Provided Courtesy of Nutrition411.com
Healthy Mom, Healthy Baby
Nutrition as the Foundation of Life
Throughout Pregnancy and Beyond
K-0739
Review Date 8/13
Introduction
By the end of this presentation, you will have
learned:
• The importance of nutrition in achieving a
healthy pregnancy
• The specific roles of key nutrients that are
especially important during pregnancy
• The various factors that influence a pregnant
woman’s ability to obtain these key nutrients
• The implications of both overeating and
undereating during pregnancy
• The importance of nutrition postpartum
Nutrition and Pregnancy
Women need to attain good
nutrition status before, during,
and after pregnancy to
optimize maternal health and
reduce risk of pregnancy
complications, birth defects,
and chronic diseases in their
children in adulthood
Kaiser L, Allen LH; American Dietetic Association. Position of the American Dietetic Association: nutrition and
lifestyle for a healthy pregnancy outcome. J Am Diet Assoc. 2008;108(3):553-561.
Healthy Baby, Healthy Adult
Fetal Origins of Adult Disease
Term infants who are small for their gestational
age are predisposed to obesity and have an
increased susceptibility to obesity, cardiovascular
disease, and type 2 diabetes (impaired glucose
tolerance) in adulthood as a consequence of
physiologic adaptations to undernutrition during
fetal life.
Source: Calkins K, Devaskar SU. Fetal origins of adult disease. Curr Probl Pediatr Adolesc Health Care.
2011;41(6):158-176. doi:10.1016/j.cppeds.2011.01.001.
Pregnancy Outcomes in
the United States (2010)
• Low birth weight (less than 5½ pounds)
– 8.1% of live births (1 in 12 babies)
– Increased by more than 6% from 2000 to 2010
• Preterm births (<37 weeks’ gestation)
– 12.0% of live births (1 in 8 babies)
• Cesarean delivery
– 32.8% of live births
– Increased by 43% between 2000 and 2010
March of Dimes® PeriSats. March of Dimes Web site. www.marchofdimes.com/peristats. Accessed
August 10, 2013.
Low Birth Weight
2000-2010
March of Dimes® PeriSats. March of Dimes Web site. www.marchofdimes.com/peristats. Accessed
August 10, 2013.
Pregnancy Outcomes and
Maternal BMI
• Low birth weight is primarily related to:
– Low prepregnancy BMI (kg/m2)
– Low gestational weight gain
• These anthropometric factors reflect inadequate
food intake, which may be related to:
– Poverty
– Cultural ideals of thinness
BMI=body mass index, kg-kilogram, m2=square meter
Ehrenberg HM, Dierker L, Milluzzi C, Mercer BM. Low maternal weight, failure to thrive in pregnancy, and adverse pregnancy outcomes. Am J Obstet Gynecol.
2003;189(6):1726-1730.
Moore VM, Davies MJ, Willson KJ, Worsley A, Robinson JS. Dietary composition of pregnant women is related to size of the baby at birth. J Nutr. 2004;134(7):1820-1826.
Macronutrients Provide
Energy and Building Material
Nutrient
Protein
Key Roles in the Body
Main building block for the body’s cells. Helps produce
extra maternal blood and energy stores.
Carbohydrate Provides energy for mother and fetus during pregnancy.
Fat
Provides long-term energy for growth. Should contribute
≤30% of daily calories.
Essential
Fatty Acids
(EFAs)
Incorporated into the central nervous system, brain, and
tissues of the fetus. Essential for proper brain growth
and development.
Eck M. Nutrition in pregnancy and lactation. In: Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food
and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012:340-374.
Vitamins Promote
Metabolism/Tissue Integrity
Nutrient
Key Roles in the Body
Vitamin A
Promotes healthy skin and mucous membranes of the
gastrointestinal, urinary, and respiratory tracts. Promotes
vision and immunity. Assists with bone and tooth growth.
Vitamin C
Promotes healthy gums, teeth, and bones. Enhances iron
absorption. Acts as an antioxidant.
Vitamin E
Prevents the oxidation of unsaturated fatty acids, which make
up the structure of cell membranes.
Vitamin B6
Helps create red blood cells. Needed for amino acid
metabolism, fatty acid metabolism, and protein synthesis.
Vitamin B12
Helps create red blood cells. Promotes normal growth and
maintenance of the nervous system.
Folic Acid/Folate
Needed for the production, repair, and functioning of DNA.
Needed to produce blood. Helps some enzymes function.
Eck M. Nutrition in pregnancy and lactation. In: Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food
and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012:340-374.
Minerals Promote
Structural Tissues/Organ
System Development
Nutrient
Key Roles in the Body
Calcium
Helps build strong bones and teeth by promoting adequate
mineralization. Involved in muscle contraction and
relaxation, nerve functioning, blood clotting, blood
pressure, and immunity.
Iron
Helps synthesize red blood cells. Helps prevent maternal
fatigue. Needed by enzymes that make amino acids,
collagen, and hormones.
Magnesium
Helps build strong bones and teeth. Helps regulate insulin
and blood sugar levels. Helps maintain acid-base balance.
Zinc
Helps form organs, skeleton, nerves, and circulatory
organs. Is a component of insulin and several enzymes.
Helps synthesize DNA, RNA, and proteins. Involved in
wound healing.
Eck M. Nutrition in pregnancy and lactation. In: Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food
and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012:340-374.
Dietary Quality and Timing:
The 1st Trimester
• Both the amount of a nutrient and its timing of
intake are extremely important to fetal
development
• The 1st trimester is a time of rapid cell division,
organ development, and preparation for the
demands of rapid fetal growth that occur later in
pregnancy
King JC. Physiology of pregnancy and nutrient metabolism. Am J Clin Nutr. 2000;71(suppl 5):1218S-1225S.
Dietary Quality and Timing:
The 1st Trimester (cont’d)
• Critical nutrients during this phase include:
–
–
–
–
Protein
Folic acid
Vitamin B12
Zinc
King JC. Physiology of pregnancy and nutrient metabolism. Am J Clin Nutr. 2000;71(suppl 5):1218S-1225S.
Dietary Quality and Timing:
The 2nd and 3rd Trimesters
• Energy intake is especially important, because
90% of fetal growth occurs during the last half of
gestation
• Critical nutrients during this phase include:
–
–
–
–
–
–
Protein
Iron
Calcium
Magnesium
B vitamins
Omega-3 fatty acid docosahexaenoic acid (DHA)
King JC. Physiology of pregnancy and nutrient metabolism. Am J Clin Nutr. 2000;71(suppl 5):1218S-1225S.
Energy Needs
During Pregnancy
• Extra energy needs for normal-weight women:
– 1st trimester—approximately 0 kilocalories (kcal)
– 2nd trimester—approximately 350 kcal
– 3rd trimester—approximately 450 to 500 kcal
• Pregnant women have great variability with
regard to energy costs during pregnancy because
of differences in body size and lifestyles
• Appropriate weight gain and appetite are better
indicators of energy sufficiency than the amount
of kcal consumed
Eck M. Nutrition in pregnancy and lactation. In: Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food
and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012:340-374.
Gestational
Weight Gain Patterns
• Many women gain more weight than is necessary
during pregnancy, which is related to postpartum
weight retention
• Excessive gain during pregnancy may result in
adverse outcomes, including hyperglycemia,
large babies, a low Apgar score, and seizures
Kaiser L, Allen LH; American Dietetic Association. Position of the American Dietetic Association: nutrition and
lifestyle for a healthy pregnancy outcome. J Am Diet Assoc. 2008;108(3):553-561.
Inadequate Nutrient
Intake/Weight Gain
•
•
•
•
Nausea and vomiting
Heartburn
Constipation
Food aversions:
– Alcohol
– Caffeinated beverages
– Meats
Eck M. Nutrition in pregnancy and lactation. In: Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food
and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012:340-374.
Inadequate Nutrient
Intake/Weight Gain (cont’d)
• Food avoidances
–
–
–
–
Milk
Lean meats
Pork
Liver
• Poor prepregnancy diet:
– Inappropriate dietary patterns
– History of frequent dieting, weight cycling, and/or
eating disorders
• Excessive physical activity
Eck M. Nutrition in pregnancy and lactation. In: Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food
and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012:340-374.
Eating Strategies
• Strategies that are recommended to deal with
some of these issues include:
–
–
–
–
–
Small, frequent meals and snacks
Adequate fiber intake
Adequate fluid intake
Avoiding an empty stomach
Choosing foods that are well tolerated
Conditions That May Result
in Excessive Weight Gain
• Food cravings:
– Dairy foods
– Sweet foods
• Psychological influences on eating behavior:
– Reduced attempts to control food intake
– Pregnancy legitimizes eating more
• Reduction in physical activity
Life in Balance
• It is necessary to balance the risk of
overweight because of excessive pregnancy
weight gain against the risk of poor fetal
growth associated with inadequate weight
gain
• A nutrient-dense diet is needed to supply
sufficient nutrients to the developing fetus,
because fetal demands may double some
micronutrient requirements
An Additional 300 kcal
Is Not Much!
Meal Equivalents (300 kcal)
Nutrients Provided
8 oz low-fat yogurt (sweetened),
medium apple
Protein, carbohydrate, fiber, vitamin B12,
calcium
Whole-wheat pita, ¼ C hummus,
12 baby carrots
Protein, carbohydrate, fat, fiber, vitamin A,
vitamin B6, vitamin E, folic acid, iron
1 C raisin bran, 6 fl oz skim milk,
4 fl oz orange juice
Protein, carbohydrate, fiber, vitamin B6,
vitamin B12, vitamin C, folic acid, calcium,
iron, magnesium, zinc
Two slices whole-wheat bread,
1 Tbsp peanut butter,
one-half banana
Protein, carbohydrate, fat, fiber, vitamin
B6, vitamin E, folic acid, iron, magnesium,
zinc
4 oz salmon, one medium sweet
potato, ½ C steamed broccoli
Protein, carbohydrate, fat (omega-3),
fiber; vitamin A, vitamin C, vitamin B12,
vitamin E, folic acid, magnesium
C=cup, fl oz=fluid ounce, kcal=kilocalorie, oz=ounce, Tbsp=tablespoon
What Are Pregnant Women
Really Eating?
• A prospective study of lower- to middle-income
women had these results:
– Foods with poor nutrient density were major contributors
to energy, fat, and carbohydrates—biscuits, muffins,
whole milk, French fries, and fried potatoes
– Carbohydrates were mostly refined and low in dietary
fiber—soft drinks, biscuits, muffins, and white bread
– Median iron intake was below recommended levels
Siega-Ritz AM, Bodnar LM, Savitz DA. What are pregnant women eating? Nutrient and food group
differences by race. Am J Obstet Gynecol. 2002;186(3):480-486.
Eating for Two?
• Another study of the dietary intakes of pregnant
women enrolled in WIC found the following:
– Consumed only 85% of the RDA for energy
(kilocalories)
– Average energy intake from fat was higher than
recommended (37% vs 30%)
– 90% consumed less than two-thirds of the RDA for iron
– 22% had iron-deficiency anemia
RDA=Reference Daily Intakes, WIC=Special Supplemental Program for
Women, Infants, and Children
Swensen AR, Harnack LJ, Ross JA. Nutritional assessment of pregnant women enrolled in the Special
Supplemental Program for Women, Infants, and Children (WIC). J Am Diet Assoc. 2001;101(8):903-908.
The Dilemma
•
•
•
•
Overeating of total energy or kilocalories
Undereating of total energy or kilocalories
Overconsumption of low nutrient-dense foods
Underconsumption of high nutrient-dense foods
Beyond Pregnancy
• Energy and nutrient needs still are elevated
postpartum, particularly in women who choose to
breastfeed or who have had a cesarean section
̶ The energy required for daily milk production is close
to 330 to 400 kcal
• The inherent demands of a newborn are a
challenge to the new mother and her family
Eck M. Nutrition in pregnancy and lactation. In: Mahan LK, Escott-Stump S, Raymond JL. Krause’s Food
and the Nutrition Care Process. 13th ed. St Louis, MO: Elsevier Saunders; 2012:340-374.
Meals and Snacks
Choose meals and snacks that are:
• Healthy
• Convenient
• Tasty
• Economical
Summary
• Critical nutrients are required in the right
amounts at the right time to achieve a healthy
pregnancy
• The majority of women do not gain weight within
the recommended ranges during pregnancy
• Various factors influence eating patterns during
pregnancy, resulting in either inadequate or
excessive intake of energy (kilocalories) and
certain nutrients
Summary (cont’d)
• Studies show that pregnant women eat too many
refined carbohydrates and fat, and too little iron
and fiber
• Pregnant women should consume meals and
snacks that are healthy or nutrient dense, tasty,
convenient, and economical