1431 Introduction

As previously mentioned, use of MVMM during pregnancy is very common in the United States. In addition, programs to distribute MVMM in developing countries are thought by some to be desirable for the purposes of increasing birth weight and decreasing perinatal mortality. In this section, we summarize the evidence for benefit of the consumption of these multinutrient supplements during pregnancy. Fig. 14.1. Simplified illustration of the relationship among nutrient intake levels, Recommended...

121 Macronutrients 1211 Energy

Energy needs during pregnancy vary according to a woman's basal metabolic rate, prepregnancy weight, amount and composition of weight gain, stage of pregnancy, and physical activity level. It is estimated that on average a pregnant woman requires a total of 85,000 additional calories over the course of 40 weeks of pregnancy, which extrapolates to approximately 300 extra calories per day 3 . For most women, however, energy needs in the first trimester of pregnancy are minimal. While the first...

123weight gain

HIV-infected pregnant women tend to gain less weight during pregnancy compared with women who are not infected 4 , putting them at higher risk for complications. Additionally, HIV infection is oftentimes associated with wasting and a progressive loss of body mass 18 . This can lead to adverse pregnancy outcomes. Weight loss or suboptimal weight gain during pregnancy is related to increased risk of intrauterine growth retardation (IUGR) 10 , fetal death, preterm delivery, and low-birth-weight...

62considerations for bariatric surgery

Bariatric surgery is reserved for individuals who are severely obese as defined by body mass index, or BMI. The BMI is calculated by dividing a patient's weight in kilograms by the square of their height in meters. Alternatively, BMI equals the patient's weight in pounds divided by the square of their height in inches and multiplied by 703. BMI is measured in units of kg per m2. A BMI between 18 and 25 kg m2 is considered normal. Individuals are considered candidates for bariatric surgery when...

1913 micronutrients and postpartum depression 19131 Iron

Iron is a component of hemoglobin in red blood cells (RBC) and as such, an iron deficient diet can result in iron deficiency anemia characterized by the production of RBC that do not contain a full complement of hemoglobin and are inefficient at delivering oxygen to cells. Pregnancy and childbirth place women at risk for iron deficiency anemia due to a marked blood volume expansion during pregnancy, increased maternal needs, fetal requirements, and blood loss associated with childbirth. Iron...

112hypertensive disorders of pregnancy

Complications from hypertension are a leading cause of pregnancy-related deaths, ranking third behind hemorrhage and embolism 2 . Hypertensive disorders that may be found during pregnancy include chronic hypertension, preeclampsia- From Nutrition and Health Handbook of Nutrition and Pregnancy Edited by C.J. Lammi-Keefe, S.C. Couch, E.H. Philipson Humana Press, Totowa, NJ eclampsia, preeclampsia superimposed on chronic hypertension, and gestational hypertension 3 . Chronic hypertension is...

74 confounding variables

There are many confounding variables that can contribute to birth weight and early neonatal outcomes in multifetal pregnancies. All multifetal pregnancies can be considered high risk because of the increase of many obstetrical complications, compared with those of singleton pregnancies. Maternal complications include preeclampsia, hypertension, gestational diabetes, placenta previa, abruptio placenta, cesarean birth, and maternal mortality. For the fetuses, the risks include prematurity, low...

1871 Background

The most well appreciated function of vitamin D is to maintain normal blood calcium and phosphorus concentrations thereby promoting bone health. Vitamin D can be obtained from food, or synthesized in the skin by exposure to ultraviolet light. Solar ultraviolet-B (UVB) photons are absorbed by 7-dehydrocholesterol in the skin, transformed to previtamin D, and then rapidly converted to vitamin D. Total body exposure to 10-15 min peak sunlight during the summer months in a Caucasian is equivalent...

951 Energy and Macronutrients

Energy needs increase in the last two trimesters to support the maternal and fetal products of pregnancy as well as spare protein to build these new tissues. Weight gain serves as a proxy indicator that these tissues have developed normally (see Chap. 2, Optimal Weight Gain). What is unique in AN is the controlled intake of food energy in those with restricting type. Intakes of 200-700 kcal per day, typical of an individual with restricting-type AN, are simply inadequate to supply the energy...

102historical background

Before 1921, women with diabetes were advised to avoid pregnancy or to abort if they conceived because of adverse perinatal outcomes. If the pregnancies advanced to the stage of fetal viability, the infants were often stillborn or were born with major malformations. Medical nutrition therapy was the primary method of management for pregnant women with diabetes prior to 1921 however, the diets were often severely restricted or nutritionally unbalanced. These dietary approaches varied from high...

54 weight gain recommendations and consequences of noncompliance

In 1990, the IOM issued recommendations for weight gain during pregnancy based on prepregnancy weight status 3 . The goal of these recommendations was to optimize neonatal birth weight to between 3 and 4 kg and prevent the morbidity and mortality associated with low birth weight (LBW). According to these recommendations, an underweight woman (based on WHO BMI criteria above) should gain 28-40 lb (12.5-18 kg), a normal weight woman should gain 25-35 lb (11.5-16 kg), an overweight woman should...

99 nutrition intervention

Working from nutrition diagnoses, areas for nutrition intervention that will positively alter behaviors, reduce risks, and improve and or promote the health of the mother and fetus can be identified. Pregnancy can provide a unique opportunity to improve AN or BN behaviors if interventions focus on fetal nutritional requirements 45, 47, 55 , fetal growth and development 45, 46 , and relationships among maternal body weight gain, shape changes, and fetal growth 47 . Planning individualized,...

Transition in the Nutritional Status on Pregnant Women

Jaime Rozowski and Carmen Gloria Parodi Summary In most developing countries, including Chile, an epidemiologic and nutrition transition has taken place, the former characterized by an increase of the population due to a reduced mortality, followed by a decrease in fertility and an increase in longevity. The nutrition transition has been characterized by an increase in the consumption of fats and simple sugars and a decrease in fruit and vegetable intake. This, together with a decrease in...

197 phenomenology of postpartum depression

Loss of control is the basic problem women grapple with when suffering from postpartum depression 29 . Mothers try to resolve this loss of control in a four-stage process as outlined in Fig. 19.1 29, 30 . In the first stage, mothers are bombarded with horrifying anxiety, relentless obsessive thoughts, and difficulty concentrating. In the second stage, women feel that their normal selves are gone. The women describe feeling unreal, like they were just robots going through the motions caring for...

Alyce M Thomas

Summary Diabetes mellitus is the most common complication in pregnancy, affecting nearly 8 of all pregnancies. Nearly 90 of women with diabetes develop the condition during pregnancy diabetes in the other 10 antedated the pregnancy. Since the discovery of insulin, perinatal mortality rates for women with diabetes have decreased, however, infant morbidity remains higher than in the nondiabetes pregnant population. Diabetes in pregnancy can be classified as type 1 diabetes, type 2 diabetes, and...

84 nutrient needs of the pregnant adolescent

Nutrition screening and assessment is a cornerstone for comprehensive prenatal care for all pregnant adolescents. Adolescence is a period of rapid physical growth, with heightened nutritional requirements to support growth and development. The additional energy and nutrient demands of pregnancy place adolescents at nutritional risk 13 . The physiological and psychosocial immaturity of the teen compounds the potential for obstetric risks and complications 13 . Nutrition screening and counseling...

References

World Health Organization WHO , United Nations' Children's Fund, United Nations' Population Fund. 2004 Maternal mortality in 2000 estimates developed by WHO, UNICEF, UNFPA. World Health Organization, Geneva, Switzerland 2. Ronsmans C, Graham WJ, on behalf of the Lancet Maternal Survival Series steering group 2006 Maternal mortality who, when, where, and why. Lancet 368 1189-1200 3. Campbell OMR, Graham WJ, on behalf of the Lancet Maternal Survival Series steering group. 2006 Strategies for...

18114 Sources of LCPUFAs

Meat and eggs are rich sources of ARA, while EPA and DHA are derived mainly from fatty fish such as mackerel, salmon, herring, trout, and sardines. Several foods are available that have added omega-3 fats including eggs, milk, yogurt, cheese, pasta, and bread. There is considerable concern about increasing the omega-3 series LC-PUFAs via fish consumption during pregnancy and lactation because of the possible risk of contaminants. This issue, for the most part, centers on the methylmercury and...

37 the elite athlete

The elite athlete experiences limitations and physiological changes in pregnancy similar to the recreational athlete, including ligament relaxation, change in posture, and weight gain. These changes may in turn impact a woman's competitive ability and increase her desire for strenuous training, making her more prone to injury 12 . The elite athlete should be aware that pregnancy is not a time for improving competitive fitness, but instead she should focus on remaining physically active,...

551Weight Loss Strategies for Prepregnancy and Postpartum

Weight loss is not recommended during pregnancy however, overweight and obese women should be advised to aim for a moderate weight loss prior to conception and postpartum. To help motivate women in their efforts, health care providers and obstetricians should clearly define the risks associated with overweight and obesity in pregnancy and beyond. Consultation with a registered dietitian RD should be considered, as these individuals can provide assistance in the assessment of current eating...

234Total Energy Cost of Pregnancy

The total energy cost of pregnancy in well-nourished women has been estimated from the sum of BMR or TEE and energy deposited in laying down maternal and fetal tissues 14 . Gestational weight gain is a major determinant of the incremental energy needs during pregnancy because it reflects not only energy deposition, but also the increase in BMR and TEE resulting from the energy cost of metabolism and moving a larger body mass. Using the gestational weight gain recommended by IOM for pregnant...

Elliot H Philipson

Summary All multifetal pregnancies can be considered high risk due to frequent obstetrical complications associated with this type of pregnancies. Nutritional assessment with current dietary recommendations and specialized antenatal care are important for a good outcome. Maternal weight and weight gain are also important factors, but nutritional supplements, assessment of calorie intake, and adjustments as needed are crucial as well. Confounding variables must be considered, particularly when...

65 nutrition deficiencies after weight loss surgery

Deficiencies in vitamins and other nutrients are common after bariatric surgery, particularly with RYGB and BPD-DS, since these operations result in decreased intestinal surface area and bypass the duodenum Fig. 6.5 . Since BPD-DS results in more significant malabsorption than does RYGB, there are more nutrient deficiencies reported among BPD-DS patients. Although not as prevalent, nutritional deficiencies have also been reported after AGB and SG, primarily because of decreased food intake and...

39fuel utilization in exercise and pregnancy

Measurements by indirect calorimetry reveal preferential use of carbohydrates during exercise in pregnancy 53 . The respiratory exchange ratio RER reflects the ratio between CO2 output and oxygen uptake VO2 . The RER provides information on the proportion of substrate derived from various macronutrients. For carbohydrate to be completely oxidized to CO2 and H2O, one volume of CO2 is produced for each volume of O2 consumed. An RER of 1 indicates carbohydrates are being utilized, while an RER of...

536 Macrosomia Shoulder Dystocia and Fetal Death

Several large US population-based cohort studies have shown a significant relationship between progestational BMI and macrosomia, which is defined as a birth weight gt 4,000 g or above the 90th percentile 40, 44-46 . Risk for having a macrosomic infant appears to increase in mothers with degree of excess weight. For example, in the multicenter study by Weiss et al. 31 , the incidence of macrosomia was 8.3 in nonobese women, 13.3 in obese women, and 14.6 in morbidly obese women. In the study by...

Optimal Weight Gain

Coppage Summary Optimal birth weight and outcome are influenced by maternal weight gain. Low gestational weight gain is associated with poor fetal growth and risk of preterm delivery. Excessive weight gain affects infant growth, body fatness in childhood, and the potential for postpartum weight retention and future obesity. Guidelines from the Institute of Medicine recommend that a woman with a normal body mass index BMI of 19.8 to 26 should gain 11.5-16 kg 25...

14 development of a food pattern meeting nutrient recommendations

The key recommendations in the 2005 Dietary Guidelines regarding nutrient adequacy emphasize the importance of consuming a variety of nutrient-dense foods and beverages within and among the five basic food groups. The 2005 Dietary Guidelines Advisory Committee recognized, however, that the general public would benefit from guidance on specific food patterns that meet the DRIs. The Dietary Guidelines' key recommendations emphasize the types of foods to select, but lack the specificity needed by...

41 introduction

The traditional wisdom of many cultures relates that what women eat while they are pregnant or lactating can have long-lasting effects on their children. Many of these food traditions evolved to protect and provide strength to both mother and child because of the high mortality that was typically associated with pregnancy and the early postpartum period 1 . Although there is little science-based evidence to support their efficacy, these practices, which revolve around a cuisine that combines...

22 gestational weight gain recommendations

Although the need for appropriate weight gain during pregnancy has long been recognized, recommendations for weight gain have changed over the years as new data have become available. The changes in recommended ranges for gestational weight gain are summarized in Table 2.1. Prior to 1970, it was standard obstetric practice to restrict gestational weight gain to between 18 and 20 lb 8-9 kg 2 . Overeating was believed to cause large babies and, as a consequence, more difficult deliveries. In...

Sarah C Couch and Richard J Deckelbaum

Summary Obesity in pregnancy is associated with numerous maternal and neonatal complications including difficulty conceiving, increased risk of miscarriage, fetal anomalies and mortality, higher rates of gestational hypertension, gestational diabetes and preeclampsia, and an increased risk of cesarean section and delivery related complications. Nevertheless, more women are entering pregnancy with excessive weight and are gaining weight above the Institute of Medicine IOM recommendations during...

Preface

Handbook of Nutrition and Pregnancy is written for the clinician and other healthcare professionals who treat and counsel pregnant women and women of childbearing age. Thus, physicians, physicians' assistants, nurses, and dietitians, in particular, as well as dietetic students and graduate and medical students, will find this book a useful resource. In addition to the historical perspective and background to support recommendations that are provided in each chapter, important for the...

1 Nutrient Recommendations and Dietary Guidelines for Pregnant Women

King Summary The requirements for selected nutrients increase appreciably during pregnancy. The recommended intakes for the following nutrients are gt 25 higher than are the amounts recommended for nonpregnant women protein, a-linolenic acid, iodine, iron, zinc, folate, niacin, riboflavin, thiamin, and vitamin B6. The needs for protein, iron, folate, and vitamin B6 are about 50 higher. Good food sources of these nutrients are grains, dark green or orange...