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Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Chapter 11
Diet during Pregnancy and Lactation
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Facts
• Good nutrition in pregnancy essential for mother and child
• Relationship between mothers’ diet and health of baby at birth
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Concerns during Pregnancy
• Nausea• Constipation• Heartburn• Excessive weight gain
• Pregnancy-induced hypertension
• Pica• Anemia• Alcohol, caffeine,
drugs, and tobacco
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Nausea
• Hyperemesis gravidarum:– Occurs when nausea becomes so severe that it is life-
threatening
– May require hospitalization and parenteral nutrition
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Anemia
• Condition caused by insufficiency of RBCs, hemoglobin, or blood volume
• Causes weakness, fatigue, poor appetite, and pallor
(continues)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Anemia
• Iron-deficiency anemia– Most common form
• Folate deficiency may lead to megaloblastic anemia– Prevented by folate supplement
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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
(continues)
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Alcohol, Caffeine, Drugs, and Tobacco
• 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)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Alcohol, Caffeine, Drugs, and Tobacco
• 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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Pregnancy during Adolescence
• Inadequate nutrition of mother related to both mental and physical birth defects
• Much counseling and emotional support needed
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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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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)
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
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
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