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Pregnancy and Lactation

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					Pregnancy and Lactation
Are you really eating for two?
Prepregnancy Requirements
   Necessary to insure fertility
    –   Genetics
    –   Proper body fat composition
    –   Health state that ensures ability to carry pregnancy to term
            Physical
            Mental
            Emotional
    –   Dietary requirements
   Despite best preparations, 1/3 of all pregnancies terminate within the first
    trimester
Development During Pregnancy
   Placental
    – Organ necessary during pregnancy for
            Gas exchange
            Nutrient exchange
            Waste exchange
    – At the time of birth, about the size of a steak
    – Produces hormones to maintain pregnancy
    – Proper placement of placenta necessary to ensure safe pregnancy and
        delivery
Development of the Fetus
 Zygote
 Morula
 Blastocyst

    – Implantation at 1-2 weeks
 Embryo
    – Up to week 8
 Fetus until birth


Important Milestones
 Central nervous system established by week 5
 Heart begins beating by week 6

    – Can be heard at week 8~10
 Ears and eyes by week 3
 Limbs by week 3
 Teeth by week 6
 Gender determined around week 8
Critical Periods
 Times during fetal development where development of a system or structure
    may be critically interrupted
 Many times this results in the spontaneous abortion of the fetus
 If the fetus is not aborted, then the structure or system will develop
    abnormally
Defects
   Neural tube (sensitive to folic acid levels)
    – Anencephaly
    – Spina bifida
   Risk factors
    – Previous history
    – Maternal diabetes
    – Maternal obesity
    – High fever during pregnancy
    – White or Hispanic
    – Poor
Chronic Disease
 High blood pressure
 Diabetes
 Immune function

    – Autoimmune disease
 Fetal programming

    – Providing the environment to activate a gene
    – PKU?
Maternal Weight and Conception
   Underweight
    –   Infertility
    –   Low birth weight infants
    –   Premature birth
    –   Sickly


   Overweight
    –   Infertility
    –   Gestational hypertension
    –   Gestational diabetes
    –   Postpartum infections
    –   Over due infants
    –   Large babies
    –   Cesarean deliveries
    –   Late onset diabetes
            For mom and child
How much weight should I gain during a pregnancy?
   If you’re a guy, none. But, you’d be surprised.
   For females
    – Underweight
           28-40 lbs
    – Normal
           25-35 lbs
    – Overweight
           15-25 lbs
    – Obese
           15 lb minimum
Patterns of Weight Gain
 During the first trimester

    – About 1 lb per month
    – Less if you’re overweight
    – More if you’re underweight
 During the second and third trimester

    – Between 2/3 and 1 lb per week
Where is that weight coming from?
   2 lbs breast development
   4 lbs blood and interstitial fluid
   1.5 lbs of placenta
   2 lbs of amniotic fluid
   2 lbs of uterus
   7 lbs of maternal fat stores
   7.5 lbs of infant
   Total around 30 lbs


Weight Loss After Pregnancy
   Can happen pretty quick, but don’t pack your skinny jeans for the hospital
   Normal to retain a few pounds after each child
    – That doesn’t mean that it’s good
   The more you gain the more you retain
   Nursing moms usually retain a few extra until they are done nursing
How much should you exercise during a pregnancy?
   If you’re a guy, lots. So you are in shape to help out after the pregnancy is
    over.
   If you’re a female, regular, moderate, low impact exercise throughout the
    pregnancy
    –   Reduces injury
    –   Reduces excessive weight gain
    –   Strengthens muscles for delivery
   Excessive, strenuous exercise can rob fetus of necessary oxygen (maybe)
   Beware of steam rooms, hot tubs, and over heating


Pregnancy and Nutritional Requirements
   Extra calories
    – First trimester
              None
    – Second trimester
              ~340 Cal
    – Third trimester
              ~450 Cal
   Protein
    – ~25g/day
    – But not from high protein supplements
              Hard on kidneys
   Fats
    – None extra
    – Make sure that the Ω3 and Ω6 intake is good
Special Vitamins and Minerals to Watch Out For
   Pregnancy
    – Folate
            600 mg
    – B1 2
            2.6 mg
    – Iron
            27 mg
    – Zin c
            ~11-12 mg
   Lactation
    – Little more of each
    – Watch calcium and vit D requirements
    – Lactation osteoporosis
            Rebound afterward
Nutritional and Other Concerns During Pregnancy
   Nausea
    – Beware the antinausea agent
    – Watch out for weight loss
   Constipation and Hemorrhoids
   Heartburn
   Cravings and Aversions
    – Rarely physiologically driven
   Nonfood cravings
    – Pica
Risk Factors During Pregnancy
   Maternal weight
   Maternal nutrition*
   Economic status*
   Lifestyle*
    –   Smoking
    –   Alcohol
    –   Drug use


   Previous pregnancies
    –   How many
    –   How frequent
    –   Outcome
    –   Multiple birth
    –   Birth weight
   High blood pressure
   Diabetes
   Chronic disease
More on Maternal Health
   Previously existing diabetes
   Gestational diabetes
   Preexisting hypertension
    –   Placental separation
   Gestational hypertension
    –   Usually returns to normal shortly after delivery
   Preeclampsia and eclampsia
    –   High blood pressure
    –   Protein in urine
    –   Fluid retention
    –   Convulsions
    –   Coma
Does Mom’s age make a difference? You bettcha!


   Adolescent pregnancy
    –   1 in 20 children is born to a teenager
    –   Many are planned
    –   Mother’s body not done growing
    –   Mother’s maturity not done maturing
    –   Iron deficiency anemia
    –   Still birth
    –   Preterm
    –   Low birth weight
            Should shoot for maximum weight gain
    –   Can begin circle of poverty
   Premenopausal pregnancy
    –   Over age of 35
    –   Already have developed age related chronic conditions
            Hypertension
            Diabetes
            Osteoporosis
    –   Death rate increases for mother
    –   Down Syndrom rate increases from 1/10,000 to 1/300
    –   Fetal death twice as high
    –   Surprises common
            Body’s last chance to pass on DNA
Things Not to do During Pregnancy
   Abuse of alcohol
    – Fetal alcohol syndrome
   Medicinal Drugs
    – Acutane
   Herbal supplements
    – Bad side effects
    – Drug interactions


   Illicit drugs
    – Not just crack babies
   Smoking and chewing
    – SIDS
   Environmental contaminants
    – Lead and mercury


Things Not to do During Pregnancy cont.
 Foodborne illness

    – Too much vomiting and diarrhea
 Mega-vitamins
 Caffeine
 Weight loss dieting
 Sugar substitutes

    – Beware PKU and aspartame
Benefits of Breastfeeding
   For the baby
    – Perfect nutrition
    – Provides hormones for development
    – Improves mental development
          Breast fed babies are smarter
    – Provides early immune system
          Even if mom is sick
          Breast fed children not as sick as often
    – May protect against diabetes, hypertension, and obesity in later life
    – Protects against food and other alergies
Benefits of Breastfeeding cont.
 For the mother

    – Contracts uterus
    – If not using other birth control, delays onset of ovulation
    – Helps conserve iron by delaying ovulation
    – Protects against breast cancer
    – Protects against ovarian cancer
Benefits of Breastfeeding cont.
 Breast milk is free
 Medical costs are less, because children are not as sick as often
 Less trash in the land fills
 Diapers don’t smell as much

    – Hey, this is a big deal!
More on Lactation
   Caused by two different hormones
    –   Prolactin
    –   Oxytocin
   Once you’ve breast fed, it doesn’t really totally go away until menopause
   Does breast size make a difference
    –   No
   Let down reflex
   Problems with engorgement
   Women are not like cows
    –   Breasts are not like udders


What should Mom be eating?
 Extra calories

    – 1 to 6 months
          Extra    330 Cal
    – To first year
          Extra    400 Cal
    – After that depends on how much the child is nursing
          Global   weaning age is 4 years
What can help with breastfeeding?
   Initiate breastfeeding within ½ hour of birth
   Good family support
    –   This is where the husbands can help lots
   Good work support
    –   This is where good work policies and legislation can help lots
   Breastfeed on the child’s schedule
   Don’t use pacifiers
   Utilize the resources of breastfeeding support groups
    –   Le Leche League
What should the lactating mom not do?
   Alcohol
   Medicinal drugs
   Illicit drugs
   Herbal remedies
   Smoking
   Environmental contaminants
   Caffeine
   Stuff not to worry about
    – Garlic
    – cabbage
Mom’s Health Issues
   HIV is one of the few counter indicators for breastfeeding
    –   Although more research is being done on this
   Diabetes
    –   Lactation can interfere with blood glucose levels
    –   Very careful monitoring may be necessary
   Postpartum amenorrhea
    –   Normal if breastfeeding
    –   Not a 100% guarantee against pregnancy
   Breast health
    –   Is sagging an issue
–   Proper support, diet, and exercise can make you feel like you are doing
    something about this problem
–   Breastfeeding does not accelerate the process
–   Definite protective effect against breast cancer and osteoporosis

				
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