Nutrition in pregnancy

K.Andelova
The Institute for the Mother and
Child
Prague

Nutrition in pregnancy
The undeveloped countries with poor
nutritional status of mothers
The developed countries with the
owerweight and obesity and
micronutrient deficienses
Macronutrients-energetic substratescarbohydrates,proteins,fat
Micronutrients minerals,trace
elements,vitamins,folic acid,-3 fatty
acids (?)

The influence of mother

nutrition

Perinatal mortality
Perinatal morbidity
Intrauterine growth
retardation(IUGR) versus large for
gestational age(LGA) babies

Fetal programming of later diseases

in childhood and in adulthood

Important data
Sociodemografic data
Personal medical history (obstetric
history)
Dietary habits and weight changes
Abuses
Physical routine examination and
laboratory screening
Physical activity
Using of nutritional supplements

Maternal metabolic
changes
Gastric motility and gut motility
The changes in absorption of
nutrients
The changes of kidney functions
The changes of plasma levels of
proteins,minerals,aminoacids,hor
mones
The changes of apetite
The vomiting in pregnancy

Weight gain in
pregnancy
Normal weight gain in singleton
pregnancy-12kg
Normal weight gain in multiple
pregnancy- up to 18 kg
75%-fetus,placenta,amniotic
fluid,uterus,expanded volume of
circulating fluid,blood
elements,breasts
25%- adipose tissue

Macronutrients
Recommended energy intake 2500
kcal/day (200-600kcal increasing)
No extreme reducing diet in course of
pregnancy
-------------------------------------------------------------- Carbohydrates(50-60%)-the main
energetic substrate for fetus is
glucose
Proteins(20-25%)-lean body mass
Fat(20-25%)-energy supply

Micronutrients
Vitamines(B 12,B 6,A,D)
Minerals(Ca)
Trace
elements(Iron,Iodine,Zinc,Seleni
um,Copper)
Folic acid
-3 FFA

Vitamines
B12 vit.-IUGR,impaired b-cell function,CV
risk
A vit.-excessive intake-fetal malformation
E vit.-placental transport of hormones
D vit.-cofactor for Ca
homeostasis,reduced intrauterine growth
of long bones,shorter gestation,lower
birth weight and reduced bone mass in
childhood,kidney maturation
B6,B1-less importance

Trace elements(1% of
body mass)
Iron-anemia(plasma
level,ferritin,transferin)
Very common in pregnancy(second nad
third trimester)
Preterm delivery,postpartum
inflammative complications,
The fetus is partly protected
Factors indicate the increased risk
history of strong menstrual
bleeding,low meat diet,blood
donors,aspirin use,multiple
gestation,teenager pregnancy

Trace elements
Iodine essential part of thyroid
hormones(thyroxine
,triiothyronine)
Mental
disturbances,hypothyreosis,stillbirt
h,abortions,congenital
malformations
Urinary iodine excretion
Content of iodine in soil
Addition of iodine in table salt

Trace elements
Zinc-component of many enzymes
Signs of depletion-growth
restriction,impaired healing,skin
lesions,diarrhea,impaired imunne
functions,behavioral
disturbances,teratiigenic effect,preterm
delivery,hypertension
Increased risk for zinc depletion in smokers
Selenium-part of enzymes(gluthatione
peroxidase)
Cardiomyopathy(Keshan disease)
No special supplementation reccommended

Calcium and sodium

Calcium-99% in bones and teeth

Bone developement
Cardiovascular disease
Hypertension
Preeclamsia
Sodium-decreased excretion,no
special supplementation necessary
Connection to hypertensive
disorders

Folic acid
Periconceptional supplementation of
folic acid
Avoiding of neural tube defects and
other congenital malformations
Normal fetal growth
Antibody formation
Epilepsy in pregnancy-supplementation
Sterility and infertility
Future disease-cardiovascular,renal

Recommended
supplementation
Vitamin D 1ug/day
Iron 30-120mg/day-normal diet
has 6mg/1000 kcal
Iodine 200mg/day (250)
Zinc 15mg/day
Calcium 1200mg/day
Folate 500ug/day

The special dietary

counseling

Obese women
Diabetic pregnant patients
Patients with liver disease
Hypertension
Patients with metabolic disease
Patients with intestinal disease
Vegetarians
The patients with nutritional
disturbances bulimia or anorexia
The other special health conditions