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8/14/2019 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