Chapter 15, Nutrition, Mothers

Front 1

How important is nutrition early in pregnancy? What is an example of an early defect?

Back 1

Some deficiency related problems develop very early in pregnancy

Neural tube defects:(which becomes the brain and spinal cord)
•Related to inadequate level of folate
•Effects the embryo in the first few weeks
•Adequate folate(400 μg daily) before conception can reduce the risks

Front 2

What does a health diet before conception include?

Back 2

Avoiding teratogens: substances that cause birth defects
•Includes alcohol and drugs
•Avoiding other possible hazards
•Smoking, caffeine, medications, some herbs and supplements

Front 3

Which nutrition related disorders are developed during pregnancy?

Back 3

Gestational diabetes
•Pre-eclampsia(pregnancy-induced hypertension)

Front 4

Trimester

Back 4

Any of one of three stages of pregnancy, each lasting 13-14 weeks

Front 5

How long is a full term pregnancy? first trimester? second?third?

Back 5

term pregnancy lasts 38 –42 weeks:
•1st trimester: conception to 13th week
•2nd trimester: 14th to 27th week
•3rd trimester: 28th to 40th week

Front 6

Embryonic stage:

Back 6

day 15 to the 8th weekAfter the 8th week, the developing baby is called a fetus.

Front 7

1st trimester: zygote? development? vulnerabilitY?

Back 7

Zygote(fertilized egg) travels through the fallopian tube and is implanted in the wall of the uterus
•Development of organs, limb buds, facial features, placenta
•Embryos are extremely vulnerable to teratogens during this time

Front 8

Fetus:

Back 8

human growth and developmenta; stage lasting from the beginning of the 9th week after conception till birth.

Front 9

Umbilical cord:

Back 9

the cord containing arteries and veins that connect the baby )from the navel) to the mother via the placenta.

Front 10

2nd trimester: development? growth?

Back 10

Continued development of organ systems
•Growth from 3 inches to over a foot long by the end of the 2nd trimester

Front 11

3rd trimester:

Back 11

Time of considerable growth
•Fetus gains ¾ of its weight in this time
•Brain growth is also extensive
•Lungs become fully mature
•A balanced, adequate diet for the mother is essential during this time

Front 12

Low birth weight:

Back 12

a baby born weighing less than 5.5

Front 13

What else does bad nutrition increase?

Back 13

Increased risk of infections, learning disabilities, impaired physical development, and death in the 1st year

Front 14

Preterm:

Back 14

Babies are born before 38 weeks and may be low-birth weight babies.

Front 15

Weight gain during pregnancy

Back 15

Women who do not gain enough weight are at risk of having a low-birth weight baby.
•Too much weight gain is also risky.
•Women should not diet during pregnancy since this may deprive the fetus of critical nutrients.

Front 16

Pregnant women must pay attention to their intake of:

Back 16

Macronutrients
•Micronutrients
•Fluids

Front 17

How much should pregnant women increase their energy intake in the 2nd and 3rd?

Back 17

An additional 300 kcal/day may be required in the 2ndand 3rdtrimesters
•Nutrient-dense foods are essential in order to obtain sufficient nutrients

Front 18

What should the increase of Protein and carbs be?

Back 18

- 60 grams/day of protein
•130 grams/day of carbohydrates

Front 19

Fat requirements?

Back 19

The percentage of calories obtained from fat should not change during pregnancy.
•Limit saturated fat, avoid trans fats
•Consume a source of docosahexaenoicacid (DHA)for fetal brain growth (fatty fish)
•Fat is required by the newborn for temperature regulation and as an energy source

Front 20

Which micronutrients are most critical during pregnancy? (10)

Back 20

folate:
calcium
vitamin B12
iron
vitamin C
zinc
vitamin A
sodium
vitamin D
iodine

Front 21

Folate: why? requirements? when is it critical?

Back 21

Required for cell division
•Critical in the first 28 days for development of the neural tubewhich becomes the brain and spinal cord
•400 μg/day for sexually active women
•600 μg/day for pregnant women

Front 22

Vitamin B12

Back 22

Regenerates the active form of folate
•2.6 μg/day during pregnancy
•Deficiency could be an independent risk factor for neural tube defects

Front 23

Vitamin C

Back 23

Production of collagen, a component of connective tissue
•85 mg/day during pregnancy
•Deficiency results in infections, preterm births

Front 24

Vitamin A

Back 24

Needs increase by 10% in pregnancy
•Excess vitamin A can cause abnormalities in fetal kidneys and nervous system

Front 25

Vitamin D

Back 25

AI does not increase during pregnancy
•Excessive vitamin D can cause developmental disabilities in newborns

Front 26

Calcium

Back 26

1000 mg/day, same as for nonpregnant women
•Pregnant women absorb calcium better

Front 27

Zinc

Back 27

Critical for making proteins, DNA, RNA
•Need increases 38% during pregnancy

Front 28

Iron

Back 28

Increased need for red blood cells increases the need for iron by 50%
•Fetal need for iron increases in 3rd trimester
•Fetus will take iron from mother causing iron-deficient anemia

Front 29

Sodium

Back 29

1500 mg/day, same as for nonpregnant women

Front 30

Iodine

Back 30

Need for iodine increases significantly
•220 μg/day can be obtained from iodized salt

Front 31

How does the fluid need increase during pregnancy? why?

Back 31

3 litres per day for
•Increase in the mother’s blood volume
•Regulating body temperature
•Production of amniotic fluidto protect and cushion the fetus
•Combat fluid retention and constipation
•Prevent urinary tract infections

Front 32

Morning sickness:

Back 32

nausea and vomiting associated with pregnancy.
•Can occur at any time; often lasts all day
•May begin after the 1st missed period and last 12 to 16 weeks
•High levels of 2 pregnancy hormones may be the cause
•No cure, but symptoms can be reduced by:
- eating lightly
- small snacks at night
- prenatal supplement
- lots of fluids

Front 33

Craving and aversions:

Back 33

Most women crave a certain type of food (sweet, salty) rather than a specific food.
•Little evidence supports the idea that cravings indicate a deficiency.
•Pica: craving a non-food item (ice, clay).
•Food aversions are common, but not universal among pregnant women.

Front 34

Heart burn

Back 34

Heartburn occurs when the sphincter above the stomach relaxes, allowing stomach acid into the esophagus.
•Hormones in pregnancy relax smooth muscles, thereby increasing heartburn.
•Enlargement of the uterus pushes up on the stomach and compounds the problem.

Front 35

Constipation and hemorrhoids

Back 35

Pregnancy hormones that cause smooth muscle to relax also slow the movement of material through the large intestine.
•Hemorrhoids: swollen varicose veins in the rectum that are caused by or exacerbated by constipation.
•Reduce constipation by consuming 25-35 g/day of fibre and plenty of fluids.

Front 36

Gestational diabetes:

Back 36

insufficient insulin production or insulin resistance that increases blood glucose levels during pregnancy.
•Condition resolves after birth occurs
•Risk of delivering a large baby
•Uncontrolled blood glucose levels may lead to pre-eclampsia

Front 37

Preeclampsia

Back 37

pregnancy-induced hypertension.
•Can be fatal to mother and fetus if left untreated
•Deficiencies in vitamin C, vitamin E, and magnesium increase the risk
•Treatment focuses on managing blood pressure and often includes bed rest
•The only cure is childbirth

Front 38

Adolescent Pregnancy

Back 38

Nutritional needs of pregnant adolescents are higher than those of adult women
•Adolescent bodies are still growing and changing, adding to the nutritional needs of pregnancy
•Pregnant adolescents are more likely to have preterm babies, low-birth weight babies, and other complications

Front 39

Vegetarianism

Back 39

A vegetarian consuming eggs and dairy products has the same nutritional concerns as a non-vegetarian

A complete vegetarian (vegan) must carefully watch her intake of:
vitamin D
calcium
vitamin B6
iron
vitamin B12
zinc

Front 40

Dieting

Back 40

Dieting to lose weight is not advisable during pregnancy.
•Calorie restriction limits nutrient availability for the mother and the fetus.
•Fad diets are often unbalanced in macronutrients and micronutrients.

Front 41

Consumption of Caffeine

Back 41

Caffeine is a stimulant that crosses the placenta and reaches the fetus.
•Health Canada recommends pregnant women limit caffeine consumption to 300 mg per day from all sources (approx. two 250 mL cups of coffee).
•Greater than two cups of coffee may slightly increase the risk of miscarriage and low birth weight.

Front 42

Alcohol:

Back 42

Alcohol is a known teratogen that crosses the placenta and is associated with various birth defects

Front 43

Fetal Alcohol Sprectrum Disorder (FASD):

Back 43

a variety of disabilities and birth defects associated with prenatal exposure to alcohol.
•Malformations of face, limbs, heart
•Many developmental disabilities

Front 44

Food borne illnesses

Back 44

Listeriosiscan cause miscarriage or still birth.
•Toxoplasmosiscan cause a severe infection in the fetus.
•Pregnant women need to practice safe food handling techniques.
•Advised to see physician if flu-like symptoms develop to rule out a food-borne illness

Front 45

Exercise:

Back 45

Keeps a woman physically fit
•Is a great mood booster
•Helps compensate for an increased appetite
•Helps keep blood pressure down
•Makes it easier to lose weight after the pregnancy

Front 46

Lactation

Back 46

production of breast milk.

Front 47

Prolactin

Back 47

hormone responsible for the synthesis of milk.
•Produced toward the end of pregnancy
•Suppressed by estrogen and progesterone until childbirth

Front 48

Colostrum

Back 48

first milk produced; rich in proteins, antibodies, vitamins, minerals.
- helps infants expel meconium: first stool

Front 49

Steps in breast feeding (4)

Back 49

1. Suckling stimulates nipple
2. Nerves send message to hypothalamus
3. Hypothalamus sends message to pituitary
4. Pituitary gland releases prolactin, which stimulates milk production and oxytocin, which stimulates milk release

Front 50

What are the nutrition requirements for breast feeding

Back 50

Milk production requires 700 –800 kcal/day
•Lactating women should consume an extra 500 kcal/day above their own needs.
•This allows a woman to gradually lose weight (1 –4 pounds per month).

Front 51

What are the benefits of breastfeeding?

Back 51

High quality nutrition
•Protection from allergies and infections
•Assisting the mother in weight loss
•Suppressing ovulation
•Opportunity for bonding
•Convenient, cost efficient

Front 52

Obstacles to breastfeeding include:

Back 52

Many harmful substances are passed into breast milk, including:
•Illegal drugs, caffeine, nicotine, prescription and over-the-counter medications
•HIV is passed through breast milk
•Conflicts with mother’s employment

Front 53

Infant nutrition: why so critical?

Back 53

NutritionOptimal nutrition is critical in the first year because
•The baby’s organs are developing
•The nervous system continues to develop
•Babies typically grow 10 inches in length and triple their weight in the 1st year

Front 54

Why are infants needs so unique? (3)

Back 54

•Their energy needs are high to support rapid growth
•Their digestive tracts and kidneys are still immature
•They are small in size

Front 55

What do infants need? how many cals? how many calories from fat? protein? fluid?

Back 55

50 kcal per pound of body weight /day
•At least 40% of calories from fat
•No more than 20% of calories from protein
•2 ounces of fluid per pound of body weight

Front 56

How long should infants be breastfeed for? when should sloid food be given?

Back 56

Breast milk or formula should be supplemented with solid food beginning at around 6 months

Front 57

What should infants not eat?

Back 57

Foods they could choke on
•Corn syrup or honey
•Goat’s milk
•Cow’s milk
•Large quantities of fruit juice
•Too much salt or sugar
•Too much breast milk or formula

Front 58

What are nutrition related concerns?

Back 58

Allergies
•Dehydration
•Colic
•Anemia
•Nursing bottle syndrome
•Lead poisoning

Front 59

Allergies:

Back 59

Solid food should be introduced one at a time for a week to watch for allergies

Front 60

Dehydration

Back 60

Extremely dangerous for infants
•Caused by diarrhea, vomiting, inadequate fluid intake
•Pediatric electrolyte solution may be used

Front 61

Colic

Back 61

Uncontrollable crying that can last for hours
•Precise cause is unknown

Front 62

Anemia

Back 62

Infants are born with enough iron for only 6 months
•Anemia can develop after that

Front 63

Nursing Bottle Syndrome

Back 63

Leaving an infant alone with a bottle can lead to cavities and tooth decay
•Rather than a bottle, begin using a cup by 8 months and no bottle after 18 months

Front 64

NutritionLead poisoning

Back 64

Especially toxic to infants since the brain and nervous system are still developing
•Results in reduced mental capacity, behavioral problems, impaired growth
•Remove old lead-based paint
•Allow tap water to run a minute before use to discard lead leached from pipe