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59 Cards in this Set

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Pre-pregnancy Weight
BMI 18.5 – 24.5
Underweight women who fail to gain weight during pregnancy will have a low-birth-weight (LBW) baby, which is <5 ½ lb or 2500 g
Low Birth Weight Infants
Indicator of poor nutrition status of mother before &/or during pregnancy;
Influenced by: food intake, heredity, disease conditions, smoking, alcohol use & drug abuse
Results in:
o High risks of mortality (40x in 1st y);
o Lower adult IQ,
o Educational disadvantage,
o Short stature,
o High risk for chronic diseases in later life
Premature Babies
Born early but right size for gestational age
SGA Babies
Small for gestational age
Small for date; may/may not be premature
Overweight Women & Pregnancy
Strive for healthy weight before pregnancy to minimize medical risks for would-be mother & her future child
Infant is large, even if born prematurely; so special medical care needs not given or recognized
2x risk for neuro-tube defects but the reasons WHY are unknown
Risks for gestational diabetes, hypertension, infections after birth
Surgical Caesarian-section; may require drugs to induce labor
Greater risk of giving birth to infants with heart defects & other abnormalities
What is macrosomia
Birth after birth babies get larger and larger
Men and Pregnancy
Need for a healthy sperm - provides half of child’s inheritance
• Limited evidence of low fertility or genetic material damage due to
o Too few fruits and vegetables consumed
o Sedentary lifestyle
o Too much alcohol: may damage sperm’s genetic material
o Smoking: environmental tobacco smoke (ETS, second-hand smoke) affects fetus
Placenta
• Active, metabolic organ
• Supplies nutrients, hormones, and oxygen to the fetus – maintains pregnancy
• A means for waste removal from the fetus
• Prepares mother’s breast for lactation
Umbilical Cord and Cord Blood
Umbilical Cord
• A pipeline from the placenta to the fetus
Cord Blood
• Can be used for stem cell research
Uterus
Supports implantation of fertilized ovum & growth of placenta
Critical Periods During Pregnancy
Nutrients must be supplied on time
Heart & brain – 14 weeks
Lungs - 24 weeks
Damaging effects irreversible
Even one alcohol containing drink during a critical period can seriously impair development
Zygote
Fertilized ovum embeds itself in the uterine wall within two weeks Placenta begins to grow
Malnutrition, smoking, drug abuse may lead to failure to implant, NTDs, loss of zygote
Embryo
At 8 weeks the fetus has complete central nervous system, beating heart, fully formed GIT, well-defined fingers & toes, beginning facial features
In last 7 months fetus grows 50x heavier & 20x longer
Critical periods of cell division & development occur in all organs
Increased Energy Needs During Pregnancy
370 additional calories in 2nd trimester
450 additional calories in 3rd trimester
Best if met by adding 2 healthy snacks or 1 additional meal
To meet calories and nutrient needs, select more nutrient-dense foods such as whole grain breads & cereals, legumes, dark green leafy veggies, citrus fruits, low-fat milk products, lean MFP
Carbohydrates During Pregnancy
Fetus
Fuel for fetal brain
Spare protein for fetal growth
Mother
Fiber helps with constipation
Normal people need 130 grams/day
Preggo people need ideally 175 grams/day or more
Protein During Pregnancy
DRI higher by 25 grams/day
Canadian women’s intake already exceeds this
Protein supplements can be harmful, discourage its use
Vegetarian women should meet food energy & have generous servings of plant-protein foods
Legumes, tofu, whole grains, nuts & seeds
Fat During Pregnancy
Healthy Fats are important for brain development of the fetus, post-partum depression, etc.
Omega 6 and omega 3 fatty acids are needed
Folate & B12 During Pregnancy
Both are needed in large amounts for cell reproduction
Mothers need 600 ug folate/day from synthetic folic acid in supplements & fortified foods (better absorbed) in addition to eating folate-rich foods
Greater amounts of vitamin B12 needed to assist folate in manufacture of new cells
Vitamin B12 from meats, eggs, or dairy products
Vegans need B12 fortified foods or supplements
Folate and NTDs
The early weeks of pregnancy is the critical period for the formation & closure of neural tube (brain & spinal cord)
If tube fails to close properly, NTDs (spina bifida & anencephaly) may result
Calcium During Pregnancy
In final weeks of pregnancy, more than 300 mg/day of calcium is transferred to fetus
Adequate calcium intake aimed at conserving mother’s bone mass while supplying fetal needs
Magnesium During Pregnancy
Essential for bone & tissue growth
In great demand for normal development of bones & teeth in infant and sparing bones and teeth in mother
Iron During Pregnancy
Absorption increases 3x during pregnancy to about 30% - 40%
Daily iron supplement of 30 mg recommended during 2nd & 3rd trimesters
Fetus draws heavily on its mother’s iron to store 3-6 months supply after birth
Zinc During Pregnancy
Required for protein synthesis & cell development & sperm
Severe deficiency predicts low body weight
What do prenatal supplements provide more of?
Provides more folate, iron, calcium than regular versions
Canadian Recommended Weight Gain During Pregnancy
Underweight women (BMI <20) = 28-40 pounds; 12.5-18 kg
Normal-weight women (BMI 20-25) = 25-35 pounds; 11.5-16 kg
Overweight women (BMI >27) = 15-25 pounds; 7-11.5 kg
Ideal pattern of weight gain = 1.5 kg (3 ½ pounds) in 1st trimester & 0.5 kg (1 pounds) per week thereafter
Exercise & Pregnancy
Improves physical fitness; facilitates labor; helps prevent or manage gestational diabetes; reduces psychological distress
Swimming & water aerobics – water cools & supports body; provides natural resistance; lessens impact of body’s movement; reduces intensity of back pain
Stay out of saunas, steam rooms, hot whirlpools - prevent excessively high body temp, dehydration
Babies that have mothers that exercise during exercise have a leaner body mass
Smoking During Pregnancy
May cause placenta previa
Nicotine & cyanide are toxic to fetus
Restricts blood supply, leads to low body weight
Oxidants in cigarette smoke lower maternal intakes of fiber, vitamin A, B-carotene, folate, vitamin C
SIDS – observed even with second hand smoke (environmental tobacco smoke)
What is placenta previa?
The placenta slips over the cervix and may break & bleed
Life threatening for both mother and fetus
Alcohol During Pregnancy
Halts delivery of oxygen through umbilical cord – central nervous system development affected
Slows cell division - birth defects or abnormalities, especially facial characteristics
Major detrimental effect on growing fetal brain -brain damage
Interferes with placental transport of nutrients to fetus - LBW
Damages ovum or sperm -abnormalities in child
Fetal Alcohol Syndrome
Irreversible brain damage
Growth retardation
Mental retardation
Facial abnormalities
Vision abnormalities
Medicinal Drugs during Pregnancy
Aspirin, ibuprofen; may cause excessive bleeding during delivery
Herbal Supplements during Pregnancy
Unknown components pose danger; none have been tested for safety or effectiveness during pregnancy
Drug Abuse during Pregnancy
Marijuana or cocaine; impair fetal growth & development; low birth weight, heart abnormalities, nervous system disorders
Sugar Substitutes during Pregnancy
Aspartame or other sweeteners could replace nutrient-dense, energy-yielding foods
Women with PKU should not use products with aspartame
Caffeine during Pregnancy
Crosses the placenta; fetus has limited ability to metabolize it;
Limit consumption to 1 cup coffee or two 355 mg cola beverages
Dieting during Pregnancy
Hazardous during pregnancy
Low carbohydrate diets or fasts that cause ketosis impair development of fetal brain; energy restriction dangerous
Environmental Contaminants during Pregnancy: Fish
Pb, Hg, pesticides, PCBs in ocean fish (tuna, mackerel) may lead to impaired cognitive development, severe damage to fetal NS
Skipjack tuna is recommended for pregnant women, at about 1 – 2 cans a week … It contains less mercury because it is a smaller fish
If women are limiting their fish intake they could get fatty acids from eggs, flax seed, milk, nuts, avocado, olive oil
Food borne Illness During Pregnancy
Listeriosis (Listeria monocytogenes) can cause miscarriage, stillbirth, or severe brain infections
Diet Complaints during Pregnancy
“Morning” (or anytime) sickness due to hormonal changes; eat dry toast or crackers before getting up
“Hyperemesis gravidarum” – prolonged N & V; need medical attention
Constipation – consume high-fiber foods; drink plenty of fluids; exercise routine
Heartburn – have small frequent meals, no spicy or greasy foods
Gestational Diabetes
Resolves after infant’s birth
May lead to type 2 diabetes
Edema
Fluid retention late in pregnancy especially in lower legs
Toxemia
Pregnancy-induced hypertension (PIH) or pre-eclampsia; proteinuria
Whole body edema, especially swollen face & arms
Breastfeeding
Breastfeeding for 3 months or longer seems to have accelerated weight loss
Gradual loss of 1 lb/week is safe & does not reduce milk output
Breastfeeding burns some energy, but diet & physical activity are still cornerstones for weight control
Energy Needs for Lactation
Baby takes about 750 mL breast milk/day
Mom needs 500 calories to produce it in addition to meeting her own caloric needs
Eat extra 330 kcal/d; 170 kcal drawn from fat stores
Fluid Needs for Lactation
Mom needs about 13 c fluids/d to prevent dehydration
This can be via milk, juice or water after breastfeeding & at meals
Nutritional Deprivation During Lactation
Reduces quantity of breastmilk
Women produce milk with adequate protein, carbohydrate, fat & folate even when their supplies are limited
Milk quality maintained at expense of maternal stores
Baby benefits when mom’s diet is rich in fruits, vegetables, whole grains, adequate dairy, lean meats, and healthy fats
Infants tend to be sensitive to cow’s milk lactose/protein, garlic, onions, beans, peppers, and other common “gassy foods”
Alcohol & Breastfeeding
Enters breastmilk
Affects production, volume, composition, & ejection reflex
Alcohol concentration peaks within 1 hour
Overwhelms infant’s alcohol-degrading system; can become addicts by way of breastfeeding
Cigarettes & Breastfeeding
Produce less milk, of lower fat content
Infants gain less weight
Transfers nicotine & other chemicals via breastmilk
Infant exposed to second-hand smoke = poor growth, hearing impairment, vomiting, breathing difficulties, SIDS
Dyslexia, ADHD and overall poor brain development due to smoke
Caffeine & Breastfeeding
Excess makes baby jittery, fretful, wakeful
Medications & Breastfeeding
Some can be secreted in breast milk or suppress lactation
Oral Contraception & Breastfeeding
Combined estrogen-progestin may suppress milk output, lower nutrional content, shorten duration of breastfeeding
Progestin only has no affect
Maternal Illness & Breastfeeding
With common cold, ok to breastfeed With TB or hepatitis (but with appropriate treatment, ok to breastfeed
HIV/AIDS & Pregnancy
Transferable in pregnancy, at birth, or through breast milk
NO breastfeeding, if mother tests positive & safe alternatives available such as formula supply & clean, safe water
Feeding Babies
Birth weight – doubles at 5 months; triples at 1 year
BMR – remarkably high; 2x of an adult, based on body weight
Early nutrition - affects growth & later development
Nutrient Needs in the First Year of Life
Most rapid growth period in life
Special needs for energy nutrients, vitamins A & D and calcium
100 cal/kg BW/d; as % of BW
Babies need more than 2x as much of nutrients
Vitamin K – single dose at birth to prevent uncontrolled bleeding
Vitamin K producing bacteria takes weeks to establish
Water – breast milk or infant formula provides enough water to replace losses in healthy infant
Vitamin D - supplement sometimes needed because babies don’t spend too much time outside
Breast Milk Nutrition
Breastmilk provides all the nutrients a healthy infant needs for first 6 months
Carbohydrates in milk, lactose, easily digested; enhances calcium absorption
Lipids are a main source of energy; generous amounts of EFA linoleic & linolenic acids, arachidonic & DHA (for brain & eye retina)
Proteins – alpha-lactalbumin = easy to digest; lactoferrin = iron-gathering compound (helps absorb iron)
Vitamin C – generous amounts
Vitamin D – low amounts in breastmilk; supplement needed for breastfed baby not sufficiently exposed to sunlight = daily 10 ug (40 IU)
Calcium – ideal for bone growth; well-absorbed
Sodium – low in breastmilk
Iron – limited amount highly absorbable; supplement needed after 4-6 months… Recall that the baby absorbs 4 – 6 months of iron while in the womb
Zinc – absorbed better due to zinc-binding protein
Breastfeeding Benefits for Mom
Contracts uterus
Lose weight faster
Delays return of regular ovulation (not a reliable form of birth control though!)
Conserves iron stores
Cows Milk and Babies
Never an option – whole cow’s milk before 12 months of age
Until first birthday: cow’s milk inappropriate replacement for formulas due to little iron & vitamin C
Proteins may cause intestinal bleeding and increase risk for iron deficiency
After 12 months, use cow’s milk fortified with vitamin A & D or soy milk fortified with calcium, vitamin A and D
Before 2 years, reduced-fat milk not recommended because children need the fat
Diet at 1 Year Old
Whole milk at about 2 cups/day
Iron-fortified cereal
Variety from all food groups
o See Table 13-17 in your text for an example day (pg. 522)
They can also drink liquids from a cup at this point