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Chapter 14 Pregnancy and Breastfeeding Lecture Outline without Animations:

Chapter 14 Pregnancy and Breastfeeding Lecture Outline without Animations Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display

Planned Pregnancies Have the Best Outcome:

Planned Pregnancies Have the Best Outcome Many practices can be harmful to the fetus Minimize exposure even prior to conception Nutrition is important ~50% of all pregnancies are unplanned

The First Trimester:

The First Trimester First 13-14 weeks of pregnancy Rapid increase in cell number and size Nutritional deficiency or toxicity Can be harmful to embryo Medication, radiation, trauma Can be harmful to embryo ~ Half of all pregnancies miscarry during the first trimester

The Second Trimester:

The Second Trimester Fetus begins to look more like an infant Still susceptible to toxin exposure Preparation for lactation Increase of 2-4 lb. in breast tissue Deposit of fat tissue Nutritional deficiency at this time affects mother’s ability to breastfeed

The Third Trimester:

The Third Trimester Rapid growth 2X length 2X-3X weight Transfer of fat, calcium, and iron to fetus during the last month Iron Fetus may deplete mother’s store of iron if intake is low

A Successful Pregnancy:

A Successful Pregnancy Mother’s physical and emotional health Infant: >37 weeks gestation Birth weight > 5.5 pounds Sufficient lung development The longer the gestation, the less the health risk

Low Birth Weight Infants:

Low Birth Weight Infants Less than 5.5 pounds at birth Usually due to preterm births Increased medical costs Small for gestational age Full-term babies Low birth weight More likely to have medical complications

Success in Pregnancy:

Success in Pregnancy Prenatal care Maternal age Closely spaced and multiple births Smoking, medication and drug abuse Food safety Nutritional status

Listeria monocytogenes:

Listeria monocytogenes Found in unpasteurized milk, soft cheeses make from raw milk, raw cabbage Causes flu-like symptoms 7 to 30 days after exposure May contribute to spontaneous abortion Recommend pasteurized milk, thoroughly cooked meats, fish, and poultry

Does Nutrition Matter? YES!:

Does Nutrition Matter? YES! Supports fetal growth Supports maternal changes To support pregnancy and lactation Inadequate calories Can retard fetal growth Higher risk for maternal and fetal death in famine areas The poorer the nutritional status of the mother, the poorer the outcome Women, Infant, and Children (WIC)

Energy Needs During Pregnancy:

Energy Needs During Pregnancy 1 st trimester Balanced and adequate diet 2 nd and 3 rd Trimester 350-450 extra kcal per day Choose nutrient-dense foods Adequate weight gain The best predictor of outcome

Recommended Weight Gain During Pregnancy:

Recommended Weight Gain During Pregnancy 2 - 4 lb. weight gain during 1 st trimester 0.75 - 1 lb. weekly weight gain during 2 nd and 3 rd trimester Total weight gain goal 25 - 35 lb. for normal weight women (BMI 19.8-25.9) 28 - 40 lb. for low weight (BMI < 19.8) 15 - 25 for high weight (BMI 26-29) 15 lb. for obese (BMI > 29)

Components of Weight Gained During Pregnancy:

Components of Weight Gained During Pregnancy

Physical Activity:

Physical Activity Low impact and non-contact activities 30+ minutes on most days Promotes easier delivery Non-active women Should not begin an intense exercise program High risk pregnancies May need to restrict activities Consult physician about possible limitations

Protein and Carbohydrate Needs During Pregnancy:

Protein and Carbohydrate Needs During Pregnancy RDA for protein Additional 25 gm/day Many (non-pregnant) women already consume recommended amount of protein RDA for carbohydrate Prevent ketosis 175 gm/day Most women exceed this amount


Lipids Recommendations 20-30% of total calories from fat 7% or less from saturated fat 1% or less from trans fat Omega-6 and omega-3 Required for fetal growth, brain and eye development 13 g/day Omega-6 1.4 g/day Omega-3

Additional Vitamin Needs:

Additional Vitamin Needs Folate (600 µ g/day) Synthesis of DNA Fetal and maternal growth Increased red blood cell formation Neural tube defect Other B-vitamin needs are also increased

Additional Mineral Needs:

Additional Mineral Needs Iodide (220 µ g/day) to prevent goiter Calcium (1000 mg/day) Adequate mineralization of fetal skeleton and teeth Low amounts present in prenatal supplements Zinc (11 mg/day) Supports growth and development

Iron Needs:

Iron Needs Iron (27 mg/day) Increased hemoglobin Iron stores for the fetus Iron supplement between meals Be aware of nutrient-nutrient interaction Maximize bioavailability Possible effects of iron-deficiency anemia Preterm delivery Low birth weight Fetal deaths

Should Pregnant Women Take Supplements?:

Should Pregnant Women Take Supplements? Prenatal supplements routinely prescribed Higher iron needs Higher folate needs Easier than changing diet Recommended especially for women with poor eating habits Vitamin A Should not exceed 3000 µ g RAE/day

Using MyPyramid :

Using MyPyramid 3 cups milk group 6 ounces meat and bean group 3 cups vegetable group 2 cups fruit 7 ounces grain group 6 tsp vegetable oil Supplies adequate vitamin D, folate, calcium, iron, and zinc

Pregnant Vegetarians:

Pregnant Vegetarians Lacto-ovo or Lacto-vegetarian Can usually meet nutritional needs Vegan must plan diet carefully Requires sufficient protein Focus on vitamins D, B-6, and B-12; iron, calcium, and zinc Prenatal supplements may be necessary

Discomforts of Pregnancy:

Discomforts of Pregnancy Heartburn Hormone relaxes muscles in uterus and intestine Stomach acid refluxes into esophagus Avoid lying down after eating Avoid spicy foods Check with physician regarding use of antacids

Discomforts of Pregnancy:

Discomforts of Pregnancy Constipation Relaxation of the intestinal muscle Fetus competes with the GI for space Recommendations Regular exercise Fluid (10 C/day) and fiber (28 gm/day) Hemorrhoids Straining during elimination A result of constipation

Discomforts of Pregnancy:

Discomforts of Pregnancy Edema Placental hormone causes body tissue to retain fluid Increase in blood volume Some swelling is normal Salt restriction and/or diuretics not needed for mild edema Only a problem if accompanied by hypertension and protein in urine

Discomforts of Pregnancy:

Discomforts of Pregnancy “ Morning Sickness” 70-80% will experience in 1st trimester May be due to heightened sense of smell Can occur any time of day Avoid nauseating foods or smells Eat small, frequent bland meals Consider changing prenatal supplement Megadose of vitamin B-6

Pregnancy Complications:

Pregnancy Complications Physiological anemia Mother’s blood volume increases to 150% of normal Red blood cells increase by only 20% - 30% Lower ratio of red blood cell leads to anemia Occurs as normal response to pregnancy Requires medical attention if severe

Pregnancy Complications:

Pregnancy Complications Gestational Diabetes Hormones synthesized by placenta decrease action of insulin 4% of pregnancies Routine screening at 24 - 28 weeks gestation Diabetic diet may be recommended Insulin may be needed in some cases Increased birth weight, low blood glucose, trauma, malformations Usually disappears after birth but is linked to diabetes later in life for mother

Pregnancy Complications:

Pregnancy Complications Pregnancy-induced hypertension High-risk disorder Preeclampsia (mild form) Eclampsia (severe form) Signs: Elevated blood pressure, protein in the urine, edema, change in blood clotting Convulsions in third trimester Liver and kidney damage, leading to death


Breastfeeding First 6 months of life breastfeed solely Solid foods and breast milk until 1 year Recommended by American Dietetic Association and American Academy of Pediatrics The World Health Organization Breastfeed for at least 2 years 70% of all mothers breastfeed in the hospital Number decreases as infants get older

Ability to Breastfeed:

Ability to Breastfeed Almost all women are physically capable Barriers to breastfeeding: Lack of support Lack of appropriate information Inexperienced mothers Monitoring of breastfed infants Requires patience

How Human Milk is Produced:

How Human Milk is Produced Simulates hypothalamus Suckling by infant Initiates the release of hormones prolactin and oxytocin by the pituitary gland Prolactin stimulates milk production Oxytocin causes release of milk from storage (breast) Let-down reflex Milk supply for the infant Inhibited by nervous tension, lack of confidence, fatigue

Let-Down Reflex:

Let-Down Reflex

Well-nourished Breastfed Infant:

Well-nourished Breastfed Infant Infant has 6 + wet diapers a day Shows normal weight gain Passes 1+ stool per day Softening of breast tissue May take 2-3 weeks to establish breastfeeding routine Introduce bottle-feeding only after breastfeeding is well established


Colostrum Thick, yellow fluid produced during late pregnancy and few days after birth Contains antibodies, immune-system cells and Lactobacillus bifidus factor Provides protection to infant against infections Facilitates the passage of 1 st stool (meconium)

Mature Milk:

Mature Milk Thin, watery, slightly bluish composition Easily digested proteins Protein binds to iron, reducing bacteria growth High linoleic acid and cholesterol content Needed for brain development Long chain omega-3 fatty acids (DHA) Synthesis of brain tissues, central nervous system, eyes

Milk Composition:

Milk Composition Fore milk Resembles skim milk ~17% fat, ~74% CHO, ~9% protein Hind milk Resembles cream ~66% fat, ~28% CHO, ~6% protein Released 10-20 minutes into the feeding

Fluid Needs:

Fluid Needs Human milk Provides adequate hydration for baby Additional fluids needed Hot climate, diarrhea, vomiting Too much water Leads to brain disorders Causes low blood sodium

Lactation Nutritional Needs:

Lactation Nutritional Needs Most substances ingested are secreted into mother’s milk Milk production requires ~800 kcal/day Energy RDA is additional 400-500 kcal/day kcal difference will contribute to mother’s gradual weight loss Increased need for vitamins A, E, C, riboflavin, copper, chromium, iodide, magnanese, selenium, and zinc Follow the diet plan for pregnancy

Food Plan for Lactating Moms:

Food Plan for Lactating Moms Calcium-rich sources: 3 cups Meat, meat substitute group: 6 ½ ounces Vegetable group: 3 ½ cups Fruit group: 2 cups Grain group: 8 ounce equivalents 7 teaspoons of vegetable oil

Overall Food Plan:

Overall Food Plan Balanced variety of foods Moderate fat intake Adequate fluids Reduction of milk supply caused by: Restricting kcal Ingestion of alcohol Smoking Limit high mercury fish and intake of peanuts (allergens)

Advantages of Breastfeeding:

Advantages of Breastfeeding

Barriers to Breastfeeding:

Barriers to Breastfeeding Misinformation Need to return to work force Embarrassment and modesty Medical conditions Infant with galactosemia Infant with PKU Mothers on medications Mothers with TB, AIDS, HIV+, undergoing chemotherapy

Environmental Contaminants in Breast Milk:

Environmental Contaminants in Breast Milk Avoid freshwater fish from polluted water Carefully wash and peel fruits and vegetables Remove fat from meats

Preventing Birth Defects:

Preventing Birth Defects Folic Acid Iodide Antioxidants Vitamin A Caffeine Aspartame Obesity and chronic health conditions Alcohol Environmental Contaminants

Folic Acid:

Folic Acid Prevention of neural tube defects Periconceptional period Fortified grain products Woman of childbearing years need 400 micrograms/day


Iodide Low iodide during first trimester Cretinism Causes physical and mental impairment


Antioxidants Balanced multivitamin and mineral supplements Diet rich in whole grains, legumes, fruits and vegetables

Vitamin A:

Vitamin A Teratogenic effect in high doses Facial and cardiac effects Supplements should not exceed 3000 micrograms RAE per day

What About Caffeine?:

What About Caffeine? Decreases iron absorption May reduce blood flow through the placenta Caffeine withdrawal symptoms in newborn Risk of spontaneous abortion Heavy caffeine use in the 1 st trimester Risk of low-birth-weight infant Limit caffeine intake (< 3 cups coffee/day)

What About Aspartame?:

What About Aspartame? Harmful for mothers with phenylketonuria (PKU) Disrupts fetal brain development Moderate use not harmful for women who do not have PKU

Fetal Alcohol Syndrome:

Fetal Alcohol Syndrome Large amounts of alcohol during pregnancy Excess alcohol reaches the embryo/fetus Embryo/fetus cannot metabolize alcohol Poor fetal and infant growth Physical deformities Mental retardation Irritability and hyperactivity

Fetal Alcohol Syndrome:

Fetal Alcohol Syndrome

Environmental Contaminants:

Environmental Contaminants Mercury Avoid swordfish, shark, king mackerel and tile fish < 6 ounces of tuna per week

Importance of Prenatal Care :

Importance of Prenatal Care Medical assessment throughout pregnancy Adequate diet Learn what to avoid Proper health habits Women, Infants, and Children (WIC) supplemental food program

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