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Nutrition in pregnancy K.Andelova The Institute for the Mother and Child Prague.

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Presentation on theme: "Nutrition in pregnancy K.Andelova The Institute for the Mother and Child Prague."— Presentation transcript:

1 Nutrition in pregnancy K.Andelova The Institute for the Mother and Child Prague

2 Nutrition in pregnancy The undeveloped countries with poor nutritional status of mothers The developed countries with the owerweight and obesity and micronutrient deficienses Macronutrients-energetic substrates- carbohydrates,proteins,fat Micronutrients –minerals,trace elements,vitamins,folic acid,ῲ-3 fatty acids (?)

3 The influence of mother nutrition Perinatal mortality Perinatal morbidity Intrauterine growth retardation(IUGR) versus large for gestational age(LGA) babies Fetal programming of later diseases in childhood and in adulthood

4 Important data Sociodemografic data Personal medical history (obstetric history) Dietary habits and weight changes Abuses Physical routine examination and laboratory screening Physical activity Using of nutritional supplements

5 Maternal metabolic changes Gastric motility and gut motility The changes in absorption of nutrients The changes of kidney functions The changes of plasma levels of proteins,minerals,aminoacids,hormones The changes of apetite The vomiting in pregnancy

6 Weight gain in pregnancy Normal weight gain in singleton pregnancy- 12kg Normal weight gain in multiple pregnancy- up to 18 kg 75%-fetus,placenta,amniotic fluid,uterus,expanded volume of circulating fluid,blood elements,breasts 25%- adipose tissue

7 Macronutrients Recommended energy intake 2500 kcal/day (200-600kcal increasing) No extreme reducing diet in course of pregnancy ----------------------------------------------------------------  Carbohydrates(50-60%)-the main energetic substrate for fetus is glucose  Proteins(20-25%)-lean body mass  Fat(20-25%)-energy supply

8 Micronutrients Vitamines(B 12,B 6,A,D) Minerals(Ca) Trace elements(Iron,Iodine,Zinc,Selenium,Copper) Folic acid ῲ-3 FFA

9 Vitamines B12 vit.-IUGR,impaired b-cell function,CV risk A vit.-excessive intake-fetal malformation E vit.-placental transport of hormones D vit.-cofactor for Ca homeostasis,reduced intrauterine growth of long bones,shorter gestation,lower birth weight and reduced bone mass in childhood,kidney maturation B6,B1-less importance

10 Trace elements(1% of body mass) Iron-anemia(plasma level,ferritin,transferin) Very common in pregnancy(second nad third trimester) Preterm delivery,postpartum inflammative complications, The fetus is partly protected Factors indicate the increased risk –history of strong menstrual bleeding,low meat diet,blood donors,aspirin use,multiple gestation,teenager pregnancy

11 Trace elements Iodine –essential part of thyroid hormones(thyroxine,triiothyronine) Mental disturbances,hypothyreosis,stillbirth,abortio ns,congenital malformations Urinary iodine excretion Content of iodine in soil Addition of iodine in table salt

12 Trace elements Zinc-component of many enzymes Signs of depletion-growth restriction,impaired healing,skin lesions,diarrhea,impaired imunne functions,behavioral disturbances,teratiigenic effect,preterm delivery,hypertension Increased risk for zinc depletion in smokers Selenium-part of enzymes(gluthatione peroxidase) Cardiomyopathy(Keshan disease) No special supplementation reccommended

13 Calcium and sodium Calcium-99% in bones and teeth Bone developement Cardiovascular disease Hypertension Preeclamsia Sodium-decreased excretion,no special supplementation necessary Connection to hypertensive disorders

14 Folic acid Periconceptional supplementation of folic acid Avoiding of neural tube defects and other congenital malformations Normal fetal growth Antibody formation Epilepsy in pregnancy-supplementation Sterility and infertility Future disease-cardiovascular,renal

15 Recommended supplementation Vitamin D 1ug/day Iron 30-120mg/day-normal diet has 6mg/1000 kcal Iodine 200mg/day (250) Zinc 15mg/day Calcium 1200mg/day Folate 500ug/day

16 The special dietary counseling Obese women Diabetic pregnant patients Patients with liver disease Hypertension Patients with metabolic disease Patients with intestinal disease Vegetarians The patients with nutritional disturbances – bulimia or anorexia The other special health conditions

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