Chapter 15

NUTRITION IN
PREGNANCY AND
LACTATION
Rachel Melo
BTVTEd FSM 1B
INTRODUCTION
Of all the periods in the human life cycle, the
period of pregnancy is the most critical and unique.
It is critical because during pregnancy, the
foundations of a new life is being laid that will
influence the future of succeeding generations.
Pregnancy has social importance affecting not only
individuals but also their families and society as a
whole.
PHYSIOLOGICAL BASIS OF
NUTRITIONAL NEEDS IN PREGNANCY

Pregnancy or gestation is the period

from conception to birth and for human
beings last from 38 to 42 weeks. It is often
divided into thirds or trimesters, first, second,
third trimesters. Pregnancy has three stages
namely, implantation, organogenesis and
growth.
 Blood Volume and Composition
Plasma volume begins to increase towards the
end of the first trimesters and by 34 weeks it is 50%
greater than at conception.
Women who have a small increase in plasma
compared with the average were more likely to have:
• stillbirths
• abortions
• low birth weight babies
 The Circulatory System
There is slight cardiac hypertrophy or
dilation due to increased blood volume and
cardiac output.
Cardiac output increases from 30-50%
by the 32nd week of pregnancy and declines
to about 20% increase at 40 weeks.
 Respiration
Maternal oxygen requirements increase due to
acceleration in basal metabolic rate and the need to
add tissue mass in the uterus and breast.
As the capillaries become engorged, edema and
hyperemia (excess of blood in a part of the body)
develop in the nose, pharynx, trachea and bronchi
causing congestion in the tissues of the respiratory
tract.
Thoracic breathing replaces abdominal
breathing with advancing pregnancy.
 Renal Function
Blood flow through the kidneys and the
glomerular filtration rate are increased
during pregnancy to facilitate the clearance of
waste products of fetal and maternal
metabolism.
 Gastrointestinal Function
May occur during the first trimester of pregnancy due to
hormonal changes.
• Loss of appetite
• nausea and
• vomiting
The smooth muscles of the gastrointestinal tract decreases in
tone and motility due to the increased progesterone levels leading
to esophageal regurgitation; decreased emptying time of the
stomach and reverse peristalsis. The pregnant woman may
experience heartburn as a result of this.
There is decreased emptying time of the gallbladder and this
condition together with hypercholesterolemia due to increased
progesterone, may be the cause of frequent gallstones during
pregnancy.
 Hormones
• The Pregnant woman secretes more than 30 different
hormones during pregnancy.
• Progesterone causes relaxation of the smooth muscles of
the uterus and other smooth muscles in the body.
• The role of estrogen is to promote the growth and control
the function of the uterus. It changes the structure of
mucopolysaccharides in connective tissues increasing its
affinity to water.
• Insulin affects blood glucose levels by facilitating its
transport into cells to be used for energy or fat synthesis.
 Weight Gain
All women need to gain weight during
pregnancy for fetal growth and maternal
health. Maternal weight gain during
pregnancy is closely related to the birth
weight of the infant that is a strong predictor
of the health and future development of the
infant.
 The Role Of The Placenta
The placenta plays an active role in
reproduction and is not a passive barrier between
the mother and the fetus. It is the principal site
for the production of several hormones that
regulate maternal growth and development. It is
the only way that nutrients transfer are similar
diffusion: facilatated diffusion, active transport
and pinocytosis.
 Nutrient Requirements
Nutrient needs during pregnancy and lactation are higher
than at any other time for most women.
Energy- The two factors that determine energy requirements are
the mothers usual physical activity and the increase in metabolic
rate to support the work required for growth of the fetus and the
accessory tissues. The cumulative cost of this extra work is 80,000
calories. This translates into about 300 kcal per day.
Protein- This nutrient is essential as it forms the structural basis
for all new cells and tissues in the mother and fetus. Protein
requirements are based on the needs of the non-pregnant woman
used as a reference plus the extra amounts needed for growth.
Vitamins- The vitamins are important during pregnancy, the most
importantly cited are folic acid, ascorbic acid and the B-vitamins.
VITAMINS Recommended Daily Allowance for
Pregnancy Women
Ascorbic acid 80 mg
Thiamin 0.3 mg
Riboflavin 1.6 mg
Niacin 21 mg
Folic acid 0.4 mg
Vitamin B6 1.9 mg
Vitamin A 475 mcg
Vitamin D 5 mcg
Minerals
Iron 41 mg
Calcium 900 mg
Magnesium 360-400 mg
Iodine 125 mcg
Zinc 15 mg
Fluoride 3-10 mg
 COMMON NUTRITION-RELATED
CONCERNS DURING PREGNANCY
Nausea and Vomiting
During the early part of pregnancy, the most common
discomfort is “morning sickness,” so called because nausea
and vomiting usually occur immediately after gettting up in
the morning.
Heartburn
This is a common complait the lattr part of pregnancy,
which is due to pressure of the enlarged uterus of the
stomach.
Constipation
This is due iin part to the pressure exerted by the
developing fetus on the digestive tract, lack of exercise, and
insufficient bulk (dietary fiber) and the fluid intakes.
Edema
Mild, phyiological edema is usually present in the
extremities in the third trimester.
Leg Cramps
It occurs usually at night, manifested by sudden
contractions of the gastrocnemius muscle.
Rapid Weight Gain or Loss
The popular “eating for two” is not valid among well-
nourished mothers. It may lead to overweight with
consequent toxemias or PIH (Pregnancy-Induced
Hypertension), difficulties of labor and birth of large,
sickly babies.
Pregnancy-Induced Hypertension (PIH)

Rapid weight gain, edema, high blood pressure,

excretion of albumin in the urine, and convulsions are the
clinical manifestations of PIH The old terminplohy for PIH
is toxemia of pregnancy. It classifications are:
1. Pre-eclampsia - hypertension with proteinuria and\or
edema
2. Eclampsia - convulsions or coma; usually both when
associated with hypertension, proteinuria, edema
PIH complicates about 5% of pregnancies is among
the leading causes of maternal deaths, and low birth-
weight infants.
Anemia
The classic macrocytic of preganancy
represents a combines of iron and folic acid. The
newborn becomes anemic also and there is
increased chance of premature birth.
Gestational Diabetes Mellitus
For some pegnant women, diabtes may occur
as a temporary response to the stress and it
disappears after the baby is born. As many as 10%
of pregnat women may experience gestationa
diabetes.
 SUMMARY OF NUTRIRIONAL
CARE DURING PREGNANCY
• Energy intake must allow weekly gain of about 0.4 kg for the last 30
weeks of pregnancy.
• Protein intake must be increased by an additional 10 mg/day,
preferably form food sources with high biological value.
• Sodium intakes is at least 2000 mg/day.
• Minerals, especially iron and folic aid requiremnts which are
difficult to be provided by usual diets, need supplementation under
the physician's care.
• Alcohol consumption is omitted due to adverse results to the fetus.
• Caffeine intake is limited or restricted to 200 mg/day (2 cups of
coffee OR equivalent in other caffeine-containing drinks).

Related to good diet are regular light execises, adequate rest and
sleep and avoiding stress/infections.