healthy mom, healthy baby nutrition as the foundation of life throughout pregnancy and beyond...

Healthy Mom, Healthy Baby

Nutrition as the Foundation of Life Throughout Pregnancy and Beyond

Provided Courtesy of Nutrition411.com

K-0739Review 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 meterEhrenberg 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 Key Roles in the Body

Protein 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 BodyVitamin 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.


Minerals Promote Structural Tissues/Organ

System DevelopmentNutrient

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


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)


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


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.

• Nausea and vomiting• Heartburn• Constipation • Food aversions:– Alcohol– Caffeinated beverages– Meats

Inadequate Nutrient Intake/Weight Gain


• 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

Inadequate Nutrient Intake/Weight Gain (cont’d)


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

• 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

Conditions That May Result in Excessive Weight Gain

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

• 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.

What Are Pregnant Women Really Eating?

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

S̶The 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


Choose meals and snacks that are:

• Healthy

• Convenient

• Tasty

• Economical

Meals and Snacks

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

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