Nutrition Chapter 10-12 Study Guide

7/27/2019 Nutrition Chapter 10-12 Study Guide

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Chapter 10:

During pregnancy, the mother needs more energy in the form of kilocalories, for what 2 important reasons?

-to supply the increased fuel demanded by the metabolic workload for both mother and fetus

-to spare protein for the added tissue building requirements

National standard recommends an increase of 340 kcal/day in the second trimester and approx 450 kcal/day duringthe third trimester, averaging about 2200-2800 kcal/day, 15-20% increase over the energy need of nonpregnantwomen. Active, large or nutritionally deficient women may require more

Increased complex carbs and protein in the diet are preferred sources of energy, esp during late pregnancy andlactation

Dietary guidelines regarding pregnancy and lactation?

-women of childbearing age who may become pregnant: foods high in heme iron or consume iron rich plantfoods or iron fortified foods, such as vitamin c rich foods

-women of childbearing age who may become pregnant and those in first trimester: adequate folic acid dailyfrom fortified foods or supplements, along with food forms of folate from varied diet

-pregnant women: ensure proper weight gain. Incorporate 30 mins or more of moderate intensity physicalactivity on most, if not all days of the week. Avoid activities with high risk of falling

-breastfeeding women: moderate weight reduction is safe and does not compromise infants weight gain.Neither acute nor regular exercise adversely affect the mothers ability to breastfeed.

-infants and young children, pregnant women, older adults, and immunocompromised: no raw,unpasteurized milk or any products made from unpasteurized milk, raw or partially cooked eggs or foods containingraw eggs, raw or undercooked meat and poultry, raw or undercooked fish, unpasteurized juices or raw sprouts

-pregnant women, older adults, immunocompromised: only eat certain deli meats and frankfurters that havebeen reheated to steaming hot.

Protein during pregnancy?

-rapid growth of the fetus: increase of fetus size from one cell to millions of cells in 9 months indicates therelatively large amounts of protein required for such rapid growth

-Development of placenta: lifeline to the mother. Mature placenta requires sufficient protein for its completedevelopment as a vital and unique organ to sustain, support and nourish the fetus during growth

-growth of maternal tissues: increased development of uterine and breast tissue is required to supportpregnancy and lactation

-increased maternal blood volume: mothers blood increases 20-50% which is necessary to support theincreased metabolic workload and nourish the child. There is a need for more synthesis of blood components,especially hemoglobin and plasma protein, which are vital to pregnancy. Increase in hemoglobin helps supply oxygento the growing number of cells. Plasma protein (albumin) production increases to regulate blood volume throughosmotic pressure. Adequate albumin prevents an abnormal accumulation of water in tissues beyond the normaledema of pregnancy.


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-amniotic fluid: contains various proteins and surrounds fetus during growth and guards it against shock orinjury.

-storage reserves: needed to prepare for the large amount of energy required during labor, delivery,immediate postpartum period and lactation.

Protein intake should increase 25 g/day during pregnancy, on top of nonpregnancy needs. Increase is more than50% of the average adult requirement.

The only complete protein foods of high biologic value are?

-milk, egg, cheese, soy products, meat.

Certain other incomplete proteins from plant sources such as legumes and grains contribute additional secondaryamounts

Protein rich foods also contribute other nutrients such as calcium, iron and B vitamins.

Key Minerals needed during pregnancy?

-Calcium: good supply of calcium, along with phosphorus, magnesium and vitamin D is essential for fetaldevelopment of bones and teeth as well as the mothers own body needs. Calcium is also necessary for proper bloodclotting. A diet that includes at least 3 cups of vitamin A and D fortified milk daily, plus dairy or dairy substitutes suchas soy products, and generous amounts of green vegetables and enriched whole grains, usually supplies enoughcalcium. Calcium and zinc are both significantly bioavailable during pregnancy, which means the bodys enhancedcapability to absorb and retain these nutrients during pregnancy helps meet nutrient needs of the growing fetus.

-Iron, Zinc and Copper: Particular attention to iron. Iron is necessary for hemoglobin for greater maternalblood volume and for the babys necessary prenatal storage of iron. 27 mg/day are recommended, which is more thana womens average of 18 mg/day. Consuming foods high in vitamin C along with dietary sources of iron enhance thebodys ability to absorb and use low bioavailable iron. Avoid foods that inhibit iron absorption such as whole graincereals, unleavened whole grain breads, legumes, tea and coffee. Because this 27 mg/day is hard to obtain, daily

iron supplements are recommended. Zinc and copper are increased during pregnancy, absorption of both minerals isinhibited by iron. Supplements are recommended.

-Iodine: Essential for producing more T4, which is the thyroid hormone needed in greater amounts to controlincreased bmr during pregnancy. Easily ensured by the use of iodized salt. Too much leads to mental retardation offetus.

Key vitamins during pregnancy?

-Vitamin A and C: important elements in tissue growth

-B Vitamins: play a vital role as coenzyme factors in energy production and protein metabolism

-Folate: builds mature RBC during pregnancy and is particularly needed during early periconceptionalperiod, from approx 2 months before conception to week 6 of gestation, to ensure healthy embryonic tissuedevelopment and prevent malformation of the neural tube. This tissue forms during critical period from 17-30 daysgestation and grows into the mature infants spinal column and its network of nerves. Spina bifida and anencephalyare the two most common forms of neural tube defects, which is any malformation of the embryonic brain or spinalcord. Spina bifida occurs when the lower end of the neural tube fails to close, as a result, the spinal cord andbackbones do not develop properly. Ranges from mild to severe, with limited movement and function. Anencephalyoccurs when the upper end of the neural tube fails to close. In this case, the brain fails to develop or is entirelyabsent. Pregnancies affected by this usually end in miscarriages or death soon after delivery. 600 mcg/day of folate


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is recommended during pregnancy and 400 mcg/day for nonpregnant women during child bearing years. All enrichedflour and grain products as well as fortified cereals contain a well absorbed form of folic acid. Other natural sourcesinclude liver, dark green leafy vegetables, legumes, soybeans, wheat germ, orange juice, asparagus and broccoli.

-Vitamin D: Increased vitamin D ensures absorption and utilization of calcium and phosphorus for fetal bonegrowth and can be met by 3 cups of fortified milk, or milk substitute daily. Fortified milk contains 10 mcg (400 IU) of

cholecalciferol (vitamin D) per quart, which is twice the AI amount. The mothers exposure to sunlight increasesendogenous synthesis of vitamin D as well. Lactose intolerant or vegetarian women can get it from fortified soy orrice milk products.

Weight gain during pregnancy?

The average weight gained is 29 lb.

-Underweight women: 28-40 lb

-Normal weight: 25-35

-overweight: 15-25

-obese: 15 lb

-teenage girls: 35-40

-carrying twins: 34-45 lb

-triplets: overall gain of 50 lb

Severe caloric restriction during pregnancy is potentially harmful to the developing fetus and the mother. Such arestricted diet cannot supply all the energy and nutrients essential to the growth process.

Approx 1-2 kg (2-4 lb) is the average weight gain in the first trimester. Thereafter, approx .5 kg (1 lb) a week duringthe remained of the pregnancy is usual

Intra-uterine growth restriction (IUGR)?

-an insufficient or low maternal weight gain in the second or third trimester. Less than 10% of fetal weight forgestational age. Multiple survival and growth problems. Factors include inadequate weight gain, low prepregnancyweight, use of cigarettes and alcohol.

A moderate amount (approx 2-3 g/day) of dietary sodium is needed and can be achieved through the normal use ofsalt in cooking and seasoning. Typical American diet contains 3-6 g/day so you do not need to consume extrasodium during pregnancy.

Strict vegans can meet dietary protein needs through the use of soy foods and complementary proteins

Specific counseling on avoidance of alcohol, caffeine, tobacco and recreational drug use during pregnancy is alsoimportant. Information about direct effects of poor nutrition on the fetus, especially related to the brain development,learning problems, and developmental delays, help motivate many pregnant women to choose a well selected diet.

Two important principles that govern the prenatal diet?

-pregnant women should eat a sufficient quantity of high quality food


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-pregnant women should eat regular meals and snacks, avoiding any habit of fasting or skipping meals,especially breakfast

Morning sickness in early pregnancy (which can happen at any time, not just mornings) usually is mild and onlyoccurs during the first trimester. It is caused by hormonal adaptations in the first weeks and may be increased bystress or anxieties.

How to relieve symptoms of morning sickness?

-small frequent meals and snacks that are fairly dry and consist mostly of easily digested energy foods(carbs), with liquids between, not with meals.

Hyperemesis gravidurum?

-women have persistent vomiting throughout the pregnancy that may result in fluid and electrolytedisturbances, weight loss and nutritional deficiencies.

Hemorroids are fairly common complaint during the latter part of pregnancy. This vein enlargement usually is causedby the increased weight of the baby and the downward pressure it produces. May cause discomfort, burning and

itching and may even rupture and bleed under the pressure of bowel movement, causing more anxiety to the mother.Dietary and rest help.

Heartburn usually occurs especially after meals and are caused by the pressure of the enlarging uterus crowding thestomach. Gastric reflux of food may occur in the lower esophagus, causing irritation and a burning sensation. Oftenreferred to as a full feeling.

Iron supplements may give you gray or black stools and sometimes nausea, constipation or diarrhea. To help avoidthese symptoms, iron supplements should be taken 1 hour before or 2 hours after a meal with a liquid such as wateror orange juice, not milk or tea.

Nutritional risk factors in onset pregnancy?

-age: 18 or younger, 35 or older

-frequent pregnancies: 3 or more during a 2 year period

-poor obstetric history or poor fetal performance

-poverty

-bizarre or trendy food habits

-abuse of nicotine, alcohol, drugs

-therapeutic diet required for a chronic disorder

-weight: 85% less or more than ideal weight

Risk factors during pregnancy?

-low hemoglobin or hematocrit

-inadequate weight gain

-excessive weight gain


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3 types of dietary patterns that do not support optimal maternal and fetal nutrition?

-insufficient food intake

-poor food selection

-poor food distribution throughout the day

Pica?

-craving for and consumption of non food items, sometimes seen in pregnant women, malnourished and isassociated with iron deficiency anemia.

Women over 35 may be at more risk for high blood pressure and gestational diabetes

Women with a high parity rate (several pregnancies within a few years) may be drained of nutrition resources andusual face the increasing physical and economic pressures of child care

Fetal Alcohol Syndrome and Fetal Alcohol Effects?

-combination of physical and mental birth defects born to mothers who consumed alchohol duringpregnancy. Leading cause of mental retardation and other birth defects in the US. Varies between populations and isinfluenced by environmental and behavioral conditions in addition to prepregnancy BMI and nutrition status.

Nicotine?

-smoking or environmental exposure to smoke is associated with placental abnormalities and fetal damage,including prematurity and low birth weight

Drugs?

-cross the placenta and enter the fetal circulation, thus creating a potential addiction in the unborn child.Dangers come from the drug and contaminated needles, as well as the impurities contained in street drugs.

Vitamin abuse and megadosing?

-Drugs made from vitamin A compounds, such as retinoids and tetinoin (accutane) which is prescribed forsevere acne, have caused spontaneous abortion of malformed fetuses by women who coneived during acnetreatment. Thus the use of these drugs without contraception is contraindicated.

Caffiene?

-Can cross the placenta and enter fetal circulation. Caffeine stays in the blood stream of a pregnant womanslightly longer in the third trimester

Teratogens?

-drug or substance causing birth defect

Anemia?

-most common nutritional deficiency. More prevalent in poor women. Deficiency of iron or folate.


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Hypertensive disorders of pregnancy?

-with accumulation of proteinuria the condition is called preeclampsia. Complications such as eclampticconvulsions and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) require hospitalization andoften induced labor.

Gestational diabetes?

-in pregnancy glucose in the urine (glycosuria) is not uncommon. Glucose intolerance with onset duringpregnancy, extra glucose spills into urine. Particular attention is given to women who are 30 or older, overweight andhave a history of the following factors: previous history, family history or ethnicity, glucosuria, obesity, large babies,birth of babies with multiple congenital defects

Children born to women with gestational diabetes are at greater r isk for impaired glucose tolerance, being overweightand cryptorchidism (abnormal testicular decent in boys)

Breastfeeding is recommended as the exclusive source of nutrition for infants up to 6 months of age. After 6 months,iron fortified complementary foods should be added to the basic diet of breast milk. Recommended for the first 12months. Most women stop because of difficulties such as sore nipples, infant spitting up or engorged breasts.

Upon delivery, milk production and secretion are stimulated by two hormones, prolactin and oxytocin. Stimulation ofnipple from infant suckling sends nerve signals to the brain, the nerve signal then causes the release of prolactin andoxytocin.

Prolactin?

-milk producing hormone

Oxytocin?

-responsible for the let down reflex. Let down is the process of milk moving from the upper milk producingcells down to the nipple for infant suckling

Breastfeeding mothers need adequate fluids such as milk, water, soups and juices contribute to the fluid producingmilk.

Prolactin inhibiters?

-fatigue, prolonged bed rest, medical complications and irregular breastfeeding

Advantages of breastfeeding for mother and infant?

-fewer infections: mother transfers certain antibodies in human milk

-fewer allergies and intolerances, especially in allergy prone infants

-ease of digestion, human milk forms a softer curd in the GI tract that is easier for infant to digest

-improved cognitive development in childhood

-decreases in the rish of childhood obesity and heart disease


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Benefits of breastfeeding for mother?

-promotes faster shrinking of uterus

-reduces postpartum bleeding

-decreases risk of breast and ovarian cancer

-delays resumption of the menstrual cycle

-improves glucose profile in those with gestational diabetes

-strengthens bond with infant

-enhances self esteem in maternal role

-eliminates need for preparing formula

-saves money

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Nutrition Chapter 10-12 Study Guide