PregnancyInc11

							    Maternal Nutrition

   Preconception
    » Lifestyle issues
    » Preexisting conditions

   Physiological changes
    during pregnancy
    » Nutritional implications

   Nutrient requirements
    during pregnancy
   Recommended weight gain

   Lifestyle choices
        Preconception

 ______
 _________
 _________
 medical conditions
 psychological
  readiness/stress
 ________, e.g.
    » restrictions, eating disorders
    » folic acid intake
 _________________________
  ______________
 previous __________
Preexisting Medical
    Conditions/
 Pregnancy related
    Conditions




1) Inborn Errors of
     Metabolism
2) Other conditions
       Phenylketonuria
           (PKU)

   ______________________
    » Lack of _________ to convert
      phenylalanine (phe) to
      tyrosine (tyr) leads to
      __________________
       – mental retardation, death
   Risk for:
      PKU treatment

 maintain __________ as
  low as possible
 maintain serum ________
 control ____________
    » special low-phe foods are
      necessary
   maintain ______________
    ________ during
    pregnancy

   People with PKU should
    not use aspartame
      Celiac Disease

 Sensitivity to ______ (in
  wheat, rye, barley…)
 Causes malabsorption of
  ___ and ______________

   general _____________

   general nutrient _________

   ___________

 Often undiagnosed!
 Must follow _________ diet
           Type I Diabetes


 pregnancy will make
  ____________ even harder
 increased need for ________
 uncontrolled blood glucose
  can cause damage to fetus as
  well as stress on mother

   ____________ fairly common
    during pregnancy
    »      blood _________,

    »      glomerular filtration rate
        (GFR)
    Gestational Diabetes

   Risk factors:




   Risk for:
    » _______________
    » spontaneous __________
    » perinatal ___________
    » later development of Type II
      diabetes (_________)
     Pregnancy-induced
     hypertension (PIH)

   [preeclampsia       eclampsia]

   Characterized by:




   Risk for:
    » ______________________
    » HBP, _______________, type II
      diabetes
       PIH risk factors

 preexisting ____________
 ____________
 PIH history
 dietary deficiencies:




   age extremes

   Do not restrict ________!
 Physiological
Changes during
  Pregnancy
             Glossary

   ___________ = protein to which
    oxygen bind in RBC
   ___________ = volume of packed
    red blood cells (RBC)
   __________ = physiological
    (normal) anemia of pregnancy
   _______________ = waves of
    involuntary muscle contractions
    in the GI system
   _____ = Urinary tract infections
   Glomerular filtration rate (GFR) =
    rate at which fluid passes through
    the kidneys
            GI system


   changed ___________
   increased __________
   decreased __________
    » hypoperistalsis
   enhanced ____________
   heartburn
   nausea, vomiting, constipation
    » avoid strong smells or fried, greasy
      foods; eat dry crackers before
      getting out of bed; try small,
      frequent meals; megadoses of
      vitamin B6?
   _____________
               Fluids


   Blood
    »    blood __________: 150%
    »    blood ____________
        – 12-50 ml/min to 500-600 ml/min
    » RBC increase less than BV =
      ________________ aka
      “physiological anemia of
      pregnancy”
   Body ________content
    increases as much as 20%
     Blood pressure



 drops early, then prone to
  rise in later pregnancy
 _________________
  increases due to increased
  efficiency of gas exchange
  in the lungs
 shift of diaphragm position
  leads to ____________
Clinical Blood Values

              Normal    Pregnancy

Hematocrit      35%      29-31%

Hemoglobin 13-14 g/dl 10-11 g/dl

Cholesterol     <200     200-325
               mg/dl      mg/dl

Folacin         5-21    3 mcg/dl
               mcg/dl

Iron            >50        >40
               mcg/dl     mcg/dl

TIBC          250-400    300-450
               mcg/dl     mcg/dl
Table 4-10, p. 95
        Renal function

   growth of uterus causes
    ______________
    » greater need to ____________
    » susceptibility to __________
   renal ________ and ____ increase
    » greater capacity to __________
    » greater amounts of nutrients are
      ___________, perhaps more than
      healthy kidneys can ________
   _____uria and ______uria
    are fairly common
   increased need for _____________
   Basal metabolic rate (BMR)
    ___________



   ____________ nitrogen
    balance
           Fuel Usage

   Fetus: needs mostly ________
    » 50-70%CHO, 20%aa, rest from fat
    » hoards __________ for tissue
      building
   Mother: _____ becomes more
    important
    » _______________ decreases
      because of relative lack of
      ____________
    » more ____ is stored for future
      needs, including _________
    » (with less GNG and more
      lipolysis, __________ may occur)
  Hormones (proteins,
      steroids)

1) _____________
  » relaxes smooth muscle cells
      –     GI motility
  »       maternal ________ stores
  »       capillary tension
  »       renal _____ excretion
2) ____________
  » promotes _____ growth/function
  » alters _______________
    structure
      –      flexibility
      –      water       ______ = normal if
          without HBP and proteinuria
           The Placenta

   Organ that supports __________
     » ___________ to the uterus
     » site of ________ synthesis
        –establish pregnancy
        –provide for fetal metabolism
          and glandular systems
        –suppress ______________
     » ______ of oxygen, nutrients, and
       ______________
   Mother and fetal blood supplies are
    always ____________
   Affected by ____________,
    insufficient blood supply,
    inappropriate _____________
     Placental Nutrient
         Exchange

   Simple (passive) diffusion
    » oxygen, CO2, fatty acids, fat-
      soluble vitamins, electrolytes

   Facilitative diffusion
    » CHO
   Active ________
    » amino acids, water-soluble
      vitamins, minerals
   Pinocytosis
    » immunoglobulin G (IgG)
       Stages of Fetal
          Growth

1) _________________(~ 2 weeks)
   » rapid ______________
   » early placenta
   » implantation of ____________
2) __________ stage (to 2 months)
   » ____derm       CNS, hair, ____
   » ____derm       voluntary
     muscles, _____, cardiovascular
     system, ______ systems
   » ____derm       digestive and
     ________ systems,
     glandular organs
3) ____ stage (to 38-40 weeks)
   » ______ from 6 g to 3000-3500 g
        Stages of Fetal
           Growth

   Blastogenesis and embryonic
    » Hyperplasia occurs
    » ____________ status important
    » only serious general
      malnutrition would cause harm
    » certain deficiencies/exposures
      could cause __________
      – _______ is closed by day ____
   _____ stage
    » hyper_____ and hyper____,
      then just _____________
    » malnutrition now probably not
      teratogenic, but could easily
      affect __________
Illustration 4-11, p. 105
  Terminology for
pteroylglutamic acid

   ________ = term for synthetic
    form used in supplements and in
    food fortification
   ________ = term for naturally
    occurring form found in foods;
    generic term
   ________ = generic term

   Tetrahydrofolate (THF) =
    __________
     Functions of Folate


Co-enzyme in transfer of one-carbon units

    _________ and _________
     » synthesis of




    formation of