NUTRITIONAL AND FOOD

REQUIREMENTS OF
EXPECTANT MOTHER

Manimegalai.B
 INTRODUCTION
Adequate nutrition before and during pregnancy
has greater potential for a long term health impact.
Increased absorption, decreased excretion or
alteration in metabolism improves utilization of
nutrition which results in physiological change.
A women begins her pregnancy with reserves of
several nutrients so that the foetus can be met
without affecting the mother.
Infants who are well nourished in the womb, have
an enhanced chance of entering life in good
physical and mental health.
PRECONCEPTUAL NUTRITION
Women with low body weight and poor nutrition
status have low weight infants.
A pre- pregnancy weight of less than 40kg is useful
to predict who will deliver low birth weight babies.
Administration of folic acid 400-800µg per day and
during conception and early gestation reduce
neural tube defects.
A woman should achieve a body mass within 90-
120% of ideal weight prior to conception.
NUTRITIONAL REQUIREMENT
ENERGY- for a reference Indian women
whose body weight is 55kg, the total energy
cost of pregnancy is 80,000 and the
expenditure during normal pregnancy is
27,000.
Sedentary worker- 1900+350=2250kcal.
Moderate worker- 2230+350=2580kcal.
Heavy worker- 2850+350=3200kcal.
Energy requirement during pregnancy
increases body weight consisting of protein, fat
and water.
Fat accumulate throughout pregnancy is act
as energy reserve.
When the supply of nutrients is inadequate the
fat is used to provide energy needs of growing
foetus.
This results in increase in ketones in the urine
during first trimester of pregnancy.
 PROTEINS
Normal protein requirement of an adult woman is
55g/d.
ICMR prescribed for a pregnant woman is 82.2g/d.
Additional protein is essential for rapid growth of
foetus.
Enlargement of uterus ,mammary glands and
placenta.
Increase in maternal circulating blood volume&
increased plasma protein.
Formation of amniotic fluid.
Transfer of amino acids from mother to foetus.
If protein requirement is not met during
pregnancy there is increase in risk of
pregnancy.
Maximum growth of baby is not obtained.
No. of cells in tissues in brain may be less.
Protein and calorie deficiency during gestation
result in poor utilization of food by offspring
after birth.
VISIBLE FAT AND FATTY ACIDS
Diet of pregnant women should contain 30g of
visible fat.
Should consume at least 200mg/d DHA for
optimal health and fetal development.
DHA plays a crucial role in both vision and
cognitive function.
Essential fatty acids relax muscles and blood
vessels of the uterus and make delivery
easier.
 CALCIUM
Calcium requirement for an adult woman is 600mg/d
& during pregnancy it is 1200mg/d.
A full term foetal body is made up of 30g of calcium.
Increased intake of calcium by mother is essential
for calcification of foetal bones & teeth, protection of
calcium resources of the mother to meet high
demand during lactation.
The amount of dietary calcium needed is reduced
when vit D is available.
Use of vit D & calcium reduces muscular cramps of
pregnancy.
To prevent “osteomalacia” mothers diet should
contain less of phytic acid, adequate amount
of vit D,sufficient amount of calcium.
 IRON
Normal iron requirement is 21mg/d, during
pregnancy it is 35mg/d.
Additional iron is essential because infants
have Hb levels of 18-22g/100 ml of blood iron
stores in liver lasts from 3-6 months.
Required for the formation of haemoglobin is
400 mg.
To avoid deficiency of iron a woman should
enter pregnancy with store of 300mg/d.
 SODIUM
During pregnancy there is increase in extra
cellular fluid which increases 80% body
sodium.
When sodium level drops , kidney produces
hormone renin, as a result sodium that is
needed for use by the body is retained.
When the system is over taxed it can result in
sodium deficiency causing an increased risk of
eclampsia, prematurity and low birth weight
infants.
IODINE- ICMR recommends 0f 250µg
during pregnancy, for adult it is 100-200µg.
Iodine deficiency can lead to abortion, still
births, congenital abnormalies, cretinism and
psychomotor.
ZINC- deficiency causes adverse effect on new
born including foetal malformations, CNS
teratogenecity & reduced intra uterine growth
rate.
Low zinc during pregnancy doubles the risk of
low birth weight and trebles the risk of pretem
delivery.
 VITAMIN - A
Adult requirement of β- carotene is 4800µg &
during pregnancy it is 6400µg.
Vit A deficiency during pregnancy leads to
night blindness with malnutrition,anaemia,
preterm deliveries in mother, birth asphyxia in
new born.
Daily supplementation of 6000I.U for 12
weeks improves serum vitamin A levels &
correct vit A deficiency in pregnant woman.
VITAMIN D- It is essential to enhance the
maternal calcium absorption.
Maternal deficiency of vit D results in neonatal
hypocalcaemia & hypoplasia.
Excessive vit D results in
atherosclerosis,hypercalcaemia, calcium deposit
in various vital organs and mental retardation in
the infants.
VITAMIN E- It is important in reproductive process
& reduces spontaneous abortions & still births.
Little vit E crosses placenta, so infant has low
tissue conc. That persist up to at least 6 yrs.
WATER SOLUBLE VITAMINS- little of water soluble
vitamins are stored, hence intake should be high
during pregnancy.
Maternal blood level for water soluble vitamins tend
to fall and foetal blood level increase to exceed those
of mother by 50-100% during pregnancy.
THIAMINE- 1.0mg for sedentary,1.1mg for moderate
worker,1.4 mg for moderate.
For a pregnant woman it is 0.2 mg/d.
Normal urinary excretion of thiamine drops indicating
that more is being retained and used by tissues.
Thiamine helps to relieve the nausea of pregnancy.
 RIBOFLAVIN
1.1 mg for sedentary worker
1.3mg for moderate worker
1.7 mg for heavy worker.
For pregnant woman it is 0.3mg/d.
Riboflavin is present in higher amounts in foetal
blood than in maternal blood.
Lack of riboflavin interfere with cartilage
formation resulting in skeletal malformations
such as shortening of long bones and fusion of
ribs.
NIACIN EQUIVALENT
12mg for sedentary,14mg for moderate.16 mg
for heavy worker.
In pregnant woman the RDA is increased by
2mg.
Conversion of amino acid into niacin is more
efficient during pregnancy.
.
VITAMIN B6 (PYRIDOXINE)
for adult woman it is 2.0 mg& for pregnant
woman it is 2.5mg/d.
B6 amino acids are required when the cells
are growing in size (hypertrophy).
 during “Toxaemia of pregnancy” (high
B.P ,oedema,proteinuria) B6 levels are lower.
Vitamin B6 is said to be used to control
nausea of pregnancy.
 DIETARY FOLATE
Adult woman requirement is 200µg/d & pregnancy it is
400µg/d.
They promote foetal growth and prevent macrocytic
anaemia of pregnancy.
Synthesis of essential components of DNA & RNA.
Essential for development of RBC.
Prevent neural tube defects such as spina bifida.
Deficiency causes spontaneous abortion &obstetric
complications such as preterm labour and low birth
weight.
Deficiency causes anencephaly- absence of brain.
 VITAMIN B12
Adult woman requirement is 1µg &remains same
during pregnancy.
Foetus has priority over mother in B12, & the foetal
blood had twice the amount of B12 than does
maternal blood.
Capacity to absorb B12 in woman is increases during
pregnancy & large amount is transferred to foetus.
Vegan mothers have more chances of getting B12
deficiency as vitamin B12 is present in animal
sources.
 VITAMIN C
VITAMIN C during pregnancy is 40mg.
The foetal requirement is too small.
Vit c content of foetal blood is thrice as much as
maternal blood.
Placenta can synthesis vit c, this may account for
higher levels in foetal tissue.
Lower maternal intake of vit c is associated with
premature rupture of foetal membranes&
increased neonatal death rates.
Low plasma levels of vit c causes preclampsia.
RELATIONSHIP BETWEEN
MATERNAL AND FOETAL
NUTRITION
In adequate food intake and poor nutrients utilization
 Maternal malnutrition

 Reduced blood volume expansion

 Inadequate increase in cardiac output

 Decreased blood & nutrient supply to the foetus

 Reduced placental size

 Reduced nutrient transfer

 Foetal growth retardation

FOOD REQUIREMENTS
Pregnant woman should follow basic five food
pattern.
A daily diet containing 3 cups of milk , 2 servings
of meat, fish, poultry, eggs or a complete protein, a
dark green or yellow vegetables and citrus fruits.
Small & frequent meals at regular intervals helps
woman suffer from nausea between 6th -14th week
of pregnancy.
Intake must be steady so that weight gain is not
more than 400g/week
Plenty of water 4-6 glasses in the form of milk or
beverages should be taken.
Pregnant woman limit their intake to 2 cups of
caffeine containing beverages per day like
tea ,coffee, chocolate.
DIETARY GUIDELINES
Small & frequent feedings should be taken.
Fasting should be avoided.
Consumption of eggs &other non veg foods help
to meet protein requirement.
More fibre should included to avoid constipation.
5-6 servings of fruits & vegetables should
included.
Diet should rich in calcium to prevent
osteomalacia. Min of 3 glasses of milk should
taken.
Iron rich foods should taken to prevent anaemia &
to build up iron stores In foetal body.
Raw veg & vegetables are included to meet vit
c & fibre.
Plenty of water should taken to keep bowls
regular.
Diet should include fish, flax seeds, soya bean
to meet - 3 fatty acids.
Fluids should be taken between meals rather
than along with meals.
Adequate amount of calories should be taken
so that enough fat is deposited during
pregnancy which is required for lactation.
GENERAL DIETARY PROBLEMS
NAUSEA &VOMITING
NAUSEA &VOMITING- Nausea in pregnancy due
to nervous disturbances, placental protein
intoxication, derangement in carbohydrate
metabolism.
In hyperemesis gravidarum, a severe prolonged
persistent vomiting, peripheral parental nutrition
&oral feeding is essential.
Skim milk is better tolerated than whole milk.
Fruits &vegetables can be given.
Fatty rich food, fried foods, coffee, strongly
flavoured vegetables restricted or eliminated if
nausea persists.
HEART BURN
Increased progesterone production causes
decreased tone & mobility of the smooth
muscles of G.I.
THIS LEADS TO REGURGITATION- an effect
of pressure of the enlarged uterus on the
stomach which in combination with the
relaxation of the oesophageal sphincter.
Heart burn can be relieved by small and
frequent meals limiting the amount of food
consumed at one time.
Sitting upright after meals for at least 3 hours
before lying down may also help.
BELIEFS,AVOIDANCES, CRAVINGS
&AVERSIONS.
 Food avoidances reflect mothers conscious choice not to
consume certain foods during pregnancy, e.g. heat
producing foods like papaya & gingelly seeds.
 Craving & aversions are powerful urges toward or away
from foods. E.g. craved foods are sweets & dairy
products. Aversion foods are coffee, caffeinate drinks,
meats strongly spiced foods.
 Consumption of non-food items like laundry starch, ice
cubes or clay is called pica.
 Hypothesized that a deficiency for essential nutrient,
such as calcium or iron results in eating o non food
substances that contain these nutrients.
COMPLICATIONS
Haemoglobin mass increases, red blood cell
volume increases, plasma volume rises &
haemoglobin conc. Drops from 13.4-11.6g/100ml.
When maternal Hb level falls below 8g/dl,
significant fall in birth weight occur due to
prematurity rate &intrauterine growth retardation.
Anaemic woman prone to urinary infections,
causes low birth weight infant.
Iron deficiency produce alterations in brain
function & impaired schooling later.
60 mg iron &500µg of folic acid per day in last
trimester of pregnancy to prevent anaemia.
Anaemia due to B12 deficiency pregnancy is
common. Single injection of 40 mcg of B12 is
enough.
Iron rich foods such as GLV, cereals such as
wheat,ragi, jowar &bajra, pulses &jaggery.
Vitc promotes absorption of iron.
Vit c rich foods are lemon, orange, amla,
mango.
 CONSTIPATION
Pressure of enlarging uterus on the lower
portion of intestine, hormonal muscle relaxant
effect of placental hormones on G.I tract
results in constipation.
Increased fluid intake, whole grains, dried
fruits, other fruits & vegetables that are rich in
fibre reduces constipation.
Regular exercise & sleep are essential for
proper elimination.
OEDEMA
Mild oedema is usually present in third
trimester.
The swelling of lower extremities is caused by
pressure of enlarging uterus on the veins
returning fluid from the legs.
This normal oedema requires no sodium
restriction or other dietary changes.
PREGNANCY INDUCED HYPERTENSION
PIH ( eclampsia) is associated with vit A & protein
deficiencies.
 symptoms include hypertension, abnormal
&excessive oedema, albuminuria,coma.
PIH is associated with maternal morbidity and
mortality, intrauterine growth retardation, premature
delivery & perinatal asphyxia.
In severe preeclampsia, intravenous infusion with
10% dextrose & oral feeding of 10% dextrose,
barley and fruit juice is allowed.
HYPERTENSION
This can cause maternal & foetal
consequences.
Nutritional therapy prevent weight extremes,
underweight or obesity.
It will correct any dietary deficiencies &
maintain optimal nutritional status.
It will manage any preexisting disease such as
diabetes mellitus.
Sodium intake should be moderate.
GESTATIONAL DIABETES MELLITUS
Glycosuria is common because of increased
circulating blood volume & its load of metabolites.
Insulin antagonism is due to combined effect of
human placental lactogen, oestrogen,
progesterone & degradation of insulin by placenta.
Glycosylated haemoglobin levels early in
pregnancy increases malformations.
Lowering the rate of GDM, occurrence of
neonatal macrosomia & maternal prepregnancy
obesity reduces
INDIAN PREGNANT WOMAN
A biologically mature female is a young woman who is at least
5 years post menarchial and this has greater impact on
pregnancy.
Maternal mortality rate is 400 deaths per 1,00,000 deliveries in
our country. nutrition is one imp. Cause.
Proper diet can break inter generational malnutrition cycle.
World bank assisted project is given antenatal care by
monitoring monthly weight gain, T.T immunisation, IFA
supplementation, food supplementation.
Too early pregnancies( teenager), too late ( 35 and over), too
close ( les than 2 years) too many( 4 & over) are not safe for
mother and infant.
Suggested recipes
during pregnancy
Dairy product like milk, curd, khoya, paneer,
cheese, yogurt are essential to meet protein,
calcium & vit D. to prevent muscle cramps &
constipation.
Fruit salad will be appetising & provide many
nutrients and fibre.
Omlette, boiled egg, scrambled egg, liver
curry are good quality of protein and iron.
rice flakes upma, puffed rice ball are god
source of iron and easy to digest.
Green gram dhal, pakoda, bread pudding,
carrot halwa are nutrient dense foods.
THANK U