3. Nutrition in pregnancy.pptx and pregannacy vitamins mineral

Nutrition and importance in pregnancy vitamins

1. Nutrition in pregnancy Dr. Sanaullah Iqbal

2. Time-related terms before, during, and after pregnancy

3. Carnegie Stages of Human Gestation

4. Carnegie Stages of Human Gestation

5. Carnegie Stages of Human Gestation

6. Carnegie Stages of Human Gestation

7. Normal changes in maternal physiology during pregnancy

8. Normal changes in maternal physiology during pregnancy

9. Maternal Nutrient Metabolism – CHO Metabolism adjustments to promote availability of glucose to the fetus Glucose is the fetus’s preferred fuel, even though fats can be utilized for energy maternal insulin resistance – diabetogenic effect of pregnancy

10. Maternal Nutrient Metabolism – CHO Metabolism In 1 st half of pregnancy is characterized by estrogen- and progesterone-stimulated increases in insulin production and conversion of glucose to glycogen and fat In the 2 nd half, rising levels of Human chorionic somatotropin ( hCS ) and prolactin from the mother’s pituitary gland inhibit the conversion of glucose to glycogen and fat At the same time, insulin resistance builds in the mother, increasing her reliance on fats for energy. Decreased conversion of glucose to glycogen and fat, lowered maternal utilization of glucose, and increased liver production of glucose help to ensure that a constant supply of glucose for fetal growth and development is available in the second half of pregnancy Fasting maternal BGL decline in the 3 rd trimester due to increased utilization of glucose by the rapidly growing fetus. however, post-meal blood glucose concentrations are elevated and remain higher longer than before pregnancy

11. Maternal Nutrient Metabolism – CHO Metabolism

12. Maternal Nutrient Metabolism – Fat, Protein changes in lipid metabolism promote the accumulation of maternal fat stores in the 1 st half of pregnancy and enhance fat mobilization in 2 nd half Increased fat mobilization causes blood lipid levels to increase Cholesterol-containing lipoproteins, phospholipids, and fatty acids also increase, but to a lesser extent than do triglycerides synthesis of new maternal and fetal tissues Maternal and fetal needs for protein are primarily fulfilled by the mother’s intake of protein during pregnancy

13. Nutrient Requirements During Pregnancy – Energy Additional energy for metabolic demands of pregnancy and fetal growth Metabolism increases by an average of 15% in the singleton pregnancy DRI for energy increases by only 340 kcal/day during 2 nd trimester and by 452 kcal/day in 3 rd trimester Modifying intakes to achieve recommended weight gain is more useful than calculating caloric requirements Exercise : most pregnant women compensate for increased weight gain by slowing their work and movement pace 30 minutes of moderate intensity exercise on most, if not all, days for pregnant women Excessive exercise, combined with inadequate energy intake, may lead to suboptimal maternal weight gain and poor fetal growth

14. Nutrient Requirements During Pregnancy – Protein Additional protein is required for synthesis of maternal and fetal tissues This demand increases throughout gestation - maximized during 3 rd trimester Protein RDA 0.8 g/kg current body weight/day for pregnant women in the 1 st half of pregnancy is same as that for the nonpregnant women Needs increase in the second half to 1.1 gm/kg/day For each additional fetus, at least + 25 g/day of protein is recommended WHO recommendations 0.83 g/kg/day as a baseline protein requirement +0.7 g/day (first trimester) + 9.6 g/day (second trimester) + 31.2 g/day (third trimester) to support a total 13.8 kg weight gain In developed countries, most women, eat more than enough protein, however, some need particular attention consuming a vegetarian diet, still growing themselves, pregnant with multiples

15. Nutrient Requirements During Pregnancy – CHO, Fiber, Fat RDA for carbohydrates increases slightly, helping maintain appropriate blood glucose and prevent ketosis Careful carbohydrate choices Priority should be given to complex CHO from whole grains, fruits & veg. simple sugars, including refined liquid sugars, whether natural (juices) or industrially produced (soda) should be avoided DRI for fiber during pregnancy is 14 g/day/1000 kcal will help a great deal in managing the constipation that often accompanies pregnancy Like non-pregnant, no DRI for total lipids during pregnancy Depend on energy requirements for proper weight gain Recommendations for ω -6 PUFA (LA) and ω -3 PUFA (ALA) increase slightly not a DRI, the recommended intake of DHA is 200 mg/day

16. Nutrient Requirements During Pregnancy – Vitamins All vitamins and minerals are needed for optimal pregnancy outcome requirements may be met through diet; for others a supplement are necessary Folic Acid DFE increases to support maternal erythropoiesis, DNA synthesis, and fetal and placental growth Low folate levels are associated with miscarriages, LBW, and preterm birth Early maternal folate deficiency is associated with an increased incidence of congenital malformations, including NTDs (including spina bifida and anencephaly), and possibly orofacial clefts and congenital heart defects ~3000 new cases of NTDs occur in the USA annually - > 50% pregnancies are unplanned - neural tube closes by 28 days of gestation, 50-70% can be prevented 800 mcg dose achieves recommended blood levels in 4 weeks 400 mcg dose requires 8 to 12 weeks to reach these levels RDA, Sources natural vs supplements In 2 nd trimester, helps in neutralizing BPA, mycotoxin, inflammation

17. Nutrient Requirements During Pregnancy – Vitamins Vitamin B6 cofactor for many decarboxylase and transaminase enzymes, especially those involved in AA metabolism and neurotransmitter production meat, fish, and poultry are good dietary sources, deficiency is not common Vitamin B12 generation of methionine and tetrahydrofolate vegetarians, especially vegans, are at risk for dietary deficiency Inadequate amounts of folate and B12 may affect negatively infant cognitive and motor development as well as increase risk of NTDs and inadequate fetal growth Choline Choline is needed for structural integrity of cell membranes, cell signaling, and nerve impulse transmission and is a major source of methyl groups Choline and folate are metabolically interrelated; both support fetal brain development and lower risk of NTDs and orofacial clefts Choline-rich foods include milk, meat, and eggs

18. Nutrient Requirements During Pregnancy – Vitamins Vitamin C Anti-oxidants – higher need for those who smoke, abuse alcohol or drugs, or regularly take aspirin Vitamin A critical during periods of rapid growth, important in cellular differentiation, ocular development, immune function, and lung development and maturity, as well as gene expression Toxicity - teratogenic Vitamin D Need don’t increase must be at least 20 ng/ml for bone health Vitamin E and K Need don’t increase

19. Nutrient Requirements During Pregnancy – Minerals Calcium Maternal absorption of Ca across the gut doubles during pregnancy Approximately 30 g of Ca is accumulated during pregnancy, primarily in the fetal skeleton (25 g), but there is wide variation. Remainder is stored in the maternal skeleton, held in reserve for the Ca demands of lactation Ca requirement does not increase. However, many women enter pregnancy with low intakes and often need encouragement to increase consumption of calcium-rich foods. Dairy products (milk powder, yogurt) are the most common sources of dietary calcium. Copper requirements rise slightly in pregnancy Copper deficiency alters embryo development decreased activity of cuproenzymes increased oxidative stress altered iron metabolism abnormal protein crosslinking decreased angiogenesis altered cell signaling

20. Nutrient Requirements During Pregnancy – Minerals Iodine Iodine is part of the thyroxine molecule, with a critical role in the metabolism of macronutrients, as well as in fetal neuronal myelination and gene expression TH synthesis increases 50% during pregnancy, iodine requirements also increase Severe ID is associated with increased risk of miscarriage, congenital anomalies, fetal goiter, and stillbirth, as well as prematurity, poor fetal growth, and decreased IQ. Worldwide, many people are at risk for ID caused by low intake of seafood An estimated 70% of the world population has access to iodized salt American Thyroid Association now recommends that women receive 150 mcg/day during pregnancy and lactation as potassium iodide High iodine levels are also of concern, potentially causing the same symptoms as low levels

21. Nutrient Requirements During Pregnancy – Minerals Iron The RDA for iron nearly doubles in pregnancy 42% of pregnant women worldwide have iron deficiency anemia Inadequate iron consumption may lead to poor Hb production, followed by compromised delivery of oxygen to the uterus, placenta, and developing fetus. IDA is associated with IUGR, preterm delivery, increased fetal and neonatal mortality, and if severe (<9 g/dl), with complications during delivery Early iron deficiency affects fetal brain development and the regulation of brain function in multiple ways Plasma volume increases 50% from baseline, and normal erythrocyte volume increases by 20% to 30% in pregnancy This marked increase in the maternal blood supply during pregnancy, as well as fetal needs, greatly increases the demand for iron. The estimated total requirement for pregnancy is 1190 mg nonheme iron vs heme iron

22. Nutrient Requirements During Pregnancy – Minerals Selenium Selenium functions as an antioxidant and is important for reproduction. Low selenium status is associated with recurrent miscarriages, preeclampsia, and IUGR. The DRI increases slightly during pregnancy Zinc Zinc is critical for growth and development, and requirements rise during pregnancy. A zinc-deficient diet does not result in effective mobilization of zinc stored in the maternal skeletal muscle and bone; therefore a compromised zinc status develops rapidly. Zinc is part of 100 enzymes related to the metabolism of macronutrients Deficiency is highly teratogenic, leading to congenital malformations, including anencephaly and possibly oral clefts Even a mild zinc deficiency may lead to impaired fetal growth and brain development, as well as impaired immune function

23. Pregnancy Wt. Gain Recommendations With a singleton gestation, less than half of the total weight gain of a normal-weight pregnant woman resides in the fetus, placenta, and amniotic fluid. The remainder is in maternal reproductive tissues (breast tissues and uterus), interstitial fluid, blood volume, and maternal adipose tissue. Increased subcutaneous fat in the abdomen, back, and upper thigh serves as an energy reserve for pregnancy and lactation. Distribution of weight gain during pregnancy

24. Pregnancy Wt. Gain Recommendations Risk Factors for Poor Pregnancy Outcome in Teenagers

25. Complications and Nutritional Implications in pregnancy Constipation and Hemorrhoids Pregnant women become constipated if they fail to consume adequate water and fiber Cravings, Aversions, and Pica Most women change their diets during their pregnancies as a result of medical advice, cultural beliefs, or changes in food preference and appetite. Cravings : an intense urge to eat a certain food Food aversion : an intense dislike of a specific food, together with unpleasant physical symptoms when you see or smell a particular food Pica : an eating disorder in which a person eats things not usually considered food. Geophagia (consumption of dirt or clay) Amylophagia (laundry starch or corn starch) Pagophagia (ice) Other include paper, burnt matches, stones or gravel, charcoal, bleach, cigarette ashes, baking soda, soap, tires, and coffee grounds.

26. Complications and Nutritional Implications in pregnancy The cause of pica is poorly understood One theory suggests that pica relieves nausea and vomiting, although pica often appears later in pregnancy when nausea and vomiting are not so prevalent One hypothesis is that it is due to a deficiency of an essential nutrient, most often iron, but zinc, calcium Pica also can be a craving for smell or texture as well as taste Malnutrition can be a consequence of pica when nonfood substances displace essential nutrients in the diet. Starch in excessive amounts contributes to obesity and can negatively affect glucose control. Large intakes of baking soda can raise blood pressure Substances may contain toxic compounds or heavy metals, including lead, parasites, or other pathogens.

27. Gestational diabetes mellitus (GDM)