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Claire Dezelski

on 11 November 2014

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Transcript of Pregnancy

Changes during Pregnancy:
Increased appetite
Decreased GI motility
Increased pressure on stomach from growing uterus
GERD like symptoms.
Total weight gain of 25.0-35.0#.

Nutrition in Pregnancy and Lactation
Nutrition Intervention Objectives
Provide adequate amount of weight gain during the pregnancy,
Proper rate of weight gain:
2-4# first trimester
10-11# second trimester
12-13# third trimester
Avoid nutrient deficiencies.
Manage common pregnancy symptoms.
NVP- Frequent small meals, high protein snacks, avoid lying down after meals, do not force eat, avoid strong odors and spices.
Healthy Fats
Folate B-9
(Folic Aicd)
DRI: 600ug/d
Sources: Fortified cereals, Leafy green vegetables, citrus fruits, such as orange juice, Beans, Breads, Rice, Pastas.
Role: Important role in the production of red blood cells and helps the baby's neural tube develop into the brain and spinal cord.
Vitamin B12
DRI: 2.2ug/d
Sources: Foods of animal origin (meats, dairy products)
Role: Prevents NTD.
Deficiency during 3rd trimester negatively affects infant cognitive and motor development.
Vitamin C
DRI: 85mg/d
Sources: citrus fruits, strawberries, blueberries, red peppers.
Roles: Immune health and collagen synthesis.
Encourage vit C with iron rich foods.
DHA (docosahexaenoic acid) is essential for proper brain growth and eye development especially during the third trimester, when brain growth is at its peak.
Recommended intake: 300mg/day
Sources: fatty, cold water fish (sardines are a low mercury fish), w-3 enriched eggs, flax seeds, nuts (walnuts), and algae.
Current RDA 0.8 g/kg/day during first half of pregnancy.
Second half of pregnancy increases to 71g/day.
Each additional fetus another 25 g/day of protein.
Sources: poultry, eggs, milk, legumes, nuts and seeds, and whole grains.
Estimated Average Requirement (EAR): 135 g/day,
Recommended Daily Allowance (RDA): 175 g/day.
This 135-175g/day is recommended to provide enough calories in the diet to prevent ketosis and maintain appropriate blood glucose during pregnancy.
Sources: whole grain bread, pasta, beans, legumes, brown rice.
Fiber: 28g/day. Will help manage constipation.

No DRI. Should depend on energy requirements for proper weight gain.

DRI: 770 ug/d
Sources: Fruits and vegetables that are orange, yellow and leafy greens
Role:development of the heart, lungs, kidneys, eyes, and bones, and the circulatory, respiratory, and central nervous systems.

DRIs: 1,000mg/d (1,300 for women aged 14-18y/o)
Sources: Yogurt, cheese, milk, salmon.
Role: Development of bones and teeth.
During pregnancy, 30 g of Ca is accumulated.
DRIs: 220 ug/day.
Sources: iodized salt.
Role: Regulating your thyroid gland and your metabolism
Attention deficit may be associated with mild iodine deficiency.

Due to the increase in the maternal blood supply; the demand for iron increases.
DRI: 27mg/d (500-800mg throughout pregnancy)
Deficiency could compromise oxygen supply to uterus, placenta, and developing fetus.
Iron-deficiency anemia during pregnancy is associated with preterm delivery, low birth weight, and infant mortality.
Sources: ◾Dried beans, Dried fruits, Eggs (especially egg yolks), Iron-fortified cereals, Liver, Lean red meat, oysters, Poultry, dark red meat.
DRI: 2-3 g/day
Restriction of dietary sodium is not recommended.
Salt is needed for healthy cell functioning because it maintains fluid volume outside your cells.
Role: Important in brain development, ensuring adequate birth weight, and development of nervous and respiratory systems.
Foodborne Illness
At higher risk due to hormonal changes that lead to decreased immune function

Adhere to food-safety recommendations
Fish & Seafood
Omega 3's are great but...
Non-Nutritive Sweeteners
Limited research is available regarding their safety in pregnancy
Health Conditions Between and After Pregnancies
Return to healthy weight

Diet quality and overall nutritional status
AND Position Paper
Pregnancy - 2014
Be careful of the Mercury levels
No amount of alcohol is safe

It can effect behavior, IQ, and cause neurological defects.
No more than 12 oz per day
Energy Drinks
AND advises to avoid energy drinks
a woman can accumulate 6-9 L of water during gestation
3 L per day
2.3 L (10 cups) as total beverages
Energy Intake

1st tri = +0 kcal/d
2nd tri = +340kcal/d
3rd tri = +452 kcal/d
Vitamins and minerals
Lactation is the process of milk production by the mammary glands.
During lactation adequate nutrition is required if infant depends on all of its nutrition from the mother's milk.
Lactating Mother's needs extra nutrients to meet baby's needs, in addition to her own requirement.
Nutrition deficiency can lower the levels of nutrients in the mother's milk.
During first 6 months of lactation, 500 kcal/day is required.
During 6-12 months of lactation 400 kcal/day is required.
Milk production volume is base on the frequency, duration, and intensity of infant suckling.
Protein is an important component of breast milk. It helps to maximize milk supply and optimize infants’ growth and development.
75g of protein is required in the first 6 months of lactation.
68g of protein is required in 6-12 months of lactation.
RDA 210 g/day
To maintain adequate volume of milk production and energy level during lactation.
There is no DRI for total lipids during lactation
but DRI recommended intakes of
13 g/day of Linoleic acid
1.3 g/day of Alpha- Linoleic acid
for fetal and infant brain development
Calcium 1g/d
Breastfeeding causes a temporary decrease in bone mass.
Calcium is required for breast milk secretion
30-40mg of calcium is secreted per 100ml of milk
Women who are healthy and eat a well –balanced diet do not need to take vitamin supplement.
Composition of Breast milk
Non protein nitrogen
Human milk is compose of triglycerides, phospholipids and essential fatty acids.
Contains whey, lactoferrin, lysozymes, immunoglobulin, and Casein
Human milk is lower in concentration compared to infant formula.
Compose of lactose and oligosaccharides
Three Types of Breast Milk
Colostrum or
Early Milk
Produced in late stage of pregnancy
Up till 4 days after delivery
Is rich in antibodies.
Transitional Milk
Produced from 4-10 days
Lower in protein compares to Colostrum
Mature milk
Produced from approximately 10 days after delivery
Until the termination of the breastfeeding.

Storage of Breast Milk

Store at room temperature 6-8 hrs
Store in refrigerator for about 5 days at 40 F
Store in a deep freezer about 3-12 months

Effective Breastfeeding
Feeding 8-12 times daily
Infant should have 6-8 wet diaper in 24 hrs
Infant should have minimum of 3-4 bowel movements in 24 hrs
Average daily weight gain of .5-1 oz.

Breastfeeding Benefits to
1. Decrease the risk of sudden infant
death syndrome (SIDS)
2. Ear infections
3. Respiratory infections
4. Dermatitis
5. Gastrointestinal disorders
Breastfeeding Benefits to Mothers
1. Faster recovery from pregnancy and childbirth
2. Lower risk of breast and ovarian caner
3. Lower risk of osteoporosis
4. Postpartum weight loss

Cautions While Breastfeeding
Mothers are advice to be cautions when taking:

Medications/ drugs
It can transfer into the human milk and cause harmful reaction to infants.
AND Position Paper - Lactation Trends 2009
Breastfeeding Trends
Before 1880 almost all babies were breast fed!
Breastfeeding Trends
After 1880 we began to supplement cow's milk to infants and wean them entirely by 3 month's

Babies fed cow's milk died at higher rates until the 1920's when pasteurization was introduced
Breastfeeding Trends
Breastfeeding rates continued to decline with the introduction of evaporated cow's milk and and infant formula
Breastfeeding Trends
All Time Low in 1971

24% of mothers initiated breastfeeding
Breastfeeding Trends
Rose to 61.9% in 1982 then declined through ‘90s

Increased steadily to 70% in 2000 and 74.2% in 2005
Still below the 2010 Healthy People Goals
U.S. is lower than most nations
Globally about 79% of infants are breastfed for 12 months compared to 21.4% US
Vitamin A
Sue Wilczynski, Claire Dezelski, Winnie Gao
Full transcript