REMINDERS• ABSENCES & EXCUSE LETTER

(counter sign)• RECITATION: on-the-spot signing• Feb 3 (THURS): graded recitation• Feb 4 (FRI): MIDTERM EXAM• On Saturday (JAN 8):

– Submission activity and journal review– QUIZ # 2.1 option

• GROUP WRITTEN QUIZ (CLOSED NOTES)– 1 member will be assigned as a “proctor &

checker”

• ROLEPLAYING

LIFE CYCLE LIFE CYCLE NUTRITIONNUTRITIONLIFE CYCLE LIFE CYCLE NUTRITIONNUTRITION

Each stage of the lifecycle has Each stage of the lifecycle has nutritional concerns specific to nutritional concerns specific to the physiological issues of that the physiological issues of that stage.stage.

PREGNANCY

Nutrition in pregnancy: A mother’s nutritional status before and during pregnancy can affect a child’s health for the rest of its life.

GENERAL PHYSIOLOGICAL STAGES

OF PREGNANCY• I. IMPLANTATION (1st 2 weeks)• Implantation of zygote depends on

good nutritional status – prior to conception.

• EVENTS OF PREGNANCY DURING 1ST 2 WEEKS?

• PROBLEMS THAT MAY OCCUR?

This zygote at less than one

week after fertilization is not

much bigger and is ready for

implantation

GENERAL PHYSIOLOGICAL STAGES

OF PREGNANCY• II. ORGANOGENESIS (3rd to 8th

weeks)• Characterized by cell differentiation• Process by which the ectoderm,

endoderm, and mesoderm develop into the internal organs of the organism.

• Nourishment comes from uterine environment and maternal tissues.

(2) After implantation, the placenta develops and begins to provide nourishment to the developing embryo. An embryo five weeks after fertilization is about 1/2 inch long

•EVENTS OF PREGNANCY DURING 3rd to 8th weeks?•PROBLEMS THAT MAY OCCUR?

GENERAL PHYSIOLOGICAL STAGES

OF PREGNANCY• III. FETAL GROWTH (remaining 7

months)• Differentiated tissues continues to grow.• PLACENTA plays crucial role.

– Provides n_____, h_____ & an____ to the fetus.

– Removes w_____ from the fetus.– also secretes hormones and enzymes

that support pregnancy and prepare the mother’s breasts for lactation.

(3)A fetus after 11 weeks of development is just over an inch long. Notice the umbilical cord and blood vessels connecting the fetus with the placenta.

(4)A newborn infant after nine months of development measures close to 20 inches in length. The average birthweight is about 7 1/2 pounds. From eight weeks to term, this infant grew 20 times longer and 50 times heavier.

PHYSIOLOGICAL ADJUSTMENT/CHANGES

• I. HORMONAL SECRETIONS

a)PROGESTERONE• Uterus smooth

muscle relaxation• Gastric motility• Prevents

menstruation

b)ESTROGEN• Uterus growth• Uterine contraction• Triggers fetus

development and bone density

c) ALDOSTERONE• Sodium retention

d) INSULIN• Energy production

and fat synthesise) HUMAN CHORIONIC

THYROTROPIN (HCT)• Thyroid hormone

productionf) THYROXINE• BMR (cellular

oxidation)

PHYSIOLOGICAL ADJUSTMENT

• I. HORMONAL SECRETIONS

f) HUMAN CHORIONIC GONADOTROPIN (HCG)• Pregnancy test

(1wk)• Encourage estrogen

and progesterone• Placenta (2nd

trimester)• gonad development

in the fetus

g) Lutenizing Hormone (LH)• Release of ovum

from ovary• Develops corpus

luteumh) HUMAN GROWTH

HORMONE (HGH)• Nitrogen retention

i) PARATHYROID HORMONE (PTH)• Calcium absorption

j) OXYTOCIN uterus and cervix

PHYSIOLOGICAL ADJUSTMENT

• II. WEIGHT GAIN• Depends on prior weight status.

– Normal weight: 25-35 pounds– Underweight: 28-40 pounds– Overweight: 15-25 pounds– Obese: 15 pounds minimum

• Teen mothers need to gain more because they are still growing.

• Pregnancy is not a time to diet or overeat.

• No one should lose weight during pregnancy.

1st trimester 2nd trimester 3rd trimester

Increase in breast size 2

Increase in mother's 4fluid volume

Placenta 1

Increase in blood supply 4to the placenta

Amniotic fluid 2

Infant at birth 7

Increase in size of 2uterus and supportingmuscles

Mother's necessary 7fat stores

Weight gain (lb)

30

PHYSIOLOGICAL ADJUSTMENT

• III. CRAVINGS AND MORNING SICKNESS

• Different smell and taste sensitivities.

• Morning sickness and other discomforts are due to hormonal changes.

PHYSIOLOGICAL ADJUSTMENT

• IV. BLOOD VOLUME– (RBC & PLASMA) water retention

• V. CARDIOVASCULAR SYSTEM– (HEARTBEAT) blood volume

• VI. RESPIRATION– (FETAL AND MATERNAL OXYGEN

NEEDS) BMR and tissue mass

PHYSIOLOGICAL ADJUSTMENT

• VII. GI FUNCTION– Appetite to meet higher nutrient reqt– Tone and motility (peristalsis) gastric

emptying time reflux, heartburn, nausea, vomiting

– HCL gastric acidity (Ca and Fe)• VIII. RENAL FUNCTION

– Inc waste products, metabolism and circulatory demands Thirst and GFR increases

• IX. METABOLIC ADJUSTMENT– Increase fat utilization and Conserve

glucose

Physical Activity?• Yes, with precautions. • Consult your physician!

NUTRITIONAL NEEDS• “Food energy” and “Balanced

meals” are especially important.– 1st trimester – (no caloric

increase established)– 2nd trimester - extra 300

calories per day– 3rd trimester - extra 300

calories per day

»SPARE PROTEIN

NUTRITIONAL NEEDS• Protein: increase by about 10 extra

grams/day to support growth and development.– The protein requirement is increased

by 20% for the pregnant woman over age 25 (25% for pregnant adolescent).

– Vegans need to be especially vigilant

NUTRITIONAL NEEDS• Carbohydrates: extra 175 g/day

needed to spare protein. Fiber needed to prevent constipation.

• Lipids: omega 3 and omega 6 are vital for nervous system development. BUT - Minimal fish intake is recommended because of the mercury, etc.

NUTRITIONAL NEEDS• Vitamins:

– especially folate 600ug and B12 2.6ug.• Deficiencies result

in neural tube defects (anencephaly; spina bifida)

• Folic acid supplementation prior to conception decreases risk of brain and spinal cord defects.

– Other vitamins essential?•B vitamins•Vitamin C

fetal tissue structure

•Vitamin A 800ug growth of epithelial cells

Food sources of Folate

NUTRITIONAL NEEDS• Minerals:

– Calcium, phosphorus & magnesium mineralization and growth of fetal bones and teeth.

– Iron 27/34/38mg supplement is necessary for RBC production

– Iodine 200ug avoid cretinism– Zinc 5.1/6.6/9.6 mg for protein synthesis and

cell development (cell differentiation and division).

• Supplements: should be prescribed

by doctor; Iron supplements are commonly prescribed.

NUTRITION RELATED PROBLEMS

• I. Prepregnancy weight– Mother too thin: low birth weight

babies with a variety of health problems:• Low IQ, other brain impairments &

learning difficulties• Short stature• Babies under 5 ½ lbs. are 40X more

likely to die in the 1st year.

NUTRITION RELATED PROBLEMS

• I. Prepregnancy weight– Mother too fat: gestational diabetes,

hypertension & infections in the mother. Babies are large (even when premature) and may have:•Heart defects• Neural tube defects*

NUTRITION RELATED PROBLEMS

• II. Gestational Diabetes – Usually develops after 24 weeks– Usually resolves after birth of baby,

but 1/3 develop Type 2 diabetes.– Risk is increased in

overweight/obese women.

• Treatment: insulin vs oral hypoglycemic agents

NUTRITION RELATED PROBLEMS

• III. Pregnancy-Induced Hypertension– Formerly called pre-eclampsia or

toxemia of pregnancy (usually during 3rd trimester)

– Characterized by:• blood pressure• protein in urine• edema of face & hands in addition to feet &

ankles

– May progress into the eclamptic stage “eclampsia” with convulsions, coma, and possible death of the mother and infant

NUTRITION RELATED PROBLEMS

• III. Pregnancy-Induced Hypertension– No clear relationship to dietary intake

but is increased in areas where nutrition is compromised. Inadequate calcium intake may play a role.

– Higher incidence during first pregnancy, multifetal pregnancies, morbidly obese mothers, or those with inadequate diets, especially protein deficient

NUTRITION RELATED PROBLEMS

• IV. Constipation• Caused by relaxed gastrointestinal

tract due to progesterone• Eat a high-fiber diet.• Participate in daily exercise.• Drink eight glasses of water per

day.

NUTRITION RELATED PROBLEMS

• V. Anemia• Anemia is a condition caused by

an insufficiency of red blood cells, hemoglobin, or blood volume.

• Causes weakness, fatigue, poor appetite, and pallor

NUTRITION RELATED PROBLEMS

• V. Anemia• Iron-deficiency anemia is the

most common form.• Folate deficiency may lead to

megaloblastic anemia and is prevented by folate supplement.

NUTRITION RELATED PROBLEMS

• VI. Heart burn• Caused by pressure on the

stomach by the growing fetus and relaxation of the cardiac sphincter.– Eat small, frequent meals.– Avoid spicy or greasy foods.– Avoid liquids with meals.– Wait at least 1 hour after eating to lie

down and 2 hours before exercising.

NUTRITION RELATED PROBLEMS

• VII. Pica• Pica is the craving for nonfood

substances such as starch, clay (soil), or ice.

• Multiple nutritional deficiencies can result from pica.

NUTRITION RELATED PROBLEMS

VIII. Mild nausea/vomiting

• “Morning sickness” occurs most commonly in first trimester.

• Suggestions– Eat dry crackers or dry

toast before rising– Eat small, frequent

meals– Avoid food with

offensive odors– Avoid liquids at

mealtime

VIII. and “Hyperemesis Gravidarum”

• Occurs when the nausea and vomiting becomes so severe that it is life-threatening

NUTRITION RELATED PROBLEMS

• Good nutrition is vital for the mother’s and the developing child’s health throughout pregnancy.

• Nutritional risk factors:– Teen mother/adolescent pregnancy

demands for adolescent growth competes with demands for fetal growth

– Frequent pregnancies, close together– Poor nutrition, smoking– Underweight or overweight before

conception– Gain insufficient or excessive weight during

pregnancy.– Multiple births

WHAT TO AVOID: HARMFUL

SUBSTANCES• Cigarette smoking (including second-

hand): – Decreases vitamin C absorption– Produces toxins - nicotine and cyanide– Causes vasoconstriction– Is associated with low birth weights and

SIDS.

WHAT TO AVOID: HARMFUL

SUBSTANCES• ALCOHOL: abnormalities seen with

intakes as low as 1-2 drinks/day. – Decreased oxygen and nutrient

delivery to fetus.– Slows cell division and damages DNA.– During the 1st month it is detrimental to

brain development.– Often associated with malnutrition in the

mother. (due to malabsorption of nutrients)– Before fertilization, can damage egg and

*SPERM.

WHAT TO AVOID: HARMFUL

SUBSTANCES• Fetal Alcohol Syndrome (FAS)• Alcohol-Related

Neurodevelopmental Disorder (ARND)

• and Alcohol-Related Birth Defects (ARBD)– Irreversible brain damage.– Growth retardation.– Mental retardation, mild to severe.– Behavior abnormalities.– Facial abnormalities.– Vision abnormalities.

HeadSmall head size

EyesExtra skin folds on eyelidsDrooping eyelidsDownward slant of eyesUnusually small eyes and/or eye openingsShort-sightednessInability to focus (“wandering eyes”)

LipsAbsence of groove in upper lip; flat upper lipThin upper lip

EarsUneven in placement and sizePoorly formed outer earBackward curve

JawUnderdeveloped jawReceding chinReceding or flattened upper jaw

NoseShort, upturned noseFlattened nose bridge

ForeheadNarrow, receding forehead

WHAT TO AVOID: HARMFUL

SUBSTANCES• Illegal drugs:• Medicinal drugs and herbal

supplements: – NO, including aspirin and ibuprofen; consult

your physician.• Mega vitamins/minerals: no, especially

vitamin A. Prenatal vitamins – YES.• Dieting: NO

WHAT TO AVOID: HARMFUL

SUBSTANCES• Environmental contaminants: mercury

and lead (some large ocean fish).• Sugar substitutes and caffeine – avoid

or limit.– Caffeine has been shown to cause birth

defects in rats, but no data exist for humans. Limit caffeine intake to < 300 mg/day.

Fulfillment of Nutritional Needs during Pregnancy

• Base diet on MyPyramid.• Drink additional fat-free milk or

appropriate substitute.• Prenatal vitamins and iron

supplement may be prescribed.• Over-the-counter nutrient supplements

may be harmful to the fetus.

END

LACTATION

Secretion of milk by the mammary gland.Commonly referred to as “breastfeeding/ nursing”

PHYSIOLOGY OF LACTATION: Hormonal influence

• Establishment of lactation maintained by “neuroendocrine control mechanism”

• Estrogen and progesterone– breast development

during pregnancy.– After parturition

level of estrogen and progesterone?

• Prolactin or luteotropic hormone (LTH)– Regulation of lactation

and continued milk production or galactopoiesis (progesterone drop)

– Suckling stimulus

• Oxytocin– milk ejection reflex,

or let-down reflex– Suckling stimulus, infant

cry, sight of the infant

PHYSIOLOGY OF LACTATION• OTHER FACTORS AFFECTING

LACTATION:• Development of the mammary

gland• Nutritional status of the mother• Harmful substances: drugs, alcohol,

cigarette• Frequency of feeding• Mother’s attitude towards

breastfeeding and Infant behavior

NUTRITIONAL RECOMMENDATION

• Who has most nutrient needs? Pregnant or Lactating mothers?

• CALORIE:• Milk production

requires energy.• +500 calories/day

are needed for lactation– To fortify milk with

energy– To support milk

production– For maternal adipose

tissue storage

• Average energy content of human milk is about 70kcal/100ml.

• During lactation, mothers lose the extra fat stores. BUT low calorie intake will hold back milk production.

• PROTEINS:Pregnant or Lactating mothers?

• +16 grams (1st 6 months lactation) to 12 grams (7th month onwards)

NUTRITIONAL RECOMMENDATION

• FAT:• 20-35% of total

calories or TER• Choose high in

polyunsaturated fatty acids for infant brain development

• FLUID INTAKE:• Average 2.5 L/day.• Increase intake of

fluids to prevent dehydration

• Minerals: Calcium, Phosphorus, Iron, Iodine, Selenium, Zinc

• AVOID:• Caffeine, alcohol,

smoking and most drugs except prescribed by the doctor. (Why still to be avoided?)

• VITAMIN and MINERAL supplementation: Only lactating women with poor diet and nutritional status.

Fig. 13-4, p. 486

Human BREAST MILK: Colostrum and Mature milk

• COLOSTRUM• TRANSITIONAL

MILK• MATURE MILK

– FOREMILK – HIND MILK

• Human milk is formulated to meet the nutrient needs of infants for the first 6 months of life.

• Comparison between Colostrum and Mature milk?

Composition of Mature Milk

HUMAN MILK VS FORMULA MILK or

COW’s MILK

• immunologic components AND enzymes

The immunologic components include ;-Immunoglobulins ; Human milk contains all of the different antibodies, but secretory immunoglobulin A (sIgA) is the most abundant .- lactoferrin; which binds to iron, thus making it unavailable to pathogenic bacteria;- lysozyme , which enhances sIgA bactericidal activity against gram-negative organisms;- Mucins adhere to bacteria and viruses and help eliminate them from the body. - Leukocytes; with the transition from colostrum to mature milk, the percentage of macrophages increases from 40-60% of the cells to 80-90% .

BENEFITS OF BREASTFEEDING• Breast milk has the

perfect composition for a baby’s needs.

• No babies are allergic to their mother’s milk.

• Lower incidence of ear infections, diarrhea, allergies, and hospital admissions

• Breastfed babies receive antibodies from breast milk.

• Promotes good jaw development

• Decreases risk of obesity later in life

• Most infections, treated properly, are not transmitted via breast milk. Exception - HIV.

• Facilitates bonding• Helps lose the weight

gained during pregnancy• Stimulates uterus to

contract back to its original size

• Breastfeeding is economical.

• Milk is always at the right temperature and is readily available.

Why is mothers milk preferred • 1- Its high nutritional.• 2- It is rich in immunological components

that protects the infant from infections.• 3- It is supplied by mother at the best

temperatures.• 4-It is sterile.• 5-It is cheap• 6-It is not liable to adultration. • 7-It has dramatic psychological effects on

both the mother and infant.• 8- It reduces the risk of developing breast

cancer.

TIPS IN BREASTFEEDING: Latching on and breast

feeding positions• WATCH THE VIDEO CLIP

Conclusion• A pregnant woman is most

likely to remain healthy and bear a healthy infant if she follows a well-balanced diet.

• Anemia and PIH are two conditions that can be caused by inadequate nutrition.

• Caloric and most nutrient requirements increase for pregnant and lactating women.

END• GROUP SEATWORK # 2.1