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    [insert presenter info][insert presenter info]

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    Why is nutrition so important?Why is nutrition so important?

    Meet increased nutrient demandsMeet increased nutrient demands

    Provide needed energyProvide needed energy

    Prevent or minimize commonPrevent or minimize commonpregnancy-related problemspregnancy-related problems

    Reduce risk of birth defectsReduce risk of birth defects

    Supply needed nutrients for babysSupply needed nutrients for babysgrowthgrowth

    Ensure healthy birth weightEnsure healthy birth weight

    Maintain a healthy weightMaintain a healthy weight

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    Key Components of a HealthyKey Components of a Healthy

    PregnancyPregnancy

    Appropriate weight gainAppropriate weight gain

    Consumption of a variety of foodsConsumption of a variety of foods

    Vitamin and mineral supplementationVitamin and mineral supplementationAvoidance of alcohol, tobacco andAvoidance of alcohol, tobacco and

    other harmful substancesother harmful substances

    Safe food handlingSafe food handling

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    Recommended Weight GainRecommended Weight Gain

    UnderweightUnderweight 28-40 lbs28-40 lbs

    Normal weightNormal weight 25-35 lbs25-35 lbs

    OverweightOverweight 15-25 lbs15-25 lbs

    ObeseObese at least 15 lbsat least 15 lbs

    TwinsTwins 35-45 lbs35-45 lbs

    TripletsTriplets 50 lbs50 lbs

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    Normal Pregnancy Weight GainNormal Pregnancy Weight Gain

    BreastBreast 1-1.5 lbs1-1.5 lbs

    BloodBlood 3-4.5 lbs3-4.5 lbs

    Extra waterExtra water 4-6 lbs4-6 lbsUterusUterus 2.5-3.0 lbs2.5-3.0 lbs

    Placenta/amniotic fluidPlacenta/amniotic fluid 3.5-5.5 lbs3.5-5.5 lbs

    BabyBaby 7-8 lbs7-8 lbs

    Fat storesFat stores 4-6.5 lbs4-6.5 lbs

    TotalTotal 25-35 lbs25-35 lbs

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    Risks of Low Weight GainRisks of Low Weight Gain

    Low weight gain in second or thirdLow weight gain in second or third

    trimester increases risk of intrauterinetrimester increases risk of intrauterine

    growth retardationgrowth retardation

    Low weight gain in third trimesterLow weight gain in third trimester

    increases risk of preterm deliveryincreases risk of preterm delivery

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    Guidelines for teenagersGuidelines for teenagers

    Higher weight gains and greaterHigher weight gains and greater

    postpartum weight retention ispostpartum weight retention is

    common if mother is still growingcommon if mother is still growing

    Maternal growth in multiparousMaternal growth in multiparous

    teenagers is associated with lowerteenagers is associated with lowerbirth weightsbirth weights

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    Consume a variety of foodsConsume a variety of foods

    GrainsGrains

    VegetablesVegetables

    FruitsFruits

    MilkMilk

    Meat and BeansMeat and Beans

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    Typical PlateTypical Plate

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    Reconstruct Your PlateReconstruct Your Plate

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    Minimum Servings DuringMinimum Servings During

    PregnancyPregnancy

    GrainsGrains (9 ounce equivalents)(9 ounce equivalents)

    Vegetables (3 cups)Vegetables (3 cups)

    Fruits (2 cups)Fruits (2 cups)

    Milk (3 cups)*Milk (3 cups)*

    Meat and Beans (6.5 ounce equivalents)Meat and Beans (6.5 ounce equivalents)

    *Pregnant teenagers may need an additional*Pregnant teenagers may need an additional

    serving from this groupserving from this group

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    Eating for Two!!Eating for Two!!

    ~300 calories/day during 2nd and 3rd~300 calories/day during 2nd and 3rd

    trimestertrimester

    300 calories:300 calories:

    sandwich + 1 c. milk/yogurt OR sandwich + 1 c. milk/yogurt OR

    1 c. cereal + 1 c. milk + banana OR1 c. cereal + 1 c. milk + banana OR

    Peanut butter on 2 slices toast + 1Peanut butter on 2 slices toast + 1

    c. milkc. milk

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    Proper nutritionProper nutrition

    Major NutrientsMajor Nutrients

    CarbohydratesCarbohydrates

    ProteinProtein

    FatFat

    VitaminsVitamins

    MineralsMinerals

    WaterWater

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    CarbohydratesCarbohydrates

    Sugars and starchesSugars and starches

    Bodys primary sourceBodys primary source

    of energyof energy

    Fruits, breads, some vegetables,Fruits, breads, some vegetables,

    grains, milkgrains, milk

    Should make up 60-70% of total dailyShould make up 60-70% of total daily

    caloriescalories

    Carbohydrates do not make you fatCarbohydrates do not make you fat

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    FatFat

    Source of stored energySource of stored energyburned during activityburned during activity

    Makes you feel full and noMakes you feel full and no

    longer hungrylonger hungry

    Helps the body absorb fatHelps the body absorb fat

    soluble nutrientssoluble nutrients

    Choose healthy fatsChoose healthy fats

    20-25% of total calories (use sparingly)20-25% of total calories (use sparingly)

    Contains most calories per gramContains most calories per gram

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    ProteinProtein

    Builds and repairs the bodyBuilds and repairs the body

    Used for energy if the dietUsed for energy if the diet

    is inadequate inis inadequate in

    carbohydratescarbohydratesFound in fish, poultry,Found in fish, poultry,

    meats, tofu, nuts, beans,meats, tofu, nuts, beans,

    eggs, milk, cheeseeggs, milk, cheeseNeed ~10 grams more perNeed ~10 grams more per

    day in pregnancyday in pregnancy

    10-20% of total calories10-20% of total calories

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    WaterWater

    60-75% of body weight60-75% of body weight

    Stabilizes bodyStabilizes body

    temperaturetemperature

    Carries nutrients to andCarries nutrients to and

    waste away from cellswaste away from cells

    Needed for cell functionNeeded for cell function

    8-10 cups/day8-10 cups/day

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    FiberFiber

    Fiber: Whole grains, fruits,Fiber: Whole grains, fruits,

    vegetablesvegetablesWheat bread: check the labelWheat bread: check the label

    Fruit vs. JuiceFruit vs. Juice

    Stabilizes blood sugarStabilizes blood sugarProtection from diabetes, constipationProtection from diabetes, constipation

    and diverticulosisand diverticulosis

    lowers LDL cholesterollowers LDL cholesterol

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    Vitamins and MineralsVitamins and Minerals

    Body does not make most vitaminsBody does not make most vitamins

    Good source: Deep colored fruitsGood source: Deep colored fruits

    and vegetablesand vegetables

    Fresh, frozen, cannedFresh, frozen, canned

    Multivitamin/Multi-mineralMultivitamin/Multi-mineral

    supplementssupplements

    B VitaminsB Vitamins

    IronIron

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    Special InterestSpecial Interest

    NutrientsNutrients

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    Folic AcidFolic Acid

    A supplement taken 1-3 months prior to conceptionA supplement taken 1-3 months prior to conceptionand during first 6 weeks gestation reduces the riskand during first 6 weeks gestation reduces the riskof neural tube defects, cleft palate/lipof neural tube defects, cleft palate/lip

    400 micrograms per day of synthetic folic acid400 micrograms per day of synthetic folic acid

    needed per day (pregnant women and those ofneeded per day (pregnant women and those ofchildbearing age)childbearing age)

    Folic acid in fortified foods and supplements isFolic acid in fortified foods and supplements isbetter absorbed by the bodybetter absorbed by the body

    Needed for rapidly dividing cells, proteinNeeded for rapidly dividing cells, proteinmetabolism, and formation of red blood cellsmetabolism, and formation of red blood cells

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    Food Sources of Folic AcidFood Sources of Folic Acid

    Fortified breakfast cerealsFortified breakfast cereals

    Dried beansDried beans

    Liver/meatsLiver/meats

    Spinach and green leafy vegetablesSpinach and green leafy vegetables

    Citrus fruits and juicesCitrus fruits and juices

    Whole-wheat breadWhole-wheat bread

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    IronIron

    Needed for the formation of red blood cellsNeeded for the formation of red blood cells

    15 milligrams a day for woman during15 milligrams a day for woman during

    childbearing years recommendedchildbearing years recommended

    Iron supplement (30 mg/d) recommendedIron supplement (30 mg/d) recommended

    for pregnant womenfor pregnant women

    Typical American diet 10-11 milligrams aTypical American diet 10-11 milligrams a

    dayday

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    Food Sources of IronFood Sources of Iron

    MeatsMeats

    FishFish

    PoultryPoultry

    LegumesLegumes

    Whole-grain andWhole-grain and

    enriched breadsenriched breads

    Iron-fortifiedIron-fortifiedcerealscereals

    Dark greensDark greens

    Dried fruitsDried fruits

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    CalciumCalcium

    Calcium absorption doubles early inCalcium absorption doubles early inpregnancypregnancy

    Is used in the formation of fetal bonesIs used in the formation of fetal bones

    Will be absorbed from maternal bones ifWill be absorbed from maternal bones ifnot enough calcium in dietnot enough calcium in diet

    Calcium absorption increases withCalcium absorption increases withVitamin DVitamin D

    Calcium and vitamin D supplementsCalcium and vitamin D supplementssometimes neededsometimes needed

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    Food Sources of CalciumFood Sources of Calcium

    Milk (skim, low-Milk (skim, low-fat)fat)

    Yogurt (low-fat)Yogurt (low-fat)OystersOysters

    ShrimpShrimp

    Calcium-fortifiedCalcium-fortifiedapple and orangeapple and orangejuicejuice

    Collard greensCollard greens

    BroccoliBroccoli

    Turnip greensTurnip greens

    Sesame seedsSesame seeds

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    Multivitamin and MineralMultivitamin and Mineral

    SupplementsSupplements

    Recommended for:Recommended for:

    Women who smoke or abuse drugsWomen who smoke or abuse drugs

    Women with iron deficiency anemia or poorWomen with iron deficiency anemia or poorquality dietsquality diets

    Women who eat animal products rarely or notWomen who eat animal products rarely or notat all (such as vegans)at all (such as vegans)

    Vitamin B 12 supplement important for vegansVitamin B 12 supplement important for vegans

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    Food Additives and IngredientsFood Additives and Ingredients

    Use of sweeteners that are Generally Recognized asUse of sweeteners that are Generally Recognized asSafe (GRAS) is acceptableSafe (GRAS) is acceptable

    Pregnant women should moderate intake of saccharinPregnant women should moderate intake of saccharin

    Aspartame intake within Food and DrugAspartame intake within Food and DrugAdministration guidelines is safe during pregnancyAdministration guidelines is safe during pregnancy

    Women with PKU should avoid aspartameWomen with PKU should avoid aspartame

    Moderate consumption of cured meats and otherModerate consumption of cured meats and otherfoods rich in nitrosaminesfoods rich in nitrosamines

    MSG consumption not thought to pose a health risk toMSG consumption not thought to pose a health risk tomother or childmother or child

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    Foods to AvoidFoods to Avoid

    Fish containing high levels of mercuryFish containing high levels of mercury

    (shark, swordfish, king mackerel, and(shark, swordfish, king mackerel, and

    tilefish)tilefish)

    Raw or undercooked fishRaw or undercooked fish

    Raw or undercooked shellfishRaw or undercooked shellfish

    Raw eggs or dishes containing raw orRaw eggs or dishes containing raw or

    partially cooked eggspartially cooked eggs

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    Foods to Avoid (cont.)Foods to Avoid (cont.)

    Raw or undercooked meat and poultryRaw or undercooked meat and poultry

    SushiSushi

    PatePate

    Soft or blue-veined cheesesSoft or blue-veined cheeses

    Unpasteurized cheeses and juicesUnpasteurized cheeses and juices

    Deli meatsDeli meats

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    Things to Avoid DuringThings to Avoid During

    PregnancyPregnancy

    AlcoholAlcohol

    CigarettesCigarettes

    Recreational drugsRecreational drugs

    Over-The-Counter Medications orOver-The-Counter Medications or

    Herbal SupplementsHerbal Supplements

    Consult health care providerConsult health care provider

    CaffeineCaffeine

    Consult health care providerConsult health care provider

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    AlcoholAlcohol

    Women who are or may becomeWomen who are or may become

    pregnant should not drink alcoholpregnant should not drink alcohol

    A safe level of alcohol intake has notA safe level of alcohol intake has not

    been established at any stage duringbeen established at any stage during

    pregnancypregnancy

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    Risks of Drinking DuringRisks of Drinking During

    PregnancyPregnancy

    Major birth defects (Fetal AlcoholMajor birth defects (Fetal Alcohol

    Syndrome)Syndrome)

    Mental retardationMental retardationLearning disabilitiesLearning disabilities

    Impaired fetal growthImpaired fetal growth

    Lower Apgar scoresLower Apgar scoresPossible reduction in fertilityPossible reduction in fertility

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    Smoking during PregnancySmoking during Pregnancy

    Limits oxygen supplied to the fetusLimits oxygen supplied to the fetus

    Reduces birth weight of the infantReduces birth weight of the infant

    Increases the risk of pre-term deliveryIncreases the risk of pre-term delivery

    Increases the risk of perinatal mortalityIncreases the risk of perinatal mortality

    Passive exposure to tobacco smoke may alsoPassive exposure to tobacco smoke may alsoreduce infant growthreduce infant growth

    Associated with mental retardation andAssociated with mental retardation and

    nicotine addiction in the fetusnicotine addiction in the fetus

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    Herbal and BotanicalHerbal and Botanical

    SupplementsSupplements

    Consider herbal treatments asConsider herbal treatments assuspect until safety during pregnancysuspect until safety during pregnancyis confirmedis confirmed

    American Academy of PediatricsAmerican Academy of Pediatricsrecommends limiting consumption ofrecommends limiting consumption of

    herbal teas (two 8-oz servings inherbal teas (two 8-oz servings infiltered tea bags) during pregnancyfiltered tea bags) during pregnancy

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    Common PregnancyCommon Pregnancy

    ProblemsProblems

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    Nausea and VomitingNausea and Vomiting

    Avoid strong odorsAvoid strong odors

    Eat before getting out of bed Eat before getting out of bed

    crackers, plain toast, or dry cerealcrackers, plain toast, or dry cereal

    Avoid an empty stomachAvoid an empty stomach

    Eat easy-to-digest foodsEat easy-to-digest foods

    Eat slowlyEat slowlySnack before bedSnack before bed

    Try lemon, ginger tea, lemonade, gingerTry lemon, ginger tea, lemonade, ginger

    ale, Sprite, 7-up etc. to settle stomachale, Sprite, 7-up etc. to settle stomach

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    HeartburnHeartburn

    Eat small meals frequentlyEat small meals frequently

    Cut down on caffeinated andCut down on caffeinated and

    carbonated beveragescarbonated beverages

    Eat slowly in a relaxed environmentEat slowly in a relaxed environment

    Do not lie down after eatingDo not lie down after eating

    Prop head of bed upProp head of bed up

    Wear loose-fitting comfortable clothesWear loose-fitting comfortable clothes

    Avoid gaining too much weightAvoid gaining too much weight

    Talk to doctor before taking antacidsTalk to doctor before taking antacids

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    SwellingSwelling

    As blood supply increases, legs, feet,As blood supply increases, legs, feet,

    and arms may swelland arms may swell

    Drink plenty of fluids, especially waterDrink plenty of fluids, especially waterAvoid diuretics, unless prescribed byAvoid diuretics, unless prescribed by

    health care providerhealth care provider

    Elevate your feet whenever possibleElevate your feet whenever possible

    Wear loose-fitting shoes and clothesWear loose-fitting shoes and clothes

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    Pica (nonfood cravings)Pica (nonfood cravings)

    Some pregnant women develop cravingsSome pregnant women develop cravings

    for nonfood substances like clay, dirt, ice,for nonfood substances like clay, dirt, ice,

    or laundry starchor laundry starch

    This does not reflect a physiological needThis does not reflect a physiological needfor a particular nutrientfor a particular nutrient

    Pica is especially common in AfricanPica is especially common in African

    American womenAmerican women

    Pica may lead to iron-deficiency anemia,Pica may lead to iron-deficiency anemia,

    malnutrition and lead exposure (brainmalnutrition and lead exposure (brain

    damage)damage)

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    Gestational DiabetesGestational Diabetes

    Some women develop diabetes duringSome women develop diabetes during

    pregnancypregnancy

    Gestational diabetes occurs in theGestational diabetes occurs in the

    latter half (after 24 weeks) in 7% oflatter half (after 24 weeks) in 7% of

    pregnanciespregnancies

    Increases risk of delivering infantsIncreases risk of delivering infants

    large for gestational agelarge for gestational age

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    Pregnancy-induced HypertensionPregnancy-induced Hypertension

    Calcium Supplements may be beneficialCalcium Supplements may be beneficial

    Risk factors include:Risk factors include:

    Chronic HypertensionChronic HypertensionPreeclampsia in a previous pregnancyPreeclampsia in a previous pregnancy

    First PregnancyFirst Pregnancy

    Younger than 20 years oldYounger than 20 years old

    Older than 40 years oldOlder than 40 years oldObesityObesity

    Genetic factorsGenetic factors

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    Questions??Questions??

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    ReferencesReferences

    Position of the American Dietetic Association: NutritionPosition of the American Dietetic Association: Nutritionand lifestyle for a healthy pregnancy outcomeand lifestyle for a healthy pregnancy outcome

    Krauses Food, Nutrition, and Diet TherapyKrauses Food, Nutrition, and Diet Therapy

    Nutrition for Women: The Complete Guide ElizabethNutrition for Women: The Complete Guide ElizabethSomer, MA, RDSomer, MA, RD

    What to Expect When You Are Expecting Eisenberg,What to Expect When You Are Expecting Eisenberg,Murkoff, and HathawayMurkoff, and Hathaway