nutrition in pregnancy and lactation

8/8/2019 Nutrition in Pregnancy and Lactation

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Chapter 15Chapter 15

Nutrition in PregnancyNutrition in Pregnancy

AndAnd

LactationLactation


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PregnancyPregnancy

It is the most critical and unique period InIt is the most critical and unique period In

human life.human life.

The foundation of a new life is being laid thatThe foundation of a new life is being laid thatwill influence the future of succeedingwill influence the future of succeeding

generation.generation.

Has a social importance affecting not onlyHas a social importance affecting not only

individual but also their families and society asindividual but also their families and society as

a whole.a whole.


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During this stage theDuring this stage themother and child havemother and child have

an intimate andan intimate and

inseparable relationship.inseparable relationship.

It is the period fromIt is the period from

conception to birth andconception to birth and

for human being lastfor human being last

from 38from 38--42 weeks.42 weeks.


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Physiological basis of nutritionalPhysiological basis of nutritional

needs inP

regnancyneeds inP

regnancy

Stages of PregnancyStages of Pregnancy

ImplantationImplantation

OrganogenesisOrganogenesis

GrowthGrowth


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ImplantationImplantation

The period in which theThe period in which the

fertilized ovum implantsfertilized ovum implants

itself in the uterus anditself in the uterus and

being develop.being develop.

Occurs during the firstOccurs during the first

to second week ofto second week ofconception.conception.


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OrganogenesisOrganogenesis

The embryo undergoesThe embryo undergoes

differentiation or rapiddifferentiation or rapid

cell division that occurscell division that occurs

during 2during 2--8 weeks after8 weeks afterconceptionconception

This is a critical periodThis is a critical period

when organs are beingwhen organs are being

formed and mostformed and most

vulnerable to adversevulnerable to adverse

influences.influences.


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If cell division and the final cell number achievedIf cell division and the final cell number achieved

in an organ are limited during this period, it willin an organ are limited during this period, it will

have irreversible effects on later developmentalhave irreversible effects on later developmentalstage.stage.


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GrowthGrowth

Occurs during on theOccurs during on the

remaining 7 months.remaining 7 months.


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Blood Volume and CompositionBlood Volume and Composition

The plasma volume begin to increase towardsThe plasma volume begin to increase towardsthe end of the first trimester and by 34 weeks.the end of the first trimester and by 34 weeks.It is 50% greater at conception, if nutrients andIt is 50% greater at conception, if nutrients and

blood constituents do not keep up with theblood constituents do not keep up with theexpansion in plasma volume, theirexpansion in plasma volume, theirconcentration will decrease even the totalconcentration will decrease even the totalamounts may rise.amounts may rise.

It will lead to a condition calledIt will lead to a condition calledPhysiological anemia of pregnancyPhysiological anemia of pregnancy


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Circulatory SystemCirculatory System

There is a slight cardiac hypertrophy orThere is a slight cardiac hypertrophy or

dilation due to increased blood volume anddilation due to increased blood volume and

cardiac output.cardiac output.

As the diaphragm is displaced upward, theAs the diaphragm is displaced upward, the

heart is elevated upward and to the left, pulseheart is elevated upward and to the left, pulse

increases slowly up to the 10increases slowly up to the 10--15 bpm between15 bpm between

1414--20 and persist to term.20 and persist to term.


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Bradycardia and palpitation may occur afterBradycardia and palpitation may occur after

delivery and persist for one week.delivery and persist for one week.

There is decreased in systolic and diastolicThere is decreased in systolic and diastolic

blood pressure of 5 to 10 mm Hg due toblood pressure of 5 to 10 mm Hg due to

peripheral vasodilatation from hormonalperipheral vasodilatation from hormonalchanges in pregnancy during the first half ofchanges in pregnancy during the first half of

pregnancy.pregnancy.

During the third trimester, blood pressureDuring the third trimester, blood pressureshould return to the values obtained during theshould return to the values obtained during the

first trimester.first trimester.


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Cardiac output increases from 30Cardiac output increases from 30--50% by the50% by the3232ndnd week of pregnancy and declines to aboutweek of pregnancy and declines to about

20% increase at 40 weeks.20% increase at 40 weeks.

This is due to the increased stroke volume andThis is due to the increased stroke volume and

response to increased tissue demands forresponse to increased tissue demands for

oxygen.oxygen.


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RespirationRespiration

Maternal oxygenMaternal oxygen

requirements increases duerequirements increases due

to acceleration in basalto acceleration in basal

metabolic rate and the needmetabolic rate and the need

to add tissue mass in theto add tissue mass in the

uterus and breast.uterus and breast.

There is increasedThere is increased

vascularization in thevascularization in the

respiratory tract due torespiratory tract due toelevated levels of estrogen.elevated levels of estrogen.


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Edema and HyperemiaEdema and Hyperemia

-- occurs duringoccurs duringelevation of theelevation of the

capillaries.capillaries.


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Tympanic membrane and Eustachian tube swell,Tympanic membrane and Eustachian tube swell,

giving rise to symptoms of impaired hearinggiving rise to symptoms of impaired hearing

earaches of a sense of fullness in the ear.earaches of a sense of fullness in the ear.

Thoracic breathing replaces abdominal breathingThoracic breathing replaces abdominal breathing

with advancing pregnancy.with advancing pregnancy.

The pregnant women breaths more deeply butThe pregnant women breaths more deeply but

increases her respiratory only slightly (2bpm)increases her respiratory only slightly (2bpm)


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Renal FunctionRenal Function

Blood flow through the kidneys and theBlood flow through the kidneys and the

glomerular filtration rate are increased duringglomerular filtration rate are increased during

pregnancy to facilitate the clearance of wastepregnancy to facilitate the clearance of waste

production of fetal and maternal metabolism.production of fetal and maternal metabolism.

GlucoseGlucose

AminoAmino--acidacid

Water soluble vitaminsWater soluble vitamins


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-- they appears in the urine instead of beingthey appears in the urine instead of being

reabsorbed by the kidneys to preserve bodyreabsorbed by the kidneys to preserve bodybalance.balance.

The reason is that high glomerular filtration rateThe reason is that high glomerular filtration rateoffers the tubules greater quantities of nutrientoffers the tubules greater quantities of nutrient

that they can possibly absorb.that they can possibly absorb.


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Gastrointestinal functionGastrointestinal function

Loss of appetite, nausea and vomiting mayLoss of appetite, nausea and vomiting mayoccur during the 1occur during the 1stst trimester of pregnancy duetrimester of pregnancy dueto hormonal changes. There may be alterationto hormonal changes. There may be alteration

in the sense of taste such as preference forin the sense of taste such as preference forstronger salt solution compared with nonstronger salt solution compared with nonpregnant women.pregnant women.

Smooth muscle of GISmooth muscle of GI

-- decreased tome of the gallbladder and thisdecreased tome of the gallbladder and thiscondition together with hypercholesterolemiacondition together with hypercholesterolemia


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Due to increased progesterone, may be the cause

Due to increased progesterone, may be the causeof frequent gallstone during pregnancy.of frequent gallstone during pregnancy.

some cause of discomfort due tosome cause of discomfort due tointrointro-- abdominal alterationabdominal alteration


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Pelvic pressurePelvic pressure


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flatulenceflatulence


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distentiondistention


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Bowel crampingBowel cramping


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Venous pressure increases in the pelvic organVenous pressure increases in the pelvic organ

due to the displacement of the intestines anddue to the displacement of the intestines and

pressure from expanding uteruspressure from expanding uterus


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HormonesHormones

The pregnant women secretes more than 30The pregnant women secretes more than 30

different hormones during the pregnancy.different hormones during the pregnancy.


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PlacentaPlacenta

The function is theThe function is the

production ofproduction of

hormones to regulatehormones to regulate

the activity ofthe activity of



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ProgesteroneProgesterone

Causes relaxation of theCauses relaxation of the

smooth muscles of thesmooth muscles of the

uterus and other smoothuterus and other smooth

muscles in the body.muscles in the body.

Effect of this is to favorEffect of this is to favor

maternal fat depositionmaternal fat deposition

and increased renaland increased renalsodium excretion.sodium excretion.


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EstrogenEstrogen

Promote growth and control thePromote growth and control the

function of the uterusfunction of the uterus

It changes the structure ofIt changes the structure of

mucopolyssacharides in connectivemucopolyssacharides in connective

tissues increasing its affinity to water.tissues increasing its affinity to water.

Changes in the cardiovascular systemChanges in the cardiovascular system

cause extra cellular fluid to accurate incause extra cellular fluid to accurate inthe feet and legs.the feet and legs.


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Mild edemaMild edema

-- physiological in pregnancy and the usualphysiological in pregnancy and the usual

measures commonly use to prevent it such asmeasures commonly use to prevent it such asusing diuretics and restricting dietary sodiumusing diuretics and restricting dietary sodium

is not recommended because it imposesis not recommended because it imposes

unnecessary risk.unnecessary risk.


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InsulinInsulin

Affects blood glucoseAffects blood glucose

level by facilitating itslevel by facilitating itstransport into cells totransport into cells to

be used for energy orbe used for energy or

fat synthesis.fat synthesis.


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Weight gainWeight gain

All women need to gain weight duringAll women need to gain weight during

pregnancy for fetal growth and maternalpregnancy for fetal growth and maternal

health.health.

Some are underweight, overweight, obeseSome are underweight, overweight, obese


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underweightunderweight

Laura at six monthsLaura at six monthspregnant.pregnant.

BMI


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overweightoverweight

Higher risk for havingHigher risk for havinghypertension gestationalhypertension gestationaldiabetes and post partumdiabetes and post partuminfection.infection.

More likely to born postMore likely to born postterm and weight more thanterm and weight more than9lbs.9lbs.

Overweight women shouldOverweight women should

try to achieve healthy bodytry to achieve healthy bodyweight before pregnancy.weight before pregnancy.Avoid too much gainingAvoid too much gainingweight.weight.


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Recommended RangeRecommended Range

HealthyHealthy

weightweight

UnderUnder

weightweight

OverOver

weightweight

ObeseObese CarryingCarrying

twinstwins

PregnantPregnant

adolescentadolescent

1111-- 15kg15kg

(25(25--

35lbs)35lbs)

1313--1818

kg (24kg (24--

40lbs)40lbs)

88--13.513.5

kg (18kg (18--

30lbs)30lbs)

1515--

30lbs30lbs

3535--

45lbs45lbs

35lbs35lbs


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The Role ofPlacentaThe Role ofPlacenta


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Plays an active role in reproduction and is notPlays an active role in reproduction and is nota passive barrier between the mother and thea passive barrier between the mother and thefetus.fetus.

It is the principle site for the production ofIt is the principle site for the production of

several hormones that regulate maternalseveral hormones that regulate maternalgrowth and developmentgrowth and development

The placenta supplies the fetus with maternalThe placenta supplies the fetus with maternalnutrients, and allows fetal waste to be disposednutrients, and allows fetal waste to be disposed

of via the maternal kidneysof via the maternal kidneys


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Mechanism for nutrient transferMechanism for nutrient transfer

Simple DiffusionSimple Diffusion

Facilitated diffusionFacilitated diffusion

PinocytosisPinocytosis


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Simple diffusionSimple diffusion a passive process In whicha passive process In which

nutrients move from high concentration in thenutrients move from high concentration in the

maternal blood to lower concentration in thematernal blood to lower concentration in thefetal capillaries until equilibrium is reached.fetal capillaries until equilibrium is reached.

Facilitated diffusionFacilitated diffusion involves a carrier in theinvolves a carrier in the

cell membrane so the rate of transfer is fastercell membrane so the rate of transfer is fasterthan simple diffusion. A sugar are transferredthan simple diffusion. A sugar are transferred

via facilitated diffusion.via facilitated diffusion.

PinocytosisPinocytosis the uptake of fluid materials by athe uptake of fluid materials by aliving cell, by means of invagination of the cellliving cell, by means of invagination of the cell

and vacuole formation.and vacuole formation.


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Nutrient RequirementsNutrient Requirements

Two factors thatTwo factors thatdetermine energydetermine energyrequirements are therequirements are the

mother usualmother usualphysical activity andphysical activity andthe increase inthe increase inmetabolic rate tometabolic rate tosupport the worksupport the work

required for growthrequired for growthof the fetus and theof the fetus and theaccessory motors.accessory motors.


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ProteinProtein

This nutrient is essential asThis nutrient is essential asit forms the structuralit forms the structuralbasis for all new cells andbasis for all new cells andtissues in the mother andtissues in the mother andfetus. it is based on thefetus. it is based on the

needs of the nonneeds of the non--pregnantpregnantwomen used as a referencewomen used as a referenceplus the extra amountsplus the extra amountsneeded for growth. Aboutneeded for growth. About925gm of protein are925gm of protein aredeposited in the normaldeposited in the normalfetus and maternal tissues.fetus and maternal tissues.

Maternal and fetal growthMaternal and fetal growthaccelerates only during theaccelerates only during thesecond month andsecond month andincreases progressivelyincreases progressivelyuntil just before terms.until just before terms.


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VitaminsVitamins

Important duringImportant during

pregnancy, the mostpregnancy, the most

importantly cited areimportantly cited are

folic acid, ascorbic acidfolic acid, ascorbic acid

and the B vitaminsand the B vitamins


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Ascorbic Acid RDAAscorbic Acid RDA

For pregnancy isFor pregnancy is80mgs/day,which is an80mgs/day,which is anadditional 10mg/day over theadditional 10mg/day over the

needs of non pregnant state.needs of non pregnant state.There had been studiesThere had been studiesshowing the role of vitaminsshowing the role of vitaminsC in premature rupture of theC in premature rupture of themembranes. Low plasmamembranes. Low plasma

levels of vitamin C had beenlevels of vitamin C had beenobserved in cases of preobserved in cases of pre--eclampsia.eclampsia.


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Thiamin,Riboflavin and NiacinThiamin,Riboflavin and Niacin

Related to caloricRelated to caloric

intakes, sinceintakes, since

caloric allowancescaloric allowances

increases duringincreases during

pregnancy, thepregnancy, the

caloric requirementcaloric requirement

also automaticallyalso automaticallyincreases duringincreases during



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Folic AcidFolic Acid

Deficiencies of folicDeficiencies of folicacid around the time ofacid around the time ofconception has beenconception has beenassociated with neuralassociated with neuraltube defects (NTD),tube defects (NTD),

such as spina bifida.such as spina bifida. Many babies born withMany babies born with

spina bifida grow intospina bifida grow intoadulthood withadulthood with

paralysis of the lowerparalysis of the lower

limbs and varyinglimbs and varyingdegrees of bowel anddegrees of bowel andbladder incontinencebladder incontinence

Cause megaloblasticCause megaloblasticanemia.anemia.


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Vitamin B6Vitamin B6

May control nausea andMay control nausea andvomiting duringvomiting during

pregnancy is notpregnancy is notconclusive.conclusive.

Pyridoxal phosphatePyridoxal phosphate(PLP) is the active form(PLP) is the active formand is a cofactor in manyand is a cofactor in manyreactions of amino acidreactions of amino acidmetabolism, includingmetabolism, including

transamination,transamination,deamination, anddeamination, anddecarboxylation.decarboxylation.


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Vitamin AVitamin A

Essential nutrient because ofEssential nutrient because ofits critical role inits critical role inreproduction.reproduction.

a bia bi--polar molecule formedpolar molecule formed

with biwith bi--polar covalent bondspolar covalent bondsbetween carbon andbetween carbon andhydrogen, is linked to ahydrogen, is linked to afamily of similarly shapedfamily of similarly shapedmolecules, the retinoid,molecules, the retinoid,

which complete thewhich complete theremainder of the vitaminremainder of the vitaminsequence.sequence.


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Vitamin DVitamin D

Has a positive effect onHas a positive effect oncalcium balance duringcalcium balance duringpregnancy.pregnancy.

It may be involved in neonatalIt may be involved in neonatalcalcium homeostasis.calcium homeostasis.

Poor enamel development andPoor enamel development and

neonatal hypocalcemia hasneonatal hypocalcemia hasbeen associated with maternalbeen associated with maternalvitamin D deficiency.vitamin D deficiency.


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MineralsMinerals

Needs during pregnancy are increased soNeeds during pregnancy are increased so

that if the mothers diet does not providethat if the mothers diet does not provide

what is required by the fetus, pregnantwhat is required by the fetus, pregnant

women need to access their stores towomen need to access their stores toensure that the fetus have adequateensure that the fetus have adequate

support.support.

On the other hand, excess mineral intakesOn the other hand, excess mineral intakesmay adversely affect the fetus. Thus, onmay adversely affect the fetus. Thus, on

appropriate balance is needed.appropriate balance is needed.


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IronIron

Needed for the manufacture ofNeeded for the manufacture ofhemoglobin in maternal andhemoglobin in maternal andfetal red blood cells. The fetusfetal red blood cells. The fetusaccumulates most of its ironaccumulates most of its iron

during the third trimester.during the third trimester. Iron deficiency in the motherIron deficiency in the mother

affects pregnancy outcome.affects pregnancy outcome.

A reduction is hemoglobinA reduction is hemoglobin

increases her cardiac output toincreases her cardiac output tomaintain adequate oxygenmaintain adequate oxygenconsumption by placental andconsumption by placental andfetal cells.fetal cells.


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CalciumCalcium

Promote adequate mineralization ofPromote adequate mineralization ofthe fetal skeleton and deciduoles teeththe fetal skeleton and deciduoles teethduring pregnancy.during pregnancy.

The fetus acquires most of its calciumThe fetus acquires most of its calcium

during the last trimester when skeletalduring the last trimester when skeletalgrowth id maximum and teeth aregrowth id maximum and teeth are

being formed.being formed.

Dental carries is a commonDental carries is a commonoccurrence in pregnancy and there isoccurrence in pregnancy and there is

a belief that calcium deficiencya belief that calcium deficiencycauses demineralization of teeth.causes demineralization of teeth.


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MagnesiumMagnesium

The fetus accumulatesThe fetus accumulatesabout one gram magnesiumabout one gram magnesium

during gestation. Hence, theduring gestation. Hence, the

USUS--RDA recommends 360RDA recommends 360

to 400mg magnesium perto 400mg magnesium perday for pregnant women,day for pregnant women,

which is an additional 40 towhich is an additional 40 to

90mg magnesium per day90mg magnesium per day

over the needs for nonover the needs for nonpregnant women.pregnant women.


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IodineIodine

Should be adequatelyShould be adequatelyprovided during pregnancyprovided during pregnancybecause of an increased basalbecause of an increased basalmetabolic rate.metabolic rate.

Iodine injection in the formIodine injection in the formof iodized oil beforeof iodized oil beforepregnancy will preventpregnancy will prevent

cretinism. The adversecretinism. The adverseconsequence of iodineconsequence of iodineoverdose is mentaloverdose is mentalretardation in infants.retardation in infants.


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ZincZinc

When severe reductionWhen severe reductionof circulatory Zincof circulatory Zinc

occurs in the motheroccurs in the mother

blood, there is theblood, there is thepossibility of increasespossibility of increases

risk of spontaneousrisk of spontaneous

abortions andabortions and

congenitalcongenital

malformation.malformation.


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FluorideFluoride

Development of primaryDevelopment of primarydentition of the fetus startsdentition of the fetus starts

on the 10 to 12on the 10 to 12thth weeks ofweeks of

pregnancy.pregnancy. The 32 teeth are formedThe 32 teeth are formed

during gestation. Theduring gestation. The

adequate intake of fluorideadequate intake of fluoride

is 3mg/dayis 3mg/day 10mg/day10mg/day


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Common NutritionCommon Nutrition--RelatedRelated

concern during pregnancyconcern during pregnancy


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Nausea and VomitingNausea and Vomiting

Morning sicknessMorning sickness

Most common discomfort duringMost common discomfort during

the early part of pregnancythe early part of pregnancy

Nausea and vomiting occur afterNausea and vomiting occur aftergetting up in the morninggetting up in the morning

Caused by increase hormoneCaused by increase hormone

secretionsecretion

Disappear after the first trimesterDisappear after the first trimester


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Nutrition expert recommendsNutrition expert recommends

Frequent feeding of dry meals, instead of 3 large mealsFrequent feeding of dry meals, instead of 3 large meals

Food high in carbohydrate and low fat food can overFood high in carbohydrate and low fat food can over

come nausea and vomitingcome nausea and vomiting

Liquids are better taken between meals rather than mealLiquids are better taken between meals rather than meal

timetime

Avoid excessive mealtimeAvoid excessive mealtime

Piece of candy helps curb the nausea.Piece of candy helps curb the nausea.

* Severe prolonged episode of vomiting requires* Severe prolonged episode of vomiting requires

hospitalization to administerIV fluid and electrolytehospitalization to administerIV fluid and electrolytereplacements to avoid dehydrationreplacements to avoid dehydration


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HeartBurnHeartBurn

Common complaint in latter partCommon complaint in latter part

of pregnancyof pregnancy

Pressure of the enlarged uterusPressure of the enlarged uterus

on the stomachon the stomach

Esophageal sphincterEsophageal sphincter-- dilationdilation

or relaxation results inor relaxation results in

regurgitation of acidic stomachregurgitation of acidic stomach

contents into the esophagus.contents into the esophagus.


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Limit the amount of food consumed at one timeLimit the amount of food consumed at one time

Eating less spicyEating less spicy

Less greasy foodLess greasy food

Drinks fluids between meals rather than with mealsDrinks fluids between meals rather than with meals Eat slowly and sit upright for at least 2hrs.after eatingEat slowly and sit upright for at least 2hrs.after eating

Avoid lying down after mealAvoid lying down after meal

Walk around the house after mealWalk around the house after meal

Loose clothing around the waist must be wornLoose clothing around the waist must be worn


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ConstipationConstipation

Pressure exerted by thePressure exerted by thedeveloping fetus on thedeveloping fetus on the

digestive track.digestive track.

Due to lack of exercise andDue to lack of exercise andinsufficient bulk and fluidinsufficient bulk and fluid

intakesintakes


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Lots of fresh fruits, vegetables, andLots of fresh fruits, vegetables, and

fluidsfluids

Regular exerciseRegular exerciseDo not use medication like laxativesDo not use medication like laxatives

without the doctors advicewithout the doctors advice

Bulking stool softener isBulking stool softener isrecommendedrecommended..


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EdemaEdema

Present in the extremities inPresent in the extremities in

the 3the 3rdrd trimester.trimester.

Swelling of the lowerSwelling of the lowerextremities may be cause byextremities may be cause by

the pressure of the enlargingthe pressure of the enlarging

uterus on the veins thatuterus on the veins that

return fluid from legsreturn fluid from legs..


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RecommendationRecommendation

Does not require sodium restriction or otherDoes not require sodium restriction or other

dietary changedietary change


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Leg CrampsLeg Cramps

Sudden contractions ofSudden contractions ofgastrocnemius musclegastrocnemius muscle

Occur usually at nightOccur usually at night

Decline in serum calciumDecline in serum calcium

levels related to a calciumlevels related to a calcium--

phosphorus imbalancephosphorus imbalance


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Rapid weight gain or lossRapid weight gain or loss

Excessive weight gainExcessive weight gain

Increase of a kg or moreIncrease of a kg or moreper month in the secondper month in the secondand third 3and third 3rdrd semestersemester

Sudden increase inSudden increase inweight after about 20weight after about 20thth

week of gestation isweek of gestation iscause for suspecting thatcause for suspecting thatwater is being retained atwater is being retained at

an inordinate rate andan inordinate rate andwarning sigh ofwarning sigh ofimpending eclampsiaimpending eclampsia


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Excessive weight lossExcessive weight loss

Gain of less than 500 g/month duringGain of less than 500 g/month during

the 1the 1stst trimester of pregnancy and 250trimester of pregnancy and 250g during the 2g during the 2ndnd trimester istrimester is

considered a maternal risk factorconsidered a maternal risk factor*Effects of seriously underweight on entering*Effects of seriously underweight on entering

pregnancy (


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Unwise choices in selection of foodsUnwise choices in selection of foods

An underlying condition impairing absorptionAn underlying condition impairing absorption

*Protein calories supplements*Protein calories supplements

Correct past nutritional deficits and depleted storesCorrect past nutritional deficits and depleted stores

as well as provides for pregnancy needs.as well as provides for pregnancy needs.

Committee on Nutritional Status during PregnancyCommittee on Nutritional Status during Pregnancy

-- Recommends weight gain of 13Recommends weight gain of 13--18kg and18kg and

pregnant women carrying twins can gain 16pregnant women carrying twins can gain 16--

20kg.20kg.


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PregnancyPregnancy-- induced Hypertensioninduced Hypertension

Toxemia of pregnancyToxemia of pregnancy

Rapid weight gain, edema, high bloodRapid weight gain, edema, high blood

pressure, excretion of albumin in the urine andpressure, excretion of albumin in the urine and

convulsions are some clinical manifestationconvulsions are some clinical manifestation

Classifications:Classifications:

PrePre--eclampsiaeclampsia

EclampsiaEclampsia


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PrePre-- eclampsiaeclampsia

HypertensionHypertensionwithwith

proteinuria/edemaproteinuria/edema


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EclampsiaEclampsia

Convulsion/coma,Convulsion/coma,usually both whenusually both whenassociated withassociated with

hypertension,hypertension,proteinuria, edemaproteinuria, edema

Calcium andCalcium andmagnesiummagnesiumdeficiency may playdeficiency may playa role in thea role in thedevelopment of predevelopment of pre--eclampsiaeclampsia


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RecommendationsRecommendations

Protein foods of high biological valueProtein foods of high biological value

Sources of iron, calcium and other mineralsSources of iron, calcium and other minerals

Salt intake is restricted to edemaS

alt intake is restricted to edema Under go physician's careUnder go physician's care


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AnemiaAnemia

Combine deficiencyCombine deficiencyof iron and folic acidof iron and folic acid

Effect:Effect:

Newborn becomesNewborn becomes

anemicanemic

Increased chance ofIncreased chance of

premature birthpremature birth

*Preventive measure*Preventive measureunder physiciansunder physicians

care is safe.care is safe.


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Gestational Diabetes MellitusGestational Diabetes Mellitus

Diabetes may occur as aDiabetes may occur as atemporary response to the stresstemporary response to the stress

of pregnancy and it disappearsof pregnancy and it disappears

after the baby is bornafter the baby is born

EffectsEffects

Risk of perinatal deathRisk of perinatal death PrematurityPrematurity

Macrosamia of the infantMacrosamia of the infant


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Physiology ofLactationPhysiology ofLactation

Is the period of milk production by theIs the period of milk production by the

mammary glandsmammary glands

Its starts during adolescence when hormonalIts starts during adolescence when hormonal

changes brings about development andchanges brings about development and

increase;increase;

BreastBreast

AreolaAreola

NippleNipple


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Prolactin and oxytocinProlactin and oxytocin two main hormonestwo main hormonesresponsible for milk production.responsible for milk production.

ColostrumsColostrums-- The first milk is a thick, yellowishThe first milk is a thick, yellowishfluid that comes out on the 2fluid that comes out on the 2ndnd to the 5h dayto the 5h dayafter delivery.after delivery.

I

t is very important that the baby is fed thirdI

t is very important that the baby is fed thirdfirst milk because it contains antibodies andfirst milk because it contains antibodies andimmune cells.immune cells.

Rich in protein and lower in carbohydrates andRich in protein and lower in carbohydrates and

fats.fats. It is laxative, which initially cleans out theIt is laxative, which initially cleans out the

babys digestive organs.babys digestive organs.

N t iti l R i t d iN t iti l R i t d i


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Nutritional Requirements duringNutritional Requirements during

LactationLactation

EnergyEnergy

Water and other fluidsWater and other fluids

ProteinProtein LipidLipid

MineralsMinerals

VitaminsVitamins


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Advantages ofBreast FeedingAdvantages ofBreast Feeding


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1.1. Human milk is nutritionally superior to other kinds of milk.Human milk is nutritionally superior to other kinds of milk.

2.2. Breast milk is bacteriologically safe.

Breast milk is bacteriologically safe.

3.3. Breast milk is always fresh and the right temperature for theBreast milk is always fresh and the right temperature for the

body.body.

4.4. It contains immune cells and antibodies that will give naturalIt contains immune cells and antibodies that will give natural

immunity for the baby.immunity for the baby.

5.5. It is the least allergenic of any infant food.It is the least allergenic of any infant food.

6.6. It is inexpensive compared to commercial milks.It is inexpensive compared to commercial milks.

7.7. BreastBreast--feeding is convenient.feeding is convenient.

8.8. It promotes closer motherIt promotes closer mother--baby ties or contact.baby ties or contact.

9.9. Babies are least likely to be overfed with breastBabies are least likely to be overfed with breast--feeding.feeding.

10.10. BreastBreast--feeding promotes good tooth and jaw development.feeding promotes good tooth and jaw development.

T t t f l b tT t t f l b t


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Ten steps to successful breastTen steps to successful breast--

feedingfeeding

Have a written breastHave a written breast--feeding policy that Isfeeding policy that Isroutinely communicated to all health care staffroutinely communicated to all health care staffin the hospitalin the hospital

Train all health care staff to acquire the skillsTrain all health care staff to acquire the skillsnecessary to implement this policy.necessary to implement this policy.

Inform all pregnant women about the benefitsInform all pregnant women about the benefitsand management of breastand management of breast--feedingfeeding

Help the mother initiate breastHelp the mother initiate breast--feeding withinfeeding within30 minutes after birth.30 minutes after birth.

Sh h h b f d d h i iSh h h b f d d h i i


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Show mother how to breast feed and how to maintainShow mother how to breast feed and how to maintain

lactation, even if they are separated from the infants.lactation, even if they are separated from the infants.

Give new born infants no food or drink. Other thanGive new born infants no food or drink. Other thanbreast milk, unless medically indicated.breast milk, unless medically indicated.

Practice roomingPractice rooming--in; allow mothers and infants toin; allow mothers and infants to

remain together 24 hours a day.remain together 24 hours a day.

Encourage breastEncourage breast--feeding on demand.feeding on demand.

Give no artificial teats or pacifiers to breastGive no artificial teats or pacifiers to breast--fedfed

infants.infants.

Foster the establishment of breastFoster the establishment of breast--feeding groups andfeeding groups andrefer mother to them upon discharge.refer mother to them upon discharge.


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BreastBreast--Feeding ProblemsFeeding Problems

Medical advances have permitted breastMedical advances have permitted breast--feeding to mothers with chronic diseases,feeding to mothers with chronic diseases,which were not allowed in the past years towhich were not allowed in the past years to

nurse their babies.nurse their babies. Retracted or invert nipples, sore nipples,Retracted or invert nipples, sore nipples,

plugged milk ducts, breast abscess in one side,plugged milk ducts, breast abscess in one side,baby has narrow mouth, baby fall asleepbaby has narrow mouth, baby fall asleep

during feeding, engorged breast, poor milkduring feeding, engorged breast, poor milkproduction, poor letproduction, poor let--down reflex.down reflex.


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The endThe end

Thank you for listening!!Thank you for listening!!

nutrition in pregnancy and lactation

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