Nutrition in Pregnancy
Nutrition in Pregnancy
Nutrition in Pregnancy
Dr.Anupama
Objectives
Integrating Nutrition Into the Obstetric History
Maternal Weight Gain Recommendations
Maternal Weight Gain Recommendations for Special
Population
Maternal Nutrient Needs: Current Recommendations
Vitamin and Mineral Supplementation Guidelines
Nutrition-Related Problems During Pregnancy
Special Nutritional Considerations During Pregnancy
Important steps to a healthy pregnancy
include
Eating a balanced diet
Gaining the right amount of weight
Enjoying light regular physical activity
Taking a vitamin and mineral supplement if
recommended by a physician
Avoiding alcohol, tobacco and other harmful
substances.
Good nutrition is an important component of a healthy
lifestyle and a healthy baby
The best time to review the nutritional status to make
appropriate changes is prior to conception
A very important time of fetal development is during the
first several weeks of pregnancy as all of the major fetal
body systems are undergoing formation and rapid
development
Many women may not even realize they are pregnant at
this time.
Therefore it is prudent to make your lifestyle and
nutritional changes several months before conception
occurs
INTEGRATING NUTRITION
INTO THE OBSTETRIC HISTORY
Purpose
To identify the quality of a patient’s diet
To assess any nutritional risk factors that could
jeopardize her health or the health of her developing
baby.
Nutritional assessment
How to do Nutritional
Assessment
Medical history -nutritional deficiencies And Chronic diseases with
nutritional implications
Weight status Gestational weight gain in previous pregnancies and
history of hyperemesis, gestational diabetes, anemia, and pica should
be determined
Dietary intake appetite, meal patterns, dieting regimens, cultural or
religious dietary practices, dietary restrictions, food allergies, cravings,
and aversions
Laboratory data should be reviewed. absorption, eating, and
metabolic disorders; infections; inflammatory bowel disease; diabetes
mellitus; phenylketonuria; sickle cell trait; and renal disease
Nutritional counseling
To be done prior to or during pregnancy
This is a opportune time to encourage the development of
good nutrition and physical activity practices
To prevent future medical problems such as obesity,
diabetes, hypertension, and osteoporosis.
Pregnant women found to be at risk may benefit from a
referral to a registered dietitian
About 75% of pregnant females in India are underweight &
anaemic.
Anaemia thus remains a major cause of maternal & fetal
morbidity,mortality and low birth weight.
Too early, Too close, Too many, Too late conception also
adversely affect the health status (nutritional status) of the
females.
Another indirect important factor is Gastro-intestinal
Infections,Infestations, which are heralded further with under-
nutrition, setting up a vicious cycle.
SITUATIONS IN WHICH CONSULTATION WITH
A REGISTERED DIETITIAN IS ADVISABLE
Pregnancy involves multiple gestations (twins, triplets).
Gestations are frequent (less than a 3-month interpregnancy interval).
Tobacco, alcohol, or drug use (chronic medicinal or illicit) is occurring.
Severe nausea and vomiting (hyperemesis gravidarum) is a problem.
Eating disorders are present, including anorexia, bulimia, and compulsive eating.
Weight gain is inadequate during pregnancy.
Pregnancy occurs in adolescence.
Eating is restrictive (vegetarianism, macrobiotic, raw food, vegan).
Food allergies or food intolerances are present.
Gestational diabetes mellitus (GDM) or history of GDM is involved.
Patient has a history of low-birthweight babies or other obstetric complications.
Social factors are present that may limit appropriate intake (e.g., religion, poverty).
Weight gain in Pregnancy
Guidelines were made to address many issues regarding the role of
nutrition in pregnancy.
In 1990 the Institute of Medicine (IOM) first published
recommendations on weight gain during pregnancy
Obesity rate has surged in recent decades. In 2009, the IOM
updated the 1990 guidelines regarding weight gain
2009 guidelines emphasize that women begin pregnancy at a healthy
weight.
Consuming healthy food is the goal to meet the IOM gestational
weight guidelines and address the individual needs of the patient.
T he 2009 IOM guidelines are based upon the World Health
Organization (WHO) classifications to define underweight, normal
weight, overweight, and obese patients
Physiological changes in Pregnancy
Distribution
of weight gain
Components of Average Weight Gain in a
Normal Singleton Pregnancy Weight
RECOMMENDATIONS FOR WEIGHT GAIN
DURING PREGNANCY BY PREPREGNANCY
BODY MASS INDEX (BMI)
Weight gain
MATERNAL WEIGHT GAIN
RECOMMENDATIONS FOR
SPECIAL POPULATIONS
Multiple Gestations
PROVISIONAL GUIDELINES FOR WEIGHT GAIN WITH TWIN PREGNANCIES
MATERNAL NUTRIENT
NEEDS: CURRENT
RECOMMENDATIONS
IMPORTANT NUTRIENTS FOR
PREGNANCY
Folate
Iron
Calcium
Vitamin D
Vitamin A
Omega Fatty Acid
Essential Amino Acids from protein sources
Calorie providing Food(Carbohydrate and Fats in
proper ratios)
Why is it important in pregnancy?
Needed to reduce risk of :-
Neural tube defects Congenital heart defects, Cleft lips,
Limb defects
Urinary tract anomalies
Preterm delivery
Infant low birth weight
Fetal growth retardation
Folate
400 micrograms of synthetic folic acid daily from
fortified foods and/or supplements has been
suggested for all non-pregnant women, in order to
have adequate folic acid intake even in case of
unplanned pregnancies.
Ideal to start before conception occurs. It is
hypothesized that the insulin-like growth factor 2
gene is differentially methylated and these changes
in IGF2 result in improved intrauterine growth and
development.
Rich sources of folate