2. Nutrition for the Lifecycle - Pregnancy

3. Objectives Describe the importance of adequate dietary intake prior to pregnancy. Describe the importance of adequate nutrient intake during pregnancy Describe the significance of the timing of adequate nutrients during pregnancy.

4. Nutrition and Fertility Chronic Undernutrition Acute Undernutrition Body Fat, Weight and Fertility Vegetarian Diets and Fertility Caffeine and Fertility Alcohol and Fertility Zinc Status and Male Fertility

5. Premenstrual Syndrome-Signs and Symptoms Fatigue Abdominal bloating Swelling of the hands or feet Headache Tender breasts Nausea Craving for sweet or salty foods Depression Irritability Mood swings Anxiety Social withdrawal

6. Diet and PMS Caffeine Magnesium Calcium B6B6 Herbal Remedies

7. Status of Pregnancy Outcomes Status of reproductive outcomes is assessed through examination of a particular set of vital statistics data called natality statistics. Data on complications and harmful behaviors, infant mortality(death) and morbidity (illness). Data is used to identify problems in need of resolution. Data is used to identify progress in meeting national goals.

8. Infant Mortality Infant mortality is a mirror of a population’s health status. Infant mortality reflects the general health status of a population to a considerable degree because so many of the environmental factors that affect the health of pregnant women and newborns also affect the health of the rest of the population.

9. Pregnancy Outcomes in US Not a Source of Pride US ranks 26 th for infant mortality/1000 live births ¼ of babies are less than 2,500 grams (5 lbs 8 oz) or considered LBW 1/10 of babies born prematurely (before 37 weeks) Low birth weight results in developmental delays, disabilities long term illnesses Our country spends more on health care than any other but we are fixing poor outcomes rather than preventing them which carries a very high price tag.

10. Infant Deaths per 1,000 live Births CountryIMRRank Japan3.81 Singapore3.81 Finland4.03 Norway4.03 Sweden4.03 Hong Kong4.16 Spain4.77 US7.326

11. Data to Consider 40,000 Infants in US die before their 1 st Birthday 1 in 3 pregnant women receives inadequate prenatal care in US Approximately 73,000 women in US receive no prenatal care More children at risk than previously Black infant mortality is double the rate of whites Premature rupture of membranes and premature labor are the leading cause of perinatal mortality in US Infants born to women who receive no prenatal care are 3X more likely to die in infancy 250,000 infants (7% of births) born with birth defects Leading types of birth defects: CVD (38.2%) CNS Defects Anencephalus Spina Bifida (14.9%) Respiratory Defects (10.9%)

12. Low Birth Weight Infants born low birthweight or preterm are at substantially higher risk of dying in the first year of life than are larger and older newborns. LBW make up 7.6% of all birth,s yet comprise 64% of all infant deaths. Birthweight is the the most powerful predictor of new born outcome

13. 12 Factors that Contribute to LBW Infants Socioeconomic Status Biological Immaturity High Parity Short Stature Low Prepregnancy Weight for Height Low gain in weight during pregnancy Poor Nutritional Status Smoking Certain Infectious agents Chronic Disease Complications of Pregnancy History of Unsuccessful Pregnancy

14. Healthy People 2010 Objectives Reduce anemia among low-income pregnant females in their third trimester from 29-20% Reduce infant mortality from 7.6 to no more than 5/1000 live births Reduce the incidence of spina bifida and other neural tube defects from 7 to 3 per 10,000 live births Reduce low birthweight (<2500 grams) from 7.3-5% Reduce preterm births (<37 weeks) from 9.1 to 7.6% Increase abstinence from alcohol use by pregnant women from 79-95% Reduce the incidence of fetal alcohol syndrome Increase the proportion of women who gain weight appropriately during pregnancy.

15. Pregnant women do NOT appear to consume an adequate diet. Mean intakes below the RDA for Vitamin D, E, Folate, B6, Iron, Zinc, Calcium and Magnesium Mean intakes exceed the RDA for Protein, Vitamin A, Thiamin, Riboflavin, Niacin, B12, and C

16. Lifestyle of Pregnant Women 1/3 Pregnant women smoke (about 1/3 of these will quit during part of pregnancy) 6-25% use illicit drugs 12% of all pregnant women are teens

17. Placenta

18. Fetus in Relation to Placenta

19. Future Health of An Individual Depends on the Nutritional Foundation Established in Prenatal Life

20. Maternal Physiology Changes in maternal physiology during pregnancy are so profound that they were previously considered abnormal and attempts were made to correct them. We now understand these changes are normal stages of pregnancy. Three examples: Increase in blood volume and fluid retention Dilution of blood constituents because of increase in fluid volume Increase in blood lipid levels

21. Normal Changes in Maternal Physiology Blood Volume Expansion Hemodilution - Decreased concentration of vitamins and minerals in blood Blood Lipid Levels - increased LDL, Triglycerides and HDL Blood Glucose levels rise with increased insulin resistance Maternal organ and tissue enlargement Circulatory System - Increased cardiac output through increased heart rate and stroke volume Respiratory System - increased oxygen consumption Food Intake - taste and odor changes, modification in preference, increased thirst Gastrointestinal changes - relaxed gastrointestinal tract muscle tone, nausea, vomiting, heartburn, constipation Kidney - increased GFR, increased sodium conservation BMR - Increased 2nd half of pregnancy

22. Nutrient Metabolism Carbohydrate Metabolism Protein Metabolism Fat Metabolism Mineral Metabolism

23. Common Problems of Pregnancy and Possible Solutions Nausea and Vomiting Hyperemesis Gravidarum HeartBurn Constipation The Fetus is Not a Parasite

24. Assessment of Infant Ponderal Index (PI) = weight in grams/cm 3 x 1000 Values between approximately 23-25 reflect normal weight-for-length <23 = thinness >25 = heavy AGA = appropriate for gestational age LGA = large for gestational age

25. Fetal Origins Hypothesis of Chronic Disease Risk The implications of the associations between fetal nutrition and adult disease are immense, and if substantiated demand intense scrutiny of current prenatal nutrition policies. Allergies Obesity Autoimmune diseases PCODCVDSchizophrenia BronchitisStrokeType 2 Diabetes HypertensionRenal DiseaseMetabolic Syndrome Ovarian Cancer

26. NRC Recommendations BMI is a better indicator of maternal nutritional status than weight alone Recommended Gain Low (BMI < 19.8)28-40 lbs Normal (BMI 19.8-26)23-35 High (BMI 26 – 29)15-25

28. Status of the Mother at the Time of Conception is Known to be as Important to the Outcome of Pregnancy as Diet During Pregnancy

29. Nutrition of the mother is a major determinant of fetal growth, size and health of the infant at birth.

30. NRC Recommendations EVERY pregnant woman should have a nutritional assessment EVERY pregnant woman should receive nutrition education EVERY pregnant woman should have a supplement of 30 mg of Ferrous Iron Where warranted from assessment a zinc supplement of 30 mg, copper supplement of 2 mg Calcium supplements for women < 25 with < 600 mg calcium/day Vegetarians should have a supplement Women at risk should have a supplement

31. Nutrient Requirements Energy Carbohydrate Artificial Sweeteners Alcohol Protein Vegetarian Diets DHA Essential Fatty Acids Water Folate

33. Nutrients Vitamin A Vitamin D Calcium Fluoride Iron Zinc Iodine Sodium Caffeine

35. Sample Diet for Pregnancy Breads, Cereals, Rice, Pasta 6-11 serv Vegetables 3-5 serv Fruits 2-4 serv Milk, Yogurt, Cheese 3 serv Meat, Poultry, Fish 3 serv Fats, oils, sweets (Based on Kcal need)

36. Safety Issues Herbal Remedies Exercise Mercury Contamination WIC Program