Nlc pregnancy

NUTRITION IN THE LIFE CYCLE
Presented by:
CHARLEMAGNE E. TAN, RND
PREGNANCY

DEFINITION OF TERMS:
Conception – the process of becoming
pregnant involving
fertilization or implantation or both
Gestation – the time when a person or
animal is developing
Inside its mother or before it is born
Embryo – the human or animal in the
early stages of development before it is
born or hatched
Fetus – a human being or animal in the
later stages of development before it is
born; usually two months after
conception to birth

Cont. DEFINITION OF TERMS
Parturition – the action or
process of giving birth to
offspring
Pregnancy – a condition
of a woman or female
animal that is
Going to have a baby or
babies
Ovum – egg cell
Ovulation – discharge of
mature egg from the ovary

DEFINITION OF PREGNANCY
 Period from conception to delivery
 Condition of having a developing embryo
into a fetus after the fertilization of an
ovum with a sperm within the uterine
environment
 Also known as gestation
 The period of pregnancy which is about:
 266 days (measured by ovulation
age)
 280 days or 40 weeks (measured by
menstrual age)

PARTURITION
- The act of giving birth,
delivery of the fetus from the
mother.
1. Low-birth-weight (LBW)
infants: babies weighing
less than 2,500 grams (<5.5
pounds)
2. Small for gestational age
infants (SGA): full term
babies who weigh less than
2,500 grams (5.5 pounds)

PARTURITION
3. Premature infants: babies
born less than 37 weeks of
gestation; also called
preterm infants
4. Intrauterine growth
retardation (IUGR):
depressed growth of the
uterus due to inadequate
nutritional environment in
utero.
5. Postmature infants: babies
born after 42 weeks or more
of gestation

FACTORS CONTRIBUTORY TO
INTRA UTERINE GROWTH
RESTRICTION
 Inadequate maternal nutritional status before
conception
 Short maternal stature (due to under nutrition)
 Poor maternal nutrition during pregnancy (low
gestational weight gain)
 Intrauterine infection
 Small/inefficient placenta
 Maternal smoking, alcoholism, drug addiction

PHYSIOLOGICAL STAGES OF
PREGNANCY
 Period of implantation (2 weeks of gestation)
 Nourishment is called uterine milk from the
secretion of the uterine gland
 Also called period of the ovum
 Period of organogenesis (6-week period following
implantation; by cell differentiation, formation
of organs and structure of the fetus

PHYSIOLOGICAL STAGES OF
PREGNANCY
 Purposes of placenta (450-1000g at birth)
 Supplying fetus with nutrients and oxygen
 Storing nutrients particularly vitamins
 Synthesizing hormones and removing fetal
waste products

MATERNAL PHYSIOLOGICAL
ADJUSTMENTS
a. Progesterone – hormone causing relaxation of the
smooth muscles, reduces gastric motility, favors
maternal fat deposition and increases renal sodium
excretion.
b. Estrogen – promotes the growth and function of the
uterus, increases hydroscopic properties of the
connective tissue, causes uterine contraction and
postpartum involution of the uterus

ADJUSTMENTS
c. Human chorionic gonadotropin (HCG) – a
pregnancy hormone, stimulates secretion of the
corpus luteum (ovarian tissue) to maintain
pregnancy
d. Human placental lactogen (HPL) hormone -
stimulates growth of the placenta and fetus and
mammary gland development in preparation for
lactation
e. Human chorionic thyrotropin (HCT) placenta
hormone- stimulates production of thyroid
hormones

ADJUSTMENTS
f. Human growth hormone (HGH) – promotes
nitrogen retention and stimulates growth of long
bones
g. Thyroxine hormone–regulates rate of cellular
oxidation (basal metabolism)
h. Parathyroid hormone (PTH) –promotes
calcium resorption from bones and increases
calcium absorption
i. Insulin – reduces blood glucose levels to
promote energy production and fat synthesis.
j. Aldosterone – promotes sodium retention

CHANGES IN GASTROINTESTINAL
FUNCTIONS
a. Increased appetite
due to increased
nutrient requirement
b. Decreased tone and
motility of the smooth
muscles which leads
to esophageal
regurgitation,
decreased emptying
time of the stomach
and reverse
peristalsis

Cont. CHANGES IN GASTROINTESTINAL FUNCTIONS
d. Decreased emitting time of the gallbladder together
with hypercholesterolemia from increased
progesterone levels which may lead to
development of gallstones
e. Decreased secretion of hydrochloric acid which
reduces gastric acidity and depresses calcium and
iron absorption

CHANGES IN BLOOD VOLUME
AND COMPOSITION
a. Total blood volume during pregnancy increases
by about 33% above non pregnant level.
b. Plasma volume in non pregnant women
averages to 2600 mL and by 34 weeks of
pregnancy, the plasma volume is about 50%
greater than it was at conception

Cont. CHANGES IN BLOOD VOLUME AND COMPOSITION
c. Red cell production
increases by 18%
during pregnancy but
not as much as the
production of the
plasma volume.
d. Hematocrit level
which is normally
around 35% among
non pregnant women
is decreased to only
29-31% during
pregnancy

CHANGES IN CARDIAC FUNCTION
a. Cardiac output increases
from 30 to 50% by 32
weeks of pregnancy and
declines to about 20%;
increase at week 40 is
due to the increased
stroke volume and
increased tissue
demands for oxygen.
b. Heart rate increases from
70-85 beats per minute

CHANGES IN RESPIRATORY
FUNCTION
a. Maternal oxygen needs
are higher due to
increased BMR and
additional tissue mass in
the uterus and breasts;
fetus requires oxygen
too.
a. Ventilation rate or
respiratory rate rises
during pregnancy from
about 71/min to about
101/min, an increase of

Cont. CHANGES IN RESPIRATORY FUNCTION
c. Vital capacity of the lungs is not increased but tidal
volume (amount of gas passing in & out of lungs) is
greater so that the lungs are more collapsed than usual
at the end of normal expiration
d. The pregnant woman may experience dyspnea (difficulty
or labored breathing) with increased awareness of the
need to breath

CHANGES IN RENAL FUNCTION
a. The renal tract from the
kidney to the bladder
becomes dilated as
pregnancy progress.
b. Glomerular filtrate rate is
increased by
approximately 50% by the
end of gestation
c. There is a greater activity
in the rennin-
angiotensin-aldosterone
system- hormone system
that regulates blood

Cont. CHANGES IN RENAL FUNCTION
d. The kidney during gestation shows an astonishing
profligacy with nutrients; substantial quantities of
nutrients such as glucose, amino acids and water
soluble vitamins appear in urine.
e. The relaxation and dilatation of the urinary tract with its
higher nutrient concentration may lead to urinary tract
infections.
f. The increased urine volume may cause women to
experience pronounced thirst.

METABOLIC ADJUSTMENTS
a. The BMR is increased by 20-25% by the end of
the term
b. The major adjustments in energy utilization is a
shift in the fuel source
c. Fat is the major maternal fuel source while
glucose is the major fetal fuel

WEIGHT GAIN
 A normal weight gain for most healthy women that is consistent
with good reproduction performance is about 10 – 12.5 kg (22 –
28lb)
 The components of maternal weight gain in pregnancy shows
that less than half of the total weight gain is accounted for the
fetus, placenta and amniotic fluid, the remainder is found in the
maternal reproductive tissues, blood, fluids and fat

MATERNAL WEIGHT GAIN
WEIGHT CATEGORY TOTAL WEIGHT GAIN
KILOGRAMS POUNDS
Underweight, BMI <18.5 12.5 -18.0 28-40
Normal weight, BMI 18.5 – 24.9 11.5-16.0 25-35
Overweight, BMI 25.0 – 29.9 7.0-11.5 15-25
Obese, BMI >= 30.0 >=6.8 >=15
The pattern of wt gain can also be an indicator of
INCREASED risk during pregnancy. During the 1st
trimester, wt gain should be 2 – 5 pounds for the entire
period followed by a gain of ONE lb/wk for normal-wt
women. Underweight women should gain slightly
more the 1 lb/wk, overweight women, about 0.66
lb/wk.

NUTRITIONAL REQUIREMENT OF
PREGNANCY
1. NUTRITIVE NEEDS: the recommended increase over
the normal nutrient need of the woman to meet the
demands of pregnancy varies from one nutrient to
another; nutritional requirements are increased during
pregnancy.
a. To meet the normal requirements of the mother;
b. To meet the nutrient of the growing fetus and other
maternal tissues; and
c. For building reserves in preparation for delivery and
lactation

RECOMMENDED ENERGY & NUTRIENT INTAKE/DAY
FOR PREGNANT WOMEN
ENERGY/NUTRIENT PREGNANCY PERIOD
1ST
TRIMESTER
2ND
TRIMESTER
3RD
TRIMESTER
Energy, kcal --- + 300 + 300
Protein, g 66 66 66
Vitamin A, μg RE 800 800 800
Vitamin C, mg 80 80 80
Thiamin, mg 1.4 1.4 1.4
Riboflavin, mg 1.7 1.7 1.7
Niacin, mg NE 18 18 18
Folate, μg DFE 600 600 600

RECOM. ENERGY & NUTRIENT INTAKE/DAY FOR PREG. W. (continuation)
1ST
TRIMESTER
2ND
TRIMESTER
3RD
TRIMESTER
Calcium, mg 800 800 800
Iron, mg 27 34 38
Iodine, μg 200 200 200
Magnesium, mg 205 205 205
Phosphorous, mg 700 700 700
Zinc, mg 5.1 6.6 9.6
Selenium, μg 35 35 35
Flouride, mg 2.5 2.5 2.5

RECOM. ENERGY & NUTRIENT INTAKE/DAY FOR PREG. W. (continuation)
1ST
TRIMESTER
2ND
TRIMESTER
3RD
TRIMESTER
Manganese, mg 2.0 2.0 2.0
Vitamin D, mg 5 5 5
Vitamin E (L-
tocopherol), mg
12 12 12
Vitamin K, μg 51 51 51
Vitamin B6, mg 1.9 1.9 1.9
Vitamin B12, μg 2.6 2.6 2.6
*FNRI-DOST, 2002

RATIONALE FOR INCREASING
SPECIFIC NUTRIENT REQMNT.
2. Protein: increase by an average of 8 g/day
throughout pregnancy to:
a. meet the needs of the developing maternal
tissues;
support the growth of the fetus and the
placenta;
and
b. protect the pregnancy course and outcome
against risk associated with low protein
intakes.

RATIONALE FOR INCREASING SPECIFIC
NUTRIENT REQMNT.
3. Vitamin A:
- essential for the health of the epithelial tissues
including the skin and the membranes that like
glandless ducts and passages of the
gastrointestinal, urinary and respiratory tracts; the
RNI of 800 μg RE/day for the pregnant woman also
accounts for the vitamin A storage in the fetal
tissues; maintenance of immune system.

4. Vitamin C: an extra 10 mg/day is recommended for
the pregnant woman to maintain the integrity of
fetal membranes and tissue structure.
5. Thiamin, riboflavin and niacin: are important
during pregnancy particularly with reference to
CHO, CHON and FATS metabolism; additional
amount of 0.3 mg and 0.6 mg and 4 mg NE/day for
thiamin, riboflavin and niacin respectively, are
recommended throughout pregnancy.

6. Folate: the recommended intake for the pregnant
woman which is a total of 600 μg DFE daily or an
additional 200 μg/day is based on folacin’s role in
promoting normal fetal growth (DNA synthesis) and
in erythrocyte maturation and preventing neural
tube defects (birth defects of brain and spinal
cord).
7. Calcium: an additional allowance of 50 mg or a total
of 800 mg is recommended to promote adequate
mineralization of fetal skeleton and deciduous
teeth (milk teeth) of the fetus.

8. Iron: the daily requirement for pregnant women is
higher than what can be provided by the usual diet
alone, thus, supplementation is recommended; this
amount is needed to:
a. allow for build-up of iron stores;
b. allow for the expansion of the red cell mass; and
c. provide for the needs of the fetus and the placenta
Infants are born with high hemoglobin levels and with a
supply of Fe stored in the liver at the expense of
maternal iron reserves if mother’s iron intake is low.

9. Iodine: an additional allowance of 50 μg/day is
recommended so as not to comprise the
development of the fetus; iodine deficiency in
pregnancy has been known to result in cases of
cretinism.
10. Zinc: the increase in zinc requirement is minimal
during the 1st trimester of pregnancy (0.6 mg/day),
but by the 3rd trimester the requirement is more
than the twice that of the non pregnant woman (4.5
mg/day) to provide the needs for maternal and
embryonic or fetal tissue growth; maintains acid-
base balance.

11. Selenium: the recommended amount of 35
μg/day during pregnancy should allow for
accumulation of enough selenium by the fetus to
saturate its selenoproteins.
12. Vitamin B6: a total of 1.9 mg/day throughout the
pregnancy will take care of the fetal, placental and
maternal needs and its bioavailability in food.
13. Water: an additional 300 ml/day is recommended
because of the expanding extracellular fluids, the
needs of the fetus and the amniotic fluid.

14. Sodium: the increase in extracellular fluids calls
for an increase in body sodium, thus restriction
of Na intake is not recommended as a routine
procedure
 Na restriction stresses the renin-angiotensin
aldosterone mechanism in order to maintain
homeostasis
The additional needs in pregnancy is 69 mg/day.

EFFECTS OF GOOD NUTRITION
1. On the mother:
a. Increased chances of
normal pregnancy
leading to normal
delivery;
b. Absence or reduced
chances of
complications during
pregnancy;
c. Reduced incidence of
premature deliveries;
d. Reduced incidence of
maternal depletion;
e. Reduced incidence of
morbidity and mortality;
f. Increased chance of
successful lactation.

EFFECTS OF GOOD NUTRITION
2. On the infant
a. normal growth and development:
normal birth weight and length;
b. Reduced incidence of IUGR;
c. Reduced chances of stillbirths,
congenital malformations and
neonatal deaths;
d. Reduced incidence of illness and
stronger resistance to infections;
e. Adequate nutrient reserves.

FETAL AND MATERNAL NUTRITION
1. Fetal growth and development is dependent upon
the utilization by the fetus of adequate energy and
nutrients, the gene expression of the factors
promoting tissue growth and the hormonal
framework. The failure of the maternal-placental
nutrient supply to match fetal nutrient demand
causes restriction of fetal growth.

RELATIONSHIP BETWEEN FETAL AND
MATERNAL MALNUTRITION
Inadequate food
intake
Maternal malnutrition
Reduced blood
volume expansion
Inadequate increase
in cardiac output
Decreased blood and
nutrient supply to
fetus
Reduced placental
size
Poor nutrient
utilization
Reduced nutrient
transfer
Fetal growth
retardation

PROBABLE PROBLEMS OF PREGNANCY
WITH NUTRITIONAL IMPLICATIONS
1. Mild nausea and vomiting
during the 1st trimester of
pregnancy due to
increased hormone
production resulting in
disturbed physiologic and
biochemical processes
which may be related to
hypoglycemia, decreased
gastric motility, relaxation
of the cardiac sphincter or
anxiety.

2. Loss of appetite usually accompanies nausea and
vomiting:
a. High carbohydrate foods such as crackers, jelly
and dry toast before arising are prescribed;
b. Frequent small meals are preferable with fluids
taken between meals rather than at mealtime.
3. Constipation may occur due to decreased muscle tone
and motility of the GIT and the pressure of the fetus on
the lower portion of the intestines.

PROBABLE PROBLEMS OF
PREGNANCY WITH NUTRITIONAL
IMPLICATIONS
a. The diet should provide liberal allowance of fruits
and vegetables with adequate fluid intake
b. Regular elimination, sleep and exercise are
recommended.
3. Heartburn – or “full feeling” caused by hypo motility
a. Frequent small meals rather than heavy meals
are recommended.
b. Eliminate liquids immediately before and after
meals to avoid gastric distention.

4. Hyperemesis gravidarum - prolonged vomiting
throughout pregnancy can be life threatening if
not controlled; may lead to dehydration.
a. IV feeding can help prevent dehydration and
provide nutrients.
b. If tolerated, enteral feeding of an appropriate
formula thru NGT may be given and this can be
followed by a dry in 6 small feedings with clear
liquids between feedings.

5. Pica refers to the compulsion for persistent
ingestion of unnatural foods or nonfood items
such as clay, starch, ice, charcoal, etc.;
 ingestion of pica subs. can limit intake of
nutritious foods and/or interfere with the
absorption of nutrients
 Some pica substances may also contain toxic
compounds
 Pica for raw rice is known as amylophagia.
a. Determine what is being ingested and why.
b. Stress the importance of an adequate and the
potential dangers of pica.

6. Anemia mainly due to Fe and folic acid deficiencies;
occurs frequently in pregnancy
a. Microcytic hypochromic anemia is produced by a
deficiency of Fe, the mineral needed for hemoglobin
synthesis
- Treatment is by Fe supplementation & by including
foods rich in Fe in the diet
b. Megaloblastic anemia can be caused by folic acid
deficiency but is more commonly found in assoc
with lack of Fe
- Treatment is folic acid supplementation & emphatic
selection of foods rich in folic acid in the diet.

7. Neural tube defects (NTD) occur when the neural
tube, w/c develops into the spinal cord 18-26
days after conception fails to close.
 Errors at the top of the tube affects the brain
(anencephaly) causing death
 Errors at the lower end of the spinal cord results
to spina bifida characterized by inc. closing of the
bone casing surrounding the spinal cord
- Eat a balanced diet; pay attention to leafy,
green
vegetables, legumes, nuts, citrus fruits and
whole
grain cereals

8. Inadequate weight gain may occur secondary to
poor appetite related to nausea, vomiting,
heartburn or smoking, or from an inadequate food
intake. Low weight gain in pregnancy is assoc
with increased risk of having a LBW infant.
a. Depending on the cause, make appropriate diet
modification to improve the appetite and
cultivated good eating practices;
b. Set weight gain goals based on recommended
rate and amount of weight gain assoc with optimal
maternal and infant health.

9. Excessive weight gain in pregnancy increases the risk of
complications during labor and delivery as well as post
partum obesity.
 Dietary counseling and exercise for weight reduction;
 Limit the rate of weight gain without compromising
nutrient intake
10. Pregnancy-induced hypertension (PIH) or eclampsia:
initially known as toxemia w/c is a misnomer since blood
toxin is neither a cause nor a symptom of the condition;
later, it was called eclampsia w/c means sudden dev’t –
a hypertensive syndrome induced by pregnancy.

a. Two stages of eclampsia are:
- pre-eclampsia: HPN with proteinuria, edema,
headache, blurred vision and/or sudden weight
gain.
- eclampsia: extension of pre-eclampsia with
convulsive seizures.
b. Tx varies depending on the severity of symptoms;
attn to sufficient CHON, energy and Na in order to
control symptoms and to maintain nutritional
support is necessary.

11. Gestational diabetes is an intolerance to CHO that
appears during pregnancy; characterized by higher
fasting and postprandial plasma concentrations of
glucose. The condition may be an extreme
manifestation of the normal insulin resistance of
pregnancy or may reflect a predisposition to type 2
diabetes.
a. Lower energy intakes for overweight and obese women
to improve insulin sensitivity and reduce the risk of
infant macrosomia (big baby syndrome)
b. Adequate food intake (diet therapy) is essential prevent
ketone formation and promote proper weight gain.
c. Monitoring of blood glucose and urinary ketoses is
necessary; insulin therapy is needed if FBS >5mmol/L

LIFESTYLE IMPLICATIONS TO
PREGNANCY
1. Cigarette smoking
2. Alcohol drinking
- fetal defects
- growth retardation
abnormalities of the CNS, CVS and GUS
3. Narcotics – antagonist of vitamins
4. Caffeine – in moderation (2-3 cups of coffee
4 cups tea
6 cola drinks
5. Food contaminants
- lead is embryotoxic, abortive, mental disorder
- mercury is embryotoxic, brain damage

SPECIAL CONCERS
“Adolescent
growth and
pregnancy make
competing
demands for
nutrients, THUS
both the mother
and child will be
affected.”
ADOLESCENT PREGNANCY

Most at risk… pregnant
adolescents:
 with a gynecologic age (age at
conception minus age of meanarche) or
less than 4 years are at high nutritional
risk;
 are more likely to be emotionally,
financially and socially immature;
 give low priority to nutrition and tend to
have erratic patterns and practices;
 seek prenatal care later;
 are more likely to have LBW infants and
have more complications/problems

PROPER HEALTH NUTRITION COUSELING &
ENCOURAGEMENT SHOULD BE GIVEN TO
TEENAGE MOTHERS…
 realistic goals for wt gain should be
set;
 Healthy lifestyle – adequate diets,
plenty of exercise and rest , and no to
smoking, alcohol drinking and use of
drugs—should be practiced;
 emotional and socio-economic care
and support should given

Review Computation:
DBW of 5’5” male student
 5 x 12 = 60 + 5 = 65
 65 x 2.54 = 165.1 or 165
 165 -100 = 65
 65 – 6.5 = 58.5 or 59
 DBW = 59Kg
TOTAL ENERGY REQUIREMENT (TER)
TER = DBW X PA (Physical Activity)
= 59Kg x 40
= 2,360 Kcal

PHYSICAL ACTIVITY REFERENCE
Category Male Female Kinds of
Activity Activity
Sedentary 35 30 cashier, typist, encoder,
executive
call center agent
Light 40 35 nurse, student, teacher,
housewife
with maid
Moderate 45 40 mechanic, vendor, housewife
w/o
maid
Heavy 50 45 farmer, construction worker,

TER % DISTRIBUTION
2,360 X 70% = 1,652 CHO
2,360 X 10% = 236 CHON
2,360 X 20% = 472 FAT

BASAL METABOLIC INDEX (BMI)
BMI = weight
ht m
1m = inches/ 39.37
1Kg = 2.2 lbs
5’5” ; 59Kg
 5’5” = 5 x 12 = 60 +5 = 65 inches
 65 / 39.37 = 1.65
= 2.72
 BMI = 59Kg
2.72
= 21.69 (normal)
2
2

BASAL METABOLIC INDEX REFERENCE
(NDAP)
Category
Underweight < 18.5
Normal weight 18.5 – 24.9
Overweight 25 – 29.9
Obese > 30
REFERENCES:
• NDAP

Nlc pregnancy

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