pregnancy is the greatest physiological stress accompanied with major alternation of the normal...
TRANSCRIPT
Pregnancy is the greatest physiological
stress accompanied with major
alternation of the normal biological
changes to which the mother has to
adjust hers nutritional requirements
during the period of pregnancy as well as
the period of lactation.
Normal pregnancy is associated with
endocrine and metabolic changes which
result in altered nutritional requirements.
Pituitary Growth
Hormone
Pituitary Growth
Hormone
Sex
Hormone
s(Estrogen &
Progesterone)
Sex
Hormone
s(Estrogen &
Progesterone)
Protein Catabolis
m
Retention of
calcium
Retention of
calcium
Iron(storage &
absorption)
Iron(storage &
absorption)
The amount iron stored = Amount utilized by the fetus + amount secreted in breast milk
Dilution of the maternal blood during
pregnancy is partly due to general retention of
water in the body during the latter months of
pregnancy which decreases the hemoglobin
content below the normal by 10-15%.
Hemoglobin concentration of 12 gm/100 ml is
considered normal.
On the other hand, a microcytic,
hypochromic anaemia may occur during
pregnancy in women who had deficiency in
iron before pregnancy and in woman
greater demands of pregnancy has
aggravated the severity of this deficiency.
Life long marginal
diet
Pregnancy
Macrocytic megaloblasitc
anaemia
• Spontaneous abortion.
• Toxaemia
• Intrauterine growth retardation
• Premature delivery
• Fetal malformation
• Antepartum haemorrhage
Rate
Macrocytic megaloblasitc
anaemia
Folic Acid
Niacin Requirements
Niacin Requirements
TryptophanDerivatives of niacin
Oestrogens
Thiamin Requirements
Thiamin Requirements
Thiamin deficiency during Thiamin deficiency during pregnancypregnancy
Severe cardiac decompensation occurs in pregnant women.
Congestive heart failure in their new babies.
• Stillbirths
• Maternal mortality
• Perinantal
mortality
•Toxaemia
Rate
Thiamin
supplementation
Vit. B6 Requirements
Vit. B6 Requirements
Protein needs
Coenzyme for transamination
Inadequate Vitamin B6Inadequate Vitamin B6
•Toxaemia.
• Low birth weight.
• Poor general condition of
infants of deficient mothers at
birth.
Vitamin C
Levels
Vitamin C
Levels
And thus due to
normal
expansion of
blood volume
Vitamin D
Requireme
nt
Vitamin D
Requireme
nt
Because of the
increased utilization
of calcium and
Phosphorous
Calcium
Calcium
Magnesium
Intake
Activity ofThyroid Gland
Activity ofThyroid Gland
Demands
for Iodine
Demands
for Iodine
Metabolic
Rate
23%
Dietary Recommendations is Pregnancy
These nutrients could be achieved through
the proper selection of food and without
the addition of special supplements except
for Iron and vitamin D.
Pregnancy diet is a well-balanced ordinary
diet modified through an increase in
animal protein intake and a decrease in fat
and carbohydrate foods.
Less expensive protein foods like dried skim milk, beans or peas may be partially substitute the good quality protein, occasionally, when there is a tight budget.
A lot of citrus fruits, tomatoes, and deep yellow and dark green leafy vegetables should be eaten daily.
The higher intake of fruits and vegetable supply a sufficient amounts of fibers which maintain normal bowel function and counteracts the tendency to constipation during pregnancy.
Foods known to cause digestive distress or gaseousness, highly spiced foods, fried foods, heavy desserts should be avoided. Intake of butter, cream, margarine, or other fat, and noodles, pies, pastries, rich desserts, soft drinks and sweets should be decreased.
Fluid intake should be adequate ~ 2 liters of fluids or more is required. This may be in the form of water, fruit juices, soups, and coffee and tea in moderate amounts.
Excessive amounts of salt or salted foods
are not advised especially during the last
2 months of pregnancy.
Five to six small meals are preferable to
three large ones. As the enlargement of
uterine mass begins to affect
gastrointestinal capacity, gaseonsness,
indigestion, and “heart-burn” are more
effectively controlled by small frequent
feedings especially in the third trimester.
It is known that the energy allowance
should be increased during the second
and third trimesters in order to cope with
the increase in metabolism.
This will help sparing protein for use by
the fetus and storage by the mother.
This increase in caloric intake is
justified even in the case of the
overweight pregnant women.
In order to avoid excessive weight gain,
the total amount of food eaten during the
first 4 months should be unchanged if the
expectant mother has normal body weight.
During the 2nd and 3rd trimester, the total
intake may be increased to permit a
gradual weight gain I kg/week.
The nutritional demands of pregnancy in adolescence, are critical since the growing pregnant youngster has the task of developing another human being before her body has completed its own growth.
Pregnancy may compromise their growth potential and increase the risk in complications such as iron-deficiency anemia, prolonged labor, premature labor and toxemia, the average birth weight of infants born to adolescent mothers is lower with higher infants mortality rates.
So the nutritional requirement of adolescent pregnant women should be higher than the adult pregnant women and this increase should be translated into higher dietary intakes of calories, protein, calcium, iron, and folic acid.
Underweight pregnant women who fails to gain acceptably weight during first and second trimesters requires strict dietary attention.
Underweight pregnant patients are more prone to premature labor.
A subsequent excessive weight gain
during the late second trimester or third
trimester is undesirable because it is
usually associate with a greater incidence
of preeclampsia.
A Vitamin D supplement is desirable
during the second half of pregnancy,
especially in the fall and winter.
Iodized salt should be used.
During lactation, the energy requirement
increases considerably over the normal
requirements because of the caloric value
of the milk secreted.
The daily meal plan should include 1.5 liter
of milk to satisfy additional protein,
calcium, phosphorous and riboflavin needs.
Dietary Recommendations During Lactation
Free amounts of vegetables and fruits,
especially citrus fruits, will take care of
increased vitamin A and ascorbic acid.
Nutrition In Infancy
Breast feedingArtificial feeding
Advantages: Advantages:
Many advantages.
Breast milk has about as many white blood
cells as blood itself, most of them
specialized monocytes which convey
immunoprotection against microorganisms
and antigens encountered by the mother
and to which the baby will exposed.
Breast feeding
It is higher in aminopolysaccharides,
concentration which stimulate a rapid
development of a favorable microflora in
the intestinal tract of infants. Such flora is
characterized by the prevalence of
lactobacilli, e.g. L. bifidus. which have a
protective action against growth of
undesirable pathogenic enteric bacteria.
It has higher content of immune supportive
protein, e.g. complement, protective enzymes,
e.g. lysozymes, and antiviral substances.
beta-lactoglobulin of cow’s milk is completely
absent from human milk. Since it is a foreign
protein, it is the most common food allergen in
infancy.
Lactoferrin is another milk protein found in
human milk but not in cow milk. It neutralizers
bacterial infection.
Absorption of zinc from breast milk is
better because human zinc binding
protein is different from the cow.
Human enzymes in breast milk facilitate
the baby’s digestion, absorption, and use
of the nutrients.
1. Mother should be in good health previous
history of tuberculosis must prevent breast
feeding.
2. Mother’s diet must be adequate.
3. Mother’s should be free from emotional
stress since psychological upsets interfere
with a normal flow of milk.
4. Beginning soon after delivery. This
preliminary nursing stimulates milk
production.
The average nursing time is about 15 min., longer periods will not produce additional milk but may lead to injury of nipples.
If possible, only one breast should be offered at each nursing, this facilitates complete emptying and stimulates lactation.
Regularity of nursing and the complete emptying of the breast after each feeding help to maintain lactation on the desired level.
Precaution
In case of prolonged insufficient lactation,
the material milk supply must be
supplemented with bottle-feeding and a
gradual change over to the bottle is
indicated. The most frequent cause for
early weaning from the breast is an
inadequate milk supply which is frequently
a result of inadequate emptying of
the breast several times daily.
Beginning with the first month, breast-fed
infants should receive 400 I.U. of Vitamin D
daily and if not breast fed, orange Juice or
a similar source of vitamin
(supplying 35 mg/day or more).
Artificial feedingCow milk contains about 7 times as casein as
in human milk.
The excess proteins in cow milk is catabolized
for energy purposes. This will pose a higher
load on the infants kidney and increases the
water requirements for renal clearance of the
large amounts of urea and of other solutes
which are present in cow’s milk in greater
concentration then in breast milk.
The higher concentration of urea will lead to
greater ammonia production by urea-forming
bacteria in the diaper leading to diaper rash.
In addition ,the use of cow’s milk for infants
younger than 140 days is associated with
(minor) bleeding into the G.I.T.
It carries an increased risk of anemia due to
copper and iron deficiency besides it is zinc
deficient.
The number of feedings per day differs
according to infant age.
A fixed schedule is not mandatory where
spontaneous feeding demand by the baby
is popular.
The appetite of infant changes from time
to time. So, he has not to finish his
prescribed bottle at each feeding.
With the beginning of the second or third
week, formula-fed infants should receive
400 I.U. Vitamin D daily, as well as
orange juice or a similar source of vitamin
C supplying 35 mg or more.
A number of proprietary formulas which
simulate the composition of human milk
are specifically formulated to serve infants
allergic to cow’s milk.
In order to ensure the freedom from pathogenic
microorganisms, one of two methods of
sterilization may be used.
1.The fluid mixture is boiled for 3 min. And then
poured into presterilized bottles which are capped
and refrigerated.
2.The other methods where the formula is divided
into clean bottles which are capped and then
replaced in a closed vessel, half filled
with boiling water. Boiling, is continued for 25 min.
and the pasteurized bottles are refrigerated.
It is important that the milk be boiled both
for digestibility and freedom from
pathogenic organisms until the infant is at
least 6 months old, then pasteurized milk
may be used.
Introduction of solid food:
There is a general agreement that
introduction of solid food should not be
given later than the third or fourth months
to either breast fed or formula-fed babies,
since a prolonged exclusive milk diet does
not supply all the essential nutrients,
particularly iron and thiamin.