Pregnancy and Lactation

Chapter 10:Pregnancy and Lactation

J Pistack MS/Ed

Nutritional Needs During PregnancyOn average, daily caloric intake should increase by

approximately 340- 450 kilocalories per dayThe increase in calories should be from high nutrient

density foods Major body organs form 2~3 months after

conceptionFrom implantation to birth 100 mcg–7.5 lbs

Protein and Fat NeedsFatty acids have proved essential to fetal retina and

brain developmentProtein essential for building fetal tissues

Vitamin NeedsVitamin C is necessary for collagen formation and

tissue buildingVitamin B12 concentrated and stored in the fetal liver

—provides infant stores to sustain them for the first several months of life

Folic acid has been shown to decrease neural tube defects and is recommended to start before pregnancy

Fat Soluble VitaminsVitamins A, E, and K is not recommended to

supplementVitamin D—no recommendations yet - it is however

involved with multiple growth and development usesImmune system developmentBrain developmentCellular differentiation

Mineral NeedsIron supports the mother’s increased blood volume,

support fetal red blood cells, placenta, umbilical cordCalcium-30 grams are donated to a fetus at 350mg

a day in the third trimesterIodine, fluoride, zinc – not transferred from mother

– normal intake is required

Water and Weight GainOn average woman of normal weight should gain 2

to 4 pounds during the first trimesterFollowed by 1 pound per week for the remainder of

the pregnancy Charts to plot weight gain based on pre-pregnancy

BMI can be found here: www.nal.usda.gov/wicworks/Sharing_Center/NY/prenatalwt_charts.pdf

Substances to Avoid During PregnancyAlcohol—fetal alcohol syndromeCaffeine

Limit to < 300 mg/dayPregnancy outcomes unaffected by decaffeinated

beverages Soft cheeses and ready-to-eat meats

Listeriosis—often fatal in newborns

Substances to Avoid (continued)Certain fish, due to mercury contentUndercooked meatUnwashed produceCat litter—Toxoplasmosis

Common Problems During PregnancyMorning sickness

Dry crackers before arisingFruits and complex carbohydrates in small, frequent

mealsAvoidance of fatty foodsCold foodsLiquids between mealsHigh-protein snack at bedtime

Leg cramps—magnesium supplement may helpPica – eating non food items

Common Problems During Pregnancy (Continued)Constipation

Adequate fluid intakeRegular exerciseUp to 30 grams of fiber as food rather than

supplementsHeartburn

Avoid spicy or acidic foodsEat small, frequent mealsSit up for 1 hour after meals

Complications of PregnancyHyperemesis gravidarum

Severe nausea and vomiting after 14th week of pregnancy

Can be life threateningGestational diabetes

Any degree of abnormal glucose tolerance beginning or first recognized in pregnancy

Screening with glucose tolerance tests usually part of prenatal care

Treated aggressively by health care team

Complications of PregnancyHypertensive disorders of pregnancy

Chronic hypertensionGestational hypertensionPre-eclampsia—hypertension + proteinuria

convulsions and coma, rarely coma alone, occurring in a pregnant or puerperal woman

Eclampsia—pre-eclampsia + seizures Disorders of late pregnancy associated with high

blood pressure, fluid retention, and protein in the urine

Obstetrics emergency May occur postpartum

Nutritional Needs of the Breastfeeding MotherVitamins

Chronic maternal deficiencies may affect milk production

Vegan mothers—check vitamin B12 statusMinerals

Calcium resorbed from bones regardless of intake and replaced after weaning

Iodine critical for neurological development must be obtained dietarily

Breast feeding Benefits Through the release of oxytocin uterine

muscles contract and return to their nonpregnant size which also minimizes postpartum blood loss

Helps with child spacingBreastfeeding is associated with a decreased

risk of breast cancer

Maternal Contraindications to BreastfeedingCertain diseases

HIV in developed countriesActive untreated tuberculosis

Exposure to toxic chemicalsUse of illegal drugsSome medications given to mother

AntimetabolitesTherapeutic radiopharmaceuticals