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Nutrition in pregnancy
- 1.
- 2. Introduction • Pregnancy-40week periodthat involves various physiological changes. • Growing fetus fully depends on mother for nourishment. • So it is important to take care of the nutrition of pregnant women.
- 3. Physiological changes 1. Growthof the baby-occurs in 3 stages – Stage of Fertilized egg(0-2weeks) – The embryo stage(2-8week) – The foetal stage (8th week – birth) 2. Changes in maternal tissues – Uterus expands to support growing baby – Placenta is formed – Blood volume increases – Breast size increases – Fat is stored in mother’s body to be utilized for energy during lactation.
- 4. PHYSIOLOGICAL ADJUSTMENTS THATAFFECTS NUTRIENT NEEDS OF PREGNANCY • The physiological adjustments are often grouped by period of gestation • First half of pregnancy-preparation for the demands of rapid fetal growth that occur in pregnancy. • Corpus luteum and placenta secrete hormones that maintain pregnancy.
- 5. Hormonal profile inpregnancy • Human Chorionic Gonadotrophin is detected in serum and urine within few days of implantation-Maintains corpus luteum –reaches at peak around 8 weeks of gestation and then decreases to a stable value till birth. • Human placental lactogen increases progressively- affects CHO and lipid metabolism-maintains flow of substrates to foetus; promotes mammary gland development along with prolactin.
- 6. • Biosynthesis ofthe estrogens (estrone, estradiol & estriol)- Stimulates uterine growth ,increases blood flow to uterus, promote breast development-Induces prolactin secretion by maternal pituitary gland. • Progesterone-increases progressively of which the initial sources is the corpus luteum and at the later stages it is- placental sources • Cortisol-Increased content in maternal plasma during pregnancy-enhance glucose production from amino acid- increases availability of glucose to foetus which relies on glucose level.
- 7. • Expansion ofplasma volume-Increases by 50% by 34 weeks of pregnancy-fall in Hb concentration, haematocrit and RBC count. • Fetal growth –rapid during last half of gestation-Changes in basal metabolism, protein and mineral accretions- 60% increase in BMR. • Energy metabolism and fetal growth – – The cumulative energy needed for increase in basal metabolism is approx. 36,000 Kcal – To meet this requirements-following adjustments are made • Alteration in intensity of physical activity • Increases in food consumption and therefore energy intake- depended on pre pregnancy energy status of the mother and quality of her living conditions during pregnancy (King et. al ,1994)
- 8. • Underweight womenliving in constraints of limited food and hard physical activity/ work –unable to increase the food intake but have to maintain a high level of physical activity for survival reducing the BMR to conserve energy for their growing fetus. • There is decreased ability to taste saltiness-physiological mechanism for in taking salt. • Maternal fat stores between 10th to 30th week of gestation-Approx. 3.3 kg fat is deposited at maternal stores-proving energy reserve
- 9. • Protein metabolismadjustment-for nitrogen conservation& for fetal growth-it achieves full potential during last quarter of pregnancy. – Total serum proteins gradually along with sharp decline in serum albumin- Vit. C, folic acid, Vit.B6, and B12 is reduced in serum albumin levels. – low dietary supply of protein –a great change in the physiological adjustments is needed to meet fetal needs
- 10. • Altered renalfunctions – High glomerular filtration rate(50%) due to increased blood volume – renal tubules are found unable to adjust fully,and a percentage of nutrients that would have been reabsorbed in the non-pregnant women are excreted in the urine – Increased amount of amino acids, glucose and water soluble vitamins may appear in the urine – This may be reason for increased chance for urinary tract infection among pregnant women. – Water excretion is lowered-oedema in legs and ankles are common.
- 11. • Less thanhalf of the total wt resides in fetus, placenta and amniotic fluid • Remainder is found in maternal reproductive tissue,fluids,blood and as maternal stores. • As days progress – There is an increase in subcutaneous fat in the abdomen, back and thigh-energy reserve for pregnancy & lactation. • Placental role- – Responsible for production of various hormones for regulation of fetal growth and development. – Helps in the transfer of oxygen, nutrients and waste products – Any inadequacy in placenta compromises the ability to nourish the fetus –regardless how well the mother is/her diet is.
- 12. • it isimportant to form a diet plan on individual basis-to meet the nutritional needs of pregnant women • Diet has conformed to the basis to meet her nutritional needs. • During pregnancy-the lady should consume ‘body building ‘ and ‘protective’ foods-high in protein, vitamin and minerals. • Vegetarians must consume – increased amounts of pulses ,milk and curd – Mixture of cereals (rice ,wheat & ragi) may be used to provide energy. – Leafy vegetables –source of iron, Ca, Vit. A and folic acid. DIET IN PREGNANCY
- 13. • Daily diet-3cups milk/its equivalent,2 servings of meat, fish, poultry, eggs or a source of complete protein ,a dark green/yellow vegetables ,generous serving of citrus fruits-provides foundation for nutritionally adequate diet. • 6th to 14th week of pregnancy-75% of women suffer from nausea-affects their appetite provide consumption of small & frequent meals at regular intervals. • Intake should be maintained at steady levels-weight gain do not exceed 400g/wk in the 2nd and 3rd trimester of pregnancy.
- 14. • Food preferencesvary during pregnancy-Foods with no nutritional consequences are disliked. • At least 4-6 glasses of water (in addition to what is contained in forms like milk & beverages) should be taken ensures regular bowel functioning ,reduces urinary infections. • Faulty beliefs and wrong food habits needed to be corrected. • Stress, anxiety, fatigue & other psychosocial characteristics may influence the food choice of pregnant women.
- 15. • Fasting &missing meals should be avoided. • Introduce Fiber rich foods –avoids constipation. Inclusion of 5-6 servings of fruits & vegetables • Include Ca containing foods to avoid osteomalacia • Iron rich foods/Fe supplements should be taken –to prevent anemia & to meet RDA of iron • Include Sodium in diet –in case of oedema or hypertension Na is restricted. • Avoid fried foods, excessive seasoning, strongly flavoured vegetables –it may cause nausea, gastric disorder. • Control intake of tea, coffee /any caffeine containing beverages.
- 16. • Include fish,flax seeds, soyabean to meet the requirement of omega 3 fatty acids. • Adequate amount of calories should be taken so that enough fat is deposited – which is required for lactation • Folic acid deficiency is common in India –include green leafy vegetables, supplements –Marginal folic acid deficiency may cause birth defects • Other dietary considerations- nausea, constipation ,limited capacity to eat, or peculiar cravings are common- To avoid / control provide small frequent meals, high fibre diet and due attention to reasonable carvings(Bijlani,2004)
- 17. Sample Menu planfor a pregnant woman Time Food item Ingredients(weight in gm) 6.30 am Coffee- 1 cup Biscuits-2 no.s Milk-50 Sugar-10 Biscuits-20 8.00am Appam-4no.s Veg stew-1/2 cup Rice flour-50 Potato-20 Carrot-20 Onion-20 Coconut-30 10.30am Pineapple-2 slices Pineapple-100 12.30pm Rice-2 cups Beetroot pachadi-1/2 cup Dal-Amaranth thoran Mango pickle-1 tsp Pappad-1no. Rice-100 Beetroot-25 Onion-20 Coconut-15 Curd-120 Dal-30 Amaranth-50 Mango-10 Pappad-5
- 18. Time Food itemIngredients(weight in gm/ml) 3.30 pm Sweet aval-1 cup Plantain-1no. Tea-1 cup Aval-60 Jaggery-25 Coconut-20 Plantain-100 Milk-60 Sugar-10 5.30pm Fruit juice-1 glass Orange juice-120 Lime juice-15 Sugar-20 7.30pm Cheera chappathi-4no.s Meet curry Mixed raitha Wheat flour-60 Cheera-40 Meat-10 Tomato-50 Cucumber-20 Sprouted green gram-20 Green peas(cooked)-10 Curd-100 10.00pm Orange custard-1/2 cup Orange-30 Milk-120 Sugar-15
- 19. • In thisdiet – The food is distributed in frequent feeding so that no single meal becomes too heavy – Cheera and aval,supply Iron – Pineapple,orange juice,limejuice provide Vit C – Milk,curd and leafy veg-helps to meet Ca requirements. – Fruits,Veg and wheat flour-provide fibre.
- 20. INTRAUTERINE GROWTH RETARDATION(IUGR) • Conditionresulting in growth retardation of the child at birth. • These newborns –small for date babies. • Can have prematurity, growth retardation or low birth weight.
- 21. Factors causing IUGR MaternalFactors • Infections in mother including syphilis, herpes, rubella, toxoplasmosis. • Multiple foetuses in the same pregnancy • Maternal nutritional factors • Abnormal blood supply to the placenta. • Abnormal shape or size of the mother’s womb. • Disease conditions affecting blood vessels like High B.P, toxemia/pre-eclampsia, recurrent bleeding during pregnancy, diabetes mellitus.
- 22. Foetal factors andinfluences • Chromosomal abnormality(Turner’s syndrome,Down syndrome) • Limited blood supply due to compression0wrapping of the umbilical cord around a body part such as leg. • In an identical twin birth, one of the two foetuses may get a significantly better blood supply causing IUGR in the other twin. • Various foetal defects including abnormalities of heart
- 23. Environmental factors • Legaland illegal drugs • Medication • Cigarettes • Smoking • Alcohol • living in high altitude can be • a cause.
- 24. Why is itimportant to determine IUGR • IUGR babies have various medical problems – Hypoglycemia(Low blood sugar) – Polycythemia(thick blood) – Meconium aspiration(swallowing of fluid from amniotic sac at birth). • Infants and yet to unborn baby have to be observed to check for the signs of lack of Oxygen, infection, low temperature(due to diminished fatty tissue which is important for maintaining temperature)
- 25. • Epidemiologist DavidBarker explained on the fetal origins of adult disease. • Barker(1986) proposed the roots of cardiovascular diseases-lay in under nutrition. • He found that the lower birth weight, the higher is the risk of dying from heart disease in later life. • Barker suggests that fetuses learn to adapt to the environment they expect to enter into once outside of the womb- but a difference in the availability after the birth can have adverse effects on the child. BARKER’s HYPOTHESIS
- 26. • The thriftyphenotype hypothesis “a low availability of nutrients during the prenatal stage followed -n improvement in nutritional availability in early childhood -an increase risk of metabolic disorders, including Type II diabetes, as a result of permanent changes in the metabolic processing of glucose-insulin determined in utero” • In poor communities-maternal malnutrition is poor- fetus adapts itself to withstand the poor nutritional conditions. After birth- when the baby is given with accessible processed foods –find it hard to process the metabolic functions because metabolic systems pre-set to expect scarcity- leads to obesity and type 2 diabetes
- 28. • External factorscan affect the development of the foetus and some of these changes last for life time. • Foetal programming emerged -Dutch famine during the 2nd world war-food intake was 400-900KCal- children of pregnant women exposed to famine – susceptible to Diabetes ad other health problems. • Emerging concept that links environmental conditions during embryonic and foetal development with risk of diseases in later life. FOETAL PROGRAMMNG
- 29. • As mentioned,womb environment during sensitive periods for specific outcomes –may alter foetal development with a permanent effect on the child. • Factors contributing to foetal programming – Maternal undernutrition – Maternal experiences, emotional and physical stress during pregnancy – Maternal Alcoholism(affect brain development) – Smoking(slows down foetal growth and brain development) – Thalidomide(causes limb defects-physical deformities and disabilities)
- 30. • Growing slowlyin the womb affect both early and later stages of life. Eg.some organs like kidney &pancreas which grows differently at beginning –less able to function properly in old age. • In initial stages of pregnancy –foetus’s nerve cells develop –later connects with one another to create a specific pathway-last 20 weeks of pregnancy- brain size increases in size 17 fold. • High levels of stress hormone cortisol is found to change the development of the brain • Prenatal stress may not affect brain development in all cases –but some foetuses are affected more than others.
Editor's Notes
- #7 Prolactin-luteotropic hormone/luteotropin –Milk production
- #8 Basal metabolic rate is the amount of energy expressed in calories that a person needs to keep the body functioning at rest
- #14 Vit C –important for iron absorption
- #16 Osteomalacia-softening of bones due to deficiency of Vit D /Ca.-Demineralization of bones Osteoporosis-reduction of bone mineral density. Iron---21mg/day (normal)to 35mg/day
- #26 In 1986, Barker published findings proposing a direct link between prenatal nutrition and late-onset coronary heart disease. He had noticed that the poorest areas of England were the same areas with the highest rates of heart disease, unearthing the predictive relationship between low birth weight and adult disease. His findings were met with criticism, mainly because at the time heart disease was considered to be predominantly determined by lifestyle and genetic factors. Since Barker's initial findings, the results have been replicated in diverse populations
- #27 Essentially, all transmissions entering the placenta act as "postcards" giving the fetus clues as to the outside world, preparing its physiology appropriately. when fetal conditions of plenitude or scarcity do not match the world of birth and the child has been physiologically predisposed to inhabit an environment where expected resources are drastically different from reality.