PRENATAL NUTRITION AND FOOD ALLERGY

PRENATAL NUTRITION AND FOOD ALLERGY . BY MR. DINABANDHU BARAD

1. WELCOME

2. PRENATAL NUTRITION AND FOOD ALLERGIES BY: Dinabandhu Barad MSC TUTOR, SNC, SOA, DTU

3. INTRODUCTION Various factors determine the outcome of a pregnancy, including the nutritional status of the mother before conception and during pregnancy. Nutritional factors can affect the newborn’s birth weight, risk of neural tube defect, and foetal alcohol syndrome. Birth weight is highly correlated with infant mortality and morbidity.

4. MATERNAL NUTRITIONAL STATUS Two indicators of maternal nutritional status have consistently shown association with infant birth weight: Maternal size (height and pre-pregnancy weight of the mother) Maternal weight gain during pregnancy

5. MATERNAL SIZE Large stature women tend to have large babies, and maternal size plays an important role in determining the size of the placenta . The size of the placenta is an indicator of placental health, which determines the amount of nutrition available to the foetus, which in turn is proportional to the birth weight of the neonate. MATERNAL NUTRITIONAL STATUS

6. MATERNAL WEIGHT GAIN DURING PREGNANCY:   Less than half of the total weight gain is in the foetus, placenta, and amniotic fluid, and the remainder comprises maternal reproductive tissues, fluid, blood, and maternal stores as body fat . Gradually increasing amounts of sub-cutaneous fat in the abdomen, back, and thigh serves as an energy source for pregnancy and lactation. MATERNAL NUTRITIONAL STATUS

7. MATERNAL WEIGHT GAIN DURING PREGNANCY:   In normal weight females (BMI 18.5-24.9), ideal weight gain is between 11.5 kg to 16 kg. 1-1.5 kg in the first trimester then 1.5-2 kg per month until birth of the baby. MATERNAL NUTRITIONAL STATUS

8. NUTRITIONAL SUPPLEMENTATION DURING PREGNANCY Nutritional requirement during pregnancy in the form of energy, protein, vitamin, or minerals exceed the routine daily intake of a woman. A balanced diet results in appropriate weight gain during pregnancy by supplying required nutrients during pregnancy.

9. NUTRITIONAL SUPPLEMENTATION DURING PREGNANCY Folate supplementation is recommended in all pre-conceptional prescriptions and during pregnancies . The National protocols in India require the provision of 1 tablet containing 100 mg elemental iron and 0.5 mg folic acid for daily consumption to all women during pregnancy for 100 days.

10. NUTRITIONAL REQUIREMENTS DURING PREGNANCY ENERGY:   Additional energy is required during pregnancy to meet the metabolic demands of pregnancy and foetal growth. The metabolism increases by 15% during pregnancy . The estimated average requirement of  carbohydrates  for pregnant women is 135 g/day and an adequate intake is 175 g/day to avoid ketosis, and to maintain blood glucose levels during pregnancy

11. PROTEIN Pregnant women have additional protein requirement to support the synthesis of maternal and foetal tissues. Protein requirement increases throughout gestation and peaks during the third trimester and it increases to 78gm/day. For a gestational weight gain of 10 kg pregnant Indian women additional 7.6 gms in the second trimester and 17.6 gms in third trimester is recommended NUTRITIONAL REQUIREMENTS DURING PREGNANCY

12. FIBER Consumption of whole grain breads, cereals, leafy green vegetables, and fresh and dried fruits during pregnancy is encouraged. The recommended fibre value is 28 g/day during pregnancy. LIPIDS The amount of fat in the diet should depend on energy requirements for proper weight gain. NUTRITIONAL REQUIREMENTS DURING PREGNANCY

13. VITAMINS AND MINERALS FOLATE  Folic acid supplementation is important to support maternal erythropoiesis, maternal and foetal placental growth, and to prevent neural tube defects. VITAMINS   Vitamins B6 manages nausea and vomiting during pregnancy; vitamin D is important for calcium balance during pregnancy; and vitamins C, A, E, and K are required in adequate amounts for general nutritional requirements. NUTRITIONAL REQUIREMENTS DURING PREGNANCY

14. MINERALS Calcium  is important during pregnancy and lactation   Iron  is important for oxygen delivery to the foetus, and deficiency leads to foetal hypoxia and maternal anaemia.  Zinc supplementation avoids congenital abnormalities Magnesium  reduces the incidence of IUGR   Sodium  is important for excretion, and maternal  Iodine  deficiency results in neonatal cretinism. Phosphorous , copper, and fluoride are also required in trace amounts . NUTRITIONAL REQUIREMENTS DURING PREGNANCY

15. FLUIDS  A total of 6–8 glasses of fluid intake is mandatory during pregnancy to avoid dehydration and to maintain the amniotic fluid index. NUTRITIONAL REQUIREMENTS DURING PREGNANCY

16. FOOD ALLERGIES The term adverse reaction encompasses food intolerance and food hypersensitivity. Food intolerance is an adverse reaction to a food caused by toxic, pharmacologic, metabolic, idiosyncratic, or non-immunoglobulin E ( IgE ) reactions to food or chemical substances in the food .

17. FOOD ALLERGIES Food hypersensitivity or food allergy is an IgE mediated reaction that occurs when the immune system reacts to a normally harmless food macromolecule that the body has identified as non-self (antigen). IgE reactions usually occur instantly or within two hours of exposure, with severity ranging from mild to life threatening. Exposure includes inhalation, ingestion, and skin contact.

18. SYMPTOMS A wide range of symptoms has been attributed to food allergy. Skin , respiratory, cardiovascular, and gastrointestinal symptoms express during an allergic reaction

19. GASTROINTESTINAL MANIFESTATIONS Abdominal pain Nausea Vomiting Diarrhoea Gastrointestinal bleeding Oral and pharyngeal pruritus

20. CUTANEOUS MANIFESTATIONS Urticaria (hives) Angioedema Eczema Erythema (skin reddening) Itching Flushing

21. RESPIRATORY MANIFESTATIONS Rhinitis Asthma Cough Laryngeal edema Airway tightening

22. SYSTEMIC MANIFESTATIONS Anaphylaxis Hypotension Dysrhythmias

23. COMMON FOOD ALLERGIES CARBOHYDRATE (LACTOSE) INTOLERANCE: The deficiency of the intestinal enzyme lactase have a decreased ability to digest lactose, a sugar in milk and milk products and experience symptoms of abdominal cramping, flatulence, and diarrhoea after its ingestion. Restriction of foods containing milk and milk products avoids the allergic reaction to a large extent.

24. EGG ALLERGY  Many children and pregnant women are allergic to egg white, egg yolk, apovitellin , and other protein constituents of egg and show mild to severe cutaneous and gastrointestinal manifestations. COMMON FOOD ALLERGIES

25. PEANUT ALLERGY Ground nuts, peanut butter, beer nuts, peanut oil, mixed nuts, and products that contain peanuts have shown near fatal and fatal anaphylactic reactions. COMMON FOOD ALLERGIES

26. WHEAT ALLERGY  Atta, bread flour, cake flour, wheat bran, whole wheat flour, wheat bread, and wheat flakes/pasta/flakes have shown allergic reactions similar to lactose intolerance and results in gastrointestinal manifestations. COMMON FOOD ALLERGIES

27. SOY ALLERGY Soy flour, soy sauce/milk, curd, and soy products have proven to be allergic in many infants and children. COMMON FOOD ALLERGIES

28. DIAGNOSTIC TEST SKIN TESTING A drop of the antigen is placed on the skin, and the skin is scratched or punctured to allow penetration. This is a screening tool and cannot be relied upon as a diagnostic tool. RADIOALLERGOSORBENT TEST (RAST)  Serum is mixed with food on a paper disk and then washed with radioactively labelled IgE .

29. ENZYME-LINKED IMMUNOSORBENT ASSAY (ELISA):   Same as RAST; except non-radioactively labelled (enzyme) IgE is used. SUBLINGUAL TESTING:  Drops of allergen extract are placed under the tongue, and symptoms are recorded. PROVOCATIVE TESTING AND NEUTRALIZATION:   Subcutaneous injection of an allergen extract elicits symptoms; this is followed by the injection of a weaker or stronger preparation to neutralize the symptoms. DIAGNOSTIC TEST

30. TREATMENT Total avoidance of the food allergen is the only proven treatment for food allergy. However antihistamines are used to control allergies under unavoidable exposures.

31. THANK YOU