Pregnancy And Lactation

Pregnancy and lactation

Characteristics of Pregnancy Pregnancy

or Gestation Period when the fertilized ovum implants itself in the uterus, undergoes differentiation and grows until it can support extrauterine life Human pregnancy last for a period of 37-40 weeks

Characteristics of Pregnancy 3

Trimesters – First – implantation – Second – organogenesis – Third - growth

Maternal Diet  Maternal

diet and nutritional status have a direct impact on the course of pregnancy and its outcome. Malnutrition which occurs in the early months of pregnancy affects development and the capacity of the embryo to survive; poor nutrition in the latter part of pregnancy affects fetal growth.

NUTRITION IN PREGNANCY The

total energy cost of storage plus maintenance amounts to approximately 80,000 Kcal Energy cost of pregnancy - 300 Kcal/day Energy intake – 36 Kcal/kg of pregnant weight per day

WEIGHT GAIN

 All

pregnant women need to gain weight during pregnancy for fetal growth and maternal health.  The weight of the blood volume and the enlargement of the reproductive organs are fairly constant.

WEIGHT GAIN  An

average gain in weight during pregnancy is 24 lbs  A gain of 1.5-3 lbs during the first trimester  A gain of 0.8 lbs/week during the remainder of the pregnancy  A sudden weight gain after the 20th week of pregnancy may indicate water retention and possible onset of pre-eclampsia

WEIGHT GAIN 

Tissue Fetus Uterus Placenta Amniotic Fluid Blood Volume Extra cellular Fluid accretion Breast Tissue Fat Total

Weight (Pounds) 7.5 2.0 1.5 2.0 3.0 2.0 1.0 9.0 28.0

Recommended WEIGHT GAIN during pregnancy  Pre

Pregnancy Weight

Underweight Healthy Weight Overweight Obese

Recommended Weight Gain

BMI < 18.5 BMI 18.5 – 24.9 BMI 25.0 – 29.9 BMI ≥ 30

28 – 40 lb 25 – 35 lb 15 – 25 lb 15 lb

WEIGHT GAIN PATTERNS

Normal Underweight

Overweight

First Trimester Thereafter First Trimester Thereafter First Trimester Thereafter

3 ½ lb 1 lb per week 5 lb 1 lb per week 2 lb 2/3 per week

WEIGHT GAIN  Weight

gain during the first ten weeks is small and this is due to the growth of the uterus and expansion of the mother’s blood  Weight gain toward the end of pregnancy, growth of the fetus accounts for the greatest increase in weight gain  The total weight gain for a normal pregnant woman is kept ideally between 15-20 lbs, the gain is divided into 3, 7 and 7 lbs in the 3 trimester

MATERNAL WEIGHT Underweight – Low

birth weight infants ( <5 lbs) – Preterm infant (born 38 weeks) – Higher infant mortality rates

MATERNAL WEIGHT  Overweight –

– –

–

and Obesity High risk of complications like hypertension, gestational diabetes, and post partum infections Complications of labor and delivery Large newborn increase the likelihood of a difficult labor and delivery, birth trauma and caesarian section May double the risk of neutral tube defects

ENERGY Increase

in the metabolic rate to support the growth of the fetus and the accessory tissues = 80,000 calories or extra 300 kcal/day During the 2nd and 3rd trimester, deposition of 3.5 kg of fat account for 2/3 of the total energy needs

ENERGY Energy

needs differ due to pregnancy weight and body composition, stage of pregnancy and activity level If the rate of weight gain is appropriate for the rate of pregnancy, energy intake is adequate

PROTEIN ALLOWANCES  The

additional allowance of protein takes into account the increased nitrogen content of the fetus and its membranes, maternal tissues and the added protection of the mother against complications  Estimated that 950g are deposited during the last 6 months of gestation

PROTEIN ALLOWANCES  FAO/WHO

recommends an additional 9g of protein/day for the latter part of pregnancy  The protein needs of a normal woman is 1.1g/kg BW; a normal pregnant woman requires an additional 9.5g/day or a total of 900-950gms for the 9 months gestation period

REASONS FOR ADDITIONAL PROTEIN  To

provide for the storage of nitrogen  To protect the mother against many of the complications of pregnancy  For the growth of the women’s uterus, placenta and associated tissues  To meet the needs for the fetal growth and repair  For the growth of the mammary tissues  For the hormonal preparation for lactation

COMPLETE PROTEIN MEAL

NUTRITIONAL NEEDS DURING PREGNANCY The

normal requirements of the mother Those of developing fetus (including also the uterus and placenta) Building up reserves in preparation for labor and lactation

CALCIUM ALLOWANCES  During

the later half of pregnancy the intake and retention of calcium increased.  An adequate supply of Vit. D is essential in the use of calcium and phosphorus needed to calcify the fetal bones and teeth.  If the diet of pregnant women is inadequate in calcium, she will have to sacrifice the calcium of her bones in favor of the developing fetus

CALCIUM ALLOWANCES 64-65%

retained in the fetus during the last two months The daily intake of calcium must be increased from 0.5-0.9 to that of the non-pregnant adult’s daily allowance.

IRON ALLOWANCES  At

least 700-100mg of Fe must be absorbed and utilized by the mother throughout her pregnancy.  About 240mg are spared by the cessation of the menstrual flow  The rate of absorption is increased in the third trimester when the needs of the fetus are highest

IODINE ALLOWANCES  Specially

important to meet the needs for fetal development  An inadequate intake of iodine may result in goiter in the mother or child  The increased need for iodine can be met by regular use of iodized salt in food

VITAMIN ALLOWANCES  Thiamin

and niacin allowances are increased in proportion to the calorie increase, while riboflavin allowances increased according to the higher protein level.  Vit D and Ascorbic acid should be also increased  Vit A is especially important in the epithelial cells during organogenesis and ensure good vision

VITAMIN ALLOWANCES  Folic

acid and Vit B12 are important in synthesis of RBC  Vit B6 should be greater during pregnancy  Vit K may be given to mother at 2-5mg parentally before the birth of the baby to stabilize the prothrombin level of the infant until synthesis can take place  1-2mg can be given to the infant after birth

VITAMIN ALLOWANCES

FOOD ALLOWANCES One ounce or 30gms of meat or its equivalent and an extra pint of milk to the normal diet  Daily consumption of whole grain cereals, enriched bread, rice, leafy vegetables, fresh and dried fruits  Include liver is at least once a week  Egg in the daily diet  Fortified milk with Vit D or fish liver oil  6-8 glasses of water daily 

COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS 

Morning sickness – Beads’ longitudinal study on pregnant women reveals nausea to affect frequency of food intake, resulting in decrease in calorie intake and increase hormone secretion – Must have small frequent feedings instead of three large meals, and high CHO-low fat foods such as crackers and jelly to overcome the above complications. Liquids are better taken between meals rather than at mealtime

COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS 

Rapid weight gain or loss – “Eating for two” is not valid among well nourished mothers – Excessive weight gain during pregnancy is increase of 3kgs or more per month in 2nd and 3rd trimester. They should consciously avoid severe calorie as well as prevention of excessive weight gain – Weight gain of <500gm/month during the 1st trimester & 250gm during 2nd trimester can lead to LBW or premature infants with brain and nerve damage. Abortion may also occur.

COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS 

Toxemia – Rapid weight gain, edema, high blood pressure, excretion of albumin in the urine and convulsions – Classifications: Acute toxemia of pregnancy and Chronic hypertensive disease – Optimum nutrition is a fundamental aspect of therapy. – Salt intake is restricted for edema

COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS  Anemia –

–

The classic macrocytic anemia of pregnancy represents a combined deficiency of iron and folic acid It is difficult to overcome by raising the level of iron in the diet although its absorption can be enhanced by the inclusion of ascorbic acid-rich foods

COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS Constipation – Lots

or fresh fruits, vegetables, fluid and regular exercise will correct this disorder.

COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS

Socio-economic and Cultural factors - Low income groups tend to have big families, one reason for the decrease in kind and amount of food available to the pregnant women

COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY MODIFICATIONS 

Alcohol, Caffeine, Nicotine – Smoking during pregnancy lowers mean birth weight and increases risk or perinatal mortality. – Increasing the food intake of pregnant smokers can compensate for some of the effects of smoking. – Caffeine crosses the placenta to the fetus rapidly. – Alcohol, caffeine, and nicotine dramatically increase circulating levels of cathecolamine

LACTATION

LACTATION  Most

of the dietary essentials are increased over and above the requirements during pregnancy to meet the demands of milk production, namely: calories, proteins, calcium, Vit A, Thiamin, riboflavin, Niacin and ascorbic acid.

NUTRITION IN LACTATION  Calorie –

–

Allowances

The chief concern during lactation is the loss of the food material in the milk and the large storage of a certain amount of food which cannot be entirely accounted for by the chemical composition of the milk. It is generally suggested that the extra food calories should be about twice those secreted in the milk of approximately 700-1500 calories of food for 500-1000ml of the milk.

CALORIE ALLOWANCES  The

FNRC recommends an increase by 1000 calories above the normal requirement for an average production of 850ml of milk, with an energy value of about 600 calories,  Human milk is approximately 0.70 calories per ml or approximately 20 calories per ounce, and it contains 1.2g/100mm.

NUTRITION IN LACTATION  Protein –

–

Allowances The need for protein is greatest when lactation has reached its maximum but it is a need which should be anticipated and planned for during pregnancy. Additional protein in the diet tends to increase the yield of breast milk while a decrease of protein lowers the amount of milk secreted.

PROTEIN ALLOWANCES The

average CHON allowance for the lactating mother is an additional 20.2g CHON to her normal requirement. A 20g factor may be used

NUTRITION IN LACTATION  Calcium, –

–

–

Phosphorus and Vit D allowances

During lactation, the demand for calcium and phosphorus is increased above the requirement of the pregnant woman. The calcium allowance is 1.0g daily for good milk production. If the CHON requirement and other essentials of the diet are fulfilled., the increase need for phosphorus ill be met The Vit D requirement of 400 I.U remains the same as during pregnancy.

NUTRITION IN LACTATION  Iron

allowances – Iron rich foods are essential for the mother’s own health, while supplements are included early in the infant’s diet. – Additional intake is recommended for blood lost in parturition, for milk iron, and basal losses.

NUTRITION IN LACTATION  Vitamin –

–

Allowances

There is an increased demand for Vitamin A, Niacin, Riboflavin, Thiamine, and Ascorbic Acid above the requirements of pregnancy during lactation. Vit A – an additional of 2000 I.U to the normal allowance

BREASTFEEDING MISCONCEPTIONS A mother is sick with TB cannot breastfeed.  Breast milk is not good if the mother has stayed long under the sun.  A mother cannot breastfeed during pregnancy.  A mother cannot breastfeed with only one breast if the other breast is painful.  A mother cannot breastfeed if she has cold, flu or diarrhea.  Breast milk is not good if the mother has been caught in a sudden shower. 

ADVANTAGES OF BREASTFEEDING  Breast

milk provides antibody transfer to the newborn.  Breast milk is higher in lactose than cow’s milk.  Breastfed babies have no difficulty with the regulation of calcium, phosphorus level, than those who are bottle-fed.  Bottle feeding affects the dental arch.  Cow’s milk protein causes allergy.

ADVANTAGES OF BREASTFEEDING  For – –

–

mothers Less incidence of breast cancer in women who breastfed Less incidence of thrombophlebitis or inflammation of a vein with formation of blood clot, and It results to fast return of uterus to its original size.

FACTORS AFFECTING MILK SECRETION Diet Nutritional

State of Mothers Emotional and Physical State Suckling Use of the contraceptive and drugs