ch15: life cycle nutrition: pregnancy and lactation

weight loss after pregnancy ppt

Return to pre-pregnancy weight is not the norm Most women tend to retain a couple of pounds with each pregnancy Additional weight retention increases risk for: -Diabetes and hypertension -chronic diseases later in life

high risk pregnancies

Some pregnancies jeopardize the life and health of the mother and infant. Each year in the United States, 700 women die during or within a year of pregnancy and 22,000 infants die within the first year. Table 15-3 identifies several risk factors of a high-risk pregnancy. A woman with none of these risk factors is said to have a low-risk pregnancy. The more factors that apply, the higher the risk. All pregnant women, especially those in high-risk categories, need prenatal medical care, including the following nutrition advice: Eat well-balanced meals. Gain enough weight to support fetal growth. Take prenatal supplements as prescribed. Stop drinking alcohol.

the fetus

The fetus continues to grow during the next 7 months. Each organ grows to maturity according to its own schedule, with greater intensity at some times than at others. As Figure 15-2 shows, fetal growth is phenomenal: weight increases from less than an ounce to about pounds (3500 grams). Most successful pregnancies are full term—defined as births occurring at 39 through 40 weeks—and produce a healthy infant weighing to 8 pounds.

the zygote

The newly fertilized ovum is called a zygote. It begins as a single cell and rapidly divides to become a blastocyst. During that first week, the blastocyst floats down into the uterus, where it will embed itself in the inner uterine wall—a process known as implantation. Cell division continues at an amazing rate as each set of cells divides into many other cells.

weight loss after pregnancy

The pregnant woman loses some weight at delivery. In the following weeks, she loses more as her blood volume returns to normal and she sheds accumulated fluids. Quite likely, her goal is to return to her prepregnancy weight, but that may depend in part on whether she stayed within the pregnancy weight gain recommendations. In general, the more weight a woman gains beyond the needs of pregnancy, the more she retains and the more likely she will continue to gain over the next several years. Even with an average weight gain during pregnancy, most women tend to retain a couple of pounds more with each subsequent pregnancy. When those couple of pounds become several, complications such as diabetes and hypertension in future pregnancies as well as chronic diseases in later life become more likely, even for women who are not overweight. Those who are successful in losing their pregnancy weights are more likely to limit their weight gains through middle adulthood. A combination of diet and exercise is most effective in supporting weight loss as well as improving maternal cardiovascular fitness.

critical periods in pregnancy

Times of intense development and rapid cell division are called critical periods—critical in the sense that those cellular activities can occur only at those times. If cell division and number are limited during a critical period, full recovery is not possible (see Figure 15-3). Damage during these critical times of pregnancy inflicts permanent harm on the life and health of the fetus.

components of weight gain

Women often express concern about the weight gain that accompanies a healthy pregnancy. They may find comfort by remembering that most of the gain supports the growth and development of the placenta, uterus, blood, and breasts and the increase in blood supply and fluid volume, as well as a healthy -pound infant. A small amount goes into maternal fat stores, and even that fat has a special purpose—to provide energy for growth, labor, and lactation. Figure 15-7 shows the components of a healthy 30-pound weight gain.

underweight woman prior to conception

Women who are underweight (BMI < 18.5) face a high risk of preterm births and small for gestational age, low birthweight infants. A woman who is underweight improves her chances of having a healthy infant by gaining sufficient weight prior to conception or by gaining extra pounds during pregnancy. To gain weight and ensure nutrient adequacy, she can follow the dietary recommendations for pregnant women (described on Nutrition during Pregnancy).

food assistance programs during pregnancy

Women with high-risk pregnancies can find assistance from the WIC program—a high-quality, cost-effective health care and nutrition services program for women, infants, and children in the United States. Formally known as the Special Supplemental Nutrition Program for Women, Infants, and Children, WIC provides nutrition education and nutritious foods to infants, children to age 5, and pregnant and breastfeeding women who qualify financially and have high risks of medical or nutrition problems. The program is both remedial and preventive: services include health care referrals, nutrition education, and food packages or vouchers for specific foods. These foods supply nutrients known to be lacking in the diets of the target population—most notably, protein, calcium, iron, vitamin A, and vitamin C. WIC-sponsored foods include tuna, tofu, fruits, vegetables, eggs, milk, iron-fortified cereal, whole-grain breads, vitamin C-rich juices, cheeses, legumes, peanut butter, and iron-fortified infant formula and cereal. Almost 7 million mothers and young children receive WIC benefits each month (see Photo 15-5). Prenatal WIC participation can effectively reduce maternal preeclampsia, improve gestational weight gain, lengthen gestational age, and support birthweight appropriate for gestational age. Table 15-4 lists some of the many benefits of WIC.

lactation: a physiological process

`Lactation naturally follows pregnancy, enabling the mother's body to continue nourishing the infant (see Photo 15-8). The mammary glands develop during puberty but remain fairly inactive until pregnancy. During pregnancy, hormones promote the growth and branching of a duct system in the breasts and the development of the milk-producing cells. The hormones prolactin and oxytocin finely coordinate lactation. The infant's demand for milk stimulates the release of these hormones, which signal the mammary glands to supply milk. Prolactin is responsible for milk production. As long as the infant is nursing, prolactin concentrations remain high, and milk production continues. The hormone oxytocin causes the mammary glands to eject milk into the ducts, a response known as the let-down reflex. The mother may feel this reflex as a contraction of the breast, followed by the flow of milk and the release of pressure. By relaxing and eating well, the nursing mother promotes easy let-down of milk and enhances her ability to successfully breastfeed her infant. In addition to nourishing the infant, lactation reduces the mother's risks of developing type 2 diabetes, hypertension, and heart disease. Research has yet to explain these associations fully, but one hypothesis suggests that lactation provides a transition time to reset the many metabolic changes that occur during pregnancy. Given these health benefits for mothers and the many well-established benefits for infants, most health care providers encourage women to breastfeed.

chronic disease short explanation

adverse influences at critical times during fetal development may have consequences for baby -malnutrition - may increase risk for type 2 diabetes -overnutrition and maternal obesity - increase risk for chronic illness in adulthood

maternal weight ppt

birthweight is most reliable indicator of infant's health weight prior to conception is important -influences fetal growth -underweight women --rates of preterm births and infant deaths -overweight & obese women --medical complications --risks for infant weight gain during pregnancy -fetal growth and maternal health -correlates closely with infant birthweight --predictor of health and development

exercise during pregnancy ppt

can continue exercise throughout pregnancy -adjust duration and intensity benefits "Low-impact" activities Fetal Development -excessively high internal body temperature -dehydration

growth and development during pregnancy (cont)

fetal growth and development -fertilization of an ovum by a sperm -zygote --rapidly divides to become blastocyst --implantation -Embryo --by 8 weeks has a complete nervous system, beating heart, digestive system, well defined fingers and toes, and beginnings of facial features though only 1 ¼ inches -fetus

folate supplementation

folate supplements taken 1 month before conception and continued throughout the first trimester can help support a healthy pregnancy, prevent neural tube defects, and reduce the severity of defects that do occur. For this reason, all women of childbearing age who are likely to become pregnant should take 400 micrograms (0.4 milligram) of folate daily. A woman who has previously had an infant with a neural tube defect may be advised by her physician to take folate supplements in doses ten times larger—4 milligrams daily. Because high doses of folate can mask the symptoms of pernicious anemia associated with a vitamin deficiency, a dose of 1 milligram or more requires a prescription. Most over-the-counter multivitamin mineral supplements contain 400 micrograms of folate; prenatal supplements usually contain 800 micrograms. Because half of the pregnancies each year are unplanned and because neural tube defects occur early in development, before most women realize they are pregnant, grain products in the United States are fortified with folate to help ensure an adequate intake. Labels on fortified products may claim that an "adequate intake of folate has been shown to reduce the risk of neural tube defects." Fortification has improved folate status in women of childbearing age and reduced the number of neural tube defects that occur each year.

weight gain patterns in pregnant women

for the healthy-weight woman, weight gain ideally follows a pattern of pounds during the first trimester and 1 pound per week thereafter. Health care professionals monitor weight gain using a prenatal weight-gain grid (see Figure 15-6). Identifying inadequate or excessive weight gains by the second trimester allows sufficient time for adjustments in diet and activity.

high risk pregnancies ppt

infant's birthweight -low birthweight (LBW) --5 ½ pounds (2500 grams) or less --Risk of complications --Relationship to socioeconomic status maternal health -preexisting diabetes --risks associated with unmanaged diabetes -gestational diabetes --all women screened 24-28 weeks gestation or earlier if have risk factors --common consequences --dietary recommendations -chronic hypertension -gestational hypertension -preeclampsia --cause is unclear --risks for mother and fetus -eclampsia mothers age -ideal childbearing age -adolescents --risk of pregnancy complications --higher rates of stillbirths, preterm births, and LBW infants --weight gain recommendations --need to seek prenatal care --need for economic, social, and physical support -older women --complications often reflect chronic conditions --cesarean section rates increase --maternal death rates are higher --risks for fetus

fetal programming short explanation

mother's nutrition may change gene expression in fetus

common nutrient related concerns of pregnancy ppt

nausea ( Tips on page 462, Table 15-2) -"Morning sickness" -Hormonal changes Constipation and hemorrhoids Heartburn Food cravings and aversions -Hormone-induced changes Nonfood cravings

energy and nutrient needs during pregnancy ppt

needs tend to be higher than any other time in life to meet needs -make careful selections -body maximizes absorption -body minimizes losses energy -Increase in basal metabolic rate in second and third trimester -Increased needs --second trimester add extra 340 calories/day --third trimester add extra 450 calories/day --choose nutrient dense foods carbohydrate -ample carbohydrate is necessary to fuel fetal brain (RDA 175 g/day) protein -RDA - additional 25 grams per day --Supplements are discouraged essential fatty acids -Omega-3 and omega-6 fatty acids for brain material Blood production and cell growth -fetal growth and development -maternal red blood cell mass -needs for synthesis of DNA and new cells --folate --vitamin B12 --iron --zinc Nutrients for bone development -vitamin D --deficiency interferes with calcium metabolism -calcium --absorption and retention increase -other nutrients --optimal interval between pregnancies prenatal supplements -calcium -folate -iron

the ____ delivers oxygen and nutrients from the mother to the fetus and returns waste from the fetus to the mother, but no actual mingling of maternal and fetal blood occurs. Instead, the placental villi absorb nutrients and oxygen from the maternal pool of blood and release them to the fetus via fetal blood vessels. Likewise, the fetus returns wastes via the placental villi. The placenta develops as the fetal and maternal blood vessels coil around each other, embedded in the uterine wall. The maternal blood transfers oxygen and nutrients to the fetus's blood and picks up fetal waste products. By exchanging oxygen, nutrients, and waste products, the placenta performs the respiratory, absorptive, and excretory functions that the fetus's lungs, digestive system, and kidneys will provide after birth. The placenta is a versatile, metabolically active organ. Like all body tissues, the placenta uses energy and nutrients to support its work. It produces an array of hormones that maintain pregnancy and prepare the mother's breasts for lactation (making milk). A healthy placenta enables the developing fetus to attain its full potential.

placenta

components of weight gain in pregnant women

placenta uterus blood breasts fluid volume baby maternal fat stores

Recommended weight gains during pregnancy for obese BMI >/= 30

single birth: 11-20 lb twin birth: 25-42 lb

Recommended weight gains during pregnancy for overweight BMI 25.0-29.9

single birth: 15-25 lb twin birth: 31-50 ln

Recommended weight gains during pregnancy for healthy weight BMI 18.5-24.9

single birth: 25-35 lb twin birth: 37-54 lb

Recommended weight gains during pregnancy for underweight BMI <18.5

single birth: 28-40 lb twin birth: insufficient data

______, a common neural tube defect, occurs when the vertebrae of the spine fail to close around the spinal cord, leaving it unprotected. The B vitamin folate—consumed prior to and during pregnancy—helps prevent spina bifida and other neural tube defects.

spina bifida

fetal programming

the influence of substances during fetal growth on the development of diseases in later life.

critical periods ppt

times of intense development -cellular activities can occur only during these times adverse influences on organ and tissue development critical period for neural tube development -etween 17-30 days of gestation

(t/f) The development of each organ and tissue is most vulnerable to adverse influences (such as nutrient deficiencies or toxins) during its own critical period (see Figure 15-4). The neural tube, for example, is the structure that eventually becomes the brain and the spinal cord, and its critical period of development is from 17 to 30 days of gestation. Neural tube development is most vulnerable to nutrient deficiencies, nutrient excesses, or toxins during this critical time—when most women do not yet even realize they are pregnant. Any abnormal development of the neural tube or its failure to close completely can cause a major defect in the central nervous system.

true

(t/f) The mother's weight influences an infant's birthweight most during two periods: prior to conception and during pregnancy.

true

During embryonic development (from___ to __-weeks), many of the tissues are in their critical periods; events occur that will have irreversible effects on the development of those tissues. In the later stages of development, the tissues continue to grow and change, but the events are less critical in that they are relatively minor or reversible.

two to eight

In the early days of pregnancy, a spongy structure known as the placenta develops in the ____. Two other structures also form (see Figure 15-1). One is the amniotic sac, a fluid-filled balloonlike structure that houses the developing fetus. The other is the umbilical cord, a ropelike structure containing fetal blood vessels that extends through the fetus's "belly button" (the umbilicus) to the placenta. These three structures play crucial roles during pregnancy, and then are expelled from the uterus during childbirth.

uterus

nutrition during pregnancy

woman's body changes dramatically during pregnancy. Her uterus and its supporting muscles increase in size and strength; her blood volume increases by half to carry the additional nutrients and other materials; her joints become more flexible in preparation for childbirth; her feet swell in response to high concentrations of the hormone estrogen, which promotes water retention and helps ready the uterus for delivery; and her breasts enlarge in preparation for lactation. The hormones that mediate all these changes may cause mood swings as well. She can best prepare to handle these changes given a nutritious diet, regular physical activity, plenty of rest, and caring companions. This section highlights the role of nutrition. Eating patterns and lifestyle behaviors throughout the course of a pregnancy play key roles in supporting maternal and fetal health. In general, the following guidelines will allow most women to enjoy a healthy pregnancy: Strive for good nutrition and health prior to, and throughout, pregnancy and get prenatal care during pregnancy. Strive for a healthy prepregnancy weight and gain an appropriate amount of weight during pregnancy. Eat a balanced diet, safely prepared, and engage in physical activity regularly. Take prenatal vitamin and mineral supplements as prescribed. Refrain from smoking, alcohol, and drugs (including herbal remedies, unless prescribed by a physician). An adequate diet may also help a woman manage the challenges and possible depression that can arise after the infant arrives. Details follow.

nutrition during pregnancy ppt

-Dramatic Changes -Guidelines for a healthy pregnancy --Good nutrition --Healthy weight gain --Physical activity --Prenatal supplements --Avoiding harmful substances

what to avoid during pregnancy

-smoking, alcohol, caffeine, drugs, spicy or strong flavored foods, oral contraceptives, restrictive dieting, vitamin-mineral megadoses, sugar substitutes

maternal weight gain patterns per week after first trimester

1 lb per week

practices incompatible with pregnancy

1) Alcohol (10% more than mother - if mom drank 1 beer, then baby drank 10) 2) Aspirin - causes iron deficiency and decreases fetal circulation and causes uterine contractions 3) Tobacco - low birth weight, reduces fetal circulation, reduces breathing movements, increases chance for SIDS (sudden infant death syndrome), decreases intelligence and causes birth defects 4) Vitamin & mineral megadoses 5) Caffeine 6) Weight loss by the mother - hazardous to the baby's brain 7) environmental contaminants: -lead -mercury in some fatty fish can damge the developing brain and nervous system of the fetus 8) illicit drugs 9) herbal supplements

maternal weight gain patterns in the first trimester

3.5 lbs

weight prior to conception

A woman's weight prior to conception influences fetal growth. Even if they gain the same amounts of weight during pregnancy, underweight women tend to have smaller babies than heavier women. Ideally, before a woman becomes pregnant, she will have established diet and activity habits to support an adequate, and not excessive, weight gain during pregnancy.

pregnancy in adolescents

About 195,000 infants are born to adolescent girls each year in the United States. Nourishing a growing fetus adds to a teenage girl's nutrition burden, especially if her growth is still incomplete. Simply being young and physically immature increases the risks of pregnancy complications. Pregnant teens are less likely than others to receive early prenatal care and are more likely to smoke during pregnancy—two factors that predict low birthweight and infant death. The typical energy-dense, but nutrient-poor, diet of pregnant adolescents intensifies the risk of low-birthweight infants. Common complications among adolescent mothers include iron-deficiency anemia (which may reflect poor diet and inadequate prenatal care) and prolonged labor (which reflects the mother's physical immaturity). On a positive note, maternal deaths are less common in mothers younger than age 20. The rates of stillbirths, preterm births, and low-birthweight infants are high for teenagers. Many of these infants suffer physical problems, require intensive care, and die within the first year. The care of teen mothers and their infants costs our society billions of dollars annually. Because teenagers have few financial resources, they cannot pay these costs. Furthermore, their low economic status contributes significantly to the complications surrounding their pregnancies. At the time when prenatal care is most important, it is least likely to be used. And the pattern of teenage pregnancies continues from generation to generation, with daughters of teenage mothers likely to become teenage mothers themselves To support the needs of both mother and fetus, young teenagers (13 to 16 years old) are encouraged to strive for the highest weight gains recommended for pregnancy (review Table 15-1). For a teen who enters pregnancy at a healthy body weight, a weight gain of approximately 35 pounds is recommended; this amount minimizes the risk of delivering a low-birthweight infant. Pregnant and lactating teenagers can use the food patterns presented in Table 2-3, making sure to select a high enough kcalorie level to support adequate weight gain. Without the appropriate economic, social, and physical support, a young mother will not be able to care for herself during her pregnancy and for her child after the birth. To improve her chances for a successful pregnancy and a healthy infant, she must seek prenatal care. WIC provides health care referrals and helps pregnant teenagers obtain adequate food for themselves and their infants. (WIC is introduced Food Assistance Programs.)

In preparation for a healthy pregnancy, they can establish the following habits:

Achieve and maintain a healthy body weight. Both underweight and overweight are associated with infertility. Men who are overweight or obese have low sperm counts and hormonal imbalances that reduce fertility; excess body fat in women disrupts menstrual regularity and ovarian hormone production. In couples where both partners are obese, it seems to take longer to conceive. Should a pregnancy occur, mothers, both underweight and overweight, and their newborns face increased risks of complications. Choose an adequate and balanced diet. Malnutrition reduces fertility and impairs the early development of an infant should a woman become pregnant. In contrast, a healthy diet that includes seafood, lean meats, whole grains, fruits, and vegetables can favorably influence fertility in men and women. Be physically active. A woman who wants to be physically active when she is pregnant needs to become physically active beforehand. Obtain regular medical care. Regular health care visits help ensure a healthy start to pregnancy. Manage chronic conditions. Conditions such as diabetes, hypertension, HIV/AIDS, phenylketonuria (PKU), and sexually transmitted diseases can adversely affect a pregnancy and need close medical attention to help ensure a healthy outcome. Avoid harmful influences. Both maternal and paternal ingestion of, or exposure to, harmful substances (such as cigarettes, alcohol, drugs, or environmental contaminants) can cause miscarriages or abnormalities, alter genes or their expression, and interfere with fertility.

practices incompatible with lactation

Alcohol Alcohol readily enters breast milk, and its concentration peaks within an hour after ingestion. Infants drink less breast milk when their mothers have consumed even small amounts of alcohol (equivalent to a can of beer). Three possible effects, separately or together, may explain why. For one, the alcohol may alter the flavor of the breast milk and thereby the infant's acceptance of it. For another, because an infant metabolizes alcohol inefficiently, even low doses may be potent enough to cause sleepiness and suppress feeding. Third, the alcohol may interfere with lactation by inhibiting the hormone oxytocin. In the past, alcohol has been recommended to mothers to facilitate lactation despite a lack of scientific evidence that it does so. Limited alcohol consumption while breastfeeding may not be harmful. To minimize the effects of an occasional glass of wine or beer, women should drink after breastfeeding rather than before, eat a meal to slow alcohol absorption, and wait to breastfeed until several hours after drinking. If breasts are uncomfortably full after excessive drinking, a women can pump and discard the milk. Consuming alcohol regularly or binge drinking can be harmful to breastfed infants. Medicines Most medicines are compatible with breastfeeding, but some are contraindicated, either because they suppress lactation or because they are secreted into breast milk and can harm the infant. As a precaution, a nursing mother should consult with her physician prior to taking any drugs, including herbal supplements. Illicit Drugs Illicit drugs, of course, are harmful to the physical and emotional health of both the mother and the nursing infant. Breast milk can deliver such high doses of illicit drugs as to cause irritability, tremors, hallucinations, and even death in infants. Women whose infants have overdosed on illicit drugs contained in breast milk have been convicted of murder. Women who use methadone to control opiate withdrawal symptoms can safely breastfeed their infants. Smoking Many women who quit smoking during pregnancy relapse after delivery. Compared with nonsmokers, women who smoke are less likely to initiate and continue breastfeeding. Because cigarette smoking lowers the concentrations of lipids and proteins and reduces milk volume, the breast milk of smokers may not fully meet their infants' energy needs. The milk they do produce contains nicotine, which alters its smell and flavor. Furthermore, smoking increases the risk for SIDS. Breastfeeding protects against SIDS, but infant exposure to smoking negates this protective effect. Environmental Contaminants Chapter 19 discusses environmental contaminants in the food supply. Some of these environmental contaminants can find their way into the food supply and then into breast milk. To limit mercury intake, lactating women should heed the advice for pregnant women eating fish that are presented in Table 15-8. Caffeine Caffeine enters breast milk and may make an infant irritable and wakeful. As during pregnancy, caffeine consumption should be moderate.

fetal alcohol syndrome

Alcohol crosses the placenta freely and deprives the developing fetus of both nutrients and oxygen. The damaging effects of alcohol on the developing fetus cover a range of abnormalities referred to as fetal alcohol spectrum disorder (FASD). (Glossary H15-1 defines this and related terms.) Diagnosis is based on specific criteria of physical, intellectual, and neurobehavioral symptoms. Individuals at the extreme end of the spectrum have fetal alcohol syndrome (FAS), a cluster of symptoms that includes: Prenatal and postnatal growth restriction Abnormalities of the brain and central nervous system, with consequent impairment in cognition and behavior Physical abnormalities of the face and skull that alter normal symmetry (see Figure H15-1) Increased frequency of major birth defects such as cleft palate, heart defects, and defects in ears, eyes, genitals, and urinary system Tragically, the damage evident at birth persists: children with FAS never fully recover.

the embryo

At first, the number of cells in the embryo doubles approximately every 24 hours. Later the rate slows, and only one doubling occurs during the final 10 weeks of pregnancy. At 8 weeks, the -inch embryo has a complete central nervous system, a beating heart, a digestive system, well-defined fingers and toes, and the beginnings of facial features.

women who are overweight or obese prior to conception

At least half of all pregnant women in the United States are overweight or obese prior to conception, which can create problems related to pregnancy, infancy, and childbirth. Women who are obese have an especially high risk of medical complications such as gestational hypertension and gestational diabetes. Compared with other women, women who are obese are also more likely to have complications of labor and delivery. Pregnancy complications in women after gastric bypass surgery are generally lower than in women who are obese, but their infants are more likely to be small for gestational age, most likely because of limited nutrient absorption. Infants of women who are obese are more likely to be large for gestational age and have increased body fat at birth, setting the stage for childhood obesity. Problems associated with macrosomia include increases in the likelihood of a difficult labor and delivery, birth trauma, and infant injury. Consequently, these infants face greater risks of poor health and death than infants of healthy weight.

nutrition during lactation

Childbirth marks the end of pregnancy and the beginning of a new set of parental responsibilities—including feeding the newborn. Before the end of her pregnancy, a woman needs to consider whether to feed her infant breast milk, infant formula, or both. These options are the only recommended foods for an infant during the first 4 to 6 months of life. The current rate of breastfeeding is almost 85 percent at birth, but then falls to just below 60 percent at 6 months, and about 35 percent at 1 year. This section focuses on how the mother's nutrition supports the making of breast milk, and the next chapter describes how the infant benefits from drinking breast milk. In many countries around the world, a woman breastfeeds her newborn without considering the alternatives or making a conscious decision. In other parts of the world, a woman feeds her newborn formula simply because she knows so little about breastfeeding. She may have misconceptions or feel uncomfortable about a process she doesn't understand. Breastfeeding offers many health benefits to both mother and infant, and every pregnant woman should carefully consider it (see Table 15-10). Even so, women's choices are often influenced by factors other than health and science— factors such as culture, politics, religion, and marketing. In any case, keep in mind that mothers may have valid reasons for not breastfeeding and that formula-fed infants grow and develop into healthy children.

dos and donts of exercise during pregnancy

DO: exercise gradually exercise regularly warm up with 5-10 mins of light activity 30mins or more of moderate activity cool down with 5-10 mins of slow activity and gentle stretching drink water before, during, and after eat enough to support the needs of pregnancy plus exercise rest adequately DONT: exercise vigorously after long periods of inactivity exercise in hot, humid weather exercise when sick with fever exercise while lying on your back after the first trimester of pregnancy or stand motionless for long periods exercise if you experience any pain, discomfort, or fatigue participate in activities that may harm the abdomen or involve jerky, bouncy movements scuba dive

neural tube defects

Each year in the United States, approximately 3000 pregnancies are affected by neural tube defects—malformations of the brain, spinal cord, or both during embryonic development. The two most common types of neural tube defects are anencephaly (no brain) and spina bifida (split brain). In anencephaly, the upper end of the neural tube fails to close. Consequently, the brain is either missing or fails to develop. Pregnancies affected by anencephaly often end in miscarriage; infants born with anencephaly die shortly after birth. Spina bifida is characterized by incomplete closure of the spinal cord and its bony encasement (see Figure 15-5). The membranes covering the spinal cord often protrude as a sac, which may rupture and lead to meningitis, a life-threatening infection. Spina bifida is accompanied by varying degrees of paralysis, depending on the extent of the spinal cord damage. Mild cases may not even be noticed, but severe cases lead to death. Common problems include clubfoot, dislocated hip, kidney disorders, curvature of the spine, muscle weakness, intellectual disabilities, and motor and sensory losses.

maternal energy and nutrient needs during lactation ppt

Energy intake and exercise -Almost 500 extra kcalories per day (330 from extra food and 170 from body stores 1st 6 months, then 400 from food 2nd 6 months) -Exercise is compatible with breastfeeding Energy nutrients -Recommendations increase for carbohydrates and fibers Water vitamins and minerals -inadequacies reduce the quantity, not quality of breast milk --quality maintained at expense of maternal stores -prolonged inadequate intakes --impacts several nutrients Supplements -Iron Food assistance programs -Participants are less likely to breastfeed -WIC incentives to encourage breastfeeding Particular foods -Flavors -Allergies

Risk factors for neural tube defects include

Family history of a neural tube defect Maternal diabetes or obesity Overheating or fever Maternal use of certain medications Inadequate folate

fetal growth and development

Fetal development begins with the fertilization of an ovum by a sperm. Three stages follow: the zygote, the embryo, and the fetus

weight gain during pregnancy

Fetal growth and maternal health depend on a sufficient weight gain during pregnancy (see Photo 15-2). Maternal weight gain during pregnancy correlates closely with infant birthweight, which is a strong predictor of the health and subsequent development of the infant. Almost 50 percent of pregnant women gain more, and about 20 percent gain less, than the recommended amount of weight gain during pregnancy—leaving roughly 30 percent gaining an appropriate amount. Not gaining enough weight may result in low birthweight infants whereas gaining too much weight may result in cesarean deliveries and weight retention for mothers and macrosomia and childhood obesity for infants.

energy and nutrient needs during pregnancy

From conception to birth, all parts of the infant—bones, muscles, blood cells, skin, and all other tissues—are made from nutrients in the foods the mother eats (see Photo 15-3). For most women, nutrient needs during pregnancy and lactation are higher than at any other time (see Figure 15-9). To meet the high nutrient demands of pregnancy, a woman needs to make careful food choices; her body will also help by maximizing absorption and minimizing losses. The Dietary Reference Intakes (DRI) table on the inside front cover provides separate listings for women during pregnancy and lactation, reflecting their heightened nutrient needs. For a 2000-kcalorie daily intake, these added kcalories represent about 15 to 20 percent more food energy than before pregnancy. The increase in nutrient needs is often greater than this, so nutrient-dense foods should be chosen to supply the extra kcalories: foods such as whole-grain breads and cereals, legumes, dark green vegetables, citrus fruits, low-fat milk and milk products, and lean meats, fish, poultry, and eggs. Carbohydrate The RDA for carbohydrate during pregnancy is 175 grams per day to provide adequate fuel for the fetal brain as well as the mother's. Sufficient carbohydrate also ensures that the protein needed for growth will not be broken down and used to make glucose. Protein The protein RDA for pregnancy is 25 grams per day higher than for nonpregnant women. Pregnant women can easily meet their protein needs by selecting meats, milk products, and protein-containing plant foods such as legumes, whole grains, nuts, and seeds. Taking high-protein supplements during pregnancy may be harmful to the infant's development and is discouraged unless medically prescribed and supervised. Essential Fatty Acids The essential long-chain polyunsaturated fatty acids are particularly important to the growth and development of the fetus. The brain is largely made of lipids, and it depends heavily on the long-chain omega-3 fatty acids for its growth, structure, and function. (See Table 5-4 for a list of good food sources of the omega fatty acids.) Nutrients for Blood Production and Cell Growth New cells are created at a tremendous pace as the fetus grows and develops. At the same time, the mother's red blood cell mass expands. All nutrients are important in these processes, but for folate, vitamin , iron, and zinc, the needs are especially great because of their key roles in the synthesis of DNA and new cells. The requirement for folate increases dramatically during pregnancy (from 400 micrograms to 600 micrograms daily). It is best to obtain sufficient folate from a combination of supplements, fortified foods, and a diet that includes fruits, juices, green vegetables, and whole or enriched grains. The pregnant woman also has a slightly greater need for the B vitamin that activates the folate enzyme—vitamin . Generally, even modest amounts of meat, fish, eggs, or milk products together with body stores easily meet the need for vitamin . Vegans who exclude all foods of animal origin, however, need daily supplements of vitamin or vitamin -fortified foods to prevent the neurological complications of deficiency. Pregnant women need iron to support their increased blood volume and to provide for placental and fetal needs. The developing fetus draws on maternal iron stores to create sufficient stores of its own to last through the first 4 to 6 months after birth. Ideally, a woman enters pregnancy with adequate iron stores and maintains sufficient iron nutrition throughout her pregnancy. The transfer of significant amounts of iron to the fetus is regulated by the placenta, which gives the iron needs of the fetus priority over those of the mother. Women with inadequate iron stores are left with too little iron to meet their own health needs. Blood losses are inevitable at birth and can further drain the mother's iron supply. During pregnancy, the body makes several adaptations to help meet the exceptionally high need for iron. Menstruation, the major route of iron loss in women, ceases, and iron absorption improves thanks to an increase in transferrin, the body's iron-absorbing and iron-carrying protein. Without sufficient intake, though, iron stores quickly dwindle. Few women enter pregnancy with adequate iron stores, so a daily iron supplement is recommended early in pregnancy, if not before. To enhance iron absorption, the supplement should be taken between meals or at bedtime and with liquids other than milk, coffee, or tea, which inhibit iron absorption. Drinking orange juice does not enhance iron absorption from supplements as it does from foods; vitamin C enhances iron absorption by converting iron from ferric to ferrous, but supplemental iron is already in the ferrous form. Vitamin C is helpful, however, in preventing the premature rupture of amniotic membranes. Zinc is required for DNA and RNA synthesis and thus for protein synthesis and cell development. Typical zinc intakes for pregnant women are lower than recommendations, but fortunately, zinc absorption increases when intakes are low. Nutrients for Bone Development Vitamin D and the bone-building minerals calcium, phosphorus, magnesium, and fluoride are in great demand during pregnancy. All are needed to produce healthy fetal bones and teeth. Vitamin D plays a central role in calcium absorption and utilization. Consequently, severe maternal vitamin D deficiency interferes with normal calcium metabolism, resulting in rickets in the infant and osteomalacia in the mother. Regular exposure to sunlight and consumption of vitamin D-fortified milk are usually sufficient to provide the recommended amount of vitamin D during pregnancy, which is the same as for nonpregnant women. Calcium absorption and retention increase dramatically in pregnancy, helping the mother to meet the calcium needs of pregnancy. During the last trimester, as the fetal bones begin to calcify, up to 350 milligrams a day are transferred to the fetus. If the diet is inadequate in calcium, the mother's bones give up their calcium to meet fetal needs and become less dense. Recommendations to ensure an adequate calcium intake during pregnancy help to conserve maternal bones while meeting fetal needs. Calcium intakes for pregnant women typically fall below recommendations. Because bones are still actively depositing minerals until about age 30, adequate calcium is especially important for young women. Pregnant women younger than age 25 who receive less than 600 milligrams of dietary calcium daily need to increase their intakes of milk, cheese, yogurt, and other calcium-rich foods. The USDA Food Patterns suggest that a woman consume 3 cups per day of fat-free or low-fat milk or the equivalent in milk products. Alternatively, and less preferably, she may need a daily supplement of 600 milligrams of calcium, taken with meals. Other Nutrients The nutrients mentioned here are those most intensely involved in blood production, cell growth, and bone development. Of course, other vitamins and minerals are also needed during pregnancy to support the growth and health of both fetus and mother. Even with adequate nutrition, repeated pregnancies within a short time span can deplete nutrient reserves. Short intervals between pregnancies compromise the growth of the fetus and health of the mother. The optimal interval between pregnancies is 18 to 23 months. Nutrient Supplements A healthy pregnancy and optimal infant development depend on the mother's diet. Pregnant women who make wise food choices can meet most of their nutrient needs, with the possible exception of iron. Even so, physicians routinely recommend daily multivitamin-mineral supplements for pregnant women. Prenatal supplements typically contain greater amounts of folate, iron, and calcium than regular multivitamin-mineral supplements. These supplements are particularly beneficial for women who do not eat adequately and for those in high-risk groups: women carrying multiple fetuses, cigarette smokers, and alcohol and drug abusers.

malnutrition and pregnancy

Good nutrition clearly supports a healthy pregnancy. In contrast, malnutrition interferes with the ability to conceive, the likelihood of implantation, and the subsequent development of a fetus if conception and implantation do occur. Malnutrition and Fertility The nutrition habits and lifestyle choices people make, long before pregnancy, can profoundly influence its course. Inadequate nutrition and food deprivation can impair fertility. Women may develop amenorrhea—the temporary or permanent absence of menstrual periods. Men who are poorly nourished may be unable to produce viable sperm. Furthermore, both men and women lose sexual interest during times of starvation. Starvation arises predictably during famines, wars, and droughts, but it can also occur amid peace and plenty. Many young adults with anorexia nervosa are starving and suffering from malnutrition (see Highlight 8). Malnutrition and Early Pregnancy If a poorly nourished woman does become pregnant, she faces the challenge of supporting both the growth of a baby and her own health with inadequate nutrient stores. Inadequate nutrient stores prior to and around conception prevent the placenta from developing fully. A poorly developed placenta cannot deliver optimal nourishment to the fetus: the infant will be born small and possibly with physical and cognitive abnormalities. If this small infant is a female, she may develop poorly and have an elevated risk of developing a chronic condition that could impair her ability to give birth to a healthy infant. Thus a woman's poor nutrition status can adversely affect not only her children but also her grandchildren. Malnutrition and Fetal Development Without adequate nutrition during pregnancy, fetal growth and infant health are compromised. The consequences include fetal growth restriction, congenital malformations (birth defects), spontaneous abortion and stillbirth, preterm birth, and low infant birthweight. Malnutrition is the underlying factor responsible for the 2.5 million deaths that occur in the first month of life each year, worldwide.

lactation: a physiological process ppt

Hormones promote growth and branching of duct system & milk-producing cells -Prolactin --Milk production -Oxytocin --Cause mammary glands to eject milk into ducts Breastfeeding is a learned behavior

maternal energy and nutrient needs during lactation

Ideally, the mother who chooses to breastfeed her infant will continue to eat nutrient-dense foods throughout lactation. An adequate diet is needed to support the stamina, patience, and self-confidence that nursing an infant demands. Energy Intake and Exercise A nursing mother produces about 25 ounces of milk per day, with considerable variation from woman to woman and in the same woman from time to time, depending primarily on the infant's demand for milk. To produce an adequate supply of milk, a woman needs extra energy—almost 500 kcalories a day above her regular need during the first 6 months of lactation. To meet this energy need, she can eat an extra 330 kcalories of food each day during the first 6 months and an extra 400 kcalories each day during the second 6 months; the fat reserves she accumulated during pregnancy can provide the rest. Most women need at least 1800 kcalories a day to obtain all the nutrients required for successful lactation. Severe energy restriction may hinder milk production. After the birth of the infant, many women actively try to lose the extra weight and body fat they accumulated during pregnancy. How much weight a woman retains after pregnancy depends on her gestational weight gain and the duration and intensity of breastfeeding. Many women who follow recommendations for gestational weight gain and breastfeeding can readily return to prepregnancy weight by 6 months. Neither the quality nor the quantity of breast milk is adversely affected by moderate weight loss. Women often exercise to lose weight and improve fitness, and this is compatible with breastfeeding and infant growth (see Photo 15-9). Because intense physical activity can raise the lactate concentration of breast milk and influence the milk's taste, some infants may prefer milk produced prior to exercise. In these cases, mothers can either breastfeed before exercise or express their milk before exercise for use afterward. Energy Nutrients Recommendations for protein and fatty acids remain about the same during lactation as during pregnancy, but they increase for carbohydrates. Nursing mothers need additional carbohydrate to replace the glucose used to make the lactose in breast milk. The fiber recommendation is 1 gram higher simply because it is based on kcalorie intake, which increases during lactation. Vitamins and Minerals A question often raised is whether a mother's milk may lack a nutrient if she fails to get enough in her diet. The answer differs from one nutrient to the next, but in general, nutrient inadequacies reduce the quantity, not the quality, of breast milk. Women can produce milk with adequate protein, carbohydrate, fat, and most minerals, even when their own supplies are limited. For these nutrients and for the vitamin folate as well, milk quality is maintained at the expense of maternal stores. This is most evident in the case of calcium: dietary calcium has no effect on the calcium concentration of breast milk, but maternal bones lose some density during lactation if dietary calcium is inadequate. Exercise may help protect against bone loss during lactation. The nutrients in breast milk that are most likely to decline in response to prolonged inadequate intakes are the vitamins—especially vitamins , , A, and D. Review Figure 15-9 to compare a lactating woman's nutrient needs with those of pregnant and nonpregnant women. Water Despite misconceptions, a mother who drinks more fluid does not produce more breast milk. To protect herself from dehydration, however, a lactating woman needs to drink plenty of fluids. The recommendation for total water (including drinking water, other beverages, and foods) during lactation is 3.8 liters per day. Because foods provide about 20 percent of total water intake, beverages— including drinking water—should provide about 3.1 liters per day (roughly 13 cups). A sensible guideline is to drink a glass of milk, juice, or water at each meal and each time the infant nurses. Nutrient Supplements Most lactating women can obtain all the nutrients they need from well-balanced diets without taking multivitamin-mineral supplements (see Photo 15-10). Nevertheless, some may need iron supplements, not to add iron to the breast milk, but to refill maternal iron stores. The mother's iron stores dwindle during pregnancy as she supplies the developing fetus with enough iron to last through the first 4 to 6 months of the infant's life. In addition, childbirth may have caused blood losses. Thus a woman may need iron supplements during lactation even though, until menstruation resumes, her iron requirement is about half that of nonpregnant women the same age. Food Assistance Programs In general, women most likely to participate in the food assistance program WIC—those whose incomes are below the poverty threshold and whose education is below high school graduation—are less likely than others to breastfeed. Furthermore, WIC provides infant formula at no cost. Because WIC recognizes the many benefits of breastfeeding, efforts are made to overcome this dilemma. In addition to nutrition education and encouragement, breastfeeding mothers receive the following WIC incentives: Higher priority in acceptance into the WIC program Greater quantity and variety of foods Longer eligibility to participate in the WIC program Support from peers and experts Breast pumps and other support materials Together, these efforts help provide nutrition support and encourage WIC mothers to breastfeed. Particular Foods Foods with strong or spicy flavors (such as garlic) may alter the flavor of breast milk. A sudden change in the taste of the milk may annoy some infants. Familiar flavors may enhance enjoyment. Flavors in breast milk from the mother's diet can influence the infant's later food preferences. A nursing mother can usually eat whatever nutritious foods she chooses. If she suspects a particular food is causing the infant discomfort, her physician may recommend a dietary challenge: eliminate the food from the diet to see if the infant's reactions subside, then return the food to the diet and again monitor the infant's reactions. If a food must be eliminated for an extended time, appropriate substitutions must be made to ensure nutrient adequacy.

maternal health (page)

If a woman has an ordinary cold, she can continue nursing without worry. If susceptible, the infant will catch it from her anyway. Thanks to the immunological protection of breast milk, the baby may be less susceptible than a formula-fed baby would be. A woman who has an infectious disease such as COVID-19 can breastfeed; she should wear a mask while breastfeeding and wash her hands before and after holding the infant. Women with HIV (human immunodeficiency virus) infections, however, should consider other options. HIV Infection and AIDS Mothers with HIV infection can transmit the virus (which causes AIDS) to their infants through breast milk, especially during the early months of breastfeeding. In developed countries such as the United States, where safe alternatives are available, HIV-positive women should not breastfeed their infants. In developing countries, where the feeding of inappropriate or contaminated formulas causes more than 1 million infant deaths each year, breastfeeding can be indispensible for infant survival. Thus, in making the decision of whether to breastfeed, HIV-infected women in developing countries must weigh the potential risks and benefits. The World Health Organization (WHO) recommends exclusive breastfeeding for infants of HIV-infected women for the first six months of life unless formula feeding is acceptable, feasible, affordable, sustainable, and safe before that time. In addition, HIV-exposed infants may be protected by receiving antiretroviral treatment while being breastfed. Diabetes Women with type 1 diabetes may need careful monitoring and counseling to ensure successful lactation. These women need to adjust their energy intakes and insulin doses to meet the heightened needs of lactation. Maintaining good glucose control helps initiate lactation and support milk production. As mentioned earlier in this chapter, a woman who has gestational diabetes during pregnancy has an increased risk of subsequently developing type 2 diabetes. During lactation, glucose tolerance and insulin response improve, thereby lowering the risk of developing diabetes. For women—with or without gestational diabetes—the longer the duration of lactation, the lower the incidence of diabetes. This safe and inexpensive intervention adds yet another impressive reason for women to consider breastfeeding their infants. Postpartum Amenorrhea Women who breastfeed experience prolonged postpartum amenorrhea. Absent menstrual periods, however, do not protect a woman from pregnancy. To prevent pregnancy, a couple must use some form of contraception. Breastfeeding women who use oral contraceptives should use progestin-only pills because estrogen-containing pills reduce milk volume, which often leads to women giving up on their breastfeeding efforts. Breast Health Some women fear that breastfeeding will cause their breasts to sag. The breasts do swell and become heavy and large immediately after the birth, but even when they shrink back to their prepregnancy size, they produce enough milk to nourish a thriving infant. Given proper support, diet, and exercise, breasts often return to their former shape and size when lactation ends. Breasts change in shape as the body ages, but breastfeeding does not accelerate this process. The question whether the physical and hormonal events of pregnancy and lactation protect women from later breast cancer is an area of active research. Some results suggest a protective effect of breastfeeding against breast cancer. Postpartum Depression An estimated 10 to 20 percent of new mothers experience postpartum depression. Several eating patterns and individual nutrients have been studied in an effort to find a nutritional link. Findings have been intriguing, but limited. A healthy, well-balanced diet supports a mother's mental and physical health, which can benefit her relationships with her children. Conversely, maternal depression and an unhealthy diet often go hand in hand, and together (as well as independently) contribute to a child's emotional and behavioral problems.

pregnancy in older women

In the past several decades, many women have delayed childbearing while they pursue education and careers. As a result, the number of first births to women 35 and older has increased dramatically. Most of these women, even those older than age 50, have healthy pregnancies. The few complications associated with later childbearing often reflect chronic conditions such as hypertension and diabetes, which can complicate an otherwise healthy pregnancy. These complications may result in cesarean deliveries, which are more common in women older than 35 than in younger women. For all these reasons, maternal death rates are higher in women older than 35 than in younger women. Infants of older mothers face problems of their own, including higher rates of preterm births and low birthweight. Their rates of birth defects are also high. Because 1 out of 50 pregnancies in older women produces an infant with genetic abnormalities, obstetricians routinely screen women older than 35. For a 40-year-old mother, the risk of having a child with Down syndrome, for example, is about 1 in 100 compared with 1 in 300 for a 35-year-old and 1 in 10,000 for a 20-year-old. In addition, still births and neonatal deaths are much higher for women 35 years and older than for younger women. Why this is so remains unclear. One possibility is that the uterine blood vessels of older women may not fully adapt to support a healthy placenta and the increased demands of pregnancy.

breastfeeding: a learned behavior

Lactation is an automatic physiological process: virtually all mothers are capable of doing it. Breastfeeding, on the other hand, is a learned behavior that not all mothers decide to do. Of women who do breastfeed, those who receive early and repeated information and support breastfeed their infants longer than others. Health care professionals play an important role in providing encouragement and accurate information on breastfeeding. Especially helpful are certified lactation consultants, who specialize in helping new mothers establish healthy breastfeeding relationships with their newborn. These consultants are often registered nurses with specialized training. Women who have been successful breastfeeding can also offer advice and dispel misconceptions about lifestyle issues The mother's partner also plays an important role in encouraging breastfeeding. When partners support the decision, mothers are more likely to start and continue breastfeeding. Clearly, educating those closest to the mother can promote breastfeeding. Most healthy women who want to breastfeed can do so with a little preparation. Physical obstacles are rare, although most nursing mothers quit within a few months because of perceived difficulties. Mothers who are overweight or obese seem to have a particularly challenging time because of both psychosocial and biological factors; they tend to be less confident and to have a weaker prolactin response to suckling in the first few days. In general, mothers who are overweight or obese are more likely to not start or not continue breastfeeding. Many of them have been through high-risk pregnancies and would benefit from professional and peer support to help them feel in control of their breastfeeding decisions and to form realistic expectations. Preparation for breastfeeding includes acquiring and learning how to use a breast pump. Most mothers have a need to express milk at some point during their breastfeeding experience. By learning how to use and clean a breast pump—preferably from a person rather than from written or video instructions—a mother can safely collect breast milk. Breast pumps may be purchased or rented; health care insurance policies may cover this expense. Successful breastfeeding requires adequate nutrition and rest. This, plus the support of all who care, will help enhance the well-being of mother and infant.

review of critical periods

Maternal nutrition before and during pregnancy affects both the mother's health and the infant's growth. As the infant develops through its three stages—the zygote, embryo, and fetus—its organs and tissues grow, each on its own schedule. Times of intense development are critical periods that depend on nutrients to proceed smoothly. Without folate, for example, the neural tube fails to develop completely during the first month of pregnancy, prompting recommendations that all women of childbearing age take folate daily.

maternal health

Medical disorders can threaten the life and health of both mother and fetus. If diagnosed and treated early, many diseases can be managed to ensure healthy outcomes—another strong argument for early prenatal care. Furthermore, changes in pregnancy can reveal disease risks, making screening important and early intervention possible. Preexisting Diabetes The risks incurred by diabetes depend on how well it is managed before and during pregnancy. Without proper management of maternal diabetes, women face high infertility rates, and those who do conceive may experience episodes of severe hypoglycemia or hyperglycemia, preterm labor, and pregnancy-related hypertension. Infants may be large, suffer physical and intellectual disabilities, and experience other complications such as severe hypoglycemia or respiratory distress, both of which can be fatal. To minimize complications, a woman needs to achieve glucose control before conception and continue glucose control throughout pregnancy. Gestational Diabetes An estimated 10 percent of pregnancies in the United States are complicated by gestational diabetes. The prevalence is rising in association with the increase in maternal obesity. Gestational diabetes develops during pregnancy, and typically resolves after childbirth. Up to half of women with gestational diabetes, however, develop type 2 diabetes within five years, especially if they are overweight. For this reason, health care professionals strongly advise against excessive weight gain during—and after—pregnancy. Weight gains after pregnancy increase the risk of gestational diabetes in the next pregnancy. The most common consequences of gestational diabetes are complications during labor and delivery and high birthweight infants who face a future of obesity, type 2 diabetes, and cardiovascular disease. To ensure that the problems of gestational diabetes are dealt with promptly, physicians screen for the risk factors listed in Table 15-5 and test high-risk women for glucose intolerance immediately and average-risk women between 24 and 28 weeks gestation. Dietary recommendations should meet the needs of pregnancy and control maternal blood glucose. Diet and moderate exercise may manage gestational diabetes, but if blood glucose fails to normalize, insulin or other drugs may be required. It is noteworthy that treatment reduces preeclampsia and macrosomia. Chronic Hypertension Hypertension complicates pregnancy and affects its outcome in various ways, depending on when the hypertension first develops and on how severe it becomes. In addition to the threats hypertension always carries (such as heart attack and stroke), high blood pressure increases the risk of fetal growth restriction, preterm birth, and separation of the placenta from the wall of the uterus before the birth, resulting in stillbirth. To minimize complications, blood pressure needs to be monitored and managed before and during pregnancy. Gestational Hypertension Women with chronic hypertension face a greater likelihood of developing gestational hypertension—high blood pressure during the second half of pregnancy. For some women with gestational hypertension, the rise in blood pressure is mild and does not affect the pregnancy adversely. Blood pressure usually returns to normal during the first few weeks after childbirth. For others, gestational hypertension increases the risks of subsequent hypertension and heart disorders. Gestational hypertension is also an early sign of the most serious maternal complication of pregnancy—preeclampsia. Preeclampsia Preeclampsia is a condition characterized not only by gestational hypertension but also by protein in the urine. Table 15-6 presents the signs and symptoms of preeclampsia. The cause of preeclampsia remains unclear, but it usually occurs with first pregnancies and most often after 20 weeks of gestation. Symptoms typically regress within 2 days after delivery. Both men and women who were born of pregnancies complicated by preeclampsia are more likely to have children born of pregnancies complicated by preeclampsia, suggesting a genetic predisposition. Black women have a high risk of preeclampsia. Preeclampsia dramatically affects the mother's body—the circulatory system, liver, kidneys, and brain. Blood flow through the vessels that supply oxygen and nutrients to the placenta diminishes. For this reason, preeclampsia often restricts fetal growth. In some cases, the placenta separates from the uterus, resulting in preterm birth or stillbirth. Preeclampsia can progress rapidly to eclampsia—a condition characterized by seizures and coma. Maternal death during pregnancy and childbirth is rare in developed countries, but when it does occur, eclampsia is a common cause. The rate of death for Black women with eclampsia is more than two to three times the rate for others. Preeclampsia demands prompt medical attention. Treatment focuses on controlling blood pressure and preventing seizures. If preeclampsia develops early and is severe, induced labor or cesarean delivery may be necessary, regardless of gestational age. The infant will be preterm, with all of the associated problems, including poor lung development and special care needs. Several dietary factors have been studied, but none have proved effective in preventing preeclampsia.

chronic diseases

Much research suggests that dietary influences at critical times during fetal development program the infant's bodily functions by permanently changing an organ's structure. For example, undernutrition may limit liver growth and program lipid metabolism in such a way that the infant will develop cardiovascular disease as an adult. Similarly, overnutrition and maternal obesity may program the fetus to develop obesity, heart disease, type 2 diabetes, and asthma later in life. On a positive note, a maternal diet rich in nutrients such as folate can have epigenetic effects that may protect the developing fetus against obesity in childhood and some cancers in adulthood Undernutrition during the critical period of pancreatic cell growth provides an example of how type 2 diabetes may develop in adulthood. The pancreatic cells responsible for producing insulin (the beta cells) normally increase more than 130-fold between 12 weeks of gestation and 5 months after birth. Nutrition is a primary determinant of beta cell growth, and infants who have suffered prenatal malnutrition have significantly fewer beta cells than well-nourished infants. They are also more likely to be low-birthweight infants—and low birthweight correlates with insulin resistance later in life. One hypothesis suggests that diabetes may develop from the interaction of inadequate nutrition early in life (low birthweight) with abundant nutrition later in life (overweight adult): the small mass of beta cells developed in times of undernutrition during fetal development may produce insufficient insulin to meet needs in times of overnutrition during adulthood.

common nutrient related concerns of pregnancy

Nausea and Vomiting Not all women have queasy stomachs in the early months of pregnancy, but many do. The nausea of "morning sickness" may actually occur anytime and ranges from mild queasiness to debilitating nausea and vomiting. Severe and continued vomiting may require hospitalization if it results in acidosis, dehydration, or excessive weight loss. Physicians also need to determine whether the nausea and vomiting might be related to other causes. The hormonal changes of early pregnancy seem to be responsible for a woman's sensitivities to the appearance, texture, or smell of foods. The problem typically peaks at 9 weeks of gestation and resolves within a month or two. Traditional strategies for quelling nausea may be effective and are listed in Table 15-2. In general, women may benefit most from simply resting when nauseous and eating the foods they want when they feel like eating. A woman may also find comfort in a clean, quiet, and temperate environment. Constipation and Hemorrhoids As the hormones of pregnancy alter muscle tone and the growing fetus crowds intestinal organs, an expectant mother may experience constipation. She may also develop hemorrhoids (swollen veins of the rectum). Hemorrhoids can be painful, and straining during bowel movements may cause bleeding. She can gain relief by following the strategies listed in Table 15-2. Heartburn Heartburn is another common complaint during pregnancy. The hormones of pregnancy relax the digestive muscles, and the growing fetus puts increasing pressure on the mother's stomach. This combination causes gastroesophageal reflux, the painful sensation a person feels when stomach acid splashes back up into the lower esophagus (see Highlight 3). Tips to help relieve heartburn are included in Table 15-2. Food Cravings and Aversions Some women develop cravings for, or aversions to, particular foods and beverages during pregnancy. Food cravings and food aversions are fairly common, but they do not seem to reflect real physiological needs. In other words, a woman who craves pickles does not necessarily need salt. Similarly, cravings for ice cream are common in pregnancy but do not signify a calcium deficiency. Cravings and aversions that arise during pregnancy are most likely due to hormone-induced changes in sensitivity to taste and smell. Nonfood Cravings Some pregnant women compulsively eat nonfood items such as freezer frost, laundry starch, clay, soil, or ice—a practice known as pica. Pica is a cultural phenomenon that reflects a society's folklore; it is especially common among African women. Pica is often associated with iron-deficiency anemia, but whether iron deficiency leads to pica or pica leads to iron deficiency is unclear. Eating clay or soil may interfere with iron absorption and displace iron-rich foods from the diet.

nutrition prior to pregnancy

Nutrition may affect fertility Preparation before pregnancy -Achieve and maintain healthy body weight -Choose an adequate and balanced diet -be physically active -Obtain regular medical care -Manage chronic conditions -Avoid harmful influences

exercise during pregnancy

Physical activity during pregnancy offers many benefits. Staying active can improve cardiovascular fitness, support appropriate weight gain, prevent or manage gestational diabetes and gestational hypertension, and reduce stress. Women who exercise during pregnancy report fewer discomforts throughout their pregnancies. Regular exercise develops the strength and endurance a woman needs to carry the extra weight through pregnancy and to labor through an intense delivery. It also maintains the habits that help a woman lose excess weight and get back into shape after the birth. A pregnant woman should participate in low-impact activities and avoid sports in which she might fall or be hit by other people or objects. For example, playing singles tennis with one person on each side of the net is safer than a fast-moving game of racquetball in which the two players can collide. Swimming and water aerobics are particularly beneficial because they allow the body to remain cool and move freely with the water's support, thus minimizing back pain. Figure 15-8 provides some guidelines for exercise during pregnancy. Several of the guidelines are aimed at preventing excessively high internal body temperature and dehydration, both of which can harm fetal development. To this end, pregnant women should also stay out of saunas, steam rooms, and hot tubs or hot whirlpool baths.

growth and development during pregnancy

Placental development -Develops in uterus --Amniotic sac and umbilical cord -Expelled during childbirth -Interweaving of fetal and maternal blood vessels -Metabolically active organ --Requires energy and nutrients --Produces hormones