Nutrition, Health & Pregnancy

• Body Mass & Health Mesurements
  • BMI does not distinguish fat from lean muscle
  • Waist to Hip ratio: Max-0.8 (Cardiovascular health)
  • FBS (fasting blood sugar) , TG’s (Triglycerides), HDL
• Weight Charts
  • Set to correspond with the lowest mortality rates
  • Not factored for lifestyle
  • Optimum BMI: 19.8-24.5 (2 fold risk); 21-27 
• Mortality & Weight
  • Positive correlation between weight and mortality. Controlled for smoking. (one goes up/other goes up)
  • Mortality rates up to 35% or higher with BMI greater than 25.
• Chronic Disease & BMI
  • Type 2-diabetes
  • Hypertension
  • Chronic Heart Disease
  • Cholelithisais
  • Postmenopausal breast cancer–all breast cancer
  • Cancer
• Even a gain of 11-22 lbs. can result in an increased RR-Relative Risk of 1.5 to 3 for Chronic Heart Disease, Diabetes, & Hypertension
  • Relative Risk:
    • 1.0 = no increase risk; standard
    • 1.5 = 50% risk over population
    • 2.0 = 100% risk over population
• MyPyramid.gov
• Pre-Pregnancy BMI & (Weight gain recommendations)
  • less than 19.8 = underweight (28-40lbs)
  • 19.8-24.9 = normal weight (25-35lbs)
  • 25.0-29.9 = overweight (15-25lbs)
  • equal to/above 30 = obese (less than/equal to 15lbs)
    • Twins range= 35-45lbs
    • Higher end of range for young/black/S.Asian women
• High risk for poor weight gain groups
  • Smokers
  • Substance users
  • Very young adolesants
  • Poor
  • Busy professional women
  • Multiple gestation
• Pregnancy Risk Related to Overweight
  • hypertension
  • diabetes
  • Cesarean
  • Macrosomia (too big)
  • Shoulder Dystocia (baby shoulder caught)
  • NTD (neural tube defect)
  • Late intrauterine death
  • Infection
• Distribution of weight in pregnancy:
  • 7.5-8.5lbs = fetus
  • 7.5lbs = fat & protein
  • 4.0lbs = blood
  • 2.7lbs = tissue fluids
  • 2.0lbs = uterus
  • 1.8lbs = amniotic fluid
  • 1.5lbs = placenta & umbilical cord
  • 1.0lbs = breasts
  • TOTAL = 28-29lbs
• Weight gain & birth weight
  • when weight gain is within IOM (Institute of Medicine) recommendations incidence of SGA or LBW is reduced.
• Calorie Requirements:
  • After 20 weeks, ADD 300 CALORIES, and 25 GRAMS of PROTEIN to the woman’s non-preg calorie and protein requirements.
• Risk associated with LBW
  • Mortality
  • Mental retardation
  • Cerebral palsy
  • Learning disabilities
  • Neurologic defects
  • Vision/Hearing impairments
  • Stunted growth and development
• Brain growth
  • malnutrition during hyperplasia leads to a decrease in the number of brain cells that is irreversible.
  • BW of 3000 grams is critical
• Alcohol: No known safe level. Avoid all alcohol including beer and wine
• Caffine & Pregnancy: Half-Life prolonged in the fetus; fine, but do not overdue it; 300mg-400mg/day = SAFE amount of coffee and soft drinks
• Pregnancy Requirements:
  • 300Kcal/day
  • 25-60grams protein/day
  • Iron 30mg/day beginning at 12th week
  • Folate 400mcg/day
  • Calcium 1200mg/day (dairy, spinich, supplements)
• Sources of IRON:
  • not enough can cause–anemia
  • Liver, meats, whole grain or enriched breads and cereals, deep green leafy vegetables, legumes, dried fruits
  • take on an empty stomach
  • may cause stools to be black/green
• Sources of CALCIUM:
  • Milk & Yogurt –rich in Ca+
  • Milk, cheese, yogurt, sardines or other fish eaten with bones left in, deep green leafy vegetables except spinach or Swiss chard, calcium-set tofu, baked beans, tortillas
  • Daily Recommendations During Pregnancy
• Nutrition & Prenatal Care
  • 24hr recall
  • Cultural sensitivity
  • Consistancy weighing
  • Set weight goal at initial visit
  • Additional time with high risk groups
• Morning Sickness:
  • Dry crackers/starches
  • Upright after meals
  • Eat slowly
  • Small frequent meals
  • Ginger