1. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings PowerPoint ® Lecture Slide Presentation created by Karen Schuster Florida Community College of Jacksonville Chapter 12 Life Cycle Nutrition Pregnancy

2. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Objectives for Nutrition for Pregnancy List three ways parents-to-be can improve pregnancy outcomes prior to conception. Summarize the stages of pregnancy and fetal development. Explain “morning sickness.” Identify the components of weight gain during pregnancy. List four nutrients of great significance to support a healthy pregnancy. Discuss two potential complications of pregnancy.

3. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Hewlings/Medeiros Nutrition: Real People, Real Choices 1e © 2009 Pearson Education, Upper Saddle River, NJ 07458 All Rights Reserved. 16.3 Safe Motherhood Centers for Disease Control states that: “Safe motherhood begins before conception with proper nutrition and a healthy lifestyle and continues with appropriate prenatal care, the prevention of complications when possible, and the early and effective treatment of complications. The ideal result is a pregnancy at term without unnecessary interventions, the delivery of a healthy infant, and a healthy postpartum period in a positive environment that supports the physical and emotional needs of the woman, infant, and family.”

4. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Hewlings/Medeiros Nutrition: Real People, Real Choices 1e © 2009 Pearson Education, Upper Saddle River, NJ 07458 All Rights Reserved. 16.4 Healthy Pregnancy Begins before conception Involves mother, father, entire family Prenatal care crucial to prevent complications and infant mortality Low birth weight (an infant that weighs 5.5 lbs. or less) At increased risk for infection, lung problems, learning disabilities, insufficient growth, and death

5. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings What Nutrients and Behaviors Are Most Important for a Healthy Pregnancy? Before conception, fathers-to-be need to eat well to produce healthy sperm Smoking, alcohol and drug abuse, obesity may decrease sperm production and function Zinc, folate associated with healthy sperm production Antioxidants (vitamins C and E, carotenoids) may help protect sperm from free-radical damage. Should consume well-balanced diet of fruits, vegetables, whole grains, legumes, nuts, lean meats, and dairy foods

6. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings What Nutrients and Behaviors Are Most Important for a Healthy Pregnancy? Before conception, mothers need to adopt a healthy lifestyle Attain a healthy weight Obese pregnant women at increased risk for hypertension and gestational diabetes Decrease weight before pregnancy but should never try to lose weight during pregnancy Underweight women have lighter-weight placenta and increased risk of low birth weight baby Continued…

7. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Why Is Good Nutrition Essential for a Healthy Pregnancy? How does a baby begin developing? Full-term pregnancy: 40 weeks, divided into trimesters First two weeks after conception: zygote attaches to uterine wall Placenta and embryo (2-8 weeks) develop Placenta: common tissue between mother and embryo where nutrients, oxygen, waste products exchanged through umbilical cord Fetus after eighth week of pregnancy

8. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Stages of Pregnancy and Fetal Development Figure 12.1

9. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Hewlings/Medeiros Nutrition: Real People, Real Choices 1e © 2009 Pearson Education, Upper Saddle River, NJ 07458 All Rights Reserved. 16.9 Stages of Pregnancy 13 weeks each First trimester – weeks 1–13 Starts at conception Placenta is formed. Umbilical cord connects baby to placenta. Fetus most vulnerable to inadequate nutrition, drugs. and alcohol. Mom recommended to gain about 2 lbs during first trimester; no increase in calories needed

10. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Hewlings/Medeiros Nutrition: Real People, Real Choices 1e © 2009 Pearson Education, Upper Saddle River, NJ 07458 All Rights Reserved. 16.10 Stages of Pregnancy Second trimester (14–27 weeks) Fetus gains about 2 lbs. Responds to light and sounds Mom recommended to gain about 1 lb. per week for blood volume Third trimester (week 28 to birth) Fetal growth and development rapid Fetus stimulates birth through a signal from developed lungs. Mom recommended to continue to gain about 1 lb. per week

11. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Hewlings/Medeiros Nutrition: Real People, Real Choices 1e © 2009 Pearson Education, Upper Saddle River, NJ 07458 All Rights Reserved. 16.11 Timeline of Fetal Development

12. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings The Placenta Figure 12.2

13. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Recommended Weight Gain During Pregnancy Table 12.3

14. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Hewlings/Medeiros Nutrition: Real People, Real Choices 1e © 2009 Pearson Education, Upper Saddle River, NJ 07458 All Rights Reserved. 16.14 Recommended Weight Gain During Pregnancy Weight gain Recommended: 25–35 lbs. Based on prepregnancy weight Only 10 to 40 percent of women in United States gain the recommended weight.

15. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Components of Weight Gain During Pregnancy Figure 12.3

16. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Nutrient Needs During Pregnancy Figure 12.4

17. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings What Nutrients and Behaviors Are Most Important for a Healthy Pregnancy? Dietary considerations: Need up to 50% more folate, zinc, iron Nutrient-dense food sources, prenatal supplement may be needed Calcium needs don’t increase but diet needs to meet requirements Continued…

18. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Hewlings/Medeiros Nutrition: Real People, Real Choices 1e © 2009 Pearson Education, Upper Saddle River, NJ 07458 All Rights Reserved. 16.18 Hydration General needs increase At least 300 mL additional fluid/day

19. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Hewlings/Medeiros Nutrition: Real People, Real Choices 1e © 2009 Pearson Education, Upper Saddle River, NJ 07458 All Rights Reserved. 16.19 Meeting Increased Nutrient Needs Nutrient density is key. Calories Increase 250–300 cal/day Protein Carbohydrates Lipids Vitamins and minerals Folate Iron Calcium Zinc

20. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Hewlings/Medeiros Nutrition: Real People, Real Choices 1e © 2009 Pearson Education, Upper Saddle River, NJ 07458 All Rights Reserved. 16.20 Protein Needs increase by 25 g per day. Most already get this. Vegetarians need to pay close attention. Can obtain adequate protein with a vegetarian diet

21. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Hewlings/Medeiros Nutrition: Real People, Real Choices 1e © 2009 Pearson Education, Upper Saddle River, NJ 07458 All Rights Reserved. 16.21 Macronutrients Carbohydrates Main source of extra energy, 175 g/day Fiber important to prevent constipation and hemorrhoids Decrease simple carbs (empty calories) Fats Doesn’t change during pregnancy Focus on essential fats Nuts, oils, whole grains

22. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Hewlings/Medeiros Nutrition: Real People, Real Choices 1e © 2009 Pearson Education, Upper Saddle River, NJ 07458 All Rights Reserved. 16.22 Vitamin and Mineral Supplements Needs increase 30%. Folate + Iron needs increase 50%. Iron needs increase 50%. Prenatal vitamins Always check with health care provider first. Provide no more than 100% of the DRI

23. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Hewlings/Medeiros Nutrition: Real People, Real Choices 1e © 2009 Pearson Education, Upper Saddle River, NJ 07458 All Rights Reserved. 16.23 Changes in Nutrient Recommendations with Pregnancy

24. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings What Nutrients and Behaviors Are Most Important for a Healthy Pregnancy? Vegans and vegetarians need to ensure linolenic acid and vitamin B 12 needs are met. Also have higher zinc and iron needs Too much preformed vitamin A can be toxic: limit supplements to no more than 5,000 IU Use sugar substitutes in moderation Most nutrient needs can be met by balanced diet

25. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings What Nutrients and Behaviors Are Most Important for a Healthy Pregnancy? Get plenty of folic acid at least one month prior to decrease risk of neural tube birth defects Moderate fish and caffeine consumption Methylmercury can harm fetal nervous system Keep caffeine intake under 150 mg/day to reduce risk of miscarriage, birth defects High caffeine intake may also decrease fertility Continued…

26. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Fishing for a Healthy Baby Table 12.1

27. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings A Jolt of Caffeine Table 12.2

28. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings What Nutrients and Behaviors Are Most Important for a Healthy Pregnancy? In the first trimester: Women need to eat when food may not be appetizing Practice food safety Some women develop food aversions and/or cravings Pica: abnormal, compulsive intake of nonedible substances such as clay

29. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings What Nutrients and Behaviors Are Most Important for a Healthy Pregnancy? Morning sickness usually begins in first trimester and often ends by twentieth week Cause of morning sickness unknown; fluctuating hormones may play role Rare cases of severe morning sickness with vomiting called hyperemesis gravidarum can cause serious complications: dehydration, electrolyte imbalances, weight loss Often requires hospitalization

30. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Hewlings/Medeiros Nutrition: Real People, Real Choices 1e © 2009 Pearson Education, Upper Saddle River, NJ 07458 All Rights Reserved. 16.30 Morning Sickness and Cravings Nausea at any time during the day Tips to alleviate symptoms (see Table 16.5) Small, frequent meals Ginger Salty foods Cravings Typically not associated with body’s needs: most likely due to the changes in mom’s hormone levels Pica: often induced by iron-deficiency anemia

31. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings What Nutrients and Behaviors Are Most Important for a Healthy Pregnancy? Be wary of foodborne illness. Listeria monocytogenes may cause miscarriages, premature labor, low birth weight, developmental problems, even infant death Avoid raw and undercooked meat, fish, or poultry; unpasteurized milk, cheese, juices; raw sprouts

32. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings What Nutrients and Behaviors Are Most Important for a Healthy Pregnancy? In the second trimester: Consume adequate calories, carbohydrate, protein Should gain little less than 1 lb/week, extra 340 calories daily At least 75 g carbohydrates/day Protein needs increase by 35%

33. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings What Nutrients and Behaviors Are Most Important for a Healthy Pregnancy? In the third trimester: gastrointestinal issues can be common: eating frequent, small meals and a high- fiber diet can help with bowel irregularity, heartburn, and constipation. Should be gaining about 1 lb/week and taking in 450 extra daily calories Pressure exerted on stomach and intestines, hormones may slow food through GI tract Small, frequent meals, avoiding spicy foods can help heartburn More fiber-rich foods can help prevent constipation

34. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings What Nutrients and Behaviors Are Most Important for a Healthy Pregnancy? The importance of exercise Exercise can improve sleep, lower risk of hypertension and diabetes, prevent backaches, relieve constipation, shorten labor, and reduce stress, depression, and anxiety. 30 minutes or more of moderate exercise most days of the week Low-impact activities best

35. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Hewlings/Medeiros Nutrition: Real People, Real Choices 1e © 2009 Pearson Education, Upper Saddle River, NJ 07458 All Rights Reserved. 16.35 Exercise and Pregnancy Moderate-intensity aerobic exercise Trained athletes Benefits Decreased risk for gestational diabetes Decreased risk for high blood pressure Precautions

36. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Safe and Unsafe Exercises During Pregnancy Table 12.4

37. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings What Nutrients and Behaviors Are Most Important for a Healthy Pregnancy? Potential complications Gestational diabetes: high blood glucose levels develop after about twentieth week of pregnancy Can result in macrosomia: large baby weighing more than 8 lbs, 13 oz. Increases risk of baby having jaundice, breathing problems, birth defects Pregnancy-induced hypertension includes gestational hypertension, preeclampsia, eclampsia

38. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings What Nutrients and Behaviors Are Most Important for a Healthy Pregnancy? Gestational hypertension: high blood pressure develops about halfway through pregnancy Preeclampsia: includes hypertension, severe edema and protein in urine Treatment includes bedrest, medication, even hospitalization until baby can be safely delivered If untreated, can lead to eclampsia Eclampsia: can cause seizures in mother and is major cause of death of women during pregnancy

39. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Hewlings/Medeiros Nutrition: Real People, Real Choices 1e © 2009 Pearson Education, Upper Saddle River, NJ 07458 All Rights Reserved. 16.39 Health Conditions Pregnancy-induced hypertension 5–10% of all pregnancies Pre-eclampsia Eclampsia Edema Gestational diabetes 7% of all pregnancies Goes away after delivery Mother has increased risk of diabetes later in life Controlled with diet and exercise Can result in large baby Testing performed at 24–28 weeks

40. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings What Special Concerns Might Younger or Older Mothers-to-Be Face? Pregnant teenagers face special challenges since they are still growing and are likely to have unbalanced diets. May be short of iron, folic acid, calcium, and calories Teenage mothers more likely to develop pregnancy-induced hypertension, to deliver premature and low birth weight babies Women older than 35 more likely to develop diabetes and hypertension Achieve healthy weight prior to conception, avoid smoking, obtain adequate folic acid

41. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Hewlings/Medeiros Nutrition: Real People, Real Choices 1e © 2009 Pearson Education, Upper Saddle River, NJ 07458 All Rights Reserved. 16.41 Precautions During Pregnancy Avoid extremes in weight Overweight and underweight at increased risk Caffeine Avoid caffeine or limit daily caffeine intake to no more than 300 mg per day 136 mg in 8 oz. of coffee, 48 mg in 8 oz. of tea, and 35 mg in a 12 oz. soda Alcohol Drugs Smoking Foodborne illnesses and toxins Listeria and toxoplasma Decrease fish, especially tuna Avoid raw or partially cooked foods such as sushi

42. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings Hewlings/Medeiros Nutrition: Real People, Real Choices 1e © 2009 Pearson Education, Upper Saddle River, NJ 07458 All Rights Reserved. 16.42 Herbal and Botanical Supplements Always check with health-care provider. Caution should be applied. Herbs to avoid: Aloe (taken internally): Causes severe diarrhea Black cohosh: Premature contractions Chamomile oil: A uterine stimulant Cinnamon: Uterine stimulant in high doses, safe as a culinary herb; avoid the essential oil completely Fennel: Uterine stimulant in high doses, but okay as a culinary herb Korean ginseng: High doses may lead to the development of an androgynous baby. Lavender: High doses can be a uterine stimulant. Licorice: High doses can exacerbate high blood pressure. Peppermint oil: Avoid completely—it can be a uterine stimulant. Peppermint tea (black): Limit to two cups a day, as excess can lead to palpitations and increased heart rate.

43. Copyright © 2008 Pearson Education, Inc., publishing as Pearson Benjamin Cummings What Nutrients and Behaviors Are Most Important for a Healthy Pregnancy? Avoid cigarettes, alcohol, botanical supplements, and illicit drugs Infants of smokers weigh less, have increased risk of premature birth, death, SIDS Alcohol can lead to fetal alcohol spectrum disorders. Even low levels of alcohol may cause learning and behavioral disorders. Herbs and botanical supplements can be harmful – check with health care provider before consuming them Illicit drugs increase risk of miscarriage, preterm labor, low birth weight, and birth defects