copyright © 2011 delmar, cengage learning. all rights reserved. chapter 11 diet during pregnancy...

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Chapter 11

Diet during Pregnancy and Lactation


Objectives

• Identify nutritional needs during pregnancy and lactation

• Describe nutritional needs of pregnant adolescents

• Modify normal diet to meet needs of pregnant and lactating women


Facts

• Good nutrition in pregnancy essential for mother and child

• Relationship between mothers’ diet and health of baby at birth


Weight Gain during Pregnancy

• Average:– 25 to 35 pounds for normal-weight woman

– 28 to 40 pounds for underweight woman

– At least 15 pounds for overweight woman• But less than normal-weight woman

• No one should lose weight

(continues)


Weight Gain during Pregnancy

• First trimester:– 2- to 4-pound weight gain

– No additional calories usually required

• Second and third trimesters:– 1-pound weight gain per week

– Additional 300 calories required


Nutritional Needs during Pregnancy

• Folic acid supplementation prior to conception decreases risk of brain and spinal cord defects

• Protein requirement increased by 20 percent for pregnant woman over age 25– 25 percent for pregnant adolescent

• Excess vitamin A can cause birth defects

(continues)


Nutritional Needs during Pregnancy

• Requirements for the following increased:– All water-soluble vitamins

– Vitamin B and vitamin C

– Calcium, iron, zinc, iodine, and selenium• Iron supplements commonly prescribed due to drastic increase in

needs


Fulfillment of Nutritional Needs during Pregnancy

• Base diet on MyPyramid

• Drink additional fat-free milk or appropriate substitute

• Prenatal vitamins and iron supplement may be prescribed

• Over-the-counter nutrient supplements may be harmful to fetus


Concerns during Pregnancy

• Nausea• Constipation• Heartburn• Excessive weight gain

• Pregnancy-induced hypertension

• Pica• Anemia• Alcohol, caffeine,

drugs, and tobacco


Nausea

• Also known as morning sickness

• Occurs most commonly during first trimester

• Suggestions:– Eat dry crackers or dry toast before rising

– Eat small, frequent meals

– Avoid food with offensive odors

– Avoid liquids at mealtime

(continues)


Nausea

• Hyperemesis gravidarum:– Occurs when nausea becomes so severe that it is life-

threatening

– May require hospitalization and parenteral nutrition


Constipation

• Constipation and hemorrhoids can occur during pregnancy.

• Suggestions:– Eat high-fiber diet

– Participate in daily exercise

– Drink at least 8 glasses of water per day

– Respond promptly to urge to defecate


Heartburn

• Can result from pressure on stomach by growing fetus and relaxation of cardiac sphincter and smooth muscles related to progesterone.

• Suggestions:– Eat small, frequent meals

– Avoid spicy or greasy foods

– Avoid liquids at mealtime

– Wait at least one hour after eating to lie down and two hours before exercising


Excessive Weight Gain

• Re-evaluate diet and eliminate foods that do not fit within MyPyramid

• Suggestions:– Drink fat-free milk

– Eat clean, crisp, raw vegetables as snack

– Eat fruits and custards made with fat-free milk as desserts

– Broil, bake, or boil instead of fry


Pregnancy-Induced Hypertension

• Formerly known as pre-eclampsia or toxemia

• Characterized by high blood pressure, presence of protein in urine, and edema in third trimester

• May progress into eclamptic stage with convulsions, coma, and possible death of mother and infant

(continues)


Pregnancy-Induced Hypertension

• Higher incidence with first pregnancy, multifetal pregnancies, morbidly obese women, or women with inadequate diets– Especially protein-deficient

• More frequent in pregnant adolescents


Pica

• Craving for nonfood substances– E.g., starch, clay (soil), or ice

• Discourage ingestion of soil due to possible contamination and nutrient deficiencies

• Multiple nutritional deficiencies can result


Anemia

• Condition caused by insufficiency of RBCs, hemoglobin, or blood volume

• Causes weakness, fatigue, poor appetite, and pallor

(continues)


Anemia

• Iron-deficiency anemia– Most common form

• Folate deficiency may lead to megaloblastic anemia– Prevented by folate supplement


Alcohol, Caffeine, Drugs, and Tobacco

• Alcohol– Fetal alcohol syndrome (FAS)

• Characterized by growth deficiency, central nervous system dysfunction, microcephaly, and other physical characteristics

– Fetal alcohol effect (FAE)• Causes fewer physical defects but many behavioral and

psychosocial problems

– Abstinence recommended

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• Caffeine– Causes birth defects in rats, but no data exist for humans

– Limit intake to < 300 mg per day

• Drugs– Effect of prescription or self-prescribed drugs varies but

includes possible damage to fetus

– Vitamin A and its derivatives can cause fetal malformations and spontaneous abortions

(continues)



• Drugs– Illegal drugs can cause infant to be born addicted or born

with human immunodeficiency virus (HIV)

• Tobacco– Smoking associated with low birth weights, sudden infant

death syndrome, fetal death, spontaneous abortions, and complications at birth


Diet for the Pregnant Woman with Diabetes

• Some women have diabetes before pregnancy

• Gestational diabetes– Occurs during pregnancy and disappears after birth

– Routine screening part of prenatal care• Between 16 and 28 weeks

• Insulin often used during pregnancy to control any type of diabetes

(continues)


Diet for the Pregnant Woman with Diabetes

• Nutrient requirements of pregnant woman with diabetes same as non-diabetic pregnant woman

• Diet plan depends on type and number of insulin injections required

• Artificial sweeteners found to be safe during pregnancy


Pregnancy during Adolescence

• Nutritional, physical, psychological, social, and economic demands on pregnant adolescents tremendous

• Nutrition must meet needs of adolescent’s growing body and needs of fetus

• High risk for pregnancy-induced hypertension and premature delivery

(continues)


Pregnancy during Adolescence

• Inadequate nutrition of mother related to both mental and physical birth defects

• Much counseling and emotional support needed


Lactation

• Production and secretion of breast milk for purpose of nourishing infant

• Supply and demand mechanism

• No supplemental feedings should be given until feeding routine established

• Human milk formulated to meet nutrient needs of infants for first six months of life


Benefits of Breastfeeding for the Infant

• Breast milk has perfect composition for baby’s needs

• No babies allergic to mother’s milk

• Human milk contains at least 100 ingredients not found in formula

• Breast milk provides antibodies

(continues)


Benefits of Breastfeeding for the Infant

• Lower incidence of ear infections, diarrhea, allergies, and hospital admissions

• Promotion of good jaw development

• Decreased risk of obesity later in life

• Facilitation of bonding


Benefits of Breastfeeding for the Mother

• Helps lose weight gained during pregnancy

• Stimulates uterus to contract back to original size

• Is economical

• Provides opportunity for resting

• Is always right temperature and readily available


Nutrient Requirements during Lactation

• Food and Nutrition Board suggests increase of 500 calories per day

• Most nutrient requirements increased– Especially protein

• Base nutrition on MyPyramid

• Fluid intake should replace fluids used for milk production

(continues)


Nutrient Requirements during Lactation

• Most chemicals can pass into mother’s milk– Avoid alcohol, tobacco, and illegal drugs

• Check with obstetrician before using any medication or nutrient supplement

• Caffeine may make infant irritable


Considerations for the Health Care Professional

• Articles in newspapers and magazines may be inaccurate

• Re-education may be necessary

• Teaching pregnant teenagers presents biggest challenge


Conclusion

• Pregnant woman most likely to remain healthy and bear healthy infant if following well-balanced diet

• Anemia and pregnancy-induced hypertension– Two conditions that can be caused by inadequate nutrition

• Caloric and most nutrient requirements increase for pregnant and lactating women

copyright © 2011 delmar, cengage learning. all rights reserved. chapter 11 diet during pregnancy...

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