
• Nutrient requirements during pregnancy
• Nutritional concerns during pregnancy and interventions
• Nutritional risk factors of pregnancy
• Pregnancy in adolescents
• Prevalence iron deficiency anemia in Pakistan

3. Pre-pregnancy nutrition
• Both a man’s and a woman’s nutrition may affect fertility
• But the woman’s nutrition has direct influence on the developing fetus
• Her body provides the environment for the growth and development of
newborn
• In preparation for a healthy pregnancy, a woman can establish the
following habits
– Achieve and maintain A healthy body weight
– Choose an adequate and balanced diet
– Be physically active
– Manage chronic conditions
– Avoid harmful influences

4. Conditions and Interventions
Premenstrual Syndrome
• Reduce Caffeine Intake
• Increasing daily physical
activity
Magnesium, Calcium, Vitamin
D, and
Vitamin B6 Supplementation
Obesity and Fertility
• balance diet
• Exercise
Eating Disorders (anorexia
nervosa and bulimia
nervosa)
• CBT
Polycystic Ovary Syndrome
• Weight loss
Diabetes Mellitus
Diet management

5. Pregnancy Physiology That Alters
Nutritional Needs
1- Altered Metabolism:
• Increase the basal metabolic rate: by the fourth month of
gestation and rises to 15 - 20% above normal by term.
• Altered the metabolism of nutrients: fat becomes the
major source of maternal fuel, making glucose available for
the fetus.

6. CONTINUE
2- Gastrointestinal Changes:
• Slow gastrointestinal motility: an advantage of slowed motility
is that nutrient absorption increases
• Nausea and vomiting are common in the first trimester and may
be related to hypoglycemia, decreased gastric motility, relaxation
of the cardiac sphincter, or anxiety.
• Increases in appetite and thirst
• Heartburn and constipation: due to slow motility or enlarging
uterus

7. COUNTINUE
3- Blood Volume Changes:
• Increase total body water throughout pregnancy.
• Hemodilution or a physiologic anemia of pregnancy: due
to the increase in blood volume.
• Minor edema: may be considered normal if it is not
accompanied by hypertension and proteinuria.

8. CONTINUE
• Recommendations for weight
gain are divided into three
categories based on the
woman’s pre-pregnancy
weight.
• The weight category is
determined using body mass
index (BMI).
• The range for women carrying
twins is 35 lb to 45 lb (16 - 20
kg).
4- Ideal Weight Gain:
• The average weight gain is
about 25 to 30 lb (11.5 kg to
14.0 kg).
• Weight gain during pregnancy
consists of the weight of the
fetus and associated fetal
tissues (e.g. placenta), plus
the weight increases in
maternal tissue.

9. Recommended total weight gain ranges for pregnant
women*
Pre-pregnancy
Weight-for-Height
Recommended Total
Gain
Category (lb) (kg)
Low (BMI < 19.8) 28 - 40 12.5 - 18.0
Normal (BMI 19.8 - 26.0) 25 - 35 11.5 - 16.0
High (BMI >26 - 29) 15 - 25 7.0 - 11.5
Obese (BMI > 29)  15  7

10. Nutrition During Pregnancy
• Maternal diet and nutritional status have a direct impact on
the course of pregnancy and its outcome
• Malnutrition that occurs in
– Early months of pregnancy affects development and the
capacity of the embryo to survive
– Poor nutrition in the latter part of pregnancy affects fetal
growth

11. Nutrient Requirements During Pregnancy
• Actual requirements during pregnancy are influenced by
previous nutritional status and health history, including:
chronic illnesses, multiple pregnancies
• The requirement for one nutrient may be altered by the intake
of another. E.g., women who do not meet their calorie
requirements need higher amounts of protein.
• Nutrient needs are not constant throughout the course of
pregnancy - nutrient needs change little during the first
trimester and are at their highest during the last trimester.

12. ENERGY
Energy needs increase because of:
• The increase in basal metabolic rate.
• Weight gain increases the amount of calories burned during
activity.
• Uses additional calories to store energy in preparation for
lactation after delivery.
• An additional 300-340 kcalories per day during the second
trimester
• An extra 450 kcalories per day during the third trimester

13. Carbohydrates
• Ample carbohydrate (ideally, 175 grams or more per
day and certainly no less than 135 grams) is
necessary to fuel the fetal brain
• Sufficient carbohydrate ensures that
• the protein needed for growth will not be broken
down and used to make glucose

14. Protein
The protein RDA ◆ for pregnancy is an additional 25 grams per day
higher than for nonpregnant women.
Sources: meats, milk products, and protein-containing plant foods
such as legumes, whole grains, nuts, and seeds
Protein needs increase to support :
• Fetal growth and development.
• The formation of the placenta and amniotic fluid.
• The growth of maternal tissues and the expanded blood volume.

15. Fats and Essential Fatty Acids
• Intake of 30g of visible fat/day is recommended during pregnancy
• The high nutrient requirements of pregnancy leave little
room in the diet for excess fat
• But the essential long-chain polyunsaturated fatty acids are
particularly important to the growth and development of the fetus.
• The brain is largely made of lipid material,
– Requires the long-chain omega-3 and omega-6 fatty acids for its
growth, function, and structure

16. Nutrients for Blood Production and Cell
Growth
• New cells are laid down at a tremendous pace as the fetus grows
and develops. At the same time, the mother’s red blood cell mass
expands.
• All nutrients are important in these processes, but folate, vitamin
B12, iron, and zinc needs more
• The increased requirement for vitamin B6 is proportional to the
increase in protein because it is involved in protein metabolism.

17. Folate And Vitamin B12
• The requirement for folate
increases dramatically during
pregnancy
• Prevent neural tube defect
Folate RDA : 600 μg/day
Folic acid sources:
• Natural form of folic acid
(folate): orange juice, other
citrus fruits and juices, green
leafy vegetables, dried peas
and beans, broccoli, and
whole-grain products.
• Because vitamin B12 is
necessary for the metabolism
of folate, a slight increase in
intake is recommended.
• Vitamin B12 RDA during
pregnancy: 2.6 μg/day

18. Iron
• A daily supplement of 30 mg
of ferrous iron is
recommended for all women
during the second and third
trimesters.
• It is preferably taken between
meals or at bedtime on an
empty stomach to maximize
absorption.
Importance for iron during
pregnancy:
• To support the increase in
maternal blood volume.
• To provide iron for fetal liver
storage, which will sustain the
infant for the first 4 - 6
months of life.
• Iron RDA during
pregnancy:27 mg/day

19. Nutrients for Bone Development
• Vitamin D and the bone-building minerals calcium, phosphorus,
magnesium, and fluoride are in great demand during pregnancy
• The calcium requirement for an adult woman is 400mg/day. During
pregnancy the need increases to 1000mg/day.
• Insufficient intakes may produce abnormal fetal bones and teeth
• Vitamin D plays a vital role in calcium absorption and utilization
• severe maternal vitamin D deficiency
– Rickets in the infant
– Osteomalacia in the mother
• Regular exposure to sunlight and consumption of vitamin D–fortified
milk

20. Dietary Guide Lines for pragnant
1- Eat in moderation.
2- Aim for balance.
3- Eat three meals daily plus two or three snacks.
4- Drink adequate fluids.
5- Do not restrict salt intake
6- Be aware of food borne risks during pregnancy.

21. Daily food guide for pregnancy and breastfeeding
Pregnancy
Food Group Adult Woman Adolescent Breastfeeding
Woman
Milk, Yogurt,
Cheese
3 - 4 servings 4 - 5 serving 4 - 5 servings
Meat and Meat
substitutes
5 - 6 oz 6 - 7 oz 6 - 7 oz
Fruits 2 - 4 servings 2 - 4 servings 2 - 4 servings
Vitamin C-rich 1 - 2 servings 1 - 2 servings 2 servings
Vegetables 3 - 5 servings 3 - 5 servings 3 - 5 servings
Vitamin A-rich 1 serving 1 serving 1 serving
Breads, Cereals,
Rice, Pasta
6 -11 servings 6 - 11 servings 6 - 11 servings

22. Nutritional concerns during pregnancy and
intervention
1- Nausea and Vomiting
Women should be advised to:
• Eating small, frequent meals every 2 to 3 hours.
• Eat carbohydrate foods such as: dry crackers, Melba toast, dry cereal, or
hard candy before getting out of bed in the morning.
• Avoid drinking liquids with meals.
• Avoid coffee, tea and spicy foods.
• Limit high-fat foods, because they delay gastric emptying time.
• Eliminate individual intolerances.

23. Continue
2. Constipation
may be caused by:
• Relaxation of gastrointestinal
muscle tone and motility
• Pressure of the fetus on the
intestines.
• Decrease in physical activity
• Inadequate intake of fluid and
fiber.
• Side effect of the consumption
of iron supplements.
Intervention
• Increase fiber intake.
• Drink at least eight 8-ounce
glasses of liquid daily.
• Try hot water with lemon or
prune juice upon waking to
help stimulate peristalsis
• Participate in regular
exercise.

24. Continue
3- Heartburn:
• Eat small, frequent meals and eliminate liquids immediately
before and after meals to avoid gastric distention.
• Avoid coffee, high-fat foods and spices.
• Eliminate individual intolerances.
• Avoid lying down or bending over after eating.

25. Continue
4- Inadequate Weight Gain:
• Inadequate weight gain during pregnancy increases the
risk of giving birth to a low-birth-weight (LBW) infant
(i.e., a baby weighing less than 2500 g).
• The recommended weight gain for normal weight women
is @ 0.44 kg/week,
• Underweight women more than 0.44 kg/week whilst
overweight women about 0.29 kg/week and women
pregnant with twins at least 0.44 kg/week.

26. Continue
5- Excessive Weight Gain, may be related to:
• Overeating.
• Stress.
• Decrease in physical activity.
• Counsel the client on the recommended rate and quantity of
weight gain associated with optimal maternal and infant health
and successful breast-feeding.

27. Nutritional Risk Factors Of Pregnancy
• Pre-partum Weight < 85% Or > 120% Of Ideal Weight
• Use Of A Therapeutic Diet For A Chronic Disease
• Use Of Alcohol, Tobacco, Or Drugs
• Food Faddism, Unbalanced Diet, Pica
• Teens And Women Older Than 40 Years Of Age
• Poor Obstetric History (LBW, Stillbirth, Abortion, Fetal Anomalies)
• Repetitive Pregnancies At Short Intervals
• Low Socioeconomic Status
• Chronic Preexisting Medical Problems, Such As Hypertension, Diabetes, Heart Disease,
Pulmonary Disease, Renal Disease, Maternal PKU
• Untimely Prenatal Care

28. Pregnancy in Adolescents
• Nourishing a growing fetus adds to a teenage girl’s nutrition burden,
especially if her growth is still incomplete.
• increases the risks of pregnancy complications among adolescent mothers
include
– iron-deficiency anemia (which may reflect poor diet and inadequate
prenatal care)
– prolonged labor (which reflects the mother’s physical immaturity)
• On a positive note, maternal death is lowest for mothers under age 20
• Pregnant teenagers have higher rates of stillbirths, preterm births, and
low-birthweight infants than do adult women

29. Prevalence Iron Deficiency Anemia In
Pakistan
• NNS 2018 confirms that micronutrient deficiencies are
widespread in Pakistan.
• Anemia was common in non-pregnant women of
reproductive age 43.0% and 53.1% in girls
• Iron deffieciency anemia 21.2% s in women of reproductive
age 15–49 years
(NNS 2018)

30. References
• Understanding Of Normal And Clinical Nutrition
• National Nutrition Survey 2018
• Nutrition Through The Life Cycle
• Nutrition by Deepti Chauhan

31. Thanks