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Why is nutrition so important?
Meet increased nutrient demands Provide needed energy Prevent or minimize common pregnancy-related problems Reduce risk of birth defects Supply needed nutrients for baby’s growth Ensure healthy birth weight Maintain a healthy weight

Key Components of a Healthy Pregnancy
Appropriate weight gain Consumption of a variety of foods Vitamin and mineral supplementation Avoidance of alcohol, tobacco and other harmful substances Safe food handling

Recommended Weight Gain
Underweight Normal weight Overweight Obese Twins Triplets 28-40 lbs 25-35 lbs 15-25 lbs at least 15 lbs 35-45 lbs 50 lbs

Normal Pregnancy Weight Gain
Breast Blood Extra water Uterus Placenta/amniotic fluid Baby Fat stores Total 1-1.5 lbs 3-4.5 lbs 4-6 lbs 2.5-3.0 lbs 3.5-5.5 lbs 7-8 lbs 4-6.5 lbs 25-35 lbs

Risks of Low Weight Gain
Low weight gain in second or third trimester increases risk of intrauterine growth retardation Low weight gain in third trimester increases risk of preterm delivery

Guidelines for teenagers
Higher weight gains and greater postpartum weight retention is common if mother is still growing Maternal growth in multiparous teenagers is associated with lower birth weights

Consume a variety of foods
Grains Vegetables Fruits Milk Meat and Beans

Typical Plate

Reconstruct Your Plate

MyPyramid

Minimum Servings During Pregnancy
Grains (9 ounce equivalents) Vegetables (3 ½ cups) Fruits (2 cups) Milk (3 cups)* Meat and Beans (6.5 ounce equivalents) *Pregnant teenagers may need an additional serving from this group

Eating for Two!!
~300 calories/day during 2nd and 3rd trimester 300 calories: ½ sandwich + 1 c. milk/yogurt OR 1 c. cereal + 1 c. milk + banana OR Peanut butter on 2 slices toast + 1 c. milk

Proper nutrition
Major Nutrients Carbohydrates Protein Fat Vitamins Minerals Water

Carbohydrates
Sugars and starches Body’s primary source of energy Fruits, breads, some vegetables, grains, milk Should make up 60-70% of total daily calories Carbohydrates do not make you fat

Fat
Source of stored energy burned during activity Makes you feel full and no longer hungry Helps the body absorb fat soluble nutrients Choose healthy fats 20-25% of total calories (use sparingly) Contains most calories per gram

Protein
Builds and repairs the body Used for energy if the diet is inadequate in carbohydrates Found in fish, poultry, meats, tofu, nuts, beans, eggs, milk, cheese Need ~10 grams more per day in pregnancy 10-20% of total calories

Water
60-75% of body weight Stabilizes body temperature Carries nutrients to and waste away from cells Needed for cell function 8-10 cups/day

Fiber
Fiber: Whole grains, fruits, vegetables Wheat bread: check the label Fruit vs. Juice Stabilizes blood sugar Protection from diabetes, constipation and diverticulosis lowers LDL cholesterol

Vitamins and Minerals
Body does not make most vitamins Good source: Deep colored fruits and vegetables Fresh, frozen, canned Multivitamin/Multi-mineral supplements B Vitamins Iron

Special Interest Nutrients

Vitamin B12
Generally adequate amounts are obtained through animal products Fish, eggs, milk, meats, etc. Vegans that do not have any animal products in their diet need supplementation Works with folic acid in cell growth and is essential to the normal development of the infant

Folic Acid
A supplement taken 1-3 months prior to conception and during first 6 weeks gestation reduces the risk of neural tube defects, cleft palate/lip 400 micrograms per day of synthetic folic acid needed per day (pregnant women and those of childbearing age) Folic acid in fortified foods and supplements is better absorbed by the body Needed for rapidly dividing cells, protein metabolism, and formation of red blood cells

Food Sources of Folic Acid
Fortified breakfast cereals Dried beans Liver/meats Spinach and green leafy vegetables Citrus fruits and juices Whole-wheat bread

Iron
Needed for the formation of red blood cells 15 milligrams a day for woman during childbearing years recommended Iron supplement (30 mg/d) recommended for pregnant women Typical American diet 10-11 milligrams a day

Food Sources of Iron
Meats Fish Poultry Legumes Whole-grain and enriched breads Iron-fortified cereals Dark greens Dried fruits

Calcium
Calcium absorption doubles early in pregnancy Is used in the formation of fetal bones Will be absorbed from maternal bones if not enough calcium in diet Calcium absorption increases with Vitamin D Calcium and vitamin D supplements sometimes needed

Food Sources of Calcium
Milk (skim, lowfat) Yogurt (low-fat) Oysters Shrimp Calcium-fortified apple and orange juice Collard greens Broccoli Turnip greens Sesame seeds

Multivitamin and Mineral Supplements
Recommended for: Women who smoke or abuse drugs Women with iron deficiency anemia or poor quality diets Women who eat animal products rarely or not at all (such as vegans) Vitamin B 12 supplement important for vegans

Food Additives and Ingredients
Use of sweeteners that are Generally Recognized as Safe (GRAS) is acceptable Pregnant women should moderate intake of saccharin Aspartame intake within Food and Drug Administration guidelines is safe during pregnancy Women with PKU should avoid aspartame Moderate consumption of cured meats and other foods rich in nitrosamines MSG consumption not thought to pose a health risk to mother or child

Foods to Avoid
Fish containing high levels of mercury (shark, swordfish, king mackerel, and tilefish) Raw or undercooked fish Raw or undercooked shellfish Raw eggs or dishes containing raw or partially cooked eggs

Foods to Avoid (cont.)
Raw or undercooked meat and poultry Sushi Pate Soft or blue-veined cheeses Unpasteurized cheeses and juices Deli meats

Things to Avoid During Pregnancy
Alcohol Cigarettes Recreational drugs Over-The-Counter Medications or Herbal Supplements Consult health care provider Caffeine Consult health care provider

Alcohol
Women who are or may become pregnant should not drink alcohol A safe level of alcohol intake has not been established at any stage during pregnancy

Risks of Drinking During Pregnancy
Major birth defects (Fetal Alcohol Syndrome) Mental retardation Learning disabilities Impaired fetal growth Lower Apgar scores Possible reduction in fertility

Smoking during Pregnancy
Limits oxygen supplied to the fetus Reduces birth weight of the infant Increases the risk of pre-term delivery Increases the risk of perinatal mortality Passive exposure to tobacco smoke may also reduce infant growth Associated with mental retardation and nicotine addiction in the fetus

Herbal and Botanical Supplements
Consider herbal treatments as suspect until safety during pregnancy is confirmed American Academy of Pediatrics recommends limiting consumption of herbal teas (two 8-oz servings in filtered tea bags) during pregnancy

Common Pregnancy Problems

Nausea and Vomiting
Avoid strong odors Eat before getting out of bed – crackers, plain toast, or dry cereal Avoid an empty stomach Eat easy-to-digest foods Eat slowly Snack before bed Try lemon, ginger tea, lemonade, ginger ale, Sprite, 7-up etc. to settle stomach

Constipation
Hormonal changes slow down the intestine Drink 8-12 glasses of water everyday Eat high-fiber foods Try dried plums, prune juice, or figs Be as physically active as possible Do not use laxatives unless prescribed by health care provider

Heartburn
Eat small meals frequently Cut down on caffeinated and carbonated beverages Eat slowly in a relaxed environment Do not lie down after eating Prop head of bed up Wear loose-fitting comfortable clothes Avoid gaining too much weight Talk to doctor before taking antacids

Swelling
As blood supply increases, legs, feet, and arms may swell Drink plenty of fluids, especially water Avoid diuretics, unless prescribed by health care provider Elevate your feet whenever possible Wear loose-fitting shoes and clothes

Pica (nonfood cravings)
Some pregnant women develop cravings for nonfood substances like clay, dirt, ice, or laundry starch This does not reflect a physiological need for a particular nutrient Pica is especially common in African American women Pica may lead to iron-deficiency anemia, malnutrition and lead exposure (brain damage)

Gestational Diabetes
Some women develop diabetes during pregnancy Gestational diabetes occurs in the latter half (after 24 weeks) in 7% of pregnancies Increases risk of delivering infants large for gestational age

Pregnancy-induced Hypertension
Calcium Supplements may be beneficial Risk factors include:
Chronic Hypertension Preeclampsia in a previous pregnancy First Pregnancy Younger than 20 years old Older than 40 years old Obesity Genetic factors

Questions??

References
Position of the American Dietetic Association: Nutrition and lifestyle for a healthy pregnancy outcome Krause’s Food, Nutrition, and Diet Therapy Nutrition for Women: The Complete Guide Elizabeth Somer, MA, RD What to Expect When You Are Expecting Eisenberg, Murkoff, and Hathaway

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