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The module presents the roles of nutrition in fostering proper fetal growth,
development and long-term health; it discusses the physiology of the
different stages of pregnancy and the nutrient requirements at each stage.
The discussion covers common problems during pregnancy with nutritional
measures to address them.
Learning objectives:
1. Describe the physiological changes/adjustments during pregnancy
2. Discuss the nutritional requirements during pregnancy as basis for
meal planning.
3. Discuss the nutritional concerns/problems during pregnancy and
measures to address them.
Topics
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Physiology of pregnancy
Characteristics of Pregnant woman
Recommended Energy and Nutrient Requirement
Food Guide Pyramid
Monitoring weight
Nutritional Concerns
Myths and Facts
Definition of Terms
1. edema - the build-up of excess fluid in extracellular spaces
2. hemodilution - "physiological anemia of pregnancy" resulting from
increased blood volume
3. heartburn - a pain emanating from the esophagus as a result of
stomach acid backward flow into the esophagus causing irritation of
the esophageal lining
4. glomerular filtration rate - measure of the amount of blood filtered
by the cup-like glomerulus at the head of each kidney nephron, per
unit of time.
5. insulin resistance - a condition in which cells "resist" the action of
insulin in facilitating the passage of glucose into cells.
6. basal metabolic rate - the rate at which the body uses energy to
support all the involuntary activities that are necessary to sustain life
like circulation, respiration, etc. Basal metabolism is the largest
component of the average person's daily energy expenditure.
Introduction
Pregnancy is the period during which the fertilized ovum implants itself in
the uterus, undergoes differentiation, and grows until it can support extrauterine life. It lasts for 266-280 days or 37-40 weeks. The three stages of
pregnancy are:
. Implantation- the first two weeks of gestation when the fertilized ovum
becomes imbedded in the wall of the uterus and the placenta develops
. Organogenesis- the next six weeks of pregnancy where vital organs
develop or undergoes differentiation.
. Growth- the remaining 7 months of pregnancy, characterized by rapid cell
division and development
Characteristics
Pregnancy is accompanied by anatomic and physiologic changes that affect
almost every function of the body. Most of these changes occur in the early
weeks of pregnancy.
1. Blood volume and composition
Plasma volume increase to about 50% greater than it was at conception by
34 weeks of gestation. Red cell production is stimulated and thereby
increases during pregnancy. Since the increase in red cell volume is
proportionately less than the increase in plasma volume, the concentration
of red cells in the blood as well as the hemoglobin declines. This is referred
to as "hemodilution" or "physiological anemia of pregnancy".
2. Changes in the Cardiovascular system
During the first half of pregnancy, there is a decrease in both systolic and
diastolic pressure by 5-10 mm Hg. The decrease is probably the result of
peripheral vasodilation brought about by hormonal changes during
pregnancy.
3. Respiratory changes
Maternal oxygen requirements increase in response to the acceleration in
metabolic rate and the need to add to the tissue mass in the uterus and
breast. The pregnant woman breathes deeper (greater tidal volume) but
increases the respiratory rate only slightly.
4. Gastrointestinal function
There are changes in the functioning of the gastrointestinal tract which result
to an increase in appetite, occurrence of nausea and vomiting, diminished
gastro-intestinal motility, reduced intestinal secretion, altered sense of taste
and enhanced absorption of nutrients.
Increased progesterone production causes decreased tone and motility of
the stomach muscles. This leads to esophageal regurgitation, decreased
emptying of the stomach, and reverse peristalsis. As a result, the pregnant
woman may experience heartburn. The decreased smooth muscle tone also
results in an increase in water absorption from the colon and constipation
may result.
5. Hormonal Changes
Progesterone and estrogen are two hormones that have major effects on
maternal physiology during pregnancy. The chief action of progesterone is to
cause a relaxation of the smooth muscles of the uterus, so it can expand as
the fetus grows. The secretion of estrogen is slower than that of
progesterone during the early months of pregnancy. Its role is to promote
the growth and control the function of the uterus. Because of estrogen,
many pregnant women complain of excess fluid retention in the skin, or
edema.
6. Metabolic adjustments
The metabolic rate usually rises by the fourth month of gestation, although
small increments may occur before that time. The elevation in BMR reflects
increased oxygen demands of the uterine-placental fetal unit as well as
oxygen consumption from increased maternal cardiac work.
2ND 3RD
+300 +300
66 66
800 800
80 80
1.4 1.4
1.7 1.7
18 18
600 600
800 800
34 38
200 200
Weight (kg)
3.0-3.3
.65
.8
.9
.4
1.2
.9-1.4
.5-2.5
11-12 kg
Management:
-high fiber foods
-drink plenty of water
e. Rapid weight gain or loss
Weight gain of 3 kg or more per month. This may be brought about by the
belief that a pregnant women is eating for two. On the other hand, failure to
gain weight of 1 kg every month during the first trimester is also a "risk
factor". The ideal total weight gain for the three trimesters is 24 lbs
Management:
-moderate calorie restriction for overweight
-increase consumption of nutrient-dense foods
f. Toxemia
Pregnancy-induced hypertension. It maybe a cause of maternal death, prenatal death and low birth weight infants
Symptoms:
-Rapid weight gain
-edema
-high blood pressure
-excretion of albumin in the urine
Management
-optimum nutrition
-protein foods of high biologic value
-adequate iron, calcium intake
g. Anemia
Lack of iron-rich foods; impairment in absorption and utilization of Fe as well
as vitamin B12 and folic acid
Management:
-increase intake of iron-rich foods like liver, green vegetables
-iron and folic acid supplementation
h. Gestational diabetes
An elevation of blood sugar (glucose) levels that occur during pregnancy but
returns to normal after delivery. The cause of gestational diabetes is not
known. But the condition is linked to the hormones from the placenta that
help the baby develop. These hormones also block the action of the mother's
insulin in her body. Glucose builds up in the blood to high levels. This
condition can be managed by eating a balanced diet, i.e. selecting foods that
do not elevate blood sugar levels very much.
Key Words
Implantation Organogenesis Growth Hormonal changes Pica