Nutrition In Pregnancy

Dr.Anupama
 Objectives
 Integrating Nutrition Into the Obstetric History
 Maternal Weight Gain Recommendations
 Maternal Weight Gain Recommendations for Special
Population
 Maternal Nutrient Needs: Current Recommendations
 Vitamin and Mineral Supplementation Guidelines
 Nutrition-Related Problems During Pregnancy
 Special Nutritional Considerations During Pregnancy
Important steps to a healthy pregnancy
include
 Eating a balanced diet
 Gaining the right amount of weight
 Enjoying light regular physical activity
 Taking a vitamin and mineral supplement if
recommended by a physician
 Avoiding alcohol, tobacco and other harmful
substances.
 Good nutrition is an important component of a healthy
lifestyle and a healthy baby
 The best time to review the nutritional status to make
appropriate changes is prior to conception
 A very important time of fetal development is during the
first several weeks of pregnancy as all of the major fetal
body systems are undergoing formation and rapid
development
 Many women may not even realize they are pregnant at
this time.
 Therefore it is prudent to make your lifestyle and
nutritional changes several months before conception
occurs
 INTEGRATING NUTRITION
INTO THE OBSTETRIC HISTORY
 Purpose
 To identify the quality of a patient’s diet
 To assess any nutritional risk factors that could
jeopardize her health or the health of her developing
baby.
 Nutritional assessment
How to do Nutritional
Assessment
 Medical history -nutritional deficiencies And Chronic diseases with
nutritional implications
 Weight status Gestational weight gain in previous pregnancies and
history of hyperemesis, gestational diabetes, anemia, and pica should
be determined
 Dietary intake appetite, meal patterns, dieting regimens, cultural or
religious dietary practices, dietary restrictions, food allergies, cravings,
and aversions
 Laboratory data should be reviewed. absorption, eating, and
metabolic disorders; infections; inflammatory bowel disease; diabetes
mellitus; phenylketonuria; sickle cell trait; and renal disease
 Nutritional counseling
 To be done prior to or during pregnancy
 This is a opportune time to encourage the development of
good nutrition and physical activity practices
 To prevent future medical problems such as obesity,
diabetes, hypertension, and osteoporosis.
 Pregnant women found to be at risk may benefit from a
referral to a registered dietitian
 About 75% of pregnant females in India are underweight &
anaemic.
 Anaemia thus remains a major cause of maternal & fetal
morbidity,mortality and low birth weight.
 Too early, Too close, Too many, Too late conception also
adversely affect the health status (nutritional status) of the
females.
 Another indirect important factor is Gastro-intestinal
Infections,Infestations, which are heralded further with under-
nutrition, setting up a vicious cycle.
SITUATIONS IN WHICH CONSULTATION WITH
A REGISTERED DIETITIAN IS ADVISABLE
 Pregnancy involves multiple gestations (twins, triplets).
 Gestations are frequent (less than a 3-month interpregnancy interval).
 Tobacco, alcohol, or drug use (chronic medicinal or illicit) is occurring.
 Severe nausea and vomiting (hyperemesis gravidarum) is a problem.
 Eating disorders are present, including anorexia, bulimia, and compulsive eating.
 Weight gain is inadequate during pregnancy.
 Pregnancy occurs in adolescence.
 Eating is restrictive (vegetarianism, macrobiotic, raw food, vegan).
 Food allergies or food intolerances are present.
 Gestational diabetes mellitus (GDM) or history of GDM is involved.
 Patient has a history of low-birthweight babies or other obstetric complications.
 Social factors are present that may limit appropriate intake (e.g., religion, poverty).
Weight gain in Pregnancy
 Guidelines were made to address many issues regarding the role of
nutrition in pregnancy.
 In 1990 the Institute of Medicine (IOM) first published
recommendations on weight gain during pregnancy
 Obesity rate has surged in recent decades. In 2009, the IOM
updated the 1990 guidelines regarding weight gain
 2009 guidelines emphasize that women begin pregnancy at a healthy
weight.
 Consuming healthy food is the goal to meet the IOM gestational
weight guidelines and address the individual needs of the patient.
 T he 2009 IOM guidelines are based upon the World Health
Organization (WHO) classifications to define underweight, normal
weight, overweight, and obese patients
Physiological changes in Pregnancy
 Distribution
of weight gain
Components of Average Weight Gain in a
Normal Singleton Pregnancy Weight
RECOMMENDATIONS FOR WEIGHT GAIN
DURING PREGNANCY BY PREPREGNANCY
BODY MASS INDEX (BMI)
Weight gain
MATERNAL WEIGHT GAIN
RECOMMENDATIONS FOR
SPECIAL POPULATIONS
 Multiple Gestations
 PROVISIONAL GUIDELINES FOR WEIGHT GAIN WITH TWIN PREGNANCIES
MATERNAL NUTRIENT
NEEDS: CURRENT
RECOMMENDATIONS
IMPORTANT NUTRIENTS FOR
PREGNANCY
 Folate
 Iron
 Calcium
 Vitamin D
 Vitamin A
 Omega Fatty Acid
 Essential Amino Acids from protein sources
 Calorie providing Food(Carbohydrate and Fats in
proper ratios)
Why is it important in pregnancy?
 Needed to reduce risk of :-
 Neural tube defects Congenital heart defects, Cleft lips,
Limb defects
 Urinary tract anomalies
 Preterm delivery
 Infant low birth weight
 Fetal growth retardation
Folate
 400 micrograms of synthetic folic acid daily from
fortified foods and/or supplements has been
suggested for all non-pregnant women, in order to
have adequate folic acid intake even in case of
unplanned pregnancies.
 Ideal to start before conception occurs. It is
hypothesized that the insulin-like growth factor 2
gene is differentially methylated and these changes
in IGF2 result in improved intrauterine growth and
development.
Rich sources of folate

 Leafy vegetables - spinach, asparagus, turnip greens, lettuce

 Legumes - dried or fresh beans, peas and lentils
 Egg yolks
 Bakers yeast
 Fortified grain products (pasta, cereal, bread)
 Breakfast cereals (ready-to-eat and others)
 Sunflower seeds
 Liver and liver products
 Kidney
 IRON

 Why is it important in pregnancy ?

 Pregnancy causes a surge in the volume of blood in the body; the
expanded volume may go up by 50%.
 To meet the demands of the increased blood volume, iron
requirements go up significantly
 Iron is also required for the normal development of the growing
baby and the Placenta.
Iron requirements in pregnancy
 Go up from 18 to 27-30 mg per day.
 Because iron is not easily absorbed from the diet, it is
recommended to take an iron supplement
 Risk profile of an anaemic mother includes
 Preterm birth
 Low birth weight
 Increased blood loss during and after labour
 Depleted stores.
ELEMENTAL IRON DOSE

 According to Government of India (GOI)

 100mg of elemental iron and 500mcgs of folic acid
should be taken for 100 days during pregnancy
 IFA also given in lactation period
Calcium
 Why is it important during pregnancy
 Total calcium concentration falls because of physiologic
hypoalbuminemia
 Free ionized calcium concentration does not change (9-11gm
%)
 The placental produces 1,25-dihydroxyvitamin D, which
results in increased intestinal absorption of calcium
 Calcium is actively transported across the placenta to the
fetus, facilitated by parathyroid hormone-related peptide
RICH SOURCES OF CALCIUM
 Dairy foods - Milk, yogurt, Cheese, Cottage Cheese, Rasgullas.
 Leafy & Green vegetables - Broccoli, Spinach, Okra, Horseradish,
Watercress
 Fruits - Oranges, Bananas.
 Beans and Peas – Red kidney beans, Soyabean, Cabbage, Celery
 Tofu, Peanuts, Peas, Black Beans, Baked Beans
 Fish - Salmon, Sardines
 Miscellaneous - Sesame Seeds, Blackstrap Molasses, Corn, Almonds,
Brown Sugar.
 Fortified foods
 Vitamin D
 It helps the body to use calcium that is consumed.
 Maintain blood calcium & phosphorous levels.
 Anti proliferative action.
 RECENT STUDIES INDICATE INCREASED
RISK OF AUTISM IN INFANTS WITH VIT. D
DEFICIENCY
 Sources of Vitamin D
 Sunlight exposure
 Fish - Salmon, Tuna, Flounder, Sole.
 Milk
 Cereal
 Pork
 Mushrooms
 cod liver oil
 Vitamin A
 Need enough for healthy growth
 Too much can cause birth defects
 Formation of Rhodopsin, essential for normal vision 
Glycoprotein synthesis (epithelial cell function)
 Maintain normal skin health by switching on genes and
differentiating keratinocytes (immature skin cells) into mature
epidermal cells.
 Regulates gene transcription.
 Anti Oxidant action.
Sources of vitamin A
 Liver (Beef, Pork, Chicken
 Cheddar Cheese
 Melon
 Cod Liver Oil
 Carrots
 Papaya
 Broccoli Leaf
 Mango
 Sweet Potato
 Butter
 Broccoli
 Spinach
 Milk
 Pumpkin

 Amino Acid
 They serve as building blocks of proteins.
 Used in production of DNA, Cell membrane, Haemoglobin,
Receptors, Enzymes, Neurotransmitters, Hormones,
Antibodies & other Bioactive molecules
 Serve as body store of energy after fat stored in adipose tissue.
Omega 3 fatty acids
 Are fats commonly found in marine and plant oils
 They are considered essential fatty acids, meaning that
they cannot besynthesized by the human body but are vital
for normal metabolism.
 Mammals cannot synthesize omega−3 fatty acids, they
have alimited ability to form the long-chain omega−3 fatty
acids including Eicosapentaenoic Acid Acid
Docosahexaenoic Acid Acid α-Linolenic Acid
 DHA is important for development of the central
nervous system in all mammals
 There is an enormous growth spurt in the human
brain during the last trimester of pregnancy and the
first postnatal months, with a large increase in the
cerebral content of Arachidonic Acid (AA) and
DHA.
 The fetus and the newborn infant depend on a
continual maternal supply ofDHA and AA.
 Carbohydrates
 Principle energy yielding food.
 Digestible Carbs’ – Sugars & Starches. Carbs‘
 Indigestible Carbs’ – Cellulose, Hemicellulose, CarbsGum,
Pectin, Lignin
 Foods with carbohydrates in them have a wide range of effect
on the blood glucose levels, during digestion. This is known as
the ‘Glycaemic Response’ ‘Glycaemic Index’ is the effect of
carbs on the blood glucose levels
 . Rapidly breaking down carbs have high GI, and vice versa.
 Fats
 FAT IS ESSENTIAL FOR VITAMIN ABSORPTION
 Fats act as carriers for fat-soluble Vitamins such as A,
D, E and K.
 Vitamin D Helps Keep Bones And Teeth Healthy.
 Vitamin E Protects Cell Membranes By Acting As An
Antioxidant
 Vitamin K Helps Wounds Heal Properly As It Helps
With Blood Clotting And Also Helps Build Strong
Bones
Recommend daily dietary allowances
Additional requirements in Pregnancy and
lactation
WHO-recommended quantities of minerals
and vitamins per day during pregnancy
 Daily dietary allowances for a woman of
reproductive age, pregnancy and lactation
NUTRITION-
RELATED
PROBLEMS
DURING
PREGNANCY
STRATEGIES FOR MANAGING NAUSEA,
VOMITING, HEARTBURN, AND INDIGESTION IN
PREGNANCY
MANAGING CONSTIPATION IN
PREGNANCY
Conclusion
 Pregnant mother are encourage to get a balance diet to ensure
sufficient nutrients for fetal growth and development.
 Those extra nutrients that essential included extra energy,
protein (iron, zinc), healthy fat (omega-3 fatty acids), variety
vegetables and fruits (folate, vitamin B, vitamin C) milk
(calcium) and adequate fluid intake
 Reduce unhealthy food choices such as high refined sugar
beverage/ foods (empty nutrients dense calorie), high saturated
fat (deep-fried foods, coconut milk) and salty foods (processed,
preserved and canned foods)