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BY- PROF. DR. MC BANSAL

 DR. RIDHI KATHURIA
LET THY KITCHEN BE THY
 APOTHECARY, AND LET
 FOODS BE THY MEDICINE
 Good nutrition is an important component of a healthy lifestyle and a
healthy baby.

 The best time to review the nutritional status to make appropriate
changes is prior to conception.

 A very important time of fetal development is during the first several
weeks of pregnancy as all of the major fetal body systems are undergoing
formation and rapid development.

 Many women may not even realize they are pregnant at this time.


 Therefore it is prudent to make your lifestyle and nutritional changes
several months before conception occurs.
Pregnancy is the only time in life of women when weight gain is not only
desirable, but also encouraged.



Weight gain should not be confused with being obese.



There are multiple growth spurts of multiple organ systems that contribute
to the normal weight gain.
Placenta (avg) at term = 650gms *

Amniotic fluid = 800gms*

Breast enlargement = 405gms*

Uterine mass = 900gms*

Fat & fluid = 1200gms*

Maternal blood = 1800gms*

Average weighing baby = 2500 – 3000gms*

  It is easy to see that the recommended weight gain of about 11,000gms
                       (11-14 kg) is very appropriate.
                                    * Weights are shown as approx values
Extra 11-14kgs recommended translate into an additional 200-300
calories/day.

This increases the average daily caloric intake from 2200 calories per
day to approximately 2400-2700 calories per day.

Total extra energy cost of a pregnancy is 77,000kcal.


 1st Trimester   85kcal/day


 2nd Trimester   285kcal/day


 3rd Trimester   475kcal/day
Pre pregnancy   Weight for Height   Recommended
      BMI           Category        gain in body
                                     weight (kg)

    <18.5           Underweight       12.5 – 18



  18.5 – 24.9      Normal Weight      11.5 – 16



   25 – 29.9        Overweight        7.0 – 11.5
About 75% of pregnant females in India are underweight & anaemic.

Anaemia thus remains a major cause of maternal & fetal morbidity,
mortality and low birth weight.

Too early, Too close, Too many, Too late conception also adversely
affect the health status (nutritional status) of the females.

Another indirect important factor is Gastro-intestinal Infections,
Infestations, which are heralded further with under-nutrition, setting up
a vicious cycle.
IMPORTANT NUTRIENTS FOR
         PREGNANCY

 Folate

 Iron

 Calcium

 Vitamin D

 Vitamin A
 Omega Fatty Acids

 Essential Amino Acids from protein sources

 Calorie providing Food
(Carbohydrate and Fats in proper ratios)
• Why is it important in pregnancy
   – Needed to reduce risk of :- Neural tube defects
     Congenital heart defects,
     Cleft lips, 
     Limb defects
     Urinary tract anomalies
     Preterm delivery
     Infant low birth weight
     Fetal growth retardation
 400 micrograms of synthetic folic acid daily from fortified foods
and/or supplements has been suggested for all non-pregnant women, in
order to have adequate folic acid intake even in case of unplanned
pregnancies.


 Ideal to start before conception occurs.

 It is hypothesized that the insulin-like growth factor 2 gene is
differentially methylated and these changes in IGF2 result in improved
intrauterine growth and development.
RICH SOURCES OF FOLATE
Certain foods are very high in folate:

 Leafy vegetables -  spinach, asparagus, turnip greens, lettuce.

 Legumes - dried or fresh beans, peas and lentils

 Egg yolks

 Baker's yeast

 Fortified grain products (pasta, cereal, bread)

 Breakfast cereals (ready-to-eat and others)

 Sunflower seeds

 Liver and liver products

 Kidney
Moderate amounts:

 Fruit Juices (Orange Juice, Canned Pineapple Juice, Cantaloupe,
Melon, Grapefruit Juice, Banana, Raspberry, Grapefruit And Strawberry)

 Vegetables (Beets, Corn, Tomato Juice, Vegetable Juice, Broccoli,
Brussels Sprouts)
•   Why is it important in pregnancy


    – Pregnancy causes a surge in the volume of blood in the
      body; the expanded volume may go up by 50%.


    – To meet the demands of the increased blood volume,
      iron requirements go up significantly.


    – Iron is also required for the normal development of the
      growing baby and the Placenta.
On an average, the iron requirement during pregnancy is as follows:-

Basal iron = 280 mg
Expansion of red cell mass = 570 mg
Fetal transfer = 200-350 mg
Placental development = 50-150 mg
Blood loss at delivery (normal) = 100-250 mg

After deducting iron conserved by amenorrhoea (240-480mg), additional
500-600 mg iron is required in pregnancy.

If the patient is chronically anaemic, then her iron stores
also stand to be depleted.
This necessitates an extra supplementation of
500 mg is needed.

Thus Total Iron Supplementation Stands At 1000 Mg.
• Iron requirements in pregnancy go up from 18 to 27-30 mg per day.

• Because iron is not easily absorbed from the diet, it is recommended to
take an iron supplement

• Risk profile of an anaemic mother includes-
a)Preterm birth.
b)Low birth weight.
c)Increased blood loss during and after labour.
d)Depleted stores.
RICH SOURCES OF IRON
oCooking In An Iron Skillet
                              o Fortified Bread & Breakfast Cereals
o Red Meat 
                              o Soybean
o Poultry
                              o Spinach
o Lentils
                              o Beetroot
o Beans
                              o Jaggery
o Leafy Vegetables

o Pistachios

o Tofu
IRON               ELEMENAL IRON
                                                    DOSE (mg)
  PREPARATION           CONTENT (mg%)


     Ferrous
                                 30                     200
    Fumerate

     Ferrous
                                 11                     550
    Gluconate

     Ferrous
                                 20                     300
     Sulphate
Ferrous Penta-Carbonyl Has Not Yet Been Approved By The FDA For Use
During Pregnancy And Lactation. However, If No Other Preparations Cant
 Be Used And Benefits Out W eigh The Risks, Then It Can Be Used W ith
                      High Degree Of Vigilance.
•   Why is it important during pregnancy?

1. Total calcium concentration falls because of physiologic
   hypoalbuminemia

2. Free ionized calcium concentration does not change (9-11gm%)

3. The placental produces 1,25-dihydroxyvitamin D, which results
   in increased intestinal absorption of calcium

4. Calcium is actively transported across the placenta to the
   fetus, facilitated by parathyroid hormone-related peptide
This increased demand if not met in the diet – Will lead to excessive
       calcium resorbtion from the maternal bones – Osteoporosis.

 Involved in mineralization of bones and teeth, energy and cell
production and electrolyte acid-base buffering.

 Fetal bone and teeth calcification primarily occurs in last 2-3 months.
(total fetal requirement=)

 2 cup full of milk daily or equivalent to supply 1200 mg
calcium/1200mg phosphorous daily

 Excess phosphorous can be a problem. Avoid snack foods, processed
meats and cola drinks.

Therapeutic calcium supplementation (1200mg/day) should
Be in the form of calcium citrate/ calcium gluconate
Supplemented with vit -d
RICH SOURCES OF
              CALCIUM
 Dairy foods - Milk, yogurt, Cheese, Cottage Cheese, Rasgullas.

 Leafy & Green vegetables - Broccoli, Spinach, Okra,
                              Horseradish, Watercress

 Fruits - Oranges, Bananas.

 Beans and Peas – Red kidney beans, Soyabean,
                   Cabbage, Celery.

 Tofu, Peanuts, Peas, Black Beans, Baked Beans

 Fish - Salmon, Sardines

 Miscellaneous - Sesame Seeds, Blackstrap Molasses,
                  Corn, Almonds, Brown Sugar.

Fortified foods
Why is it important in pregnancy?

   • It helps the body to use calcium that is consumed.
   • Maintain blood calcium & phosphorous levels.
   • Anti proliferative action.



                              RECENT
                              STUDIES
                             INDICATE
                         INCREASED RISK
                           OF AUTISM IN
                          INFANTS WITH
                               VIT. D
                            DEFICIENCY
ᴥ Sunlight exposure

ᴥ Fish - Salmon, Tuna, Flounder, Sole.

ᴥ Milk

ᴥ Cereal

ᴥ Pork

ᴥ Mushrooms

ᴥ Riccota Cheese

ᴥ cod liver oil
Nutrition In Pregnancy
Why is it important in pregnancy?

    Need enough for healthy growth

    Too much can cause birth defects

    Formation of Rhodopsin, essential for normal vision

    Glycoprotein synthesis (epithelial cell function)

    Maintain normal skin health by switching on genes and
     differentiating keratinocytes (immature skin cells)
     into mature epidermal cells.

    Regulates gene transcription.

    Anti Oxidant action.
ToxiciTy
One of the rare entities which cause adverse effects if taken in
excessive amounts.

Since vitamin A is fat-soluble, disposing of any excesses taken in through
diet takes much longer than with water-soluble B vitamins and vitamin C.

                   This allows for toxic levels of vitamin A to accumulate.
Nausea                    Hair loss

Irritability              Dry skin

Anorexia                  Drying of the mucous membranes

Vomiting                  Fever

Blurry vision             Insomnia

Headaches                 Fatigue

Hair loss                 Weight loss

Muscle & Abdominal pain   Bone fractures

Drowsiness                Anemia

Altered mental status.    Diarrhea
Nutrition In Pregnancy
 Liver (Beef, Pork, Chicken,    Cheddar Cheese 
         Turkey, Fish)  
                                 Melon
 Cod Liver Oil
                                 Egg
 Dandelion Greens
                                 Apricot 
 Carrot
                                 Papaya
 Broccoli Leaf
                                 Mango
 Sweet Potato 
                                 Pea
 Butter
                                 Broccoli 
 Spinach 
                                 Milk
 Pumpkin 
                                 Tomatoes
Why are they important in pregnancy?

   • They serve as building blocks of proteins.
   • Used in production of DNA, Cell membrane, Haemoglobin,
   Receptors, Enzymes, Neurotransmitters, Hormones, Antibodies &
   other Bioactive molecules .
   • Serve as body store of energy after fat stored in adipose tissue.
INDISPENSABLE DISPENSABLE      CONDITIONALLY   PRECURSORS OF
 AMINO ACIDS  AMINO ACIDS      INDISPENSABLE   CONDITIONALLY
                                               INDISPENSABLE

HISTIDINE       ALANINE        ARGININE        GLUTAMINE/
                                               GLUTAMATE

ISOLEUCINE      ASPARTIC       CYSTEINE        ASPARTATE
                ACID
LEUCINE         ASPARAGINE     GLUTAMINE       METHIONINE

LYSINE          GLUTAMIC ACID GLYCINE          SERINE

METHIONINE      SERINE         PROLINE         GLUTAMIC ACID/
                                               AMMONIA

PHENYLALANIME                  TYROSINE        SERINE

THREONINE                                      CHOLINE

TRYPTOPHAN                                     GLUTAMATE

VALINE                                         PHENYLALANINE
 According to the American College of Nurse-Midwives, pregnant women
require 71 grams of complete protein each day.

Some types of amino acid protein supplements contain only certain essential
amino acids required by the body.




If consuming amino acid protein supplements during pregnancy, choose those
that contain all nine essential amino acids.
Many types of amino acid protein supplements contain added ingredients such
as Creatine, Herbs, Caffeine, Artificial Sweeteners and Preservatives.

A pregnancy diet has more restrictions than a non-pregnant person. Not all
herbs and artificial sweeteners are safe for pregnant women.




In fact, according to the American Pregnancy Association, the FDA
encourages pregnant women to consult with their healthcare provider before
taking any types of herbal products. This includes amino acid protein
supplements that contain herbs.
ETE                                      INC
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     in s fr s, Milk                               s, N - L
 rote , Egg ghurt.                               Ve     u      eg
P                                  l                get ts, S ume
  Fish        Yo               ntia
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                        ne                     eo
                 a ll ni cids                am r mo
          vi d e in o a                         ino re
     Pro        am                                   aci esse
                                                        ds.    nti
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Nutrition In Pregnancy
Deposition Of Protein In The
      Fetus & Maternal Tissues During
SITE OF PROTEIN
   DEPOSITION       Pregnancy
                 DEPOSITION (g) BY WEEKS OF GESTATION
                10               20             30    40

    Fetus        0.3         27          160         440


   Placenta      2           16          60          100


Amniotic Fluid   0           0.5          2           3


   Uterus        24          55          102         166


   Breasts       9           36          72           81


    Blood        0           30          102         135


   TOTAL         35          165         498         925
Omega-3 fatty acids are fats commonly found in marine and plant oils.

They are considered essential fatty acids, meaning that they cannot be
synthesized by the human body but are vital for normal metabolism.




Though mammals cannot synthesize omega−3 fatty acids, they have a
limited ability to form the long-chain omega−3 fatty acids including 
       Eicosapentaenoic Acid 
                         Acid

      Docosahexaenoic Acid  
                      Acid

      α-Linolenic Acid
Nutrition In Pregnancy
DHA is important for development of the central nervous system in all
mammals.

There is an enormous growth spurt in the human brain during the last
trimester of pregnancy and the first postnatal months, with a large increase
in the cerebral content of Arachidonic Acid (AA) and DHA.




The fetus and the newborn infant depend on a continual maternal supply of
DHA and AA.
CARBOHYDRATES

Principle energy yielding food.

‘Digestible Carbs’ – Sugars & Starches.
            Carbs

‘Indigestible Carbs’ – Cellulose, Hemicellulose,
              Carbs
Gum, Pectin, Lignin.

               Foods with carbohydrates in them have a wide range of
                 effect on the blood glucose levels, during digestion.

                       This is known as the ‘Glycaemic Response’


            ‘Glycaemic Index’ is the effect of carbs on the blood glucose
                                        levels.
              Rapidly breaking down carbs have high GI, and vice versa.
BASED ON NUMBER OF SUGAR UNITS


                   NUMBER OF SUGAR
     NAME                                     EXAMPLES
                       UNITS


Monosaccharides            1            Glucose, Fructose

                                         Sucrose, Lactose,
 Disaccharides             2
                                             Maltose

Oligosaccharides          3-10         Raffinose, Stachyose

                                        Starch (plant food),
Polysaccharides           >10            Glycogen (animal
                                               food)
Should Pregnant Women Go on
          Low-Carb Diets?
 Pregnant women should not go on low-carb diets, let alone carb-free
                               diets.

   In fact, it is recommended that at least half of the calories that
          pregnant women consume should be carbohydrates.

The main reason is because carbs are known to turn to glucose, which is
                   necessary for the unborn baby.

Carbs are known to provide the baby with nutrients, protein and healthy
 fats. All of these are quite essential to the proper development of the
                                  baby.
Can a Carb-Free Diet Harm an Unborn
               Baby?
What many people do not realize is that a carb-free diet can actually harm
                               an unborn baby.
 It is highly likely that the baby will not get the nutrients that he or she
needs for healthy development when one puts oneself on a carb-free, high-
                                 protein diet.

 When women choose to go on a diet that is high in protein when they are
         pregnant, their cortisol levels are known to increase.

When an unborn baby is exposed to higher cortisol levels, the chances that
 he or she will have high blood pressure later on in childhood or adulthood
                                 increases.

Although a low-carb diet may not be as bad, it is important to keep in mind
 that these same side effects may also affect your unborn baby when you
Are There Any Types of Carbs
     Pregnant Women Should Eat?
 There are various types of carbs that pregnant women should eat while
they are pregnant in order to ensure the ultimate health and development
                             of their baby.

    Some of these carbs include fruits, vegetables and whole grains.




These are what most people refer to as "GOOD CARBS" and ultimately,
                                                CARBS
 are what will provide the baby with the nutrients needed for healthy
                             development.
Nutrition In Pregnancy
What Types of Carbs Should
        Pregnant Women Avoid?
  There are many carbs that pregnant women should avoid, or only eat in
                             moderation.

 These are what most people call "BAD CARBS." Some of these types of
                                      CARBS
             carbs include donuts, candy, fast food etc.

These carbs and known to cause weight gain and gestational diabetes among
                           pregnant women.

Although eating bad carbs will not necessarily cause any harm to the baby,
                they will not provide any health benefits.

  Eating bad carbs in moderation may not be harmful, but when it comes
   down to it, one should not eat them too frequently during pregnancy.
Nutrition In Pregnancy
WHY THE DEVELOPING BABY NEEDS FATS

 Babies need a diet high in beneficial fats, as these are
   their main source of energy.

 A baby’s brain, which is around 60% fat, uses nearly three quarters
of total dietary energy for growth, whereas an adult's uses only a fifth.

 Once born, they’ll get a lot of essential fats from breastmilk, which
contains over 50% of its calories as fat.




 But while still in the womb, they rely on maternal
  fat supply.
FAT IS ESSENTIAL FOR VITAMIN
           ABSORPTION
Fats act as carriers for fat-soluble
 Vitamins such as A, D, E and K.

       Vitamin D Helps Keep Bones And Teeth
                      Healthy.

       Vitamin E Protects Cell Membranes By
             Acting As An Antioxidant

      Vitamin K Helps Wounds Heal Properly As
        It Helps With Blood Clotting And Also
               Helps Build Strong Bones
BUTTER & OTHER COOKING MEDIA       FAT (g/unit)



          Butter 100 g                 81



          Ghee 100 g                  100



      Vegetable Oil 100 g             100



Vegetable Hydrogenated Oil 100 g      100
BREADS AND CEREALS          FAT (g/unit)

      Chapati (one)               0.4

        Puri (one)                2.8

      Paratha (one)               4.1

  Aloo ka Paratha (one)           3.5

Cooked Rice (3/4 th katori)       0.1

    Khicheri (1 katori)           7.3

          Dosa                    3.5

Bread large sized (1 slice)       0.7

 Dry Cereal (3/4 th katori)       0.3
LEGUMES (1 katori cooked dal including veg oil used)   FAT (g/unit)

          Bengal Gram (Channe ki dal)                      4.1

            Black Gram (Urad ki dal)                       4.5

           Green Gram (Moong ki dal)                       5.6

              Lentil (Masoor ki dal)                       4.1

             Red Gram (Arhar ki dal)                       2.0

                     Sambar                                2.1

            Chickpea (Kabuli Channa)                       6.6

       Green Gram (Saboot Moong ki dal)                    3.3

       Lentil whole (Saboot Masoor ki dal)                 2.5

                      Rajma                                5.7
VEGETABLE PREPARATIONS (1 katori incld oil used)   FAT (g/unit)

   Matar Paneer (Cottage Cheese with Peas)            10.4

       Aloo Matar (Potatoes with Peas)                 6.4

                 Potato curry                          6.2

                   Veg Kofta                          13.7

                  Veg Korma                            7.9

      Aloo Baingan (Potatoes with Brinjal)             6.7

                    Carrots                            6.0

                   Pumpkin                             6.3

                   Cabbage                            10.3

                 Ridge Gourd                           7.3

                     Okra                             15.0

                    Bhurtha                            8.2

               Stuffed Tomatoe                         3.4
RAW VEGETABLES & FRUITS        FAT (g/unit)

      Green Peas 100 g             0.1

        Brinjal 100 g              0.3

   Sweet Potatoes 100 g            0.3

        Beams 100 g                1.0

  All other Vegetables 100 g      < 0.3

         Apple 100 g               0.5

         Pear 100 g                0.2

      Most other 100 g             0.3
SNACKS          FAT (g/unit)

    1 Samosa            12.6

  1 -1/4 th Upma        11.3

French Fries 90 g       11.3

Palora (4 pieces)       11.0

 Besan ka Pura          11.7

  Dahi Vada (1)          9.6

Masala Vada (2)          4.6

Poha 1-1/2 katori       13.1

 Potato cutlet (1)       5.4

      Chaat             10.0
MILK PRODUCTS           FAT (g/unit)

      Milk (1 cup)              8.6

    2% Milk (1 cup)             4.9

  Skimmed Milk (1 cup)          0.2

   Buttermilk (1 cup)           2.4

Ice Cream regular (1 cup)      14.1

    Yoghurt (1 cup)             9.8

 Cottage Cheese (30 g)          1.2

  Swiss Cheese (30 g)           7.9

 Cheddar Cheese (30 g)          9.1
MEAT, FISH & POULTRY          FAT (g/unit)

      Lamb Leg (90 g)                9.4

     Lamb Chop (90 g)               15.8

Chicken, white, no skin (90 g)       2.9

    Fried Chicken (90 g)             7.9

      Fried Liver (90 g)             9.8

      Fried Fish (90 g)             12.5

     Fish Jhol (1 katori)            2.5

 Mutton ball curry (1 katori)       17.6

    Prawn curry (1 katori)           6.5

       Boiled Egg (1)                5-6

        Fried Egg (1)                7-9
DESSERTS                FAT (g/unit)

         Halwa (100 g)                15.9

    Jelly & Custards (100 g)           1.2

         Kheer (150 g)                13.4

        Sevian (100 g)                10.0

       Suji Kheer (150 g)             14.2

       Sriikhand (100 g)              19.7

      Sandesh (2 pieces)               9.0

     Besan ki Barfi (60 g)            25.4

         Chikki (60 g)                12.0

  Fruit Cake (50 g – 1 piece)         15.1

   Jam Tart (35 g – 1 piece)           9.1

  Lemon Tart (55 g – 1 piece)          9.2

Nutty Biscuits (40 g – 2 pieces)      13.8
Nutrition In Pregnancy
MINERAL         DIEARY                     RDA’S                CLINICAL
                SOURCES                                        MANIFESTATION

SODIUM      Table salt, Dairy        Adults = 1.5 g/dl        Only excess loss can
            products                                          produce deficiency –
                                                              Muscular cramps,
                                                              Weakness, Hypovolemia


POTASSIUM   Bananas,                 Adults = 4.7 g/dl        Weakness, Paraesthesia,
            Muskmelon, Bael          Preg = 4.7 g/dl          Arrhythmias.
            fruit, Citrus fruit,     Lactation = 5.1 g/dl
            Leafy veg, Milk, Meat


MAGNESIUM   Whole grains, Leafy      Men = 400 mg/dl          Muscle weakness,
            veg                      Women = 310 mg/dl        Twitching, Tremors,
                                     Preg = 350 mg/dl         Numbness, Apathy.
                                     Lactation = 310 mg/dl


PHOSPHORU   Milk, Cheese,            Adults = 700 mg/dl       Weakness, Fatigue,
S           Yoghurt, Fish,           Preg & Lactation = 700   Leukocyte & Platelet
            Poultry, Meat, Grains.   mg/dl                    dysfunction, Heart
                                                              failure, Haemolysis
IODINE      Seaweeds, Salt water   Preg = 220 micro g/dl   Thyroid enlargement
            fish, Shell fish,      Lactation = 290 micro
            Iodised salt           g/dl
                                   Women = 150 micro
                                   g/dl



Manganese   Nuts, Dry fruits,      Women = 1.8 mg/dl       Impaired growth &
            Cereals, Unrefined     Preg = 2.0 mg/dl        skeletal development,
            grains, Tea            Lactation = 2.6 mg/dl   Decline in
                                                           reproductive function




Selenium    Seafood, Muscle        Women = 55 micro        Cardiomyopathy,
            meat, Cereals          g/dl                    CHF, Striated muscle
                                   Preg = 60 micro g/dl    degeneration
                                   Lactation = 65 micro
                                   g/dl



Zinc        Nuts, Legumes,         Women = 8 mg/dl         Growth retardation,
            Meats, Shellfish       Preg = 11 mg/dl         Poor wound healing,
                                   Lactation = 12 mg/dl    Hypogonadism
TRIMESTER   EXTRA ENERGY               EXAMPLES OF FOODS
                   NEEDS


1st trimester   100 extra           •A   large apple OR
                calories each day   •A   slice of cheese OR
                                    •A   glass of milk OR
                                    •A   piece of bannock

2nd and 3rd     300 extra           •A piece of toast with peanut
trimester       calories each day   butter and a glass of milk OR
                                    •A small piece of meat or fish
                                    with bannock OR
                                    •A bowl of vegetable soup with
                                    crackers and cheese
NOT ENOUGH WEIGHT GAIN          TOO MUCH WEIGHT GAIN
• Low birth weight baby
                               • High birth weight baby

• Early birth
                               • Difficult birth (Feto pelvic
                               disproportion)
• Baby may not develop
properly
                               • Higher perinatal mortality

• Baby may have life-long
health problems                • Mother may develop
                               gestational diabetes

• Higher perinatal mortality
                               • Baby may develop diabetes &
                               cardiac problems in later life
•Baby may have mental and
behavioural problems
•   Too much caffeine is not good during pregnancy


•   Coffee, tea and some pop has caffeine

•   3 small cups of coffee per day (400-450 mg of caffeine) is
    safe.


•   Switch to decaf or try half decaf, half regular
•   Smoking is harmful to the baby


•   Passive smoking is dangerous


• Nicotine causes vasospasm leading to
Placental insufficiency.


•   IUGR


•   Preterm Birth.
Nutrition In Pregnancy
Nutrition In Pregnancy
Nutrition In Pregnancy
Nutrition In Pregnancy

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Nutrition In Pregnancy

  • 1. BY- PROF. DR. MC BANSAL DR. RIDHI KATHURIA
  • 2. LET THY KITCHEN BE THY APOTHECARY, AND LET FOODS BE THY MEDICINE
  • 3.  Good nutrition is an important component of a healthy lifestyle and a healthy baby.  The best time to review the nutritional status to make appropriate changes is prior to conception.  A very important time of fetal development is during the first several weeks of pregnancy as all of the major fetal body systems are undergoing formation and rapid development.  Many women may not even realize they are pregnant at this time.  Therefore it is prudent to make your lifestyle and nutritional changes several months before conception occurs.
  • 4. Pregnancy is the only time in life of women when weight gain is not only desirable, but also encouraged. Weight gain should not be confused with being obese. There are multiple growth spurts of multiple organ systems that contribute to the normal weight gain.
  • 5. Placenta (avg) at term = 650gms * Amniotic fluid = 800gms* Breast enlargement = 405gms* Uterine mass = 900gms* Fat & fluid = 1200gms* Maternal blood = 1800gms* Average weighing baby = 2500 – 3000gms* It is easy to see that the recommended weight gain of about 11,000gms (11-14 kg) is very appropriate. * Weights are shown as approx values
  • 6. Extra 11-14kgs recommended translate into an additional 200-300 calories/day. This increases the average daily caloric intake from 2200 calories per day to approximately 2400-2700 calories per day. Total extra energy cost of a pregnancy is 77,000kcal. 1st Trimester 85kcal/day 2nd Trimester 285kcal/day 3rd Trimester 475kcal/day
  • 7. Pre pregnancy Weight for Height Recommended BMI Category gain in body weight (kg) <18.5 Underweight 12.5 – 18 18.5 – 24.9 Normal Weight 11.5 – 16 25 – 29.9 Overweight 7.0 – 11.5
  • 8. About 75% of pregnant females in India are underweight & anaemic. Anaemia thus remains a major cause of maternal & fetal morbidity, mortality and low birth weight. Too early, Too close, Too many, Too late conception also adversely affect the health status (nutritional status) of the females. Another indirect important factor is Gastro-intestinal Infections, Infestations, which are heralded further with under-nutrition, setting up a vicious cycle.
  • 9. IMPORTANT NUTRIENTS FOR PREGNANCY  Folate  Iron  Calcium  Vitamin D  Vitamin A
  • 10.  Omega Fatty Acids  Essential Amino Acids from protein sources  Calorie providing Food (Carbohydrate and Fats in proper ratios)
  • 11. • Why is it important in pregnancy – Needed to reduce risk of :- Neural tube defects Congenital heart defects, Cleft lips,  Limb defects Urinary tract anomalies Preterm delivery Infant low birth weight Fetal growth retardation
  • 12.  400 micrograms of synthetic folic acid daily from fortified foods and/or supplements has been suggested for all non-pregnant women, in order to have adequate folic acid intake even in case of unplanned pregnancies.  Ideal to start before conception occurs. It is hypothesized that the insulin-like growth factor 2 gene is differentially methylated and these changes in IGF2 result in improved intrauterine growth and development.
  • 13. RICH SOURCES OF FOLATE Certain foods are very high in folate:  Leafy vegetables -  spinach, asparagus, turnip greens, lettuce.  Legumes - dried or fresh beans, peas and lentils  Egg yolks  Baker's yeast  Fortified grain products (pasta, cereal, bread)  Breakfast cereals (ready-to-eat and others)  Sunflower seeds  Liver and liver products  Kidney
  • 14. Moderate amounts:  Fruit Juices (Orange Juice, Canned Pineapple Juice, Cantaloupe, Melon, Grapefruit Juice, Banana, Raspberry, Grapefruit And Strawberry)  Vegetables (Beets, Corn, Tomato Juice, Vegetable Juice, Broccoli, Brussels Sprouts)
  • 15. Why is it important in pregnancy – Pregnancy causes a surge in the volume of blood in the body; the expanded volume may go up by 50%. – To meet the demands of the increased blood volume, iron requirements go up significantly. – Iron is also required for the normal development of the growing baby and the Placenta.
  • 16. On an average, the iron requirement during pregnancy is as follows:- Basal iron = 280 mg Expansion of red cell mass = 570 mg Fetal transfer = 200-350 mg Placental development = 50-150 mg Blood loss at delivery (normal) = 100-250 mg After deducting iron conserved by amenorrhoea (240-480mg), additional 500-600 mg iron is required in pregnancy. If the patient is chronically anaemic, then her iron stores also stand to be depleted. This necessitates an extra supplementation of 500 mg is needed. Thus Total Iron Supplementation Stands At 1000 Mg.
  • 17. • Iron requirements in pregnancy go up from 18 to 27-30 mg per day. • Because iron is not easily absorbed from the diet, it is recommended to take an iron supplement • Risk profile of an anaemic mother includes- a)Preterm birth. b)Low birth weight. c)Increased blood loss during and after labour. d)Depleted stores.
  • 18. RICH SOURCES OF IRON oCooking In An Iron Skillet o Fortified Bread & Breakfast Cereals o Red Meat  o Soybean o Poultry o Spinach o Lentils o Beetroot o Beans o Jaggery o Leafy Vegetables o Pistachios o Tofu
  • 19. IRON ELEMENAL IRON DOSE (mg) PREPARATION CONTENT (mg%) Ferrous 30 200 Fumerate Ferrous 11 550 Gluconate Ferrous 20 300 Sulphate Ferrous Penta-Carbonyl Has Not Yet Been Approved By The FDA For Use During Pregnancy And Lactation. However, If No Other Preparations Cant Be Used And Benefits Out W eigh The Risks, Then It Can Be Used W ith High Degree Of Vigilance.
  • 20. Why is it important during pregnancy? 1. Total calcium concentration falls because of physiologic hypoalbuminemia 2. Free ionized calcium concentration does not change (9-11gm%) 3. The placental produces 1,25-dihydroxyvitamin D, which results in increased intestinal absorption of calcium 4. Calcium is actively transported across the placenta to the fetus, facilitated by parathyroid hormone-related peptide
  • 21. This increased demand if not met in the diet – Will lead to excessive calcium resorbtion from the maternal bones – Osteoporosis.  Involved in mineralization of bones and teeth, energy and cell production and electrolyte acid-base buffering.  Fetal bone and teeth calcification primarily occurs in last 2-3 months. (total fetal requirement=)  2 cup full of milk daily or equivalent to supply 1200 mg calcium/1200mg phosphorous daily  Excess phosphorous can be a problem. Avoid snack foods, processed meats and cola drinks. Therapeutic calcium supplementation (1200mg/day) should Be in the form of calcium citrate/ calcium gluconate Supplemented with vit -d
  • 22. RICH SOURCES OF CALCIUM  Dairy foods - Milk, yogurt, Cheese, Cottage Cheese, Rasgullas.  Leafy & Green vegetables - Broccoli, Spinach, Okra, Horseradish, Watercress  Fruits - Oranges, Bananas.  Beans and Peas – Red kidney beans, Soyabean, Cabbage, Celery.  Tofu, Peanuts, Peas, Black Beans, Baked Beans  Fish - Salmon, Sardines  Miscellaneous - Sesame Seeds, Blackstrap Molasses, Corn, Almonds, Brown Sugar. Fortified foods
  • 23. Why is it important in pregnancy? • It helps the body to use calcium that is consumed. • Maintain blood calcium & phosphorous levels. • Anti proliferative action. RECENT STUDIES INDICATE INCREASED RISK OF AUTISM IN INFANTS WITH VIT. D DEFICIENCY
  • 24. ᴥ Sunlight exposure ᴥ Fish - Salmon, Tuna, Flounder, Sole. ᴥ Milk ᴥ Cereal ᴥ Pork ᴥ Mushrooms ᴥ Riccota Cheese ᴥ cod liver oil
  • 26. Why is it important in pregnancy?  Need enough for healthy growth  Too much can cause birth defects  Formation of Rhodopsin, essential for normal vision  Glycoprotein synthesis (epithelial cell function)  Maintain normal skin health by switching on genes and differentiating keratinocytes (immature skin cells) into mature epidermal cells.  Regulates gene transcription.  Anti Oxidant action.
  • 27. ToxiciTy One of the rare entities which cause adverse effects if taken in excessive amounts. Since vitamin A is fat-soluble, disposing of any excesses taken in through diet takes much longer than with water-soluble B vitamins and vitamin C. This allows for toxic levels of vitamin A to accumulate.
  • 28. Nausea Hair loss Irritability Dry skin Anorexia Drying of the mucous membranes Vomiting Fever Blurry vision Insomnia Headaches Fatigue Hair loss Weight loss Muscle & Abdominal pain Bone fractures Drowsiness Anemia Altered mental status. Diarrhea
  • 30.  Liver (Beef, Pork, Chicken,  Cheddar Cheese  Turkey, Fish)    Melon  Cod Liver Oil  Egg  Dandelion Greens  Apricot   Carrot  Papaya  Broccoli Leaf  Mango  Sweet Potato   Pea  Butter  Broccoli   Spinach   Milk  Pumpkin   Tomatoes
  • 31. Why are they important in pregnancy? • They serve as building blocks of proteins. • Used in production of DNA, Cell membrane, Haemoglobin, Receptors, Enzymes, Neurotransmitters, Hormones, Antibodies & other Bioactive molecules . • Serve as body store of energy after fat stored in adipose tissue.
  • 32. INDISPENSABLE DISPENSABLE CONDITIONALLY PRECURSORS OF AMINO ACIDS AMINO ACIDS INDISPENSABLE CONDITIONALLY INDISPENSABLE HISTIDINE ALANINE ARGININE GLUTAMINE/ GLUTAMATE ISOLEUCINE ASPARTIC CYSTEINE ASPARTATE ACID LEUCINE ASPARAGINE GLUTAMINE METHIONINE LYSINE GLUTAMIC ACID GLYCINE SERINE METHIONINE SERINE PROLINE GLUTAMIC ACID/ AMMONIA PHENYLALANIME TYROSINE SERINE THREONINE CHOLINE TRYPTOPHAN GLUTAMATE VALINE PHENYLALANINE
  • 33.  According to the American College of Nurse-Midwives, pregnant women require 71 grams of complete protein each day. Some types of amino acid protein supplements contain only certain essential amino acids required by the body. If consuming amino acid protein supplements during pregnancy, choose those that contain all nine essential amino acids.
  • 34. Many types of amino acid protein supplements contain added ingredients such as Creatine, Herbs, Caffeine, Artificial Sweeteners and Preservatives. A pregnancy diet has more restrictions than a non-pregnant person. Not all herbs and artificial sweeteners are safe for pregnant women. In fact, according to the American Pregnancy Association, the FDA encourages pregnant women to consult with their healthcare provider before taking any types of herbal products. This includes amino acid protein supplements that contain herbs.
  • 35. ETE INC MPL INS CO TE PR OM P O y, OT LETE PR o ultr at, P se, Pr ot e EIN - Me , Chee Gr ins S om ain from in s fr s, Milk s, N - L rote , Egg ghurt. Ve u eg P l get ts, S ume Fish Yo ntia La ck abl eed s ess e on es. s, , ne eo a ll ni cids am r mo vi d e in o a ino re Pro am aci esse ds. nti al
  • 37. Deposition Of Protein In The Fetus & Maternal Tissues During SITE OF PROTEIN DEPOSITION Pregnancy DEPOSITION (g) BY WEEKS OF GESTATION 10 20 30 40 Fetus 0.3 27 160 440 Placenta 2 16 60 100 Amniotic Fluid 0 0.5 2 3 Uterus 24 55 102 166 Breasts 9 36 72 81 Blood 0 30 102 135 TOTAL 35 165 498 925
  • 38. Omega-3 fatty acids are fats commonly found in marine and plant oils. They are considered essential fatty acids, meaning that they cannot be synthesized by the human body but are vital for normal metabolism. Though mammals cannot synthesize omega−3 fatty acids, they have a limited ability to form the long-chain omega−3 fatty acids including  Eicosapentaenoic Acid  Acid Docosahexaenoic Acid   Acid α-Linolenic Acid
  • 40. DHA is important for development of the central nervous system in all mammals. There is an enormous growth spurt in the human brain during the last trimester of pregnancy and the first postnatal months, with a large increase in the cerebral content of Arachidonic Acid (AA) and DHA. The fetus and the newborn infant depend on a continual maternal supply of DHA and AA.
  • 41. CARBOHYDRATES Principle energy yielding food. ‘Digestible Carbs’ – Sugars & Starches. Carbs ‘Indigestible Carbs’ – Cellulose, Hemicellulose, Carbs Gum, Pectin, Lignin. Foods with carbohydrates in them have a wide range of effect on the blood glucose levels, during digestion. This is known as the ‘Glycaemic Response’ ‘Glycaemic Index’ is the effect of carbs on the blood glucose levels. Rapidly breaking down carbs have high GI, and vice versa.
  • 42. BASED ON NUMBER OF SUGAR UNITS NUMBER OF SUGAR NAME EXAMPLES UNITS Monosaccharides 1 Glucose, Fructose Sucrose, Lactose, Disaccharides 2 Maltose Oligosaccharides 3-10 Raffinose, Stachyose Starch (plant food), Polysaccharides >10 Glycogen (animal food)
  • 43. Should Pregnant Women Go on Low-Carb Diets? Pregnant women should not go on low-carb diets, let alone carb-free diets. In fact, it is recommended that at least half of the calories that pregnant women consume should be carbohydrates. The main reason is because carbs are known to turn to glucose, which is necessary for the unborn baby. Carbs are known to provide the baby with nutrients, protein and healthy fats. All of these are quite essential to the proper development of the baby.
  • 44. Can a Carb-Free Diet Harm an Unborn Baby? What many people do not realize is that a carb-free diet can actually harm an unborn baby. It is highly likely that the baby will not get the nutrients that he or she needs for healthy development when one puts oneself on a carb-free, high- protein diet. When women choose to go on a diet that is high in protein when they are pregnant, their cortisol levels are known to increase. When an unborn baby is exposed to higher cortisol levels, the chances that he or she will have high blood pressure later on in childhood or adulthood increases. Although a low-carb diet may not be as bad, it is important to keep in mind that these same side effects may also affect your unborn baby when you
  • 45. Are There Any Types of Carbs Pregnant Women Should Eat? There are various types of carbs that pregnant women should eat while they are pregnant in order to ensure the ultimate health and development of their baby. Some of these carbs include fruits, vegetables and whole grains. These are what most people refer to as "GOOD CARBS" and ultimately, CARBS are what will provide the baby with the nutrients needed for healthy development.
  • 47. What Types of Carbs Should Pregnant Women Avoid? There are many carbs that pregnant women should avoid, or only eat in moderation. These are what most people call "BAD CARBS." Some of these types of CARBS carbs include donuts, candy, fast food etc. These carbs and known to cause weight gain and gestational diabetes among pregnant women. Although eating bad carbs will not necessarily cause any harm to the baby, they will not provide any health benefits. Eating bad carbs in moderation may not be harmful, but when it comes down to it, one should not eat them too frequently during pregnancy.
  • 49. WHY THE DEVELOPING BABY NEEDS FATS  Babies need a diet high in beneficial fats, as these are their main source of energy.  A baby’s brain, which is around 60% fat, uses nearly three quarters of total dietary energy for growth, whereas an adult's uses only a fifth.  Once born, they’ll get a lot of essential fats from breastmilk, which contains over 50% of its calories as fat.  But while still in the womb, they rely on maternal fat supply.
  • 50. FAT IS ESSENTIAL FOR VITAMIN ABSORPTION Fats act as carriers for fat-soluble Vitamins such as A, D, E and K. Vitamin D Helps Keep Bones And Teeth Healthy. Vitamin E Protects Cell Membranes By Acting As An Antioxidant Vitamin K Helps Wounds Heal Properly As It Helps With Blood Clotting And Also Helps Build Strong Bones
  • 51. BUTTER & OTHER COOKING MEDIA FAT (g/unit) Butter 100 g 81 Ghee 100 g 100 Vegetable Oil 100 g 100 Vegetable Hydrogenated Oil 100 g 100
  • 52. BREADS AND CEREALS FAT (g/unit) Chapati (one) 0.4 Puri (one) 2.8 Paratha (one) 4.1 Aloo ka Paratha (one) 3.5 Cooked Rice (3/4 th katori) 0.1 Khicheri (1 katori) 7.3 Dosa 3.5 Bread large sized (1 slice) 0.7 Dry Cereal (3/4 th katori) 0.3
  • 53. LEGUMES (1 katori cooked dal including veg oil used) FAT (g/unit) Bengal Gram (Channe ki dal) 4.1 Black Gram (Urad ki dal) 4.5 Green Gram (Moong ki dal) 5.6 Lentil (Masoor ki dal) 4.1 Red Gram (Arhar ki dal) 2.0 Sambar 2.1 Chickpea (Kabuli Channa) 6.6 Green Gram (Saboot Moong ki dal) 3.3 Lentil whole (Saboot Masoor ki dal) 2.5 Rajma 5.7
  • 54. VEGETABLE PREPARATIONS (1 katori incld oil used) FAT (g/unit) Matar Paneer (Cottage Cheese with Peas) 10.4 Aloo Matar (Potatoes with Peas) 6.4 Potato curry 6.2 Veg Kofta 13.7 Veg Korma 7.9 Aloo Baingan (Potatoes with Brinjal) 6.7 Carrots 6.0 Pumpkin 6.3 Cabbage 10.3 Ridge Gourd 7.3 Okra 15.0 Bhurtha 8.2 Stuffed Tomatoe 3.4
  • 55. RAW VEGETABLES & FRUITS FAT (g/unit) Green Peas 100 g 0.1 Brinjal 100 g 0.3 Sweet Potatoes 100 g 0.3 Beams 100 g 1.0 All other Vegetables 100 g < 0.3 Apple 100 g 0.5 Pear 100 g 0.2 Most other 100 g 0.3
  • 56. SNACKS FAT (g/unit) 1 Samosa 12.6 1 -1/4 th Upma 11.3 French Fries 90 g 11.3 Palora (4 pieces) 11.0 Besan ka Pura 11.7 Dahi Vada (1) 9.6 Masala Vada (2) 4.6 Poha 1-1/2 katori 13.1 Potato cutlet (1) 5.4 Chaat 10.0
  • 57. MILK PRODUCTS FAT (g/unit) Milk (1 cup) 8.6 2% Milk (1 cup) 4.9 Skimmed Milk (1 cup) 0.2 Buttermilk (1 cup) 2.4 Ice Cream regular (1 cup) 14.1 Yoghurt (1 cup) 9.8 Cottage Cheese (30 g) 1.2 Swiss Cheese (30 g) 7.9 Cheddar Cheese (30 g) 9.1
  • 58. MEAT, FISH & POULTRY FAT (g/unit) Lamb Leg (90 g) 9.4 Lamb Chop (90 g) 15.8 Chicken, white, no skin (90 g) 2.9 Fried Chicken (90 g) 7.9 Fried Liver (90 g) 9.8 Fried Fish (90 g) 12.5 Fish Jhol (1 katori) 2.5 Mutton ball curry (1 katori) 17.6 Prawn curry (1 katori) 6.5 Boiled Egg (1) 5-6 Fried Egg (1) 7-9
  • 59. DESSERTS FAT (g/unit) Halwa (100 g) 15.9 Jelly & Custards (100 g) 1.2 Kheer (150 g) 13.4 Sevian (100 g) 10.0 Suji Kheer (150 g) 14.2 Sriikhand (100 g) 19.7 Sandesh (2 pieces) 9.0 Besan ki Barfi (60 g) 25.4 Chikki (60 g) 12.0 Fruit Cake (50 g – 1 piece) 15.1 Jam Tart (35 g – 1 piece) 9.1 Lemon Tart (55 g – 1 piece) 9.2 Nutty Biscuits (40 g – 2 pieces) 13.8
  • 61. MINERAL DIEARY RDA’S CLINICAL SOURCES MANIFESTATION SODIUM Table salt, Dairy Adults = 1.5 g/dl Only excess loss can products produce deficiency – Muscular cramps, Weakness, Hypovolemia POTASSIUM Bananas, Adults = 4.7 g/dl Weakness, Paraesthesia, Muskmelon, Bael Preg = 4.7 g/dl Arrhythmias. fruit, Citrus fruit, Lactation = 5.1 g/dl Leafy veg, Milk, Meat MAGNESIUM Whole grains, Leafy Men = 400 mg/dl Muscle weakness, veg Women = 310 mg/dl Twitching, Tremors, Preg = 350 mg/dl Numbness, Apathy. Lactation = 310 mg/dl PHOSPHORU Milk, Cheese, Adults = 700 mg/dl Weakness, Fatigue, S Yoghurt, Fish, Preg & Lactation = 700 Leukocyte & Platelet Poultry, Meat, Grains. mg/dl dysfunction, Heart failure, Haemolysis
  • 62. IODINE Seaweeds, Salt water Preg = 220 micro g/dl Thyroid enlargement fish, Shell fish, Lactation = 290 micro Iodised salt g/dl Women = 150 micro g/dl Manganese Nuts, Dry fruits, Women = 1.8 mg/dl Impaired growth & Cereals, Unrefined Preg = 2.0 mg/dl skeletal development, grains, Tea Lactation = 2.6 mg/dl Decline in reproductive function Selenium Seafood, Muscle Women = 55 micro Cardiomyopathy, meat, Cereals g/dl CHF, Striated muscle Preg = 60 micro g/dl degeneration Lactation = 65 micro g/dl Zinc Nuts, Legumes, Women = 8 mg/dl Growth retardation, Meats, Shellfish Preg = 11 mg/dl Poor wound healing, Lactation = 12 mg/dl Hypogonadism
  • 63. TRIMESTER EXTRA ENERGY EXAMPLES OF FOODS NEEDS 1st trimester 100 extra •A large apple OR calories each day •A slice of cheese OR •A glass of milk OR •A piece of bannock 2nd and 3rd 300 extra •A piece of toast with peanut trimester calories each day butter and a glass of milk OR •A small piece of meat or fish with bannock OR •A bowl of vegetable soup with crackers and cheese
  • 64. NOT ENOUGH WEIGHT GAIN TOO MUCH WEIGHT GAIN • Low birth weight baby • High birth weight baby • Early birth • Difficult birth (Feto pelvic disproportion) • Baby may not develop properly • Higher perinatal mortality • Baby may have life-long health problems • Mother may develop gestational diabetes • Higher perinatal mortality • Baby may develop diabetes & cardiac problems in later life •Baby may have mental and behavioural problems
  • 65. Too much caffeine is not good during pregnancy • Coffee, tea and some pop has caffeine • 3 small cups of coffee per day (400-450 mg of caffeine) is safe. • Switch to decaf or try half decaf, half regular
  • 66. Smoking is harmful to the baby • Passive smoking is dangerous • Nicotine causes vasospasm leading to Placental insufficiency. • IUGR • Preterm Birth.