HND 301: APPLIED NUTRITION

NUTRITION DURING PREGNANCY

DR. O.O.KAYODE
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 INTRODUCTION 1/4
• We need essential amino acids, carbohydrate,
essential fatty acids, vitamins and minerals to sustain
life and health. However, nutritional needs vary from
one life stage to another.

• During intrauterine development, infancy, and

childhood, for example, recommended intakes of
macronutrients and most micronutrients are higher
relative to body size, compared with those during
adulthood. In elderly persons, some nutrient needs
(e.g., vitamin D) increase, while others (e.g., energy
and iron) are reduced.
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 INTRODUCTION 2/4
• The National Academy of Sciences has published
recommendations for Dietary Reference Intakes (DRI)
that are specific for the various stages of life.

• It should be noted, however, that the DRIs are not

designed for individuals who are either chronically ill or
who are at high risk for illness due to age, genetic, or
lifestyle factors (e.g., smoking, alcohol intake,
strenuous exercise).
• Clinicians must make their own judgments

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 INTRODUCTION 3/4
• Nutrition challenges continue throughout the life
cycle.
• Poor nutrition often starts in utero and extends,
particularly for girls and women, well into adolescent
and adult life. It also spans generations.
• Undernutrition that occurs during childhood,
adolescence, and pregnancy has an additive
negative impact on the birth weight of infants.
• Low-birth weight (LBW) infants who have suffered
intrauterine growth retardation (IUGR) as fetuses are
born undernourished and are at a far higher risk of
dying in the neonatal period or later infancy .
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 INTRODUCTION 4/4
• If they survive, they are unlikely to significantly catch
up on this lost growth later and are more likely to
experience a variety of developmental deficits.

• A low-birthweight infant is thus more likely to be

underweight or stunted in early life.

• By making wise nutrition and diet choices throughout

the life cycle, the quality and quantity of one’s life
may improve.

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 NUTRITION DURING PREGNANCY
• A woman’s nutritional status before and during
pregnancy affects not only her own health but also the
health and development of her baby.
• If a woman is underweight before becoming pregnant
or fails to gain sufficient weight during pregnancy, her
chance of having a premature or low-birth-weight
infant is increased.
• Overweight women, on the other hand, have a high
risk of complications during pregnancy, such as high
blood pressure (hypertension) and gestational
diabetes, and of having a poorly developed infant or
one with birth defects.
• Weight loss during pregnancy is never recommended. 6
• Recommended weight gain during pregnancy is 11.5 to 16 kg
for a woman of normal weight—slightly more for an
underweight woman and slightly less for an overweight woman.
• At critical periods in the development of specific organs
and tissues, there is increased vulnerability to nutrient
deficiencies, nutrient excesses, or toxins. For example,
excess vitamin A taken early in pregnancy can cause brain
malformations in the fetus.
• One important medical advance of the late 20th century
was the recognition that a generous intake of folic acid
(also called folate or folacin) in early pregnancy reduces
the risk of birth defects, specifically neural tube defects
such as spina bifida and anencephaly (partial or complete
absence of the brain), which involve spinal cord damage
and varying degrees of paralysis, if not death
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• Overall nutritional requirements increase with
pregnancy. In the second and third trimesters,
pregnant women need additional food energy—
about 300 kilocalories above nonpregnant needs.

• Most additional nutrient needs can be met by

selecting food wisely, but an iron supplement (27
milligrams per day) is usually recommended during
the second and third trimesters, in addition to a folic
acid supplement throughout pregnancy. Other key
nutrients of particular concern are protein, vitamin D,
calcium, and zinc.

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• Heavy alcohol consumption or “binge drinking”
during pregnancy can cause fetal alcohol syndrome,
a condition with irreversible mental and physical
retardation.
• Even lighter social drinking during pregnancy may
result in milder damage—growth retardation,
behavioral or learning abnormalities, or motor
impairments—sometimes described as fetal alcohol
effects
• Caffeine consumption is usually limited as a
precautionary measure, and cigarette smoking is not
advised under any circumstances. Limiting intake of
certain fish, such as swordfish and shark, which may
be contaminated with methylmercury, is also
recommended. 9
• Pregnant women have increased requirements for both
macronutrients and micronutrients. The failure to achieve
required intakes may increase risk for certain chronic
diseases in their children, sometimes manifesting many
years later.
• A well- nourished average size woman is expected to gain
weight in the range of 11.5 to 16kg during pregnancy, a low
weight woman is expected to higher weight up to 18kg while
an 0bese person should gain less, not more than 8kg.
• The weight gain consist of:
- Weight of the foetus, amniotic fluid and placenta
- Weight of the uterus, the support muscles, and blood
supply
- Increase in the weight of the mother’s breasts and
body fluids
- Increase in body fat to provide energy for lactations 10
 Protein Need during Pregnancy
• Protein requirements in pregnancy rise to 1.1
g/kg/day to allow for fetal growth and milk
production. The source of protein may be as
important as the quantity, however. Some evidence
suggests that protein requirements can be more
safely met by vegetable than by animal protein.
• Pregnant women also should not meet their
increased need for protein by the intake of certain
types of fish, such as shark, swordfish, mackerel,
and tilefish, which often contain high levels of
methylmercury, a potent human neurotoxin that
readily crosses the placenta.
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 CARBOHYDRATE NEED
• Based on the DRIs, a pregnant woman requires
about 175 grams of carbohydrates daily. This
amounts to about 700 calories’ worth of
carbohydrates daily (175 grams of carbohydrates × 4
carbohydrate calories per gram = 700 daily calories).
At least half of these carbohydrates should be from
whole grains for fiber and nutrients. The Adequate
Intake (AI) for fiber for pregnant women is 28 grams
daily

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 Calcium
• Calcium helps build the baby’s bones and
regulates body’s use of fluids.
• Pregnant women need at least three servings of
calcium per day.
• In pregnant teens, the recommendation is five
servings. Good sources of calcium include:
• milk
• yogurt
• cheese
• cabbage
• tofu
• eggs 13
 Folate
• Folate, also known as folic acid, plays an important part in
reducing the risk of neural tube defects.
• These are major birth defects that affect the baby’s brain and
spinal cord, such as spina bifida and anencephaly.

• Pregnant women need 600 to 800 micrograms of folate.

Sources include:

• liver
• nuts
• dried beans and lentils
• eggs
• nuts and peanut butter
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• dark green leafy vegetables
 Iron
• Iron works with sodium, potassium, and water to increase blood
flow. This helps ensure that enough oxygen is supplied to both
mother and baby.

• Pregnant women needs 27 milligrams of iron per day. Good

sources of this nutrient include:

• dark green, leafy vegetables

• citrus fruits
• enriched breads or cereals
• lean beef and poultry
• eggs
• dried fruits
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 Gastrointestinal Disturbances
• Due to the hormonal changes of pregnancy, the smooth
muscles that line the gastrointestinal tract relax and
movements slowdown, which may cause constipation.
This condition is worsened by iron supplements and
inadequate fluid intake. Adequate fiber and fluid intake and
regular activity help to stimulate the gastrointestinal tract.
• As the fetus grows inside the mother’s womb in the last
trimester, the uterus pushes upward into the mother’s
abdomen and causes pressure on her stomach. Stomach
acid may back up into the esophagus, causing rebound
acidity, or heartburn. Rather than take antacids, a
pregnant woman should consume smaller meals, avoid
spicy and/or fatty foods, and avoid lying down after meals.
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 Gestational Diabetes

• Midway through pregnancy, many health providers

test pregnant women for gestational diabetes, a form
of Type II diabetes that may disappear once
pregnancy is completed.
• Sometimes women with gestational diabetes must
inject insulin until their blood sugar returns to normal
after birth. Women who have experienced gestational
diabetes may be more likely to develop Type II
diabetes later in life.
• Women with a family history of diabetes should
monitor their weight gain and manage their food and
beverage intake, especially carbohydrates.

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 Morning Sickness
• Morning sickness is a condition that can happen at
any time of day, but it frequently occurs early in the
morning. It can range from general ill feelings to
nausea and vomiting.
• Morning sickness often occurs at the start of
pregnancy and disappears by the second trimester.
It may be so intense that it leads to weight loss and
necessitates bed rest.
• Some women go through pregnancy without any
morning sickness. Others may have extreme cases
that may require hospitalization. Taking dry crackers,
control cooking odors can help minimize morning
sickness. 18
 Pregnancy-induced Hypertension
• When pregnant women gain weight rapidly after the fifth month
of pregnancy, this may be a sign of pregnancy-induced
hypertension (PIH), or preeclampsia. This condition is
characterized by edema, swelling that is caused by fluid
trapped within body tissues. Edema occurs most often in the
ankles, feet and legs.
• Abnormal liver function, hypertension and protein “spillage” in
the urine characterize preeclampsia. If preeclampsia worsens, a
woman could suffer convulsions. This condition is called
eclampsia and may lead to coma and/or death.
• Excessive sodium intake, teenage pregnancy, pregnancy over
35 years of age, multiple fetuses (as in twins or triplets), and a
family history of diabetes or hypertension may predispose a
woman to PIH.
• Blood pressure should be monitored regularly throughout
pregnancy. A family history of hypertension and pregnancy-
induced hypertension should be disclosed to health 19care