1. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Nutrition Before Conception Some deficiency related problems develop very early in pregnancy. Neural tube defects: Related to inadequate level of folate Effects the embryo in the first few weeks Adequate folate (400mg daily) before conception can reduce the risks

2. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Nutrition Before Conception A healthful diet before conception includes Avoiding teratogens: substances that cause birth defects Includes alcohol and illegal drugs Avoiding other possible hazards Smoking, caffeine, medications, some herbs and supplements

3. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Nutrition Before Conception A healthful diet before conception reduces the risk of developing nutrition-related disorders during pregnancy, such as Gestational diabetes Preeclampsia

4. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Nutrition During Pregnancy A full term pregnancy lasts 38 – 42 weeks: 1st trimester: conception to 13th week 2nd trimester: 14th to 27th week 3rd trimester: 28th to 40th week Embryonic stage: ~ day 15 to the 8th week After the 8th week, the developing baby is called a fetus.

5. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Nutrition During Pregnancy 1 st trimester Zygote (fertilized egg) travels through the fallopian tube and implants in the wall of the uterus Development of organs, limb buds, facial features, placenta Embryos are extremely vulnerable to teratogens during this time

6. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Ovulation, Conception, and Implantation

7. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings The First Ten Weeks

8. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Placental Development

9. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Nutrition During Pregnancy 2 nd trimester Continued development of organ systems Growth from ~ 3 inches to over a foot long by the end of the 2nd trimester

10. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Nutrition During Pregnancy 3 rd trimester Time of considerable growth Fetus gains ¾ of it’s weight in this time Brain growth is also extensive Lungs become fully mature A balanced, adequate diet for the mother is essential during this time

11. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Nutrition During Pregnancy An undernourished mother is more likely to give birth to a low-birth weight baby. Low-birth weight: any baby born weighing less than 5.5 pounds Increased risk of infections, learning disabilities, impaired physical development, and death in the 1st year Preterm babies are born before 38 weeks and may be low-birth weight babies.

12. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Nutrition During Pregnancy Weight gain during pregnancy: Women who do not gain enough weight are at risk of having a low-birth weight baby. Too much weight gain is also risky. Women should not diet during pregnancy since this may deprive the fetus of critical nutrients.

13. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Nutrition During Pregnancy

14. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Nutrition During Pregnancy The requirement for nearly all nutrients increases during pregnancy. Pregnant women must pay attention to their intake of: Macronutrients Micronutrients Fluids

15. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Macronutrients 1.Energy An additional 300 kcal/day may be required in the 2 nd and 3 rd trimesters Nutrient-dense foods are essential in order to obtain sufficient nutrients 2.Proteins and Carbohydrates 60 grams/day of protein 130 grams/day of carbohydrates

16. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Macronutrients 3.Fat The percentage of calories obtained from fat should not change during pregnancy. Limit saturated fat, avoid trans fats Fat is required by the newborn for temperature regulation and as an energy source

17. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Micronutrients The micronutrients that are most critical during pregnancy include folatecalcium vitamin B 12 iron vitamin Czinc vitamin Asodium vitamin Diodine

18. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Micronutrients Folate Required for cell division Critical in the first 28 days for development of the neural tube which becomes the brain and spinal cord 400mg/day for sexually active women 600mg/day for pregnant women

19. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Micronutrients Vitamin B12 Regenerates the active form of folate 2.6mg/day during pregnancy Vitamin C Production of collagen, a component of connective tissue 85 mg/day during pregnancy Deficiency results in infections, preterm births

20. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Micronutrients Vitamin A Needs increase by 10% in pregnancy Excess vitamin A can cause abnormalities in fetal kidneys and nervous system Vitamin D AI does not increase during pregnancy Excessive vitamin D can cause developmental disabilities in newborns

21. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Micronutrients Calcium 1000mg/day, same as for nonpregnant women Pregnant women absorb calcium better Zinc Critical for making proteins, DNA, RNA Need increases 38% during pregnancy

22. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Micronutrients Iron Increased need for red blood cells increases the need for iron by 50% Fetal need for iron increases in 3rd trimester Fetus will take iron from mother causing iron- deficient anemia

23. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Micronutrients Sodium 1500 mg/day, same as for nonpregnant women Iodine Need for iodine increases significantly 220 mg/day can be obtained from iodized salt

24. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Fluids During Pregnancy The need for fluids increases to 3 liters per day for Increase in the mother’s blood volume Regulating body temperature Production of amniotic fluid to protect and cushion the fetus Combat fluid retention and constipation Prevent urinary tract infections

25. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Nutrition-Related Concerns Nutrition-related problems during pregnancy can include Morning sickness Cravings and aversions Heartburn Constipation and hemorrhoids Gestational diabetes Preeclampsia

26. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Nutrition-Related Concerns Adolescent pregnancy Vegetarianism Dieting Caffeine Alcohol Exercise

27. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Morning Sickness Morning sickness: nausea and vomiting associated with pregnancy. Can occur at any time; often lasts all day May begin after the 1st missed period and last 12 to 16 weeks High levels of 2 pregnancy hormones may be the cause No cure, but symptoms can be reduced

28. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Cravings and Aversions Most women crave a certain type of food (sweet, salty) rather than a specific food. Little evidence supports the idea that cravings indicate a deficiency. Pica: craving a non-food item (ice, clay). Food aversions are common, but not universal among pregnant women.

29. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Heartburn Heartburn occurs when the sphincter above the stomach relaxes, allowing stomach acid into the esophagus. Hormones in pregnancy relax smooth muscles, thereby increasing heartburn. Enlargement of the uterus pushes up on the stomach and compounds the problem.

30. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Constipation and Hemorrhoids Pregnancy hormones that cause smooth muscle to relax also slow the movement of material through the large intestine. Hemorrhoids: swollen varicose veins in the rectum that are caused by or exacerbated by constipation. Reduce constipation by consuming 25-35 g/day of fiber and plenty of fluids.

31. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Gestational Diabetes Gestational diabetes: insufficient insulin production or insulin resistance that increases blood glucose levels during pregnancy. Condition resolves after birth occurs Risk of delivering a large baby Uncontrolled blood glucose levels may lead to preeclampsia

32. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Preeclampsia Preeclampsia: pregnancy-induced hypertension. Can be fatal if left untreated Deficiencies in vitamin C, vitamin E, and magnesium increase the risk Treatment focuses on managing blood pressure and often includes bed rest The only cure is childbirth

33. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Adolescent Pregnancy Nutritional needs of pregnant adolescents are higher than those of adult women Adolescent bodies are still growing and changing, adding to the nutritional needs of pregnancy Pregnant adolescents are more likely to have preterm babies, low-birth weight babies, and other complications

34. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Vegetarianism A vegetarian consuming eggs and dairy products has the same nutritional concerns as a non-vegetarian. A complete vegetarian (vegan) must carefully watch her intake of: vitamin Dcalcium vitamin B 6 iron vitamin B 12 zinc

35. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Dieting Dieting to lose weight is not advisable during pregnancy. Calorie restriction limits nutrient availability for the mother and the fetus. Fad diets are often unbalanced in macronutrients and micronutrients.

36. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Consumption of Caffeine Caffeine is a stimulant that crosses the placenta and reaches the fetus. One to two cups of coffee per day is very likely causing no harm. Greater than two cups of coffee may slightly increase the risk of miscarriage and low birth weight.

37. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Consumption of Alcohol Alcohol is a known teratogen that crosses the placenta and is associated with various birth defects. Fetal alcohol syndrome (FAS): variety of characteristics associated with prenatal exposure to high quantities of alcohol. Malformations of face, limbs, heart Many developmental disabilities

38. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Exercise Exercise during pregnancy Keeps a woman physically fit Is a great mood booster Helps compensate for an increased appetite Helps keep blood pressure down Makes it easier to lose weight after the pregnancy

39. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Breastfeeding Lactation: production of breast milk. Prolactin: hormone responsible for the synthesis of milk. Produced toward the end of pregnancy Suppressed by estrogen and progesterone until childbirth Colostrum: first milk produced; rich in proteins, antibodies, vitamins, minerals.

40. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Breastfeeding

41. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Breastfeeding

42. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Breastfeeding Milk production requires 700 – 800 kcal/day Lactating women should consume an extra 500 kcal/day above their own needs. This allows a woman to gradually lose weight (1 – 4 pounds per month).

43. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Breastfeeding The benefits of breastfeeding include High quality nutrition Protection from allergies and infections Assisting the mother in weight loss Suppressing ovulation Opportunity for bonding Convenient, cost efficient

44. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Breastfeeding Obstacles to breastfeeding include Many harmful substances are passed into breast milk, including: Illegal drugs, caffeine, nicotine, prescription and over-the-counter medications HIV is passed through breast milk Conflicts with mother’s employment

45. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Infant Nutrition Optimal nutrition is critical in the first year because The baby’s organs are developing The nervous system continues to develop Babies typically grow 10 inches in length and triple their weight in the 1st year

46. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Infant Nutrition

47. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Infant Nutrition Infants’ nutritional needs are unique because Their energy needs are high to support rapid growth Their digestive tracts and kidneys are still immature They are small in size

48. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Infant Nutrition Infants need 50 kcal per pound of body weight /day At least 40% of calories from fat No more than 20% of calories from protein 2 ounces of fluid per pound of body weight

49. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Infant Nutrition World Health Organization (WHO) recommends breastfeeding for at least the first 2 years. Breast milk or formula should be supplemented with solid food beginning at 4 to 6 months.

50. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Infant Nutrition Infants should not eat Foods they could choke on Corn syrup or honey Goat’s milk Cow’s milk Large quantities of fruit juice Too much salt or sugar Too much breast milk or formula

51. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Infant Nutrition Nutrition-related concerns for infants include Allergies Dehydration Colic Anemia Nursing bottle syndrome Lead poisoning

52. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Infant Nutrition Allergies Solid food should be introduced one at a time for a week to watch for allergies Dehydration Extremely dangerous for infants Caused by diarrhea, vomiting, inadequate fluid intake Pediatric electrolyte solution may be used

53. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Infant Nutrition Colic Uncontrollable crying that can last for hours Precise cause is unknown Anemia Infants are born with enough iron for only 6 months Anemia can develop after that

54. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Infant Nutrition Nursing Bottle Syndrome Leaving an infant alone with a bottle can lead to cavities and tooth decay Rather than a bottle, begin using a cup by 8 months and no bottle after 18 months

55. Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings Infant Nutrition Lead poisoning Especially toxic to infants since the brain and nervous system are still developing Results in reduced mental capacity, behavioral problems, impaired growth Remove old lead based paint Allow tap water to run a minute before use to discard lead leached from pipes