Healthy Mom, Healthy Baby

1
Healthy Mom, Healthy Baby
Nutrition as the Foundation of Life Throughout
Pregnancy and Beyond
2
Introduction

• By the end of this presentation, you will have
  learned
• The importance of nutrition in achieving a
  healthy pregnancy.
• The specific roles of key nutrients that are
  especially important during pregnancy.
• The various factors that influence a pregnant
  womans ability to obtain these key nutrients.
• The implications of both overeating and
  under-eating during pregnancy.
• The importance of nutrition post-partum.

3
Healthy Pregnancy

• One without physical or psychological pathology
  in the mother or fetus and
• Results in the delivery of a healthy baby.

Position of the American Dietetic Association
Nutrition and lifestyle for a healthy pregnancy
outcome. J Am Diet Assoc 2002102(10)1479-1490.
4
Healthy Baby, Healthy Adult

• Fetal Origins of Adult Disease -
• term infants who are small for their gestational
  age are predisposed to obesity and have an
  increased susceptibility to cardiovascular
  disease and Type II diabetes (impaired glucose
  tolerance) in adulthood as a consequence of
  physiologic adaptations to under-nutrition during
  fetal life.

Robinson R. The fetal origins of adult disease.
Brit Med J 2001322375-376.
5
Pregnancy Outcomes inthe U.S. (2002)

• Low Birth Weight
• 7.8 of live births (1 in 13 babies)
• Increased by nearly 10 from 1992 to 2002
• A major contributing factor in 2/3 of all infant
  deaths
• Preterm Births (lt37 weeks gestation)
• 12.1 of live births (1 in 8 babies)
• Cesarean Delivery
• 26.1 of live births

National Center for Health Statistics. Retrieved
from March of Dimes PeriSats on October 17, 2004
www.marchofdimes.com/peristats.
6
Low Birth Weight 1992 - 2002( of Live Births)
7
Pregnancy Outcomes and Maternal BMI

• Low birth weight is primarily related to1
• Low pre-pregnancy BMI (kg/m2)
• Low gestational weight gain
• These anthropometric factors reflect inadequate
  food intake, which may be related to2
• Poverty
• Cultural ideals of thinness

1. Ehrenberg HM, Dierker L, Milluzzi C, Mercer
BM. Low maternal weight, failure to thrive in
pregnancy, and adverse pregnancy outcomes. Am J
Obstet Gynecol 20031981726-1730. 2. Moore VM,
Davies MJ, Willson KJ, Worsley A, Robinson JS.
Dietary composition of pregnant women is related
to size of the baby at birth. J Nutr
20041341820-1826.
8
MACRONUTRIENTS Provide Energy and Building
Material
Worthington-Roberts B, Williams SR. Maternal
nutrition and the outcome of pregnancy. Nutrition
in Pregnancy and Lactation, 4th ed. College
Publishing St. Louis, Missouri, 1989. Kline DA.
Macronutrient requirements during pregnancy.
Todays Dietitian Jan 200420-24.
9
VITAMINS Promote Metabolism and Tissue Integrity
10
MINERALS Promote Structural Tissues Organ
System Development
Whitney EN, Rolfes SR. Understanding Nutrition,
9th ed. Wadsworth/Thomson Learning Belmont, CA
2002. Kline DA. Macronutrient requirements during
pregnancy. Todays Dietitian Jan 200420-24.
11
Dietary Quality and TimingThe First Trimester

• Both the amount of a nutrient and its timing of
  intake are extremely important to fetal
  development.
• The first trimester is a time of rapid cell
  division, organ development, and preparation for
  the demands of rapid fetal growth that occur
  later in pregnancy.
• Critical nutrients during this phase include
• Protein
• Folic acid
• Vitamin B12
• Zinc

King JC. Physiology of pregnancy and nutrient
metabolism. Am J Clin Nutr 2000711218S-1215S.
12
Dietary Quality and TimingThe 2nd and 3rd
Trimesters

• Energy intake is especially important since 90
  of fetal growth occurs during the last half of
  gestation.
• Critical nutrients during this phase include
• Protein
• Iron
• Calcium
• Magnesium
• B vitamins
• Omega-3 fatty acid, docosahexaenoic acid (DHA)

King JC. Physiology of pregnancy and nutrient
metabolism. Am J Clin Nutr 2000711218S-1215S. K
line DA. Macronutrient requirements during
pregnancy. Todays Dietitian Jan 200420-24.
13
Energy Needs During Pregnancy

• Extra Energy Needs for Normal Weight Women1
• First trimester 0 kilocalories
• Second trimester 350 kilocalories
• Third trimester 500 kilocalories
• There is great variability among pregnant women
  with regard to energy costs during pregnancy
  related to differences in body size and
  lifestyles.1
• Appropriate weight gain and appetite are better
  indicators of energy sufficiency than the amount
  of kilocalories consumed.2

1. Butte NF, Wong WW, Treuth MS, Ellis KJ, Smith
EO. Energy requirements during pregnancy based on
total energy expenditure and energy deposition.
Am J Clin Nutr 2004791078-1087. 2. Position of
the American Dietetic Association Nutrition and
lifestyle for a healthy pregnancy outcome. J Am
Diet Assoc 2002102(10)1479-1490.
14
Gestational Weight Gain Patterns

• Only 30 to 40 of women actually gain weight
  within the recommended ranges during pregnancy.1
• Many women gain much more weight than is
  necessary during pregnancy, which is related to
  postpartum weight retention.2

1. Hickey CA. Sociocultural and behavioral
influences on weight gain during pregnancy. Am J
Clin Nutr 2000711364S-1370. 2. Position of the
American Dietetic Association Nutrition and
lifestyle for a healthy pregnancy outcome. J Am
Diet Assoc 2002102(10)1479-1490.
15
Conditions That May Result in Inadequate
Nutrient Intake and Weight Gain During Pregnancy

• Nausea and vomiting
• Heartburn
• Constipation
• Food aversions alcohol, caffeinated beverages,
  and meats.
• Food avoidances milk, lean meats, pork, and
  liver.
• Poor pre-pregnancy diet
• Inappropriate dietary patterns
• History of frequent dieting, weight cycling,
  and/or eating disorders
• Excessive physical activity

King JC. Physiology of pregnancy and nutrient
metabolism. Am J Clin Nutr 2000711218S-1215S. Po
sition of the American Dietetic Association
Nutrition and lifestyle for a healthy pregnancy
outcome. J Am Diet Assoc 2002102(10)1479-1490.
16
Eating Strategies

• Strategies that are recommended to deal with some
  of these issues include
• Small, frequent meals and snacks
• Adequate fiber intake
• Adequate fluid intake
• Avoiding an empty stomach
• Choosing foods that are well tolerated

17
Conditions That May Result in Excessive Weight
Gain During Pregnancy

• Food cravings dairy and sweet foods.1
• Psychological influences on eating behavior2
• Reduced attempts to control food intake
• Pregnancy legitimizes eating more
• Reductions in physical activity3

1. King JC. Physiology of pregnancy and nutrient
metabolism. Am J Clin Nutr 2000711218S-1215S. 2.
Clark M, Ogden J. The impact of pregnancy on
eating behaviour and aspects of weight concern.
Int J Obes Relat Metab Disor. 199923(1)18-24. 3.
Butte NF, Wong WW, Treuth MS, Ellis KJ, Smith
EO. Energy requirements during pregnancy based on
total energy expenditure and energy deposition.
Am J Clin Nutr 2004791078-1087.
18
Life in Balance

• The risk of overweight due to excessive pregnancy
  weight gain needs to be balanced against the risk
  of poor fetal growth associated with inadequate
  weight gain.1
• Diet needs to be nutrient dense to supply
  sufficient nutrients to the developing fetus,
  since fetal demands may double some micronutrient
  requirements.2

1. Position of the American Dietetic Association
Nutrition and lifestyle for a healthy pregnancy
outcome. J Am Diet Assoc 2002102(10)1479-1490. 2
. King JC. Physiology of pregnancy and nutrient
metabolism. Am J Clin Nutr 2000711218S-1225S
19
An Additional 300 Calories Isnt Much!
20
What Are Pregnant Women Really Eating?

• A prospective study of lower- to middle-income
  women had these results
• Foods with poor nutrient density were major
  contributors to energy, fat, and carbohydrates
  such as biscuits, muffins, whole milk, french
  fries, and fried potatoes.
• Carbohydrates were mostly refined and low in
  dietary fiber, including soft drinks, biscuits,
  muffins, and white bread.
• Median iron intakes were below recommended levels.

Siega-Ritz AM, Bodnar LM, Savitz DA. What are
pregnant women eating? Nutrient and food group
differences by race. Am J Obstet Gynecol
2002186480-486.
21
Eating for Two?

• Another study of the dietary intakes of pregnant
  women enrolled in WIC found the following
• Consumed only 85 of the RDA for energy
  (kilocalories).
• Average energy intake from fat was higher than
  recommended (37 vs. 30).
• 90 consumed less than 2/3 of the RDA for iron.
• 22 had iron-deficiency anemia.

Swensen AR, Harnack LJ, Ross JA. Nutritional
assessment of pregnant women enrolled in the
Special Supplemental Program for Women, Infants,
and Children (WIC). J Am Diet Assoc
2001101903-908.
22
The Dilemma

• Overeating of total energy/kilocalories
• Undereating of total energy/kilocalories
• Overconsumption of low nutrient-dense foods
• Underconsumption of high nutrient-dense foods

23
Beyond Pregnancy

• Energy and nutrient needs continue to be elevated
  postpartum, particularly in women who choose to
  breastfeed or who have had a cesarean section.
• The energy required for daily milk production is
  close to 560 kilocalories.1
• Protein, zinc, and vitamin C promote wound
  healing.2
• The inherent demands of a newborn are a challenge
  to the new mother and her family!

1. Worthington-Roberts B, Williams SR. Lactation
and human milk nutritional considerations.
Nutrition in Pregnancy and Lactation, 4th ed.
College Publishing St. Louis, Missouri, 1989. 2.
Baranoski S, Ayello EA. Wound Care Essentials
Practice Principles, pp. 157-160. Lippincott
Williams Wilkins Philadelphis, PA 2004.
24
Meals and Snacks Need to Be

• Healthy
• Convenient
• Tasty
• Economical

25
In Summary

• Critical nutrients are required in the right
  amounts at the right time to achieve a healthy
  pregnancy.
• The majority of women do not gain weight within
  the recommended ranges during pregnancy.
• Various factors influence eating patterns during
  pregnancy, resulting in either inadequate or
  excessive intake of energy (i.e., kilocalories)
  and certain nutrients.
• Studies show that pregnant women eat too many
  refined carbohydrates and fat, and too little
  iron and fiber.
• Meals and/or snacks should be healthy
  (nutrient-dense), tasty, convenient, and
  economical.