Times of Critical Nutrient Needs • Pre-conception – folate, Vitamin B12, B6 o Achieve and maintain healthy body weight

o Good dietary habits, exercise regularly o 400 ug folic acid supplement – synthesis of DNA bases  Goal = 600 ug of folate per day  ALL women should take a folic acid supplement • 1st trimester – • 2nd trimester – calories • 3rd trimester – protein, carb, fat, vitamins Neural Tube Closure • Days 18-28 o Day 18 – neural crest forms o Day 23 – neural tube closes from center out o Day 28 – cranial and caudal openings close last Embryo formation • Neural tube – day 20 • Heart – day 18-42 • Arms/legs – day 24-44 • Eyes – day 24 – 50 • Ears – day 24 – 59 • Teeth/palate – day 39-59 • External genitalia – day 42-62 Nutrient Transfer to Fetus • Yolk sac – method of feeding fetus before week 12 o Active/passive transport o Resembles renal vessels feeding into/out of kidney • Amniotic fluid – immediately around fetus • Chorionic fluid – outside of amniotic fluid (contained by chroion) Placenta • Main route of nutrient transfer/waste removal after week 12 • Separates maternal blood from fetal blood • Produces hCG, placental lactone, prolactin Fat Soluble vitamins • Not readily absorbed • Vitamin E – syntrophoblast via lipoprotiens • Vitamin A – retinol-binding protein (RBP) • Vitamin D – Vitamin D-binding protein (VBP) Iron • • Transports oxygen Binds to transferrin in blood

B6. protein • <30% increase – riboflavin. calories. K. B12 • caffeine enhances calcium excretion • spinach prevents calcium absorption • protein goal = 71 g/day • 340/450 kcal/day (2nd/3rd trimesters) Protein in Pregnancy • 15% total energy intake should come from protein • Accumulation rate peaks towards end of pregnancy (5 g/day @ 40 weeks) • Protein used for building tissues is ~70% Transfer of Amino Acids to Fetus • Concentration of amino acids is higher in fetus • Nutrients flow more readily towards the fetus • Transporters in the syntrophoblast (placenta) move amino acids from maternal side to fetus • Syntrophoblast oxidizes and interconverts amino acids Carbohydrates • 45-55% of maternal energy needs (250-300g of carbs/day) • Glucose is main energy source for fetus • Fetus receives most of its glucose from the mother (because it has low glycogen stores and low rates of gluconeogenesis) Transfer of Glucose to Fetus • As pregnancy progresses o Fetal use of glucose increases o Maternal sensitivity to insulin decreases • Steep concentration gradient created that shunts glucose to the fetus • Fetal demand exceeds maternal intake o Mother uses tissue proteins for gluconeogenesis o Fatty acids – energy for maternal muscle . B12 – mother and fetus compete Vitamin A – excess is more harmful to fetus Nutrient Increases during pregnancy • NO INCREASE NEEDED: Vitamins D. Maternal nutrients Iron – fetal need takes precedence Protein.• • • • Fetal • • • Iron absorption efficiency increases during pregnancy o Placenta expresses transferrin receptors 80% of newborn’s iron supply accumulates during the 3rd trimester Vitamin C enhances iron absorption Black tea and whole grains reduce iron absorption vs. E. calcium. phosphorus • 50% increase – folate. iron • 30-40% increase – iodine.

D.5 kg) • Uterine enlargement (+0.8-26  25-35lb o BMI 26-29  15-25lb o BMI >29  15lb Normal rates of Weight Gain • 1st trimester – 3-4 lb • Peaks in 2nd trimester (12-14 lb) • 3rd trimester –8-10 lb (1lb/week.4 kg) • Recommended Total Gains o BMI <19. carb. E.8lb • Optimal gestational age – 39-41 weeks Excess Maternal Weight Gain/obesity prior to pregnancy • Excess birth weight (>10 lb) • Preeclampsia • Pregnancy induced hypertension • Placental insufficiency • DIETING IS INAPPROPRIATE FOR ALL PREGNANT WOMEN (regardless of their weight) Maternal Malnutrition • Growth retardation – energy. 12oz soda) • Increases calcium excretion from body .o Fats • • • • • • Ketones from FA beta-oxidation in the liver – fuel for maternal brain Should be 20-35% of energy (53-93g/day) Need omega-6 FA to absorb fat soluble vitamins (A. protein. and K) DHA is important Fetus uses long chain omega-3 FA (DHA) for brain development Syntrophoblast takes up free FA and lipids from maternal blood B-oxidation of FA  ketones  cross placenta easily (energy) Weight Gain • Breast tissue (+1.6-8. vitamins • Inadequate storage of nutrients – vitamins • Protein – negative outcomes in adulthood.25 kg) • Blood volume (+1.5 kg) • Infant (+3. may lose 1-2lb in the final 2 weeks) • Optimal infant birth weight – 6. vitamins • Brain development – energy.9 kg) • Amniotic fluid/placenta (+1. altered enzyme activity Caffeine • Limit to <300 mg (6oz coffee.8  28-40lb o BMI 19.4 kg) • Maternal fat (+3.

adequate vitamins Hyperemesis (nausea) • Small frequent meals reduces nausea Pica • Eating nonfood items Macrosomia • Excessive growth of fetus . fiber • Hypertension – 1-2g calcium/day.5 oz/day Nutritional Management of Physiological Changes • Heartburn – drink liquids between meals • Constipation – liquids.• • • Diuretic Causes intrauterine growth retardation Not metabolized by the fetus/placenta & stimulates CNS Fiber • Increase to 28 g/day AND increase fluid intake • Pregnancy reduces intestinal motility Nutrient Goals • Grains: 8 oz (240 g/day) • Vegetables: 3 cups/day • Fruit: 2 cups/day • Oils: 7 tsp/day • Milk: 3 cups/day • Meat/beans: 6.

Sign up to vote on this title
UsefulNot useful