pregnancy is the greatest physiological stress accompanied with major alternation of the normal...

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.