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Page 1: US Army: NutritionDuringPregnancy

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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 baby’sSupply needed nutrients for baby’sgrowthgrowth

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 water Extra 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 trimester Low 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 greater Higher 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 lower teenagers is associated with lower birth 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 ½ cups)Vegetables (3 ½ 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

trimester trimester 

300 calories:300 calories:

½ sandwich + 1 c. milk/yogurt OR½ 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

Water Water 

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CarbohydratesCarbohydrates

Sugars and starchesSugars and starches

Body’s primary sourceBody’s 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 per Need ~10 grams more per 

day in pregnancyday in pregnancy

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

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Water Water 

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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Fiber Fiber 

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

vegetablesvegetablesWheat bread: check the labelWheat bread: check the label

Fruit vs. JuiceFruit vs. Juice

Stabilizes blood sugar Stabilizes blood sugar Protection 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 of needed per day (pregnant women and those of childbearing 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 if Will be absorbed from maternal bones if not 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 orange juice juice

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 poor Women with iron deficiency anemia or poor quality 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 other Moderate consumption of cured meats and other foods 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 or Raw 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 or Over-The-Counter Medications or 

Herbal SupplementsHerbal Supplements

Consult health care provider Consult health care provider 

CaffeineCaffeine

Consult health care provider Consult 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 of recommends 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, ginger Try 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 water Drink plenty of fluids, especially water Avoid diuretics, unless prescribed byAvoid diuretics, unless prescribed by

health care provider health 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% of latter 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 old Younger 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

Krause’s Food, Nutrition, and Diet TherapyKrause’s 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