Pregnancy

• Pregnancy or Gestation


  The period when the fertilized ovum implants itself in the uterus, undergoes differentiation and grows until it can support extra-uterine life. Human pregnancy lasts for a period of 266 to 180 days (37-40 weeks). It consists of 3 trimesters: first, second and third corresponding to three main phases: implantation, organogenesis and growth
• Factors determining nutritional needs during pregnancy

  • Age, Gravida, and Parity
  • Complex Physiologic Interactions of Gestation
• Reasons for increased energy needs during pregnancy

  • To supply the increased fuel demanded by the metabolic workload for both the mother and the fetus
  • To spare protein for the added tissue building requirements
• Amount of energy increase during pregnancy


  • No noticeable difference in the first trimester compared to pre-pregnancy
  • 340 kcal/ day increase during the second trimester
  • 452 kcal/day increase during the third trimester, which is an increase of about 15% to 20% over the energy needs of nonpregnant women
• The increased energy needs of a woman during her second trimester of pregnancy could be met by one additional snack per day consisting of a medium banana (105 kcal), an 8-oz serving of whole milk yogurt (138 kcal), and 1/8 cup of mixed nuts (101 kcal), providing 344 kcal
• Increased complex carbohydrates, monounsaturated fats, and polyunsaturated fats are the preferred sources of energy, especially during late pregnancy and throughout lactation
• Reasons for increased protein needs during pregnancy

  • Development of the placenta
  • Growth of the fetus
  • Growth of maternal tissues
  • Increased maternal blood volume
  • Amniotic fluid
• Protein needs during pregnancy

  • Nonpregnant women: 46 g/day
  • Pregnant women: 71 g/day, an increase of 25 g/day
• Food sources of protein

  • Complete protein foods of high biologic value include eggs, milk, beef, poultry, fish, pork, cheese, soy products, and other animal products
  • Incomplete proteins from plant sources such as legumes and grains
• Key mineral and vitamin needs during pregnancy

  • Folate (B vitamin)
  • Calcium
  • Omega-3
  • Iodine
  • Zinc
  • Vitamin C
  • Fiber
  • Water
• Drink eight to twelve glasses of water fluid a day during pregnancy
• Dairy foods


  • milk
  • cheese
  • yogurt
  • Ca fortified soy milk
• Omega-3


  Development of the central nervous system, brain growth and eye development in your baby before and after he or she is born
• Omega-3 rich foods


  • oily fish like salmon, trout, herring, anchovies and sardines
  • chicken
  • eggs
  • canned tuna
  • flaxseed oil
• Iodine


  • Required for healthy thyroid function in both the mother and unborn baby
  • Insufficient iodine can lead to brain development and neurological issues problems in the baby
• Zinc


  • Rapid cell growth that occurs during pregnancy
  • Found in lean meat, wholegrain cereals, milk, seafood, legumes and nuts
• Vitamin C


  • Increased in pregnancy due to larger blood volume in the mother and the growth of the unborn baby
  • Found in fruit and vegetables
• Water


  Pregnant women should drink eight to twelve glasses of water fluid a day
• With a full-term pregnancy, the average weight gain is about 30 pounds
• Components of the 30 pound weight gain

  • 4 pounds of increased fluid
  • 4 pounds of added blood volume
  • 2 pounds of breast tissue
  • 2 pounds of uterus tissue
  • 1.5 pounds of placenta (an organ that didn't exist before!)
  • 2 pounds of amniotic fluid
  • 7 pounds of fat, protein, and other nutrient
  • 7.5 Fetus
• Rate of weight gain

  Approximately 1 to 2 kg (2 to 4 lb) is the average amount of weight gained during the first trimester of pregnancy. Thereafter, the rate of weight gain should be reflective of a woman's prepregnancy BMI. Women with a prepregnancy BMI between 18.5 and 24.9 kg/ m2 generally gain ≈0.4 kg (14 oz) per week during the remainder of the pregnancy. The rate of weight gain for underweight women should be slightly more and overweight and obese women should average a slower rate of weight gain
• Nausea and vomiting


  • Affect 69% of women during early pregnancy in the United States
  • Likely caused by hormonal adaptations to human chorionic gonadotropin (hCG) during the first trimester
  • Generally peaks at about 9 to 11 weeks' gestation
  • Resolves around 14 weeks for about half of the women
  • 90% of women will have no additional symptoms after 22 weeks' gestation
• Constipation


  • Occurs during the latter part of pregnancy as a result of the increasing pressure of the enlarging uterus and the muscle-relaxing effect of progesterone on the gastrointestinal tract
  • Helpful remedies include adequate exercise, increased fluid intake, and consumption of high-fiber foods
  • Pregnant women should avoid artificial and herbal laxatives
• Hemorrhoids


  • Enlarged veins in the anus that often protrude through the anal sphincter
  • Caused by the increased weight of the baby and the downward pressure that this weight produces
  • May cause considerable discomfort, burning, and itching, and may even rupture and bleed under the pressure of a bowel movement
• Heartburn


  • Occurs especially after meals, and is caused by the pressure of the enlarging uterus crowding the stomach
  • Gastric reflux may occur in the lower esophagus, thereby causing irritation and a burning sensation
  • Dividing the day's food intake into a series of small meals and avoiding large meals at any time usually help to relieve these issues
• Nutrition-related risk factors at the onset of pregnancy

  • Age: ≤18 years old or ≥35 years old
  • Frequent pregnancies: three or more during a 2-year period
  • History of poor obstetric performance or fetal outcome
  • Poverty, food insecurity, or both
  • Bizarre or trendy food habits or eating disorder
  • Abuse of tobacco, alcohol, or drugs
  • Therapeutic diet that is required for a chronic disorder
  • Poorly controlled preexisting condition (e.g., diabetes, hypertension)
  • Weight: ≤85% or ≥120% of ideal body weight
• Nutrition-related risk factors during pregnancy


  • Anemia: low hemoglobin level (i.e., less than 12 g) or hematocrit level (i.e., less than 34%)
  • Inadequate weight gain: any weight loss or weight gain of less than 1 kg (2 lb) per month after the first trimester
  • Excessive weight gain: more than 1 kg (2 lb) per week after the first trimester
  • Substance abuse (i.e., alcohol, tobacco, drugs)
  • Gestational diabetes, hypertensive disorder of pregnancy, hyperemesis gravidarum, pica, or another pregnancy related condition
  • Poor nutritional status, especially involving folic acid, iron, or calcium
  • Multifetal gestation
• Older pregnant women (>35 years old)


  At higher risk for obstetric and perinatal complications such as preeclampsia, gestational diabetes, and cesarean delivery
• Women with extremely high parity rate


  At increased risk for poor pregnancy outcomes and facing increasing physical and economic pressures of child care
• Obesity during pregnancy


  Poses health concerns, including increased risk for excessive gestational weight gain and complications of obesity in the offspring
• Alcohol use during pregnancy

  • Can lead to fetal alcohol spectrum disorders (FASDs), including the most severe form, fetal alcohol syndrome (FAS)
  • FASDs are the leading causes of preventable mental retardation and birth defects in the United States
  • There are no safe amounts, types, or times during pregnancy
• Nicotine use during pregnancy

  • Associated with placental complications, preterm delivery, fetal growth restriction, congenital abnormalities, and sudden infant death syndrome (SIDS)
  • Women who stop smoking at the onset of pregnancy have similar pregnancy outcomes as nonsmokers
• Drug use during pregnancy

  • Drugs cross the placenta and enter the fetal circulation, creating a potential addiction in the unborn child
  • Neonatal abstinence syndrome (NAS) is a condition from which the infant suffers after birth due to abrupt discontinuation of a drug chronically used throughout gestation
• Caffeine use during pregnancy

  • Caffeine crosses the placenta and enters fetal circulation
  • Studies on caffeine use and pregnancy risks have been controversial with conflicting results, but large-scale reviews did not find consistent evidence that normal or high intakes posed a risk
• Pica


  • The craving for and purposeful consumption of nonfood items (e.g., chalk, laundry starch, clay)
  • Significantly associated with iron deficiency anemia as well as other contributing factors
• Fetal alcohol syndrome is the most severe form of fetal alcohol spectrum disorders (FASDs)
• Characteristics of fetal alcohol syndrome

  • Small head circumference
  • Flattened nasal bridge
  • Epicanthal fold
  • Microphthalmia
  • Low set ears
  • Small midface
  • Indistinct philtrum (groove)
  • Thin upper lip
  • Small jaw
• Teratogen


  A substance that causes a birth defect