Faculty of Nursing

Maternal Nutrition
Dr. Heba Ramadan Ghaiad
Lecturer of Biochemistry
Faculty of Pharmacy, Cairo University
Heba.Ramdan@bue.edu.eg
 Maternal Nutrition
Maternal nutrition refers to the nutritional
needs of women
during pregnancy (prenatal)
& while breastfeeding (postnatal).

May also refer to the pre-conceptual

period (adolescence).
Maternal
Nutrition
ENERGY
Increased maternal metabolism

Growth of the fetal-placental unit

Increase in requirements Energy requirements
is minimal Rise significantly
1st Trimester 2nd & 3rd Trimetsers
 American Dietetic Association
Recommendations
Total intake of 2400-2700 kcal/ day during pregnancy

At the beginning of In Late pregnancy

pregnancy
Caloric intake Caloric intake
by 340 by 450
Kcal/day Kcal/day
Maternal
Nutrition
PROTEIN
An additional 25g protein/day
is recommended
 Maternal
Nutrition
CARBOHYDRATES
Provide enough calories
High Blood 135-175 Maintain appropriate
glucose g/day blood glucose
Gestational DM Prevent ketosis
 Maternal
Nutrition
FATS
During pregnancy, your body needs
more fat. Fat is the main source of 25-35% of total
energy for a developing baby's and Daily Calories
makes up almost 60% of their brain
 Maternal
Nutrition
FATS
lowering cholesterol
Mono & Poly-unsaturated Found in safflower, olives
(Beneficial FATS) olive/peanut oil, avocados, nuts,
salmon and anchovies
 Ways To Reduce Harmful Fats In Pregnancy Diet

Cook with olive oil Replace meat with fish and poultry

Remove skin from poultry before cooking

Avoid fried food

Cut cheese consumption

Skim the solid fats off the top of soups before serving

Replace full-fat dairy products with low-fat or non-fat versions

 Maternal
Nutrition
VITAMINS
Folic Acid
Folate deficiency is the most common
vitamin deficiency in pregnancy
Maternal
Nutrition
VITAMINS
Folic Acid
Augmented erythropoiesis
Required for developing fetal tissues
Required for developing placental tissues
 Maternal
Nutrition
VITAMINS
Folic Acid
Folate (400 µg/day) should be given
to ensure proper development of
to women in child-bearing age and
the 1st 3 months of pregnancy baby’s brain and spinal cord
 Maternal
Nutrition
VITAMINS
Vitamin B12
Vegetarian mothers may have a severe vitamin B12
deficiency which can lead to hematologic and neurologic
abnormalities in the fetus.
 Maternal
Nutrition
VITAMINS
Vitamin B6
The blood level of vitamin B6 decreases during pregnancy,
B6 helps in protein metabolism which builds the baby’s
muscular system
 Maternal
Nutrition
VITAMINS
Fat-soluble Vitamins
The fat-soluble vitamins cross the placenta less readily than the
water-soluble vitamins and accumulate in the fetus at lower
concentrations than in the maternal blood
Maternal
Nutrition
VITAMINS
Vitamin A
5000 IU/day Teratogenic
 Maternal
Nutrition
VITAMINS
Vitamin D
Imp for calcium metabolism and
400 IU/day regulation of mineralization of fetal
skeleton
 Maternal
Nutrition
MINERALS
Calcium
200-300 most of this is used for mineralization of the
mg/day skeleton of the fetus in the third trimester
 Maternal
Nutrition
MINERALS
Iron
30-60 Augmented Compensate blood
mg/day erythropoiesis loss during delivery
 Maternal
Nutrition
MINERALS
Sodium
iodized 3000 mg/day neither
salt restricted nor
increased
 Maternal
Nutrition
MINERALS
Iodine
Maternal iodine deficiency has long been
220 µg/day recognized as a cause of neonatal cretinism
 Maternal
Nutrition
MINERALS
Iodine
The most serious consequence of iodine deficiency is cretinism
(Congenital hypothyroidism), characterized by severe physical and
mental retardation due to deficiency of thyroid hormones during
early pregnancy.
 Maternal
Nutrition
MINERALS
Zinc
zinc deficiency has been associated with short
11-13 stature, marked hypogonadism, rough skin,
mg/day hepatosplenomegaly and iron deficiency anemia
How much TOTAL weight should a
pregnant woman gain?
Depends on BMI before pregnancy
Weight gain in pregnant women

Less than half of the total weight gain during

pregnancy resides in the fetus, placenta and
amniotic fluid

The remainder is found in maternal

reproductive tissues, fluid, blood and
maternal stores
How much weight should a pregnant
woman gain?
If she had healthy weight before pregnancy

1 lb - 4.5 lb App. 1 lb -2 lb (0.45 kg - 0.9 Kg)

(0.45 kg - 2 Kg) per week
 Not gaining enough
Gaining too much weight
weight
Gestational diabetes

Premature delivery
High blood pressure

Increased risk of cesarean delivery

Small for gestational age
(SGA) babies
Increased fatigue

Backaches and leg pain Low-birth weight

infant

Varicose veins

Hemorrhoids
 What to eat if not feeling well?
• Eat cereal before getting out of bed
Morning Sickness • Eat small, frequent meals
• Avoid fatty and fried foods.
• Eat more fresh fruit and vegetables
Constipation • Drink 6 to 8 glasses of water a day.

• Eat more foods that contain pectin and gums

Diarrhea
(help in the absorption of excess water). e.g.
bananas, white rice, oatmeal and wheat bread

• Eat small, frequent meals;

Heartburn • Try drinking milk before eating
• Limit caffeinated and citric beverages,
and spicy foods
What to avoid during pregnancy

Avoid seafood as it can be

HIGH IN MERCURY

Too much mercury could damage baby's

developing nervous system
What to avoid during pregnancy

Avoid
UNDERCOOKED MEAT, POULTRY
AND EGGS

To avoid food poisoning

What to avoid during pregnancy

Avoid UNPASTEURIZED FOODS

as
Blue cheeses (FORBIDDEN)

Lead to food borne illness

What to avoid during pregnancy

Avoid
UNWASHED FRUITS AND VEGETABLES

As they might contain disease-causing bacteria

What to avoid during pregnancy

Avoid large quantities of vitamin A

Too much vitamin A can cause birth defects.

What to avoid during pregnancy

Avoid EXCESS CAFFEINE

Caffeine can cross the placenta and affect baby's

heart rate.
 What to avoid during pregnancy

Avoid ALCOHOL

Mothers who drink alcohol have a higher risk of miscarriage and

stillbirth.
Too much alcohol during pregnancy can result in fetal alcohol
syndrome, which can cause facial deformities, heart problems,
low birth weight and mental retardation.
What to avoid during pregnancy

Avoid SMOKING

The smoking mother passes nicotine and

carbon monoxide to her growing baby.
What to avoid during pregnancy

Avoid HERBAL TEA

Avoid drinking herbal tea unless health care

provider says it's OK — even the types of
herbal tea marketed specifically to pregnant
women.
What to avoid during pregnancy

Over-the-Counter (OTC) and Prescription

Medications

There are many medications you should steer

clear of during pregnancy
Consequences of maternal malnutrition
❖Consequences for maternal health
1. Increased risk of maternal complications and death
2. Increased infection
3. Anemia
4. Lethargy and weakness, lower productivity

❖Consequences for fetal and infant health

1. Increased risk of fetal, neonatal, and infant death
2. Intrauterine growth retardation, low birth weight,
prematurity
3. Birth defects
4. Cretinism
5. Brain damage
6. Increased risk of infection
 Case Study

Case 1:
Laura, a 34-year-old woman who is 30 weeks pregnant. Laura's
pre-pregnancy weight was 200 lb. She is 61 " tall. Today her weight is
230 lb. Laura states that she does not like to exercise. She joined a health
club a few years ago but stopped going after about 6 weeks because she
felt out of place, and she thought that it was boring.
At the beginning of her pregnancy, Laura experienced
considerable nausea and occasional vomiting as well as overwhelming
fatigue. Today Laura complains of the onset of several pregnancy
discomforts. These include heartburn, intermittent diarrhea and
constipation, fatigue, and edema in her ankles.

What impacts might her weight status have on this pregnancy?

 What impacts might her weight status have on this
pregnancy?

Weight in kg = 200 lb. X 0.45 = 90 kg

Height in m = 61-inch X 2.51 = 153.1cm = 1.53 m

BMI = 90/(1.531)2 =38.39 kg/m2

Total wt. gain range should be 11-20 lb, she gained 30 lb in 7.5 months

Possible risks for gaining too much weight:

✓ Gestational diabetes
✓ High blood pressure
✓ Increased risk of cesarean delivery
✓ Increased fatigue
✓ Backaches and leg pain
✓ Varicose veins
✓ Hemorrhoids
 Case Study
Case 2:
A 24-year-old patient presented at 11 weeks gestation with a
body mass index (BMI) of 16.6 kg/m2 (height 1.55 m, weight
40 kg). At her following visit she had lost a further 1 kg and
complained of dysphagia and post-prandial vomiting but could
tolerate fluids.

1) What are the consequences of chronic maternal

malnutrition?

2) Nutritional support for the mother in pregnancy can

reverse this adverse outcome for the fetus. Give your
nutritional advice.
 What are the consequences of chronic maternal
malnutrition?

• Consequences for maternal health

• Increased risk of maternal complications and death
• Increased infection
• Anemia
• Lethargy and weakness, lower productivity

• Consequences for fetal and infant health

• Increased risk of fetal, neonatal, and infant death
• Intrauterine growth retardation, low birth weight, prematurity
• Birth defects
• Cretinism
• Brain damage
• Increased risk of infection
 Nutritional support for the mother in pregnancy
can reverse this adverse outcome for the fetus.
Give your nutritional advice.

• Make sure of consuming adequate energy intake

(Total intake of 2400-2700 kcal/ day during
pregnancy).
• Daily consumption of adequate protein,
carbohydrates, whole-grain breads and cereals, leafy
green and yellow vegetables, fresh fruits should be
encouraged.
• Folic acid, vitamin B12, vitamin D supplements.
Thank you