PRENATAL NUTRITION AND FOOD ALLERGY . BY MR. DINABANDHU BARAD

1. WELCOME

3. INTRODUCTION
• Various factors determine the outcome of a pregnancy, including the nutritional
status of the mother before conception and during pregnancy.
• Nutritional factors can affect the newborn’s birth weight, risk of neural tube
defect, and foetal alcohol syndrome.
• Birth weight is highly correlated with infant mortality and morbidity.

4. MATERNAL NUTRITIONAL STATUS
Two indicators of maternal nutritional status have consistently shown association
with infant birth weight:
• Maternal size (height and pre-pregnancy weight of the mother)
• Maternal weight gain during pregnancy

5. MATERNAL SIZE
• Large stature women tend to have large babies, and maternal size plays an
important role in determining the size of the placenta.
• The size of the placenta is an indicator of placental health, which determines the
amount of nutrition available to the foetus, which in turn is proportional to the
birth weight of the neonate.
MATERNAL NUTRITIONAL STATUS

6. MATERNAL WEIGHT GAIN DURING PREGNANCY:
• Less than half of the total weight gain is in the foetus, placenta, and amniotic
fluid, and the remainder comprises maternal reproductive tissues, fluid, blood,
and maternal stores as body fat.
• Gradually increasing amounts of sub-cutaneous fat in the abdomen, back, and
thigh serves as an energy source for pregnancy and lactation.
MATERNAL NUTRITIONAL STATUS

7. MATERNAL WEIGHT GAIN DURING PREGNANCY:
• In normal weight females (BMI 18.5-24.9), ideal weight gain is between 11.5 kg to
16 kg.
• 1-1.5 kg in the first trimester then 1.5-2 kg per month until birth of the baby.
MATERNAL NUTRITIONAL STATUS

8. NUTRITIONAL SUPPLEMENTATION
DURING PREGNANCY
• Nutritional requirement during pregnancy in the form of energy, protein, vitamin,
or minerals exceed the routine daily intake of a woman.
• A balanced diet results in appropriate weight gain during pregnancy by supplying
required nutrients during pregnancy.

9. NUTRITIONAL SUPPLEMENTATION
DURING PREGNANCY
• Folate supplementation is recommended in all pre-conceptional prescriptions
and during pregnancies.
• The National protocols in India require the provision of 1 tablet containing 100
mg elemental iron and 0.5 mg folic acid for daily consumption to all women
during pregnancy for 100 days.

10. NUTRITIONAL REQUIREMENTS DURING
PREGNANCY
ENERGY:
• Additional energy is required during pregnancy to meet the metabolic demands
of pregnancy and foetal growth.
• The metabolism increases by 15% during pregnancy.
• The estimated average requirement of carbohydrates for pregnant women is 135
g/day and an adequate intake is 175 g/day to avoid ketosis, and to maintain
blood glucose levels during pregnancy

11. PROTEIN
• Pregnant women have additional protein requirement to support the synthesis of
maternal and foetal tissues.
• Protein requirement increases throughout gestation and peaks during the third
trimester and it increases to 78gm/day.
• For a gestational weight gain of 10 kg pregnant Indian women additional 7.6 gms
in the second trimester and 17.6 gms in third trimester is recommended
NUTRITIONAL REQUIREMENTS DURING
PREGNANCY

12. FIBER
• Consumption of whole grain breads, cereals, leafy green vegetables, and fresh
and dried fruits during pregnancy is encouraged.
• The recommended fibre value is 28 g/day during pregnancy.
LIPIDS
• The amount of fat in the diet should depend on energy requirements for proper
weight gain.
NUTRITIONAL REQUIREMENTS DURING
PREGNANCY

13. VITAMINS AND MINERALS
FOLATE
Folic acid supplementation is important to support maternal erythropoiesis,
maternal and foetal placental growth, and to prevent neural tube defects.
VITAMINS
Vitamins B6 manages nausea and vomiting during pregnancy; vitamin D is
important for calcium balance during pregnancy; and vitamins C, A, E, and K are
required in adequate amounts for general nutritional requirements.
NUTRITIONAL REQUIREMENTS DURING
PREGNANCY

14. MINERALS
• Calcium is important during pregnancy and lactation
• Iron is important for oxygen delivery to the foetus, and deficiency leads to foetal
hypoxia and maternal anaemia.
• Zinc supplementation avoids congenital abnormalities
• Magnesium reduces the incidence of IUGR
• Sodium is important for excretion, and maternal
• Iodine deficiency results in neonatal cretinism.
• Phosphorous, copper, and fluoride are also required in trace amounts.
NUTRITIONAL REQUIREMENTS DURING
PREGNANCY

15. FLUIDS
A total of 6–8 glasses of fluid intake is mandatory during pregnancy to avoid
dehydration and to maintain the amniotic fluid index.
NUTRITIONAL REQUIREMENTS DURING
PREGNANCY

16. FOOD ALLERGIES
• The term adverse reaction encompasses food intolerance and food
hypersensitivity.
• Food intolerance is an adverse reaction to a food caused by toxic, pharmacologic,
metabolic, idiosyncratic, or non-immunoglobulin E (IgE) reactions to food or
chemical substances in the food.

17. FOOD ALLERGIES
• Food hypersensitivity or food allergy is an IgE mediated reaction that occurs
when the immune system reacts to a normally harmless food macromolecule
that the body has identified as non-self (antigen).
• IgE reactions usually occur instantly or within two hours of exposure, with
severity ranging from mild to life threatening.
• Exposure includes inhalation, ingestion, and skin contact.

18. SYMPTOMS
• A wide range of symptoms has been attributed to food allergy.
• Skin, respiratory, cardiovascular, and gastrointestinal symptoms express during
an allergic reaction

19. GASTROINTESTINAL
MANIFESTATIONS
• Abdominal pain
• Nausea
• Vomiting
• Diarrhoea
• Gastrointestinal bleeding
• Oral and pharyngeal pruritus

20. CUTANEOUS MANIFESTATIONS
• Urticaria (hives)
• Angioedema
• Eczema
• Erythema (skin reddening)
• Itching
• Flushing

21. RESPIRATORY MANIFESTATIONS
• Rhinitis
• Asthma
• Cough
• Laryngeal edema
• Airway tightening

22. SYSTEMIC MANIFESTATIONS
• Anaphylaxis
• Hypotension
• Dysrhythmias

23. COMMON FOOD ALLERGIES
CARBOHYDRATE (LACTOSE) INTOLERANCE:
• The deficiency of the intestinal enzyme lactase have a decreased ability to digest
lactose, a sugar in milk and milk products and experience symptoms of
abdominal cramping, flatulence, and diarrhoea after its ingestion.
• Restriction of foods containing milk and milk products avoids the allergic
reaction to a large extent.

24. EGG ALLERGY
Many children and pregnant women are allergic to egg white, egg yolk, apovitellin,
and other protein constituents of egg and show mild to severe cutaneous and
gastrointestinal manifestations.
COMMON FOOD ALLERGIES

25. PEANUT ALLERGY
Ground nuts, peanut butter, beer nuts, peanut oil, mixed nuts, and products that
contain peanuts have shown near fatal and fatal anaphylactic reactions.
COMMON FOOD ALLERGIES

26. WHEAT ALLERGY
Atta, bread flour, cake flour, wheat bran, whole wheat flour, wheat bread, and
wheat flakes/pasta/flakes have shown allergic reactions similar to lactose
intolerance and results in gastrointestinal manifestations.
COMMON FOOD ALLERGIES

27. SOY ALLERGY
Soy flour, soy sauce/milk, curd, and soy products have proven to be allergic in
many infants and children.
COMMON FOOD ALLERGIES

28. DIAGNOSTIC TEST
SKIN TESTING
• A drop of the antigen is placed on the skin, and the skin is scratched or punctured
to allow penetration. This is a screening tool and cannot be relied upon as a
diagnostic tool.
RADIOALLERGOSORBENT TEST (RAST)
Serum is mixed with food on a paper disk and then washed with radioactively
labelled IgE.

29. • ENZYME-LINKED IMMUNOSORBENT ASSAY (ELISA): Same as RAST; except non-
radioactively labelled (enzyme) IgE is used.
• SUBLINGUAL TESTING: Drops of allergen extract are placed under the tongue,
and symptoms are recorded.
• PROVOCATIVE TESTING AND NEUTRALIZATION: Subcutaneous injection of an
allergen extract elicits symptoms; this is followed by the injection of a weaker or
stronger preparation to neutralize the symptoms.
DIAGNOSTIC TEST

30. TREATMENT
Total avoidance of the food allergen is the only proven treatment for food allergy.
However antihistamines are used to control allergies under unavoidable
exposures.

31. THANK YOU