NHM201chpts45StudySoup.pdf NHM 201
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This 10 page Class Notes was uploaded by Regan Dougherty on Tuesday September 22, 2015. The Class Notes belongs to NHM 201 at University of Alabama - Tuscaloosa taught by Denise DeSalvo in Summer 2015. Since its upload, it has received 53 views. For similar materials see Nutrition Through the Lifecycle in Nutrition and Food Sciences at University of Alabama - Tuscaloosa.
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Date Created: 09/22/15
Tuesday September 15 2015 Nutrition in Pregnancy Chapters 4 amp 5 Academy of Nutrition and Dietetics areas of concern healthy prepregnancy weight appropriate weight gain physical activity wide variety of foods appropriate intake of supplements vitamins minerals avoid alcoholother harmful substances food safety Infant mortality reflects general health and socioeconomic status of the population Health Objectives for 2020 related to pregnant women and infants reduce occurrence of low birth rate preterm delivery infant mortality improve nutritional status Low Birth Weight LBW lt2500g orlt5lb802 Very Low Birth Weight VLBW lt1500gorlt3b502 Extremely Low Birth Weight ELBW lt1000gorlt2b302 Low birth weight or preterm infants are at a high risk of death in the 1st year of life Desirable birth weight 3500 4500 g 7 lb 12oz 10 lb Infants born with desirable weight are less likely to develop heart and lung diseases diabetes hypertension Tuesday September 15 2015 Preterm born before 37 weeks Post term born after 42 weeks average number of weeks for pregnancy 40 Perinatal pertaining to the period immediately before and after birth periconception the period around conception Gravida the number of pregnancies a woman has experienced Parity the number of previous deliveries experienced by a woman If a woman has delivered a child she is considered parous nuiparous no deliveries primiparous 1 delivery multiparous more than 1 delivery Physiology of Pregnancy anabolic and catabolic maternal anabolic changes building up 1st half of pregnancy mother is building stores for when the fetus is going to need it maternal catabolic changes breaking down 2nd half of pregnancy fetus utilizes what mother has stored body water increases from 7 L to 10 L as a result of increased blood and body tissues and extracellular volume and amniotic fluid Edema swelling due to accumulation of extracellular fluid normal as long as the mother s blood pressure is normal hormonal changes metabolic changes Changes can be seen in the first few weeks after conception Tuesday September 15 2015 These changes are genetically preprogrammed and genetically timed The Placenta forms from embryonic tissue functions as a twoway street nutrients etc are transferred from mom to fetus and from fetus to mom structure double lining of cells separating maternal and fetal blood round disclike nutrient transfer nutrients are first used for maternal needs then for placenta then for fetal needs the fetus is harmed more than the mother by poor maternal nutrition Pregnancy Weight Gain Weight gain during pregnancy is related to the weight and health status of the infant mother should gain 3 5 lbs during the first trimester least amount of weight gain is seen in the first trimester mother should gain 1 lb per week during the second and third trimester Recommendations for weight gain are influenced by the pre pregnancy weight status of the mother underweight recommended weight gain 28 40 lb normal 25 35 lb overweight 15 25 lb obese 11 20 lb twin pregnancy 25 54 lb Energy and Nutrient Needs During Pregnancy average of additional 300 caloriesday additional calories are not generally recommended until the 2nd trimester Tuesday September 15 2015 additional 340 caloriesday in 2nd trimester and additional 452 caloriesday in 3rd trimester 2200 2900 caloriesday on average other factors to consider level of physical activity multifetal pregnancies Caloric intake is most easily assessed by pregnancy weight gain Carbohydrate Metabolism glucose is preferred fuel for the fetus The diabetogenic effect of pregnancy results from maternal insulin resistance the mother s glucose levels begin to look like she is diabetic Early Pregnancy high estrogen and progesterone stimulate insulin which increases glucose gt glycogen and fat storage Late Pregnancy hCS and prolactin inhibit conversion of glucose to glycogen and fat glucose is available for the fetus Carbohydrate Recommendations used for energy antioxidants and to relieve constipation 45 65 of calories minimum of 175 grams of carbs at least 28 g of fiber per day Protein Metabolism There are no maternal stores of protein the mother does not store protein for later needs about 925 g of protein are accumulated during pregnancy Protein needs must be met by the mother s intake of protein each day Tuesday September 15 2015 Dietary intake of protein is used for the production of new cells enzymes and maternal hormones and fetal growth to achieve a healthy birth weight Recommended additional 25 gday for all trimesters ABOUT 11 gkg Fat Metabolism The mother should accumulate fat stores in the first half of pregnancy enhanced fat mobilization in the last half stores are broken down the mother s glycogen is being broken down for the baby a lot of fat is used maternally Blood lipid levels increase in mother primarilty triglycerides lipid profile usually returns to normal after delivery Increased cholesterol is a substrate for steroid hormone synthesis also used to make phospholipids cell membrane Recommendations 33 of calories from fat Fat consumed is an energy source for fetal growth and development source of fat soluble vitamins essential fatty acids 13 gday linoleic 14 gday linolenic 500 mgday EPA and DHA oily fatty fishes vegetarians do not get enough of this Adequate EPA and DHA during pregnancy and lactation are linked to higher intelligence better vision and a more mature CNS do not exceed 3 grams per day Water Tuesday September 15 2015 9 cups of fluid per day increased respiratory rate Vitamins Folate associated with anemia and reduced fetal growth metabolic reactions deficiencies lead to abnormal cell division and tissue formation NTDs neural tube defects malformations of the spinal cord and brain spina bifida and others important early in pregnancy often before women know they are pregnant 600 mcg dietary folate equivalents DFEs 400 mcg folic acid 200 mug DFE found in fruits vegetables whole grains fortified cereals Choline important for brain development Vitamin A cell differentiation be aware of vitamin A toxicity Vitamin D immune system development cell growthdivision Minerals Calcium needed for fetal skeletal mineralization and to maintain maternal bones low intakes of calcium are related to increase release of lead harmful to fetus 3 cups of milk or calciumfortified soy milk Tuesday September 15 2015 lron Iron deficiency is seen in early pregnancy because of increase in blood volume Iron deficiency is seen in late pregnancy because of fetal growth anemia Recommendations supplement with 30 mgday after 12th week of pregnancy 6O 180 mgday for iron deficiency anemia UL during pregnancy is 45 mgday Pros and Cons cons pa on Factors Affecting Dietary Intake During Pregnancy taste and odorsmell changes in foods and other things occur in 2 out of 3 women nausea and vomiting morning sickness Hyperemesis Gravidurum severe and longlasting nausea and vomiting can last all of pregnancy individuals may need to be hospitalized to get fluid therapy Pica eating disorder eat nonfood substances found more in African American women geophagia dirt pagophagia ice amylophagia starch cultural considerations ex If you drink beet juice when you re pregnant you won t have any issues with iron Common Health Problems During Pregnancy nausea and vomiting management separating liquids from solids when eating eating neutral foods settle stomach avoid foods that trigger nausea maybe recommend dietary supplement Tuesday September 15 2015 heartburn as baby grows stomach contents can flow back up the esophagus eat smaller meals cons pa on meet 28 grams of fiber good fluid intake fruits vegetables whole grains Chapter 5 Nutrition During Pregnancy Conditions and Interventions Obesity and Pregnancy higher rate of gestational diabetes associated with unfavorable metabolic changes for infants higher rates of stillbirth large for gestational age Csection delivery risk of surgery may increase risk of child becoming overweight and having Type 2 diabetes recommendations meet nutrient needs variety of basic foods physical activity maintain appropriate rates of weight gain Hypertensive Disorders of Pregnancy Hypertension women become pregnant with pre existing hypertension blood pressure gt 14090 mm Hh more common in African American obese over 35 years history of hypertension with pregnancy blood pressure gt 160110 mm Hh associated with increased risk of fetal death growth retardation preterm delivery Gestational Hypertension Tuesday September 15 2015 hypertension diagnosed for the first time after midpregnancy no proteinuria no protein in urine tend to be overweight or obese with excess central body fat Preeclampsia eclampsia pregnancyspecific syndrome occurring gt 20 weeks gestation accompanied by proteinuria gt 140110 mm Hg eclampsia seizure activity could be hospitalized for the duration of pregnancy can get serious enough to cause fetal andor mother death KNOW tables 54 55 and 56 recommendations adequate calcium intake adequate vitamin D status multivitamins minerals if needed over 5 servings of colorful fruitsvegetables adequate fiber intake exercise weight gain Gestational Diabetes predisposed to insulin resistance and have impaired insulin production related to metabolic changes favoring oxidative stress and elevated blood glucose elevated glucose from mother can potentially cause chronic health conditions later in life increased glucose uptake increased triglyceride formation in fetus All pregnant women should be tested for diabetes All pregnant women without diabetes should be tested for gestational diabetes by a 75 gm glucose tolerance test at 2428 weeks diagnosis fasting plasma glucose gt 92 mgdL after1 hourgt 180 mgdL after 2 hours gt 153 mgdL monitor glucose and ketones do a follow up after pregnancy Fetal Alcohol Spectrum Disorders range of effects resulting from fetal alcohol exposure Tuesday September 15 2015 behavioral problems mental retardation aggressiveness nervous short attention span stunted growth birth defects Fetal Alcohol Syndrome is most severe abnormal facial features growth problems poor communication skills visionhearing problems Alcoholrelated birth defects more moderate end of spectrum more internal issues organ system problems Adolescent Pregnancy teen growth in height and weight at the expense of the fetus Infants born to teens average 155 g less than those born to older adults Overweightobese adolescents face the same risks as overweightobese adults dietary recommendations more calories caloric needs should be form nutrientdense foods calcium RDA 1300 mg Vegetarians 1O at risk for lower levels of 812 D calcium iron zinc DHA and EPA pregnant vegans have lower protein intakes
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