1. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 11 Diet during Pregnancy and Lactation

2. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Objectives Identify nutritional needs during pregnancy and lactation Describe nutritional needs of pregnant adolescents Modify normal diet to meet needs of pregnant and lactating women

3. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Facts Good nutrition in pregnancy essential for mother and child Relationship between mothers’ diet and health of baby at birth

4. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Weight Gain during Pregnancy Average: –25 to 35 pounds for normal-weight woman –28 to 40 pounds for underweight woman –At least 15 pounds for overweight woman But less than normal-weight woman No one should lose weight (continues)

5. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Weight Gain during Pregnancy First trimester: –2- to 4-pound weight gain –No additional calories usually required Second and third trimesters: –1-pound weight gain per week –Additional 300 calories required

6. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Nutritional Needs during Pregnancy Folic acid supplementation prior to conception decreases risk of brain and spinal cord defects Protein requirement increased by 20 percent for pregnant woman over age 25 –25 percent for pregnant adolescent Excess vitamin A can cause birth defects (continues)

7. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Nutritional Needs during Pregnancy Requirements for the following increased: –All water-soluble vitamins –Vitamin B and vitamin C –Calcium, iron, zinc, iodine, and selenium Iron supplements commonly prescribed due to drastic increase in needs

8. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fulfillment of Nutritional Needs during Pregnancy Base diet on MyPyramid Drink additional fat-free milk or appropriate substitute Prenatal vitamins and iron supplement may be prescribed Over-the-counter nutrient supplements may be harmful to fetus

9. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Concerns during Pregnancy Nausea Constipation Heartburn Excessive weight gain Pregnancy-induced hypertension Pica Anemia Alcohol, caffeine, drugs, and tobacco

10. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Nausea Also known as morning sickness Occurs most commonly during first trimester Suggestions: –Eat dry crackers or dry toast before rising –Eat small, frequent meals –Avoid food with offensive odors –Avoid liquids at mealtime (continues)

11. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Nausea Hyperemesis gravidarum: –Occurs when nausea becomes so severe that it is life- threatening –May require hospitalization and parenteral nutrition

12. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Constipation Constipation and hemorrhoids can occur during pregnancy. Suggestions: –Eat high-fiber diet –Participate in daily exercise –Drink at least 8 glasses of water per day –Respond promptly to urge to defecate

13. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Heartburn Can result from pressure on stomach by growing fetus and relaxation of cardiac sphincter and smooth muscles related to progesterone. Suggestions: –Eat small, frequent meals –Avoid spicy or greasy foods –Avoid liquids at mealtime –Wait at least one hour after eating to lie down and two hours before exercising

14. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Excessive Weight Gain Re-evaluate diet and eliminate foods that do not fit within MyPyramid Suggestions: –Drink fat-free milk –Eat clean, crisp, raw vegetables as snack –Eat fruits and custards made with fat-free milk as desserts –Broil, bake, or boil instead of fry

15. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pregnancy-Induced Hypertension Formerly known as pre-eclampsia or toxemia Characterized by high blood pressure, presence of protein in urine, and edema in third trimester May progress into eclamptic stage with convulsions, coma, and possible death of mother and infant (continues)

16. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pregnancy-Induced Hypertension Higher incidence with first pregnancy, multifetal pregnancies, morbidly obese women, or women with inadequate diets –Especially protein-deficient More frequent in pregnant adolescents

17. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pica Craving for nonfood substances –E.g., starch, clay (soil), or ice Discourage ingestion of soil due to possible contamination and nutrient deficiencies Multiple nutritional deficiencies can result

18. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Anemia Condition caused by insufficiency of RBCs, hemoglobin, or blood volume Causes weakness, fatigue, poor appetite, and pallor (continues)

19. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Anemia Iron-deficiency anemia –Most common form Folate deficiency may lead to megaloblastic anemia –Prevented by folate supplement

20. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Alcohol, Caffeine, Drugs, and Tobacco Alcohol –Fetal alcohol syndrome (FAS) Characterized by growth deficiency, central nervous system dysfunction, microcephaly, and other physical characteristics –Fetal alcohol effect (FAE) Causes fewer physical defects but many behavioral and psychosocial problems –Abstinence recommended (continues)

21. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Alcohol, Caffeine, Drugs, and Tobacco Caffeine –Causes birth defects in rats, but no data exist for humans –Limit intake to < 300 mg per day Drugs –Effect of prescription or self-prescribed drugs varies but includes possible damage to fetus –Vitamin A and its derivatives can cause fetal malformations and spontaneous abortions (continues)

22. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Alcohol, Caffeine, Drugs, and Tobacco Drugs –Illegal drugs can cause infant to be born addicted or born with human immunodeficiency virus (HIV) Tobacco –Smoking associated with low birth weights, sudden infant death syndrome, fetal death, spontaneous abortions, and complications at birth

23. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diet for the Pregnant Woman with Diabetes Some women have diabetes before pregnancy Gestational diabetes –Occurs during pregnancy and disappears after birth –Routine screening part of prenatal care Between 16 and 28 weeks Insulin often used during pregnancy to control any type of diabetes (continues)

24. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Diet for the Pregnant Woman with Diabetes Nutrient requirements of pregnant woman with diabetes same as non-diabetic pregnant woman Diet plan depends on type and number of insulin injections required Artificial sweeteners found to be safe during pregnancy

25. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pregnancy during Adolescence Nutritional, physical, psychological, social, and economic demands on pregnant adolescents tremendous Nutrition must meet needs of adolescent’s growing body and needs of fetus High risk for pregnancy-induced hypertension and premature delivery (continues)

26. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pregnancy during Adolescence Inadequate nutrition of mother related to both mental and physical birth defects Much counseling and emotional support needed

27. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Lactation Production and secretion of breast milk for purpose of nourishing infant Supply and demand mechanism No supplemental feedings should be given until feeding routine established Human milk formulated to meet nutrient needs of infants for first six months of life

28. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Benefits of Breastfeeding for the Infant Breast milk has perfect composition for baby’s needs No babies allergic to mother’s milk Human milk contains at least 100 ingredients not found in formula Breast milk provides antibodies (continues)

29. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Benefits of Breastfeeding for the Infant Lower incidence of ear infections, diarrhea, allergies, and hospital admissions Promotion of good jaw development Decreased risk of obesity later in life Facilitation of bonding

30. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Benefits of Breastfeeding for the Mother Helps lose weight gained during pregnancy Stimulates uterus to contract back to original size Is economical Provides opportunity for resting Is always right temperature and readily available

31. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Nutrient Requirements during Lactation Food and Nutrition Board suggests increase of 500 calories per day Most nutrient requirements increased –Especially protein Base nutrition on MyPyramid Fluid intake should replace fluids used for milk production (continues)

32. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Nutrient Requirements during Lactation Most chemicals can pass into mother’s milk –Avoid alcohol, tobacco, and illegal drugs Check with obstetrician before using any medication or nutrient supplement Caffeine may make infant irritable

33. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Considerations for the Health Care Professional Articles in newspapers and magazines may be inaccurate Re-education may be necessary Teaching pregnant teenagers presents biggest challenge

34. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Conclusion Pregnant woman most likely to remain healthy and bear healthy infant if following well- balanced diet Anemia and pregnancy-induced hypertension –Two conditions that can be caused by inadequate nutrition Caloric and most nutrient requirements increase for pregnant and lactating women