Nutrition on

Pregnancy

P re s e n t a t i o n b y G R O U P 1
Derick Policarpio
Donna Cabradilla
Louella Ramos
Lemar Marqueza
Jane Doblado
 Prepregnancy Weight

• A woman who starts out underweight

and who fails to gain sufficiently during
pregnancy is likely to have a low-
birth weight baby (< 5 ½ pounds).
• Low birth weight babies are associated
with:
– Lower adult IQ, short stature,
chronic diseases
 Prepregnancy Weight

• Obese women are also urged to strive

for healthy weight gains before
pregnancy.
• Babies born to obese mothers are more
likely to have:
-heart defects, neural tube defects,
and other problems.
How Much Weight Should a Woman Gain during
Pregnancy?
 A Healthy Placenta and Other Organs

• A major reason the mother’s nutrition before

pregnancy is so crucial is that it determines
whether her uterus will be able to support the
growth of a healthy placenta during the first
month of gestation.

• The placenta also produces hormones that act in

many ways to maintain pregnancy and prepare
the mother’s breasts for lactation.
 The Events of Pregnancy

• The newly fertilized ovum, called a zygote,

begins as a single cell and divides many times
during the days after fertilization.
• Within 2 weeks, the zygote embeds itself in
the uterine wall in a process known as
implantation.
• Adverse influences such as drug abuse,
smoking and malnutrition can lead to
abnormalities such as neural tube defects.
• The zygote divides into an increasing numbers of cells, eventually forming a
spherical blastocyst. A few days after fertilization, the blastocyst implants
itself in the inner lining (endometrium) of the uterus, where embryonic and
fetal development continues.
From the moment of conception to the time a baby is born, remarkable
changes occur. An entire human body develops, with internal systems that can
function to support life and enable the fetus to move and react to stimuli.
• The embryo forms several extraembryonic membranes for its protection and
nourishment. The amnion is a fluid-filled sac that is used to keep the embryo moist and
cushioned. The yolk sac and allantois become partly incorporated into the umbilical
cord which connects the fetus with the placenta. The chorion is the outside membrane
that helps form the placenta, through which the blood systems of the fetus and the
mother come close enough to permit exchange (by diffusion) of nutrients and wastes.
A Healthy Placenta and Other Organs

PLACENTA – organ in uterus that links

blood supplies of mother & infant
 Fetus

Zygote

Newborn
infant

Embryo
How Much Weight Should a Woman Gain during
Pregnancy?
 Critical Periods
• Each organ and tissue type grows with its own
characteristic pattern and timing.
• The development of each takes place only at a
certain time--the critical period.
• If the development of an organ is limited during a
critical period, recovery is impossible.
Critical Periods
Increased Need for
Nutrients
 Energy, Carbohydrate, Protein, and Fat

• Pregnancy brings physiological

adjustments that demand increased
intakes of energy and nutrients.
• A balanced diet that includes more
nutrient-dense foods from the five food
groups can help to meet these needs.
 Folate and Vitamin B12

• Due to their key roles in cell reproduction, folate

and vitamin B12 are needed in large amounts
during pregnancy.
• Folate plays an important role in preventing
neural tube defects.
• One type is anecephaly, when the brain
fails to develop,
• Another is spina bifida, when the
membranes covering the spinal cord
protrude from the sac.
Folate and Vitamin B12
Nutritional Needs
During Pregnancy

• Energy:
– First Trimester - no change
– Second Trimester - increases 340 kcal/day
– Third Trimester - increases 452 kcal/day

• Protein:
– Increases from 46 g/day to 71 g/day
Vitamin and Mineral
Requirements in Pregnancy
• Pregnant women are at increased risk for folic acid, iron,
and calcium deficiencies.

• Recommendations are:
◦ Iron – increases to 27 g/day
◦ Folate – increases to 0.6 mg/day
◦ Calcium - 1000 mg/day
◦ Magnesium - increases to 360 mg/day
◦ Vitamin C - increases to 85 mg/day
Calcium Requirements

• DRI Calcium Recommendations

– 9 - 18 y/o: 1300 mg/day
– 19 - 50 y/o: 1000 mg/day (adults, pregnant and lactating)
– >51 y/o: 1200 mg/day
– Increased requirements during the third trimester
– Supplementation shown to reduce hypertension during pregnancy

• Dietary sources
– Milk, yogurt (8 oz), cheese (1 oz) ~ 300 mg calcium
– Orange juice- fortified (1 cup = 300 mg)
– Broccoli, kale (1 cup cooked = 90 mg)
– Bok choy, mustard green (1 cup cooked =180 mg)
– Tofu (made with calcium citrate- (½ cup =260 mg)
– Canned salmon (3 oz = 180 mg)
Neural Tube Defects (NTD)
Prevention: Role of Folate
 Folate deficiency is the most common deficiency during pregnancy

 Functions:
◦ Serves as a co-factor in one-carbon transfers, (nucleic acids and amino acids)
and therefore required during periods of rapid growth.

◦ Increased maternal erythropoesis causes increased folate needs during

second and third trimesters.

 Role in Prevention:
◦ NTD are thought to result from a dietary deficiency of folate and/or a genetic
defect affecting folate metabolism.

◦ During pregnancy, the neural tube is formed from the 18th to the 26th DAY of
gestation.
Folate Requirements in
Pregnancy
• Adequate folate is critical before and during the first 4 weeks of pregnancy.

• Since 50% of pregnancies are unplanned and most women do not seek
prenatal care until 8 weeks gestation, folate supplements prior to
conception are critical to prevent NTD.

• Folate Antagonists (taken during 2nd or 3rd trimester doubles fetal CV

defects):
– Phenobarbiotic
– Phenytoin
– Primidone
– Carbamazepine
– Trimethoprin
– Triamterene
Folate Requirements
in Pregnancy

• DRI=600 g pregnancy or 500 g lactating female, 400 g for non-

pregnant woman.

• Beans, peas, orange juice, green leafy vegetables, fortified cereals are
good sources.

• Prenatal vitamins contain 1000 g folate.

Iron in Pregnancy

 Iron is an essential element in all cells of the body.

 During pregnancy, maternal blood volume increases 20-30%.

 Iron needs increase from 18 to 27 g/day during pregnancy.

 Deficiency increases risk of maternal and infant death, preterm

delivery, and low birth weight babies.
Diagnosis of Iron
Deficiency Anemia

• The CDC reference criteria for anemia during pregnancy:

– First trimester Hgb <11.0 g/dl or Hct <33%

– Second trimester Hgb < 10.4 g/dl or Hct <32%
– Third trimester Hgb <11.0 g/dl or Hct <33%
Iron Deficiency Anemia
• Susceptible Populations:
– Pregnant women who have not been taking iron
supplements
– Infants and children
– Menstruating females
– Teens
– Low income women

• Etiology:
– Poor iron intake - only 25% of females 12 - 49 meet needs
– Diet with low bioavailable iron
Iron Deficiency Anemia
 Weakness, fatigue, poor work performance, and changes in behavior.

 Physical signs include pallor, fatigue, coldness and paresthesia of the

extremities, greater susceptibility to infections.

 Infants and young children with iron deficiency may have low IQ levels,
poor cognitive and motor development, learning, and behavioral
problems.
Iron Treatment Recommendations
• Iron-rich foods:
– Meat, fish, poultry, eggs
– Organ meats
– Peas and beans
– Dried fruit
– Whole grain and enriched cereal

• Therapeutic dose/supplements
– 30 mg TID but can be constipating
– IV iron, but may cause a reaction
Food Borne Illness
• Raw and highly carnivorous fish should be avoided.
– Including: fresh tuna, shark, tilefish, swordfish, king mackerel

• All dairy foods and juices should be pasteurized.

• Food contaminated with heavy metals can have neurotoxic effects for
the fetus. (Mercury)

• Listeria monocytogenes contamination in pregnancy develop into a

serious blood borne, transplacental infection.
– Wash vegetables and fruits
– Cook meats
– Avoid processed, precooked meats (cold cuts)
– Avoid soft cheeses (brie, blue cheese, etc.)
 Calcium, Magnesium, Iron, and Zinc

• Among the minerals, calcium, phosphorus, and

magnesium are in great demand during pregnancy
because they are necessary for normal
development of the bones and teeth.
• During pregnancy, the body avidly conserves iron
and absorption increases up to threefold.
• Iron needs of fetus have priority over
mother.
 Calcium, Magnesium, Iron, and Zinc

• Zinc, required for protein synthesis and

cell development, is vital during
pregnancy.
 Prenatal Supplements

• Women most likely to benefit from

prenatal multivitamin-mineral
supplements during pregnancy include
those who do not eat adequately, those
carrying twins or triplets, and those who
smoke cigarettes or are alcohol or drug
abusers.
Prenatal Supplements
CONCERNS DURING
PREGNANCY
NAUSEA
-the feeling of a need to vomit
-commonly known as morning sickness
-occurs during 1st trimester
• Hyperemesis Gravidarum – severe nausea that is life-
threatening

MANAGEMENT:
• Eat dry crackers or dry toast before rising
• Eat small, frequent meals.
• Avoid foods with offensive odors
• Limit liquids at mealtime
CONSTIPATION

• MANAGEMENT:
• - Eating High-fiber foods
• -Getting Daily Exercise
• - Drinking 8 glasses of water each day
• -responding immediately to the urge to
defecate
HEARTBURN
• As the fetus grows, it pushes on the mother’s stomach, which
may cause stomach acid to move into the lower esophagus &
create a burning sensetion.

• MANAGEMENT:
• -Eating small, frequent meals
• -Avoid spicy & greasy foods
• -Limit liquids at mealtime
• -Waiting at least an hour after eating before lying down &
• -waiting at least 2 hours before exercising
 PREGNANCY- INDUCED HYPERTENSION
• - formerly called toxemia or preeclampsia
• -characterized by high blood pressure, presence of
albumin in the urine (PROTEINURIA) and edema
• - typically occurs during late pregnancy ( 3 rd trimester)
• -somewhat causes sudden increase in weight
• - can lead to ECLAMPTIC STAGE (convulsive stage of
toxemia) , comma & death of mother & child

• CAUSE: UNKNOWN … but occurs more frequently

among pregnant adolescents & pregnant women with
inadequate diet.
PICA
• - abnormal craving of nonfood
substance
• Some believe it relieves nausea.
• It should be discouraged because it
can cause blockage of the colon &
create nutritional deficiencies.
 ANEMIA
• - condition caused by an insufficiency of RBC , hemoglobin & blood
volume.

• Iron Deficiency is its most common form

• During pregnancy, the increased volume of blood creates the need
for additional iron for the hemoglobin of blood.

• Folate Deficiency can result in a form of megaloblastic anemia.

- characterized by too few RBC & immature RBCs
The body’s requirement for folic acid increases dramatically
when new RBCs are being formed.
Some Cautions for the Pregnant Woman

• Some choices that pregnant women make or substances they

encounter can harm the fetus, sometimes severely.
Cigarette Smoking
• A surgeon general’s warning states that parental smoking can kill
an otherwise healthy fetus or newborn.
• Nicotine and cyanide in cigarettes are toxic to the fetus
• Smoking limits the oxygen delivered to the fetus
• Can damage fetal chromosomes
• Risk of low-birthweight baby
• Increased risk of sudden infant death syndrome (SIDS)
• Even environmental tobacco smoke is unhealthy
Medicinal Drugs and Herbal Supplements

• Medicinal drugs taken during pregnancy

can cause serious birth defects.
• Herbal supplements have not been
adequately tested for safety or
effectiveness during pregnancy.
Drugs of Abuse
• Illicit drugs such as marijuana and cocaine
can cause serious health problems, including
nervous system disorders to the fetus.
• Infants born to mothers who use crack and
other forms of cocaine face low birth weight,
heartbeat abnormalities, the pain of
withdrawal or even death.
Environmental Contaminants

• Infants and young children of

pregnant women exposed to lead
show signs of delayed mental and
psychomotor development.
• Mercury in some fatty fish can
damage the developing brain and
nervous system of the fetus.
Food borne Illness
• Vomiting and diarrhea caused by
foodborne illnesses can leave a pregnant
woman exhausted and dangerously
dehydrated.
• Listeriosis can cause miscarriage, stillbirth,
or severe damage to the fetus.
– Pregnant women should avoid
unpasteurized cheeses, undercooked
meat, smoked meats.
Vitamin-Mineral Megadoses

• Many vitamins are toxic when taken

in excess, and minerals are even
more so.
– A single megadose of vitamin A
has caused birth defects.
Dieting
• Weight-loss dieting, even for short
periods, is hazardous during pregnancy.
• Low-carbohydrate diets or fasts that
cause ketosis deprive the fetal brain of
needed glucose and may impair its
development.
• Energy restriction during pregnancy is
dangerous, regardless of the woman’s
prepregnancy weight or the amount of
weight gained the previous month.
Sugar Substitutes

• Artificial sweeteners have been

studied extensively and found
to be acceptable during
pregnancy if used within the
FDA’s guidelines.
–Women with pheylketonuria
should not use aspartame.
Caffeine
• Research studies
– Have not indicated that caffeine (even in
high doses) causes birth defects in human
infants.
– Have found that moderate caffeine intake
(3 cups of coffee a day) during pregnancy
has no effect on infant birth weight or
length of gestation.
Drinking during Pregnancy

• Alcohol is the most hazardous

drug to future generations
because it is legally available,
heavily promoted, and widely
abused.
Drinking during
Pregnancy
 Alcohol’s Effects
• Women of childbearing age need to know about
alcohol’s harmful effects on a fetus.
• Alcohol crosses the placenta freely and is directly
toxic. Alcohol:
• Limits oxygen delivery to the fetus
• Slows cell division which can cause
abnormalities in organs
• Affects fetal brain cell division
• Interferes with nutrient transport to fetus
• Before fertilization, alcohol can damage the
ovum or sperm, leading to abnormalities in
the child
 Fetal Alcohol Syndrome

• Abstinence from alcohol is critical to

prevent irreversible damage to the
fetus.
• Fetal alcohol spectrum disorder
(FASD) is having a few of the
symptoms.
• Fetal alcohol syndrome (FAS) is at the
most severe end of the spectrum
when all symptoms are seen.
• A child with
Fetal Alcohol
Syndrome
 Gestational Diabetes
• Gestational diabetes is a pregnancy-related
form of diabetes.
– Usually resolves after delivery but some
women go on to develop type 2 diabetes.
– Can lead to fetal or infant sickness or
death.
– More commonly leads to surgical birth and
high infant birth weight.
– All women are screened for this during the
first trimester.
 Preeclampsia
• Hypertension in pregnancy may
signal the onset of preeclampsia, a
condition characterized by high
blood pressure, protein in the
urine and edema (especially in the
hands and face).
• Affects all the mother’s organs and
can progress to eclampsia, which
can be fatal.
for Li$tENiNg