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Week 13: Nutrition during Pre-conception, Pregnancy, Lactation (Nutrition…

- - - - Male
        
        Inadequate zinc status
        
        Heavy metal exposure (lead, mercury, cadmium, manganese)
        
        Halogen and glycol exposure
        
        Estrogen exposure
        
        Sperm defects (quality and mortility)
        
        Steroid abuse
        
        High intake of soy foods
      - Female
        
        Recent oral contraceptive use (within 2 months)
        
        Anorexia and bulimia nervosa
        
        Vegan diets
        
        Age >35 years
        
        Metabolic syndrome
        
        Poor iron status
        
        Polycystic ovary syndrome
      - Female and Male
        
        Weight loss >10 to 15% of normal weight
        
        Inadequate antioxidant status (selenium, vitamin C and E)
        
        Oxidative stress
        
        Excessive body fat, especially central fat
        
        Extreme level of exercise
        
        High alcohol intake
        
        Structural abnormalities of the reproductive systems
        
        Chromosomal abnormalities in sperm and eggs
        
        Severe psychological stress
        
        Infection (STD)
        
        Diabetes, cancer and autoimmune disorders
    - - Excessive Exercise
        
        A number of studies have shown that young female athletes may experience delayed age of puberty and lack menstrual cycles
        
        Average age of menarche for competitive female athletes and ballet dancers is often delayed by 2 - 4 years
      - Oxidative stress & antioxidant nutrient status
        
        Oxidative stress occurs when the production of potentially destructive reactive oxygen molecules (free radicals) exceeds the body’s own antioxidant defenses
        
        Antioxidant nutrients are needed to protect sperm and eggs from the damage due to oxidative stress
        
        Prevent free radicals from attacking sperm membranes to decrease sperm membrane motility and reduce the ability of sperm to fuse with an egg
      - Body fat
        (changes in hormone concentration )
        
        When excess
        
        Male: lower level of testosterone, increased level of estrogen and leptin
        
        reduced sperm production and erectile dysfunction
        
        Female: higher level of estrogen, androgens and leptin
        
        Development of menstrual-cycle irregularity, ovulatory failure and amenorrhea
        
        When Inadequate
        
        Male: have lower libido and reduced sperm production
        
        Female: delays in the age of menarche and reduced fertility in later life
      - Multivitamin supplement, folate intake and fertility
        
        Intake of folic acid supplement appears to lower risk of ovulatory infertility
        
        Iron deficiency prior and during pregnancy increase risk of preterm delivery and infants born with low iron stores
        
        Easier and more efficient to build up iron stores before pregnancy than during pregnancy
        
        Iron status can be improved by
        
        Taking modest doses of iron supplements (18mg/day)
        
        Regular consumption of vitamin C-rich fruits and vegetables along with plant sources of iron and lean meat
      - Undernutrition
        
        Chronic undernutrition
        
        The birth of small and frail infants
        
        The infants who have a high risk of death in the first year of life
        
        Acute undernutrition
        
        modifying hormonal signals that regulate ovulation and menstrual cycles in females
        
        impair sperm maturation in males
  - - - Diabetes
        
        increase the risk of
        
        fetal malformations
        
        excessive infant size at birth
        
        the development of diabetes in the offspring later in life
      - Nutrient Status
        
        Vitamin A: Excessive Vitamin A intake (retinol, retinoic acid) increases the risk the fetus will develop facial and heart abnormalities
        
        Iodine: Deficiency early in pregnancy increases the risk that children will experience impaired mental and physical development
        
        Folate: Insufficient intake increases the risk of embryonic
        development of NTD
        
        Iron: Deficiency increases the risk of early delivery and development of iron deficiency in the child within the first few years of life.
      - Weight Status
        
        Underweight: Increases the risk of maternal complications during pregnancy and delivery of small and early newborns.
        
        Obesity: Increases the risk of clinical complications during pregnancy and delivery of newborns with neural tube defects (NTD) or excessive body fat
      - Alcohol: Regular intake increases the risk of fetal alcohol syndrome and fetal alcohol effects, both of which include impaired mental and physical development
  - - - 2 reasons
        
        Absence of ovulation
        
        Menstrual irregularity
      - Symptoms
        
        Menstrual irregularities
        
        Polycystic ovaries
        
        Excess abdominal fat
        
        Insulin resistance
        
        Overweight, obesity
        
        Abnormal facial and body hair
        
        High testosterone levels
        
        Infertility
        
        Low HDL
        
        High triglycerides
      - Causes
        
        Insulin resistance
        
        Genetic component
        
        Excess body fat/ weight
      - Increases risk of
        
        Spontaneous abortion
        
        Gestational and type 2 DM
        
        Hypertension
        
        Cardiovascular disease
      - Managing it with nutrition: increase insulin sensitivity
        
        Emphasize on omega-3 (EPA, DHA)
        
        Fish oil
        
        Whole grains
        
        Fruits and vegetables rich in antioxidant & fiber
        
        Non-fat dairy products
        
        Low Glycemic Index CHO
        
        Regular meals
    - - Common signs and symptoms of PMS
      - Managing it with nutrition
        
        Reduce caffeine intake
        
        Increase daily physical activity / exercise
        
        Intake of nutrient supplements:
    - - diagnosed when 3 of the following 5 conditions exists:
        
        Waist circumference > 35” in women
        
        Blood TG ≥ 150mg/dL
        
        HDL <50 mg/dL
        
        Blood pressure ≥ 130/85 mm Hg
        
        Fasting blood glucose ≥ 110 mg/dL
      - Managing it with Nutrition
        
        Diets high in antioxidant-rich fruits, vegetables, whole-grain products, fiber and low-fat dairy products
        
        Weight reduction
        
        Exercise
- - - - (Less than 1 week) Fertilized egg/ zygote divides itself to repeatedly to become a blastocyte
        
        Conception aka Pre-embryo period (First 2 weeks): Zygote travelled down the fallopian tube to implant itself on the lining of the woman’s uterus
        
        8 weeks Once attached, it starts obtaining nutrients from the mother immediately and develops into embryo. Placenta starts developing
        
        After 8th week of pregnancy
        Developing embryo is called a fetus
        Mother’s diet and lifestyle habits are important in supporting and nurturing the developing fetus
        
        (Placenta) the placental villi absorb nutrient molecules for the fetus
        
        maternal blood transfer oxygen and nutrients to the fetus’ blood and picks up fetal waste products
        
        performs the respiratory, absorptive and excretory functions
        
        Cellular activities occurs at critical periods only
        
        Full recovery is not possible if cell division and number are limited during the critical period
        
        Damage occurs will lead to permanent consequences for the life and the health of the fetus
  - - - 3 reasons
        
        To meet the fetus’ energy needs
        
        To prepare for the energy demands of lactation
        
        To meet their own
      - Excessive weight gain during pregnancy leads to postpartum weight retention
  - - - Second trimester +340 kcal/day
        Third trimester +450 kcal/day
  - - - 1.1g/kg body weight or +25g per day
    - - Causes low birth weights, preterm births and death
  - - - Fetus grows and develops at a fast pace
      - Mother’s red blood cell mass expands
    - - Folate
        
        Taken 1 month before conception and throughout 1st trimester can help reduce risk of neural tube defects
        (spina bifida)
      - Vitamin B12
        
        Needed to activate folate enzyme
      - Iron
        
        Needed for enlarged blood volume
        
        To provide for placental and fetal needs
        
        Developing fetus draws on maternal iron stores to create its own stores to last through the first 4-6 months after birth.
        
        Because breast milk (sole food) is poor in iron
        
        Daily iron supplement recommended during 2nd & 3rd trimesters
        
        Milk, coffee or tea inhibits iron absorption
      - Zinc
        
        Needed for DNA and RNA synthesis
        Needed for protein synthesis and cell development
        
        Large doses of iron supplements can interfere with the body’s absorption and use of zinc.
  - - - Maternal Vitamin D deficiency interferes with normal calcium metabolism
        
        result in rickets in fetus & osteomalacia in the mother
    - - Last trimester: Fetal bones calcify, causing a shift of calcium across the placenta
      - Final weeks of pregnancy: >300mg of calcium/day are transferred to the fetus
      - Adequate calcium intake during pregnancy aims to conserve maternal bone while supplying fetal needs
  - - - Pregnant women should seek physician’s advise before taking any medicines and herbal supplements
    - - Impairment of fetal growth and development
      - Preterm birth
      - Low-birthweight infants
      - Perinatal death
      - Sudden infant death
      - Central nervous system damage
    - - Complicated birth
      - Fetal growth retardation
      - Low-birth weight infant
      - Fetal death
      - Spontaneous abortion
      - Risks of respiratory infection
      - Childhood asthma
      - Sudden infant death syndrome (SIDS)
    - - Prevention
        
        Avoid shark, swordfish, king mackerel, golden snapper
        
        Limit average weekly consumption of 4 servings of fish/seafood (90g or 1 palm size per serving)
        
        Avoid fish oil supplements as they may contain concentrated toxins
  - - - Alleviating nausea
        
        On waking, arise slowly
        
        Eat dry toast or crackers
        
        Separate liquid and solid food intake
        
        Chew gum or suck hard candies
        
        Eat small, frequent meals
        
        Avoid foods with offensive odors
        
        When nauseated, drink carbonated beverages instead of juice, water, milk, coffee or tea
    - - symptoms
        
        severe headache
        
        vomiting
        
        edema
        
        fetal growth restriction
        
        blurred vision
      - affects almost all of the mother’s organs
        
        Blood flow that supply oxygen and nutrients to the placenta diminishes, this retards fetal growth and may leads to preterm birth or still birth
        
        demand prompt medical attention to control blood pressure
    - - Relieving/ Preventing
        
        Relax and eat slowly
        
        Chew food thoroughly
        
        Eat small, frequent meals
        
        Drink liquids between meals
        
        Avoid spicy or greasy foods
        
        Sit up while eating. Elevate the head while sleeping
        
        Wait 3 hours after eating before lying down
        
        Wait 2 hours after eating before exercising
    - - Treatments
        
        Diet and exercise are recommended to control GD
        
        Encourage 3 meals a day plus 2 snacks, each containing protein, carbohydrate, and moderate fat
        
        If blood glucose failed to normalize, insulin may be required
      - a woman is unable to produce sufficient insulin or becomes insulin resistant resulting in elevated blood glucose levels
    - - To prevent or alleviate
        
        Eat food high in fiber
        
        Exercise regularly
        
        Drink at least 8 glasses of liquids a day
        
        Respond promptly to the urge to defecate
        
        Use laxatives only as prescribed by doctor
- - - - Common Complications
      - Females attain physiological maturity about three years after menarche (first menstrual period)
      - Pregnancy before the end of these three years (while the teenager is still growing), jeopardizes the health of both mother and infant.
      - Nourishing a growing fetus adds to a teenager’s nutrition burden, especially if her growth is still incomplete
      - Young mothers (13 – 16 yrs of age) tend to have smaller newborns than older mothers (17 – 25 yrs) even when prepregnancy weight and pregnancy weight gains are similar.
      - Physically immature teenagers are encouraged to strive for the highest weight gains recommended for pregnancy (to minimize the risk of delivering low-birth weight infant)
      - Nutrition concerns
        
        Gaining less weight may limit fetal growth
        
        Teenagers who depends on fast food meals, skipping meals and paying little attention to food selection will not have the nutrient stores they need for their own growth plus pregnancy
        
        Poorly nourished, growing adolescent mothers may compete with the fetus for calories and nutrients
        
        Increasing rates of overweight and obesity among adolescents appear to be placing additional teens at risks of poor pregnancy outcome
        
        at risk for
        
        caesarean delivery
        
        hypertensive disorders of pregnancy
        
        gestational diabetes
        
        the delivery of excessively large newborns
    - - Maternal health
        
        Complications associated with later childbearing: hypertension and diabetes
        
        Can complicate a healthy pregnancy
        
        Need for cesarean delivery is twice as common in pregnant women over the age of 35 as among younger women
        
        Maternal mortality rates are higher in women over 35 than in younger women
      - Infant health
        
        Common problems among infants born to women over 35: birth defects, preterm births, growth retardation, and death
    - - Complications
      - Infants delivered in multifetal pregnancy tend to have:
        
        lower mean birth-weight.
        
        shorter mean-gestational age
        
        higher rate of low-birth-weight.
      - Energy and nutrient intake ↑ due to ↑ levels of
        
        maternal blood volume
        
        extracellular fluid
        
        uterine, placenta, and fetal growth
      - Higher caloric need for
        
        Tissue maintenance
        
        Growth
        
        Due to weight gain & quicker onset of starvation metabolism in women expecting > 1 newborn
    - - related to poor nutritional status that further compromises the body’s ability to fight infections
      - can lead to
        
        nutrient losses and fat malabsorption due to diarrhea
        
        inflammatory responses to the infection cause the loss of lean muscle mass.
        
        loss of calcium from bones and decreased bone density
      - ↑ risk of inadequate nutrient status of various vitamin and minerals as disease progresses
      - Higher energy and nutrient needs due to the effects of the virus on the body.
      - Nutritional needs ↑ the most during the later stages as diarrhea, wasting, infections and reductions in CD4 counts
      - Compromised immune status  ↓ immune response during pregnancy
        
        At higher risk of developing foodborne infections during term
        
        Avoid raw or uncooked meats and seafood, unpasteurized milk & milk products, uncooked egg
      - Safe food-handling practices can help reduce the risk of foodborne infection.
    - - Women with EDs during pregnancy are at higher risks for
        
        spontaneous abortion
        
        hypertension
        
        difficult deliveries
      - Their newborns tend to be smaller & experience higher rates of neonatal complications.
- - - - Contracts the uterus
      - Lengthens birth/pregnancy intervals
      - Conserves iron stores
      - Reduces risk of breast cancer
      - Protects bone density
      - Saves money
      - Offers convenience
    - - Provides a balance of nutrients with high bioavailability
      - Provides hormones that promote physiological development
      - Improves cognitive development
      - Protects against a variety of infections
      - Reduces the risk of sudden infant syndrome (SIDS)
      - Protects against some chronic diseases such as diabetes
      - Makes food allergies less likely
  - - - Nutritional inadequacies reduce the quantity and 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
      - Dietary calcium has no effect on the calcium concentration of breast milk
      - Maternal bones lose some of their density during lactation if calcium intake is inadequate
    - - A mother who drinks more fluid does not produce more breast milk BUT to protect herself from dehydration
    - - some may need Iron supplements to refill depleted iron stores due to
        
        maternal iron supply to growing fetus
        
        blood losses during childbirth
  - - - Higher in protein and lower in fat than mature milk
        Abundance of immune factors that protects infants against viral and bacterial infections
      - (After 3-6 days, evolve into) Transitional milk
        
        (between 7th to 14th day) change to mature milk has been completed with protein levels remaining high for the first month
        
        70kcal/100mL of milk
        
        digestible protein
        
        fat
        
        lactose
        
        adequate levels of vitamins and minerals
      - facilitates the passage of meconium (infant’s first stool)
  - - - Harmful to the physical and emotional health of both mother and the nursing infant
      - Can cause irritability, tremors, hallucinations, and even death in infants
    - - Cigarette smoking reduces milk volume
      - Infants of breastfeeding mothers who smoke gain less weight than those who do not smoke
      - Infant exposure to passive smoke increases the risk of SIDS which breastfeeding is known to have a protective effect on
    - - Most medicines are compatible with breast feeding , but some may suppress lactation
      - May harm the infant as they are easily secreted into the breast milk
    - - Enters breast milk easily & hinders breastfeeding
      - Alters flavor of the breast milk
      - Infants metabolize alcohol inefficiently and may suppress their feeding behavior
      - May reduce milk production by inhibiting oxytocin hormone
    - - May make a breastfed infant irritable and wakeful
      - Moderate intake of caffeine in a day (1-2 cups)
      - Larger doses may interfere with the availability of iron from the milk and impair the infant’s iron stores