Recommended weight gain for underweight women (<18.5)
28-40 lbs
Recommended weight gain for normal women (18.5-24.9)
25-35 lbs
Recommended weight gain for overweight women (25-29.9)
15-25 lbs
Recommended weight gain for obese women (30 or higher)
11-20 lbs
Recommended weight gain for a twin pregnancy
25-54 lbs
how much weight should be gained in the 1st trimester?
3-5 lbs
2nd trimester and on how much weight should be gained
1 lb per week (consistent and gradual)
____ pounds lost within the first 6 weeks after delivery
~14
True/False: nutrient needs are the same during the course of the pregnancy
False, depends on many factors
True/False: nutrient needs during pregnancy an be met with well balanced, adequate and healthful diets consisting of basic foods
True
Increased energy requirements are due to (4)
protein synthesis
fat synthesis
expanded metabolic activity (increased work of mom's CV, respiratory and renal systems)
Fetus accounts for 1/3 of energy needs
Calorie requirements in pregnancy
Average of ~300 additional kcal/d
Calorie requirements based on trimester
1st: no additional requirements
2nd: extra 340 kcal/day
3rd: extra 450 kcal/day
CHO intake during pregnancy
45-65% of total kcal
minimum of 175 g/day to meet the fetal brain's needs for glucose
Sources: F and V, whole grains to provide phytonutrients and prevent constipation
True/False: there is evidence related to potential effects of artificial sweeteners on pregnancy
False
just to be safe avoid--foods with artificial sweetners are bad sources of nutrients anyway
Protein requirements
71 g per day
-not hard to get as pregnant women on average consume 73 g/day
Why are protein needs increased during pregnancy?
protein tissue accretion
If no animal products consumed (vegan/vegetarian):
consume a variety of plant protein sources
If protein needs being met by cereal and legumes, needs to be
30% higher due to lower digestibility of protein in the foods
Vegetarians have an increased risk of ___ (6 things) deficiency
B12
Vitamin D
Calcium
Iron
Zinc
Omega 3s
Three Omega 3s that are essential fat sources for fetal growth and development
DHA, EPA, ALA
If vegetarian look for sources of DHA from
algea
What are sources of DHA and EPA? ALA?
Fatty fish, fish oils, seafood
flaxseed, walnuts, canola oil, soybean
Recommendation for pregnancy for linoleic acid and alphalinolenic acid?
LA: 13 g/day
ALA: 1.4 g/day
Adequate sources of what during pregnancy and lactation are linked to higher intelligence, better vision, and more mature CNS?
EPA and DHA
How much of ALA is converted to EPA and DHA
only 9%
AI for EPA and DHA during pregnancy?
300 mg/day
True/False: most women consume the proper amount go EPA and DHA
false, women consume about 1/3 of tis
Intakes greater than 3 g (3000 mg) per day of omega 3s are associated with
excessive bleeding (omega 3s are anti-platelet)
Expert groups recommend how much DHA/day during pregnancy
>200 mg DHA
Food recommendations to get the adequate EPA and DHA
consume two 4 oz servings of cooked fish/seafood each week
Fish to avoid due to mercury levels
swordfish, kin mackerel, tilefish, shark, orange roughy, big-eye tuna and marlin
**limit albacore (white) tuna to <6 oz per week
a neurotoxin that crosses the placenta and causes intellectual disability, hearing loss, serizures
mercury
Average cups of water consumed during pregnancy
9 cups/day
can be milk, water, diluted fruit juice, unsweetened beverages
Alcohol can cross the placenta T/F
true and acts as a toxin with risk of abnormal mental development and growth
Cofactor in metabolic reactions involved in the replication of DNA, gene expression and amino acid metabolism
Folate
inadequate folate is known to be associated with what other than NTDs?
Anemia in pregnancy
reduced fetal growth
enzyme that converts folate to active form and some people can't convert due to a gene variant that causes the enzyme dysfunction
Methylene tetrahydrofolate reductase (MTHFR, B2)
Major types of NTDs (3)
spina bifida
anencephaly
encephalocele
NTD where spinal cord doesn't completely close. Infant is often paralyze below the point of injury
Spina Bifida
NTD where baby is missing part of the brain-->do not survive
anencephaly
NTD where baby's skull doesn't form and brain is protruding though the skull
Encephalocele
How long does it take without folate to have NTDs?
21-27 days....some women do not even know they are pregnant by this point
Recommended intake for folate
600 mcg dietary folate equivalents
Vitamin A restriction in US (including retinol in cosmetics):
Do not consume more than 5000 IU of retinol from supplements
True/False: vitamin D deficiency is not common during pregnancy
FALSE
DRI of vitamin D
15 mcg (600 IU) daily
Food recommendation to get DRI of vitamin D
3 cups of fortifies milk/day and two 15 min sessions in the sun per week
Component in phospholipids in cell membrane and a precursor of intracellular messengers and a B vitamin
concerned that women don't get enough for adequate fetal brain growth and development
Choline
Increased need in 3rd trimester and can be met with 3 cups of milk or fortified soy milk
low intakes are related to increased release of lead from bones->harmful to fetus
Calcium
Rates of iron deficiency peak in which trimester?
3rd
Iron needs for fetus and placenta
300 mg
Iron needs for increased RBC
450 mg
Iron lost at delivery
250 mg
How much iron are women recommended to take after the 12th week of pregnancy
30 mg
True/False: iron is better absorbed in multivitamins then alone
False, due to the competition with other vitamins and minerals
Supplements of >60 mg of iron daily exposes...
the intestinal mucosa to free iron radicals which cause inflammation and mitochondrial damage to cells
Dose of >30mg/day of iron maybe interfere with ____ absorption
zinc
Recommended intake of F and V daily for antioxidant properties
5 cups at least
How many 8 oz cups of coffee are allowed in pregnancy daily
3
Effects caffeine has on a baby after it crosses the placenta
can increase HR and other effects seen with stimulants
Craving and eating non food substances such as ice laundry starch or corn starch
Pica
True/False: women experiencing pika are more likely to be iron deficient
True
unknown if pica causes iron deficiency or iron deficiency causes pica
Nutrient needs should be met by a healthy diet except
iron is the exception....can supplement in addition to MVI and Prenatal
Women are at an increased susceptibility to food born illness due to increase in what?
progesterone--decreases activity of natural killer cells and this decreases immune function in other ways
Bacteria that can cause miscarriages and stillbirth and it is found in raw or smoked fish, oysters, unpasteruized cheese or milk, raw meat, can be found in lunch meat
listeria monocytogenes
Bacteria that can cause fetal mental retardation, blindness, seizures and death and is found in raw or undercooked meats, surface of F and V and can be found in cat feces (kitty litter)
Toxoplasma gondii
Exercise recommendations for pregnancy women
20-30 mins of exercise (cardio, lifting, swimming, yoga) 3-5 times per week
**should be undertaken by healthy women consuming high quality diets and gaining appropriate weight
When does morning sickness occur
during 1st trimester but can occur at any time of the day
Dietary suppriment treatment for N/V
B6 and ginger
MNT for N/V (3)
separate liquid and solid food intake
avoid odors and foods that trigger N/V
many women tolerate high-CHO foods better than others
Management for GERD (3)
ingest small frequent meals
do not go to be with a full stomach
avoid foods that make GERD worse (caffeine, chocolate, coffee (even decaf), mint, alcohol, black, red and cheyanne pepper)
Etiology for GERD during pregnancy
progesterone is increased and it is a smooth muscle relaxer--sphincter relaxed
Ways to prevent constipation (3)
Consume 30 g/day of dietary fiber
drink water along with the fiber
exercise
What does WIC offer for low income pregnant, breast and non-breast feeding women and to infants and children up to age of 5 at nutritional risk
supplemental foods
health care referrals
nutrition and lactating education
WIC is a federal program but is administered by
the states--must meet state income level---each state is different
