SIR RHYE PPT
Gastrointestinal
- smooth muscles of the GIT decrease in acidity and motility.
-decreases emptying time of the gallbladder.
-increased venous pressure in the pelvic organs.
Endocrine
-Gonadotropins
-Progesterone -Estrogen
-BMR increases by 4.8% for age group 20-24 years
Respiration
- increase in matenal oxygen requirement.
- increased vascularisation in the respiratory tract.
SKELETAL
- bones and teeth become vulnerable.
MUSCULAR
-pelvic "joints” soften and become more movable.
Circulatory
- Blood Volume Increase
- Decrease in haemoglobin and plasma protein concentration
- Cardiac output increases 30-50% by the 32nd week, and declines to 20% increase at 40 weeks.
Renal
- blood flow through the kidneys and glomerular filtration rate increases by 50%.
HORMONAL EFFECTS ON NUTRIENT METABOLISM IN PREGNANCY
HORMONE
PROGESTERONE
PRIMARY SOURCE OF
SECRETION
PLACENTA
ESTROGEN
PLACENTA
HUMAN PLACENTAL LACTOGEN (HPL)
PLACENTA
HUMAN CHORIONIC THYROTROPHIN (HCT)
PLACENTA
HUMAN GROWTH HORMONE (HGH)
PLACENTA
THYROID STIMULATING HORMONE (TSH)
ANTERIOR PITUITARY
THYROXINE
THYROID
PARATHYROID HORMONE (PTH)
PARATHYROID
CALCITONIN (CT)
THYROID
INSULIN
BETA CELLS OF
PANCREAS
GLUCAGON
ALDOSTERONE
ALPHA CELLS OF
PANCREAS
ADRENAL CORTEX
CORTISONE
ADRENAL CORTEX
RENIN-ANGIOTENSIN
KIDNEY
PRINCIPAL EFFECTS
Reduces Gastric Motility; favors
maternal fat deposition; increases
Na Excretion; reduces alveolar
and arterial PCO2; Interferes with
folic acid metabolism.
Reduces serum proteins; increases
hydroscopic
properties
of
connective tissue; affects thyroid
function; interferes with folic acid
metabolism.
Elevates blood glucose from
breakdown of glycogen.
Stimulates production of thyroid
hormones.
Elevates blood glucose, stimulates
growth of long bones; promotes
nitrogen retention
Stimulates secretion of thyroxine;
increases uptake of iodine by
thyroid gland.
Regulates rate of cellular
oxidation (basal metabolism)
Promotes Calcium resorption
from bone; increases calcium
absorption; promotes urinary
excretion of phosphate.
Inhibits calcium resorption from
bone.
Reduces blood glucose levels to
promote energy production and
synthesis of fat.
Elevates blood glucose levels
from glycogen break down.
Promotes sodium retention and
Potassium excretion.
Elevates blood glucose from
protein break down.
Stimulates aldosterone secretion;
promotes sodium and water
retention; increases thirst
NUTRIENT ADJUSTMENTS
1. ENERGY
Why energy requirement is increased:
1. To compensate for the increase in basal metabolic rate.
2. For better utilization of protein.
3. For growth of the fetus, placenta and maternal tissues.
4. Increased muscular activity of the mother.
Factors that determine energy requirements in pregnancy:
1. The mother's usual physical activity.
2. The increase in metabolic rate to support the work for growth of the fetus and the accessory muscles.
How energy needs would differ:
1.Pregnancy weight & body composition.
2. Amount& composition of weight.
3. Stage of pregnancy and activity
2. PROTEIN

1.
2.
3.
4.
5.
6.





Reasons for the additional protein:
To provide the storage of nitrogen
To protect the mother against many of the complications of pregnancy
For the growth of the woman’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
950 grams are deposited during the last 6 months of gestation
FAO/WHO – additional 9g/day for latter part of pregnancy
For Filipinos – additional 14g/day
Philippine RENI – 8g/day throughout pregnancy
RECOMMENDATIONS:
 Protein requirements should be calculated on weight basis
 Protein is efficiently utilized during pregnancy as a result of reduced amino acid
catabolism
 Lack of energy rather than protein is the factor that is most likely to limit fetal growth
3. VITAMINS
VITAMIN
ASCORBIC ACID
VITAMIN A
RDA
120 mg/day
575 RE/4000 IU
50 RE/300 IU
1.3 – 1.4 mg/day
1.4 – 1.5 mg/day
THIAMIN (B1)
RIBOFLAVIN (B2)
NIACIN (B3)
PYRIDOXINE (B6)
COBALAMIN (B12)
FOLIC ACID
VITAMIN K
VITAMIN D
16 mg NE, 17-18 mg NE
4 mcg/day
400-600 mcg/day
4. MINERALS
CALCIUM
 500 mg – total calcium requirement
IRON
 1000 mg – is thee total iron needed during the 9 months gestation
IODINE
 Recommended 200 ug/day
MAGNESIUM
 US RDA 450 mg/day; FAO/WHO 205 mg/day
ZINC
 5.1 to 9.6 mg zinc/day Philippine RENI
NUTRIENT REQUIREMENT DURING PREGNANCY AND LACTATION
ENERGY/NUTRIENT PREGNANT
1ST
TRIMESTER
RENI
Energy, kcal
0
Protein, g
66
Vitamin A, mcg RE 800
Vitamin C, mg
80
Thiamin, mg
1.4
Riboflavin, mg
1.7
Niacin, mg NE
18
Folate, mcg DFE
600
Calcium, mg
800
Iron, mg
27
Iodine, mcg
200
Magnesium, mg
205
Phosphorus, mg
700
Zinc, mg
5.1
Fluoride, mg
35
Manganese, mg
2.5
Vitamin D, mcg
2.0
Vitamin D, mcg
5
Vitamin E, mcg
12
Vitamin K mcg,
51
Vitamin B6, mg
1.9
Vitamin B12, mcg
2.6
2ND
TRIMESTER
RENI
+300
66
800
80
1.4
1.7
18
600
800
34
200
205
700
6.6
35
2.5
2.0
5
12
51
1.9
2.6
WOMEN
3RD
TRIMESTER
RENI
+300
66
800
80
1.4
1.7
18
600
800
38
200
205
700
9.6
35
2.5
2.0
5
12
51
1.9
2.6
LACTATING
WOMEN
1ST 6 MONTHS 2ND
MONTHS
RENI
RENI
+500
+500
81
76
900
900
105
100
1.5
1.5
1.7
1.7
17
17
500
500
750
750
27
30
200
200
250
250
700
700
11.5
11.5
40
40
2.5
2.5
2.6
2.6
5
5
16
16
51
51
2.0
2.0
2.8
2.8
6
FACTORS AFFECTING MATERNAL NUTRITIONAL STATUS:
1. The birth weight
2. Levels of fetal stores of nutrients
3. The laying down of lactation reserves in the form of 4kg subcutaneous fat needed as a major
source of calories and fatty acids for subsequent milk production
COMPLICATIONS OF PREGNANCY
1.
2.
3.
4.
5.
6.
7.
8.
Weight gain/loss
Toxemia
Anemia
Diabetes
Constipation
Socio-economic cultural factors
Alcohol, caffeine, nicotine
Multiple pregnancies