Nutrition for the Lifecycle - Pregnancy

Objectives

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

Nutrition and FertilityChronic UndernutritionAcute UndernutritionBody Fat, Weight and FertilityVegetarian Diets and FertilityCaffeine and FertilityAlcohol and FertilityZinc Status and Male Fertility

Premenstrual Syndrome-Signs and Symptoms

FatigueAbdominal bloatingSwelling of the hands or feetHeadacheTender breastsNauseaCraving for sweet or salty foodsDepressionIrritabilityMood swingsAnxietySocial withdrawal

Diet and PMS

CaffeineMagnesiumCalciumB6

Herbal Remedies

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.

Infant MortalityInfant 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.

Pregnancy Outcomes in US Not a Source of Pride

US ranks 26th for infant mortality/1000 live births¼ of babies are less than 2,500 grams (5 lbs 8 oz) or considered LBW1/10 of babies born prematurely (before 37 weeks)Low birth weight results in developmental delays, disabilities long term illnessesOur 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.

Infant Deaths per 1,000 live Births

Country IMR RankJapan 3.8 1Singapore 3.8 1Finland 4.0 3Norway 4.0 3Sweden 4.0 3Hong Kong 4.1 6Spain 4.7 7US 7.3 26

Data to Consider40,000 Infants in US die before their 1st Birthday1 in 3 pregnant women receives inadequate prenatal care in USApproximately 73,000 women in US receive no prenatal careMore children at risk than previouslyBlack infant mortality is double the rate of whitesPremature rupture of membranes and premature labor are the leading cause of perinatal mortality in USInfants born to women who receive no prenatal care are 3X more likely to die in infancy250,000 infants (7% of births) born with birth defectsLeading types of birth defects:

CVD (38.2%) CNS Defects Anencephalus Spina Bifida (14.9%) Respiratory Defects (10.9%)

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

12 Factors that Contribute to LBW Infants

Socioeconomic StatusBiological ImmaturityHigh ParityShort StatureLow Prepregnancy Weight for HeightLow gain in weight during pregnancyPoor Nutritional StatusSmokingCertain Infectious agentsChronic DiseaseComplications of PregnancyHistory of Unsuccessful Pregnancy

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 birthsReduce the incidence of spina bifida and other neural tube defects from 7 to 3 per 10,000 live birthsReduce 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 syndromeIncrease the proportion of women who gain weight appropriately during pregnancy.

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 MagnesiumMean intakes exceed the RDA for Protein, Vitamin A, Thiamin, Riboflavin, Niacin, B12, and C

Lifestyle of Pregnant Women

1/3 Pregnant women smoke (about 1/3 of these will quit during part of pregnancy)6-25% use illicit drugs12% of all pregnant women are teens

Placenta

Fetus in Relation to Placenta

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

Maternal PhysiologyChanges 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

Normal Changes in Maternal Physiology

Blood Volume ExpansionHemodilution - Decreased concentration of vitamins and minerals in bloodBlood Lipid Levels - increased LDL, Triglycerides and HDLBlood Glucose levels rise with increased insulin resistanceMaternal organ and tissue enlargementCirculatory System - Increased cardiac output through increased heart rate and stroke volumeRespiratory System - increased oxygen consumptionFood Intake - taste and odor changes, modification in preference, increased thirstGastrointestinal changes - relaxed gastrointestinal tract muscle tone, nausea, vomiting, heartburn, constipationKidney - increased GFR, increased sodium conservationBMR - Increased 2nd half of pregnancy

Nutrient Metabolism

Carbohydrate MetabolismProtein MetabolismFat MetabolismMineral Metabolism

Common Problems of Pregnancy and Possible Solutions

Nausea and VomitingHyperemesis GravidarumHeartBurnConstipationThe Fetus is Not a Parasite

Assessment of InfantPonderal Index (PI) = weight in grams/cm3 x 1000Values between approximately 23-25 reflect normal weight-for-length<23 = thinness>25 = heavyAGA = appropriate for gestational ageLGA = large for gestational age

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 diseasesPCOD CVD SchizophreniaBronchitis Stroke Type 2 DiabetesHypertension Renal DiseaseMetabolic SyndromeOvarian Cancer

NRC Recommendations

BMI is a better indicator of maternal nutritional status than weight alone

Recommended Gain

Low (BMI < 19.8) 28-40 lbsNormal (BMI 19.8-26) 23-35High (BMI 26 – 29) 15-25

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

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

NRC RecommendationsEVERY pregnant woman should have a nutritional assessmentEVERY pregnant woman should receive nutrition educationEVERY pregnant woman should have a supplement of 30 mg of Ferrous IronWhere warranted from assessment a zinc supplement of 30 mg, copper supplement of 2 mgCalcium supplements for women < 25 with < 600 mg calcium/dayVegetarians should have a supplementWomen at risk should have a supplement

Nutrient Requirements

EnergyCarbohydrateArtificial SweetenersAlcoholProteinVegetarian DietsDHAEssential Fatty AcidsWaterFolate

NutrientsVitamin AVitamin DCalciumFluorideIronZincIodineSodiumCaffeine

Sample Diet for Pregnancy

Breads, Cereals, Rice, Pasta 6-11 servVegetables 3-5 servFruits 2-4 servMilk, Yogurt, Cheese 3 servMeat, Poultry, Fish 3 servFats, oils, sweets (Based on Kcal need)

Safety Issues

Herbal RemediesExerciseMercury ContaminationWIC Program