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Chapter 7

The document discusses nutrition during pregnancy and lactation. During pregnancy, women need additional energy, protein, carbohydrates, vitamins and minerals to support the growth of the fetus and expansion of maternal tissues and blood volume. Key nutrients include folate, iron, calcium and iodine. During lactation, women need adequate fluid and nutrition to support breast milk production, but breast milk composition is largely unaffected by the mother's diet. Breast milk is uniquely suited to the nutritional needs of infants.

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86 views

Chapter 7

The document discusses nutrition during pregnancy and lactation. During pregnancy, women need additional energy, protein, carbohydrates, vitamins and minerals to support the growth of the fetus and expansion of maternal tissues and blood volume. Key nutrients include folate, iron, calcium and iodine. During lactation, women need adequate fluid and nutrition to support breast milk production, but breast milk composition is largely unaffected by the mother's diet. Breast milk is uniquely suited to the nutritional needs of infants.

Uploaded by

api-317421266
Copyright
© © All Rights Reserved
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Nutrition During Pregnancy &

Lactation

Outline

Energy nutrients
Nutrient for blood production and cell growth
Nutrient for bone development
Other nutrients
Nutrition during labor
Nutrition during lactation
Characteristic of breast milk
Growth factor
2

Nutrients During Pregnancy


Energy nutrients
Pregnant women needs extra food energy, 300kcal
above the allowance for non pregnant women.
During the second and third trimesters
Pregnant teenagers, underweight woman or
physically active woman may require more
Food supply for 300kcal; whole grains, bread or
cereal, legumes, potato, dark green vegetable, citrus
fruit, non fat milk, mushroom lean meat, fish, poultry
and eggs
3

What is needed?
Protein
Carbohydrate
B vitamins associated with energy and
protein intake

Protein
Additional protein is needed for expansion
of maternal blood volume and the growth
of fetus, placenta and maternal tissue
75-100 gram / day
Sources; whole grains, meats, milk,
legumes
Use of high protein supplement during
pregnancy can be harmful and is
discouraged
5

Carbohydrate
50% of total daily energy should be
derived from carbohydrate to spare the
protein needed for growth
250grams/day
Sources; milk, legumes, fruit, grains and
vegetables

B vitamins associated with energy


& protein intake
Increase of vitamin B requirement is proportional
to increase of energy requirements
Thiamin: 1.5mg/day, Riboflavin:1.6/day,
Niacin:17mg NE/day
Vitamin B6 recommendations increases in
parallel with protein recommendations.
Substances abusers, pregnant adolescents and
women carrying more than one fetus need to
pay attention to their vitamin B6 intakes.
A daily supplement containing 2mg B6 is
recommended
7

Nutrients for blood production & cell


growth
New cell form at tremendous pace as the
fetus grows and develop
The mother red blood cell mass expands

What is needed?

Folate
Vitamin B12
Iron
zinc

Folate

Fundamental role in DNA synthesis and cell replication


A deficiency can cause placental and fetal abnormalities
400g/day
Sources; fruit juices, green vegetables, whole grain or
forfeited cereal
When dietary intake is inadequate, take supplement
300g folate
Supplement is also recommended for adolescents,
women with multiple fetuses, women who use alcohol,
drugs or cigarettes

10

Vitamin B12
Activate the folate enzyme
Required for normal cell division and
protein synthesis
2.2 g/day
Sources; meat, fish, eggs, milk products
Vegetarian; risk of B12 deficiency, need soy
milk and cereal that is fortified with B 12 and
daily supplement 2 g
11

Iron
Needed to support enlarged blood volume
and to provide for placental and fetal need
Fetal need the iron to store its own to last
through 4 to 6 months after birth
Mother will loss lots of blood during
delivery
30mg/day
Sources; meat, fish, poultry, legumes, dark
green vegetable, iron forfeited cereal
12

Body adaptation to the need of iron


Menstruation ceases
Iron absorption triples due to an increase
in the synthesis of tranferrin (ironabsorbing, iron-carrying protein)
The hormones of pregnancy mobilize iron
from storage sites, making it available in
the blood

13

Zinc
Required for DNA and RNA synthesis,
protein synthesis and cell development
11mg/day
Sources: meat, fish, poultry, oyster,
crabmeat, shrimp
Vegetarian: black-eyed peas, kidney bean
routine supplementation is not
recommended
14

Nutrients for Bone Development


Nutrients building the skeleton
To build a bone or a tooth, cells first lay
down a matrix of the protein collagen and
then fill it with crystals of minerals
Insufficient intakes of the nutrients
involved may result in abnormal fetal bone
development

15

What is needed?

Calcium and phosphorus


Vitamin D
magnesium
fluoride

16

Calcium & Phosphorus


Intestinal absorption of calcium doubles in
mother. As fetal bone began to calcify,
shift of calcium across placenta occurs.
1300mg/day
sources: milk, cheese, yogurt, calcium rich
food, calcium fortified food
High phosphorus intake interfere with
calcium absorption
Sources: additive in process food
17

Vitamin D
Play vital role in calcium absorption and
utilisation
Vitamin D deficiency interferes with normal
calcium metabolism, resulting in rickets in the
fetus and osteomalacia in the mother
5g/day
Sources: sunlight, egg yolk, liver, fatty fish,
butter, fortified milk
Routine supplement is not recommended
because of the toxicity risk
18

Magnesium
Play role in bone formation
Participates in the activation pf vitamin D
and in the release of parathyroid hormone
that acts on the kidney and bone to raise
blood calcium
400mg/day
Sources: grains, seafood, green vegetable
19

Fluoride
Mineralisation of the fetal teeth
Routine supplement is not recommended
because cause tooth decay in children
born to women taking fluoride supplement
Placenta may not defend well against
fluoride excess
2.9mg/day
Sources: fluoridated water
20

Other Nutrients

Vitamin A
Vitamin E
Vitamin C
Iodine

21

Vitamin A
Deficiency cause fetal growth retardation,
preterm birth, low birth weight
Supplementation is unnecessary and
potentially harmful
800g RE/day
Carrot, pumpkins,liver, milk, eggs,
potatoes
22

Vitamin E
Break fat in fetus during fat accumulation
in 8 10 weeks of pregnancy
In premature birth, the infant may need
supplementation
15mg -TE/day
Sources: vegetable oil, wheat germ, whole
grains and nuts
23

Vitamin C
Form the collagen
Collagen gives the structure to bone,
cartilage, muscle and blood vessel

Women with multiple fetuses, uses illicit


drugs, smoke cigarette or drink alcohol
have greater needs of vitamin C
70mg/day

24

Iodine
Internal part of two hormones released by
the thyroid gland
regulate body temperature, metabolic rate,
reproduction, growth, the making of blood
cells, nerve and muscle function

Maternal iodine deficiency impairs fetal


development, causing mental and physical
retardation (cretinism)
175 g/day
25

Food Choices During Pregnancy


Diets tailored to individual preferences
Beliefs and superstitions
Cravings and aversion

26

Beliefs & Superstitions


Irrational
Women believe that over consumption or
under consumption of craved food imparts
physical or behavioral peculiarities to the
infant

27

Cravings and aversion


These likes and dislikes are common
They did not reflect physiological needs
Due to physiological factors or hormoneinduce changes in sensitivity to taste and
smell

28

Vegetarian Diets During Pregnancy


Generally, a well planned vegetarian diets that
are adequate in food energy and include milk
products and eggs can support a healthy
pregnancy
Sources: milk, milk product, legumes, cereals,
fruits and vegetables
Strict vegetarian may require supplementation of
vitamin B12, vitamin D, calcium and iron,
fortified soy milk and tofu, legumes, nuts, seeds,
whole grain breads, cereal, vegetable
29

Nutrition During labor


Needed when give birth takes 20 to 40
hours
Labor is easier if pregnant women are well
nourished and well hydrated at the start
During labor, it is wise to eat periodically:
take snacks along when going to the
birthing center or hospital

30

Maternal Nutrition During Lactation


Water
Major nutrient in breast milk
A mother who drinks more fluid does not
produce more breast milk
A mother drinks to prevent dehydration during
lactation
Drinks after each meal and each time the
baby nurses
31

Energy & Energy Nutrients


Carbohydrate
Maternal diet has no effect on the carbohydrate
content of breast milk

Protein
Maternal diet has no effect on the protein content of
breast milk

Lipid
Maternal diet alters fatty acid composition of breast
milk, but not the total fat concentration of breast milk.
DHA increase if mother consumes oil rich in DHA.
Cholesterol is unaffected
32

Vitamins & Minerals


Fat soluble vitamins
Breast milk may change with maternal dietary
excesses and deficiencies of fat soluble vitamins,
depending on the vitamin.

Water soluble vitamin


Reflects maternal intake. Several vitamin deficient
mothers produce vitamin deficient breast milk

Minerals
Unaffected by maternal diet

33

Nutrient Supplement for Lactating


Women
Well-balance diet
Some may need iron supplement to
replenish the depletion of iron stores
Vegetarian women will need supplement

34

Characteristic
of Breast Milk
Nutrient Composition of Breast Milk
Carbohydrate
Protein
Lipid
Vitamins & Minerals

35

Carbohydrate
Disaccharide lactose
Easily digested, facilitates calcium absorption

Oligosaccharide and bifidus factornonlactose carbohydrate, defend infants


against harmful bacteria

36

Protein
Low protein concentration
contribute to low renal solute load

Alpha-lactalbumin
Efficiently digested and absorbed, richer in
sulphur containing amino acid

All essential amino-acid in appropriate


amounts

37

Lipid
Source of energy in infant diet
Infant digest fat in breast milk more completely
Infants absorb monoglycerides with palmitic acid
more efficiently
Breast milk contains more than adequate
concentration of the essential fatty acid (linoleic
acid)
Contains 10 times more cholesterol that is
needed for normal myelination in the central
nervous system
38

Vitamins & Minerals


Breast milk contains all the vitamin and
minerals needed for normal infant with the
exception of vitamin D
Low electrolyte low renal solute load
Low zinc quantities but efficient absorption
because of the presence of binding
proteins
Contains amylase enzyme that facilitates
starch digestion
39

Protein Factors
Colostrum
A premilk substances that contain mainly serum with
antibodies and white blood cells

Bifidus factor
Microbial growth factors favoring the growth of
harmless bacteria in the digestive tract (lactobacillus
bifidus)

Immunoglobulins
Protects the infant digestive tract against antigen (Ig
A). Lower incidence of intestinal infection
40

Cont
Lipase activity
Antimicrobial activity.
Milk rich in fatty acids and monglyceride

Lysoenzyme
Breaks apart bacterial wall, thus inhibiting bacterial growth in the
digestive tract

Lactoferin
Antimicrobial activity
Binds iron, making it less available to bacteria in the intestinal
tract, thus inhibiting their growth

Intestinal growth factor


Epidermal growth factor that stimulate growth of the intestinal
cell. Allow damage cell to be replaced more rapidly than normal
41

Health Advantages of Breast Milk


Protect infants against gastrointestinal
infections
Protection against the development of
allergies
Wide spectrum of flavors it introduces to
an infant (from mothers diet)

42

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