Iron Allowances

At least 700 to 1,000 mg to iron must be absorbed and utilized by the

mother throughout her pregnancy. Of this total, about 240 mg is spared
by the cessation of the menstrual flow. The remainder must be made
available from the diet. The rate of absorption is increased, therefore
in the third trimester when the needs of the fetus are highest.

Iodine Allowances
Iodine is especially important during pregnancy to meet the needs of
fetal development. An inadequate intake of iodine may result in goiter
in the mother or the child. The increased need for iodine can be met by
the regular use of iodized salt in food.

Vitamin Allowances
Thiamine and niacin allowances are increased in proportion to the
calorie increase while riboflavin allowances are increased according to
the higher protein level. The need for vitamin D is increased during
pregnancy to make easier the utilization of greater amounts of calcium
and phosphorus. Ascorbic acid, vital in tissue structure, is required in
considerably increased amounts.

Vitamin A is important in the epithelial cells during organogenesis

and is necessary to ensure good vision. Folic acid and vitamin B12 are
important in the synthesis of RBC. Vitamin B6 or pyridoxine
requirement has been observed to be greater during pregnancy. It has
been found to have much value in preventing severe nausea and
vomiting associated with childbearing.
During the early days of life, the infant often has low blood
prothrombin levels until intestinal synthesis of vitamin K is fully
established. Vitamin K maybe given to the mother at 2 mg to 5 mg
parenterally before the birth of the baby to stabilize the prothrombin
level of the infant until synthesis can take place. Otherwise 1 mg to 2
mg can be given to the infant after birth. The use of vitamin K
supplement during the course of pregnancy is, therefore not necessary.

Food Allowances
1. One ounce or 30 g of meat or its equivalent and an extra pint of
milk to the normal diet.
2. Daily consumption of the whole grain cereals; enriched bread; rice
;leafy green and yellow vegetables;and fresh dried fruits.
3. Liver at least once a week.
4. Egg in daily diet.
5. Fortified milk with vitamin D or fish liver oil.
6. Six to 8 glasses of water daily.

COMPLICATIONS OF PREGNANCY AND POSSIBLE DIETARY

MODIFICATIONS:
Nausea vomiting, improper body weight, and toxemia are among the
many conditions that complicate the normal course of pregnancy. They
influence the intake, digestion, absorption, and utilization of essential
nutrients. They become even more serious when gestation occurs
during adolescence. During the early part of pregnancy, the most
common discomfort is “morning sickness,” so called because nausea
and vomiting usually occur immediately after getting up in the morning.
When accompanied by lack of appetite, such condition leads to
malnutrition and loss of weight. A longitudinal study on pregnant
women reveals nausea to affect frequency of food intake, resulting in a
decrease in calorie intake. Increased hormone secretion is in some way
responsible for this phenomenon.

Nutrition experts recommended small frequent feedings instead of

three large meals, the high carbohydrate, low fat foods such as
crackers and jelly to overcome the above complications. Liquids are
better taken between meals rather than at mealtime.

Rapid Weight Gain or Loss

The popular concept of “eating for two’’ is not valid among well
nourished mothers. It may lead to overweight with consequent
toxemia, difficulties of labor, the birth of large sickly babies. Excessive
weight gain during pregnancy is defined as an increase of three
kilograms or more per month in the second and third trimester. A
sudden increase in weight after about the 20th week of gestation is a
cause for suspecting that water is being retained at an inordinate rat
and should be regarded as a warning sign of an impending eclampsia.

Proper management of obese pregnant patients is a matter of

controversy. Some obstetricians advocate moderate calorie restriction
with the limited weight loss. Nutrition experts generally opposes severe
calorie restriction because aside from the probability that restriction of
calories result in deficiency of some essential nutrients, the
susceptibility to starvation ketosis during pregnancy endangers fetal
and maternal health. It is advised that the overweight and obese
women should consciously avoid severe calorie restriction as well as
prevention of excessive weight gain.
 On the other hand, a gain of less than 500 g/month during the
first trimester of pregnancy and 250 g during the second trimester is
considered a maternal risk factor. Those who are seriously underweight
entering pregnancy (<38 kg), or showing inadequate weight gain (<40
kg at the 220th week of pregnancy) are more likely to deliver low birth
weight infants, or two have premature deliveries, abortions, and
offspring with brain and nerve damage. Women who show poor
increase in body weight after around the 20th week should be re
evaluated. Excessive weight gain of 3 kg or more per month in the
second and third trimesters can lead to eclampsia while weight gain of
less than 500 g per month during the first trimester and 250 g during
the second trimester can lead to the delivery of low birth weight or
premature infants and babies with brain and nerve damage. Abortions
may also occur.

Toxemia
Rapid weight gain, edema, high blood pressure, excretion of
albumin in the urine, and convulsion are clinical manifestations of
toxemia.

It classifications are as follows:

1. Acute toxemia of pregnancy: onset after the 24th week.

a. Pre eclampsia * hypertension with proteinuria and/or edema.
b. Eclampsia * convulsion or coma: usually both when associated
with hypertension, proteinuria, and edema.
2. Chronic hypertensive(vascular disease)
a. Without superimposed acute toxemia
b. With superimposed acute toxemia.
Toxemia which complicates some 4 percent to 6 percent of
pregnancies remains among the leading causes of maternal death,
prenatal deaths, and low birth weight infants. An unusually high
incidence of pre eclampsia seems to exist among socio
economically deprived groups. Optimum nutrition is a
fundamental aspect of therapy. Emphasis is laid on HBV protein
foods and sources of iron, calcium, and minerals. Salt intake is
restricted for edema. While most pregnant women adjust to
restricted sodium intake, some tolerate it poorly.

Anemia
The classic macrocytic anemia of pregnancy represents a
combined deficiency of iron folic acid. It produces anemia in
babies and increases the chances of premature birth. Once
anemia is established, it is difficult to overcome the condition
even by raising the level of iron in the diet although its absorption
can be enhanced by the inclusion of ascorbic acid rich foods in the
same meal containing rich sources of iron.

Diabetes
A pregnant woman with diabetes is more prone to develop pre
eclampsia, pyelonephritis, and polyhydramnios (an excess of
amniotic fluid), and her baby has a higher risk of dying in utero or
at birth. Rigid control of maternal blood glucose concentration is
considered vital for a good prognosis of the fetus.
Constipation
Pressure exerted by the developing fetus on the digestive tract,
lack of exercise, and insufficient bulk in the diet cause
constipation, which if chronic or habitual, gives rise to headaches
and much discomfort. Lots of fresh fruits, vegetables, fluid, and
regular exercise can correct this disorder.

Socio economic and Cultural Factors

Low income groups tend to have to have big families, one reason
for the decrease in kind and amount of food available to the
pregnant mother. Unusual eating habits such as frequent snack
rich in carbohydrates; irregular meals; special cravings; such as
raw white rice and green mangoes; and odd eating habits like
chewing cigarettes, chicken manure, and soot of fats deprive the
mother of wholesome foods.

Fallacies (that eating eggplant causes beriberi I the mother;

dark food results in dark complexion of babies; and eating crabs
produce physical abnormalities) should be ignored.