Kin 110 Lecture 11

1
Kin 110Lecture 11

• CH 13 - Pregnancy and breastfeeding
• Ch 16 Food safety
• P 523 - 536544-551

2
Pregnancy Overview

• Special considerations for time of life
• illustrates larger importance of nutrition on
  body functioning
• Important to plan pregnancy
• modification of lifestyle
• adequate nutrition
• prevent fetal and infant problems
• 350-450 kcal per day (second and third
  trimesters)
• milk, meats and alt.
• Iron, calcium, and folate (600ug/day)
• breastfeeding

3
Prenatal Growth

• Ovum to fetus first 8 weeks
• fetus to infant 32 weeks
• nourished until birth by placenta
• Fig 13-1
• organ formed in mothers uterus
• oxygen and nutrient exchange
• fetal waste removal
• release of hormones of pregnancy

4
Early Growth

• Fig 13-2
• Hyperplasia
• increase in cell number
• Hypertrophy
• increase in cell size
• 3 weeks
• specialized organs and body parts begin to form
• many women still do not know they are pregnant
• 13 weeks
• heart is functional, most organs formed, fetus
  can move

5
First Trimester

• 9 months broken into three sections, trimesters
• first trimester is critical time
• spontaneous abortion, 1/3
• miscarriage
• genetic defects or fatal error in fetal
  development
• very important to avoid harmful substances and
  maintain adequate nutrition
• Fig 13-2
• nutritional deficiencies transferred through
  placenta

6
Second Trimester

• Fetus weighs one ounce at beginning of second
  trimester
• limbs fully formed, has ears and begins to form
  tooth sockets
• fetal heart beat can be detected with stethoscope
• begins to look like infant, formed bones, can
  kick, suck its thumb
• mothers breast weight inc. 30
• under nutrition can impair ability to breast feed

7
Third Trimester

• Weighs 2-3 lbs. At beginning
• Fetus will deplete iron stores and blood glucose
  of mother
• infants born after 26 weeks have a good chance of
  survival in nursery
• difficulties suckling and swallowing
• 9 months
• 7-9 lbs. (3-4 kg) 50 cm long
• soft spot where skull bones will fuse (12-18
  months)

8
Nutrient Needs

• emphasis is on increased nutritional requirements
  
• individual assessment of requirements and
  counselling
• Energy Needs
• 350-450 kcal / day
• in 2nd and 3rd trimesters
• Eg six whole-wheat crackers, noe ounce of cheese
  and .5 cups of nonfat milk supply kcal and
  calcium needs
• nutrient dense foods, increased nutrient
  requirements vs kcal
• vitamin and mineral needs increase 20-100 kcal
  needs increase only 15

9
Weight Gain

• If active, add extra kcal for exercise to total
  intake
• Walking, cycling, swimming recommended activities
• specific precautions - slide 14
• Weight gain one of best predictors of pregnancy
  outcome
• 2 - 4 lbs. in first trimester
• .75 - 1 LB per week, 2nd and 3rd
• Average total gain 25-35 lbs. (BMI 20-26)
• Total recommended weight gain depends on
  individual BMI - Table 13.1
• fig 13-3
• Body weight requires regular monitoring
• Keeping a weekly record, allows for adjustments

10
Specific Nutrients

• Protein
• Increase 25 g / day
• many already over this, important to check
• role of protein?
• Carbohydrates
• 175 g / day
• Important to prevent ketosis(avg 200)
• Vitamins
• most increase slightly - B vit 30
• B6 45
• Folate (RDA 600ug) 50
• synthesis of DNA, rbc formation
• folate rich fruits and veg, fortified cereals

11
Mineral Needs

• Iodide - 220mg
• IRON
• 2 times the RDA in last two trimesters (30
  mg/day)
• Important for hemoglobin synthesis
• fortified breakfast cereals
• attention to nausea and absorption (caffeine and
  dairy can inhibit iron absorption)
• With severe iron deficiency, LBW, and risk of
  fetal death

12
Mineral Needs

• Calcium
• adequate mineralization of fetal skeleton and
  teeth in 3rd tri
• increase intake with conception
• 1200 - 1500 mg (milk group)
• Zinc
• growth and development
• Increase 35 above RDA
• Protein rich foods in healthy diet should supply
  this

13
Vegetarian Mothers

• Lacto ova or lacto should have no special
  concerns, with earlier recommendations in mind
• Iron supplementation
• Vegans
• focus on protein, vitamins D, B-6, B-12, iron
  and calcium
• increase grains, beans nuts and seeds
• Avoid Ketosis - difficult for fetal brain to
  utilize
• need iron and calcium supplementation as these
  are difficult to absorb from plant sources

14
Activity Recommendations

• American College of Obstetrics and Gynecology
• Do not allow HR to exceed 140
• Avoid exercise in hot, humid weather
• Discontinue exercise if discomfort or overheating
  results
• Drink plenty of liquids
• After month 4 do not exercise while lying on your
  back
• Avoid abrupt decrease in exertion - must warm
  down
• Engage in weight training only if done
  consistently prior to pregnancy
• Do not push flexibility training very hard -
  gentle and relaxing

15
Nutrition of Breast Milk

• Asses adequate intake of baby by monitoring
  wetness and stool production
• supplements with formula may be needed and are OK
• should not start before breastfeeding is well
  established
• important differences from cows milk (wait 1
  year)
• casien - protein difficult to digest
• different minerals and carbohydrates

16
Nutrition of Breast Milk

• Colostrum
• first product of breast
• antibodies
• compensate for immature immune system
• promotes intestinal health of infant
• Mature Milk
• after a few days, very different from cows milk

17
Mature Milk

• Main proteins form a soft light curd in GI
• binds iron and reduces bacterial growth
• high in essential fatty acids and fats needed for
  brain development
• DHA, visual acuity and nervous system development
  (omega 3)

18
Mature Milk

• Composition changes
• increased fat content with feeding, should last
  20 min. to get good growth and infant
  satisfaction
• can supplement up to 4 ounces of water / day

19
Food Plan and Breastfeeding

• Only slightly different from pregnancy
• no longer require increased iron, folate
• increased need for energy, vit. A,E and C,
  riboflavin, copper, chromium, iodide, magnanese,
  selemium and zinc
• increase milk group intake
• Especially for teen mothers
• should maintain balanced diet, moderate fat
  content, maintain fluid intake
• avoid crash diets

20
Attributes of Breast Feeding

• Table 13-3
• Requires 800 kcal /day
• recommend increase only 500 kcal per day
• facilitates return to pre-pregnancy weight
• breast feeding enhances reduction of uterus
• may prevent breast cancer if maintained for
  several months
• Facilitates bonding with infant
• Establishes habit of eating in moderation for
  infant
• Proper development of jaws and teeth

21
Food Safety

• History
• outbreaks of devastating human diseases
• typhoid, scarlet fever, diphtheria
• Now microbes are of concern
• bacteria, fungi and viruses can all cause
  food-borne illness
• major concern for daily health
• food additives and contaminants of significant
  concern to many

22
Food-Borne Illness (F-BI)

• cause up to half the cases of diarrhea
• considerable cost and death rate
• loss of productivity
• travelers diarrhea
• GI tract environment (bacteria) significantly
  altered with change of outside environment and
  food choices

23
Microbes

• Bacteria
• single celled organisms
• some produce toxins - illness
• others produce enzymes that digest substances
  around them
• Fungi
• simple parasitic life form
• molds, mildews, yeast
• live on dead or decaying organic matter
• Virus
• smallest, use host to reproduce
• Table 16-1, 16-2 - F-BI
• Microbes either
• directly infect intestinal wall
• produce toxins in the food
• tablespoon of dirt 2 billion

24
Mad Cow Disease
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Impact of F-BI

• Can be more severe and prolonged reaction in some
• infants, children and elderly
• liver disease, diabetes, HIV
• cancer patients
• pregnant women
• condition can become lengthy and lead to food
  allergies, seizures, blood poisoning
• F-BI often results from unsafe food handling
• World Health Organization rules

26
Why so Common?

• Increase in central processing
• large scale impact when microbe growth does occur
• increased consumption of raw animal products
• goal of increased shelf life
• science becoming more aware of its prevalence

27
Food Preservation

• Historical preservatives
• salt, sugar, smoke, fermentation, drying
• alter composition of food, to be unsuitable as
  host for microbes
• decrease free water
• fermentation, pickling
• highly acidic and alcoholic environment, no
  microbe growth

28
Preservation

• Also pasteurization, sterilization,
  refrigeration, freezing, irradiation, canning,
  chemical preservation, aseptic processing
• aseptic processing
• sterilization of food and packaging - boxed
  juice, milk
• irradiation
• alters composition of food
• does not become radioactive

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General Rules

• Purchasing
• select perishables last, keep separate, store
  quickly
• dont by or use food from broken or bulging
  containers
• purchase only pasteurized milk and cheese
• Preparation ( raw meat )
• wash hands with soapy hot water
• use clean equipment (counters, cutting boards)
• thaw in fridge, cold water or microwave

30
General Rules

• Cooking Food
• cook food thoroughly (meat)
• consume cooked food immediately
• serve animal products on clean plate, not on the
  one used for preparation.
• Storing and Re-heating
• keep hot / keep cold
• intermediate temperatures facilitates growth -
  fig 16.2
• reheat leftovers to cooking temperature

31
Treatment

• Drink lots of fluids
• bed rest
• wash hands frequently
• consult physician if severe for 2-3 days
• Report to authorities if
• food eaten at large gathering
• food from restaurant,..
• food was a commercial product
• ie. high potential for large of infections

32
Environmental Toxins

• Lead
• anemia, kidney disease, and nervous system damage
• changes in last 25 years
• lead paint, gasoline, canning soldering, (let
  taps run)
• Dioxins
• chlorine and benzene
• created by incinerating plastic an paper together
  - cancer
• also accumulate in bottom feeding fish - great
  lakes

33
Environmental Toxins

• Mercury
• birth defects, acute toxicity
• large predatory fish
• Urethane
• forms during fermentation
• cancer causing
• fruit brandies, saki
• PCBs
• liver tumors, reproductive problems
• fish (freshwater, industrial )

34
Organic Foods

• Choosing organic can reduce overall use of
  pesticides
• Pesticide contamination is low in all foods - its
  use is damaging to environment however
• Organic produce has higher content of
  phytochemicals - natural defenders against
  foreign agents
• Choosing local produce reduces shipping costs,
  use of green house fuels and the need for
  preservatives
• Genetically modified organisms (GMO)
• Prevalence is quite high, labeling now required
  in Europe
• Unknown long term consequences