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ADVANCES- Physiological basis of nutritional requirements in pregnancy and…

- - - - difficult to monitor pregnant women / see dietitian during pregnancy
    - - Consequences of over-nutrition: obesity, malformations, pre-term birth, LGA babies, low Apgar score, pre-eclampsia, GDM, labour difficulties
      - Consequences of under-nutrition: LBW, increased CHD risk, HTN, increased insulin resistence
      - eating too much can increase intake of alcohol/ vit A/ caffeine , high food chain fish with high mercury
  - - - Heighten and Lyche study- 12.5kg associated with best outcomes from studies. associated with term weight 3-4kg and mother pre-pregnancy healthy weight (depends on BMI)
        
        foetus makes up ~5kg of 12.5kg, products of conception, maternal tissue, maternal fat stores also make up weight which totals around 150mj for fat and 50mj for other components + 150MJ to lay down and maintain (METABOLISM)= 350MJ over 9 months to lay down tissue and maintain it
        
        Energy cost of pregnancy (Prentice and Goldberg 2000)- maintenance and fat deposition varies between populations but conceptus remains similar. Reduction in BMR in Gambia due to adaptations to restriction in energy intake in this population. Fat varies a lot (high in Sweden but low in Philippines).
        
        Most studies agree 50MJ for other componenets, 150 for metabolism but overestimated fat stores= 300MJ extra compared to 350MJ for 9 months pregnancy
        
        Increase in food energy required will depend on physiological and metabolic adaptations and lifestyle- Not all women will need extra 300MJ fo rexample, undernourished women may increase efficiency BMR, DIT may reduce in nourished women, efficiency in performing activity (little data to support this, most will reduce activity as gaining weight), energy costs unequally distributed across preganancy , focus on end of pregancy where growth most rapid
        
        Increase in maternal fat stores varies (depends on fat stores before pregnancy). Can range from 0-5kg fat mass but most research suggests 2-3kg for women gaining 12.5kg but ? validity as assessing body comp during pregnancy difficult/shifts in water content of FFM in late gestation
        
        Increase in metabolic rate variable- some showed +210MJ or -45MJ but correlated with weight gain and most research suggests estimate 160MJ - original 150MJ accurate
      - need to consider mothers increase in BMR to lay down tissue and energy costs of activity
    - - most eating to appetite increase/ usually not concern to recommended
  - - - Fat requirements: EU 250mg/d EPA+ DHA (Adult AI)+ 100-200mg DHA= 0.45g n3 from fatty fish
        
        US: 1.4g/d ALA of which 10% LC-PUFA
        
        UK: >200mg of DHA/d (Koletzko)
      - UK pregnancy values: no more than 2 portions of oily fish ? appropriate as women may perceive fish as risky and avoid altogether and unlikely to start eating fish when pregnant
        
        HOW TO PROVIDE: fish oil supplements expensive, especially compared to other supplements recommended in pregnancy like folate
  - - - Absoprtion 10-30% more efficient, no menstruation saves 0.5-1mg/day , 25-30% have no body stores and 85% suboptimal
      - FAO/WHO 2003: Women during pregnancy- recommenced >50mg/day and divided by bioavailability
    - - women with obesity have lower folate status may require more but no RCT supporting benefits of additional supplementation
      - low toxicity so no harm incontinuing with 400ug throughout whole pregnanncy
    - - SACN review- iodine status at SOMEBBODY STARTS PREGNANCY is important from follow up on Lancet paper (2014)
      - Up to 50% uk women and 2/3 schoolgirls iodine deficient (vanderpump)
      - not all UK prenatal supplements contain iodine
      - kelp supplements not reccomended due to possible excess iodine
    - - Saraf 2016: deficiency prevalent amongst mothers and newborns widespread (57% and 73% for European studies, respectively for mothers and infants. shows that mothers may need more to achieve same status in infants but ? how much needed. Also what outcomes basing this on as ost evdience for skeletal outcomes and not pre-term births/SGA/pre-eclampsia/gestational HTN. Severely lacking /limited RCTs (see slides for refrences)
- - - - SACN 2011 review- effiency of 80-95% may underestmate and overrestimate costs of lactation= 1.38MJ for first 6 months breastfeeding (lower than previous) more THAN PREGNANCY