Estimated Energy Requirements

The incremental energy cost of lactation is determined by the amount of milk produced (exclusivity and duration), the energy density of the milk secreted, and the energy cost of milk synthesis 6 . The Estimated Energy Requirements (EERs) for lactation, or the average daily energy intake predicted to maintain energy balance in a healthy lactating woman, of a given age, weight, height, and level of physical activity can be estimated by a factorial approach from the sum of the (1) EER of a...

Nutritional requirements for the active pregnant woman

Although the nutritional needs of active pregnant women are not clearly defined, nutritional needs in pregnancy have been well researched. Energy requirements during the second and third trimesters of pregnancy are an average of 300 kcal a day above prepregnancy requirements 40 . A wide variability in metabolic energy expenditure in pregnancy makes it difficult to set standards for energy requirements 41 . Exercise during pregnancy requires an additional caloric allowance for increased...

Macronutrients

HIV infection increases energy needs due to an increase in REE, as previously stated. This increased REE coupled with HIV-related infections and complications, such as anorexia, place HIV-infected pregnant women at greater nutritional risk than the uninfected woman 23, 24 . Current energy recommendations for HIV-infected pregnant and lactating women are an increase of 10 over baseline energy needs during the asymptomatic phase and an increase of 20-30 over baseline energy needs during the...

Supplemental Folic Acid

Supplemental forms of folic acid are available as folic acid only or as a component of a multivitamin. The majority of over-the-counter folic acid supplements or multivitamins with folic acid contain 400 mcg, which is the dose recommended to reduce NTD risk, making it easy for women of reproductive age to have access to a supplement with the recommended dose. All of the commonly prescribed prenatal vitamin supplements contain 1 mg folic acid (1,000 mcg x 1.7 1700 mcg DFE) and over-the-counter...

Macronutrients 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...

Cardiovascular and respiratory adaptations in pregnancy

During exercise, there is a redistribution of blood flow away from the visceral organs and toward the exercising muscles. The redistribution of blood away from the uterus is related to the intensity and duration of exercise. However, in pregnancy there are corresponding adaptations that are characterized by an increase in blood volume, compensated for by increased venous capacity and decreased peripheral vascular resistance 27 . Although fetal oxygen and substrate availability could be...

Conclusion

Breastfeeding is the gold standard and strongly recommended method of feeding infants. The World Health Organization recommends human milk as the exclusive nutrient source for the first 6 months of life, with introduction of solids at this time, and continued breastfeeding until at least the first 12 months postpartum. Early postpartum weight is an issue for many women as they are anxious to return to their prepregnancy body size. For many, weight management will be difficult given personal...

Michelle Price Judge and Cheryl Tatano Beck

Summary Postpartum depression is the number one complication of childbirth 1 , and healthcare providers need to have a keen understanding of the disorder in order to provide support and advice. In the first portion of this chapter, the prevalence and onset of postpartum depression is discussed, with a consideration for risk factors that have been associated with the disorder. Within this context, there is a discussion of how postpartum depression affects the mother, the mother-infant...

Complications Associated with Preexisting Diabetes

Complications associated with diabetes can adversely affect both the woman and fetus. The incidence of fetal complications is correlated with maternal glycemic control and the trimester of pregnancy. Congenital malformations and spontaneous abortions are associated with maternal hyperglycemia in the first 12 weeks of gestation. The central nervous system, heart, lungs, gastrointestinal tract, kidneys, urinary tract, skeleton, and placenta are all vulnerable to adverse effects (Table 10.1) 21-23...

Fuel 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...

References

IOM (2001) Dietary Reference Intakes for Micronutrients. Food and Nutrition Board Reports. National Academy of Science Press, Washington, D.C. 2. Scholl TO (2005) Iron status during pregnancy setting the stage for mother and infant. Am J Clin Nutr 81 1218S-1222S 3. Allen LH (2005) Multiple micronutrients in pregnancy and lactation an overview. Am J Clin Nutr 81 1206S-1212S 4. De Leeuw NK, Lowenstein L, Hsieh YS (1966) Iron deficiency and hydremia in normal pregnancy. Medicine 45 291-315 5....

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...

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...

Consequences of this negative iron balance

The consequences of depletion of the essential body pools of iron include anemia, altered hormone metabolism, altered energy metabolism, depressed immune functioning, and changes in behavior and cognition 18, 23 . The impact of each of these consequences on maternal and fetal survival, fetal growth, and postnatal development are still being examined. The possible causal routes include direct and indirect effects of anemic hypoxia, placental delivery of iron, and alterations in hormonal control...

Micronutrients and postpartum depression 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...

Assessment of iron deficiency and anemia

Numerous indicators for assessing anemia and iron status are available. These include serum ferritin, transferrin concentration and saturation, transferrin receptor, erythrocyte protoporphyrin, hemoglobin, hematocrit, and erythrocyte morphology and color (Table 22.2). Assessment of Iron Deficiency and Iron-Deficiency Anemia 9, 11 Assessment of Iron Deficiency and Iron-Deficiency Anemia 9, 11 Special considerations in developing countries Venous or capillary blood, dried blood spots (DBS) ELISA...

About the Editors

Lammi-Keefe is Alma Beth Clark Professor of Nutrition and Division Head, Human Nutrition and Food, School of Human Ecology at Louisiana State University Adjunct Professor at Pennington Biomedical Research Center, Baton Rouge and Professor Emeritus at the University of Connecticut. She has devoted over two decades to research in maternal and fetal nutrition, with an emphasis on lipids, especially n-3 fatty acids. She has been recognized by the American Dietetic Association...

Diagnosis of preeclampsia

As mentioned previously, both proteinuria and hypertension after 20 weeks of gestation must be present for a diagnosis of preeclampsia to be made. The diagnostic criteria for preeclampsia are presented in Table 11.1. Blood pressures should be measured with an appropriately sized cuff, with the patient in an upright position 8 . Edema and blood pressure elevations above the patient's baseline are no longer included in diagnostic criteria 3, 7 . In severe preeclampsia, blood pressures may be...

Iodine

Iodine intakes in the United States have declined over the past 30 years 33 , partly because of changes in the production of bread and milk. In addition, reliance on processed food has increased and food processors frequently use non-iodized salt 34 . The iodine content of most fruits, nuts, and vegetables is low, but can vary depending on soil iodine content, irrigation, and fertilization practices 35 . Vegetarians who do not use iodized salt may be at increased risk of developing iodine...

Bulimia Nervosa

Individuals with BN engage in binge eating episodes, followed by compensatory behaviors to prevent any increases in body weight. Purging behaviors include self-induced vomiting or self-prescribed use of enemas, laxatives, or diuretics. Nonpurging behaviors include fasting and excessive exercise. While clinically diagnosed BN occurs in approximately 5 of the female population, up to 20 of women have reported bulimic behaviors in their lifetimes 6, 7 . Clinical features of BN include Russell's...

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...

Dietary changes throughout pregnancy

In the United States, it is estimated that approximately 50-90 of pregnant women experience food cravings during the course of pregnancy 16-18 . Despite its prevalence, the etiology of pregnancy-related cravings is not well understood. Whereas some hypothesize that cravings are a function of cognitive characteristics of the individual 19 , others claim that cravings may represent wisdom of the body 20 . For example, pregnant women may crave certain foods to overcome nutritional deficiencies,...

Total 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...

O

Anesthesia and postpartum problems, 315 cardiovascular disease CVD , 315 cesarean delivery, 314 gestational diabetes mellitus GDM , 312 preeclampsia, 313 pregestational, consequences, 68 infertility and miscarriage, 68-69 macrosomia and shoulder dystocia, 71-72 neural tube defects and congenital malformations, 69-70 obstetric complications, 71-72 preeclampsia and gestational diabetes, 70-71 thromboembolic complications, 71 in pregnancy, 67 maternal and fetal complications, 70 type 2 diabetes...

Anemia and Maternal Mortality

Maternal Consequences Anemia

The relationship between iron deficiency, anemia, and maternal mortality is complex and controversial. Anemia that results from iron deficiency is a physiological condition Iron Requirements during Pregnancy Compartments. Gross iron loss during pregnancy is 1.2 g for a healthy woman Fetus, umbilical cord and placenta Maternal blood loss Basal losses 360 mg 150 mg 230 mg 450 mg 1,190 mg Net iron losses are 580 mg due to recovery of increased red cell mass 450 mg at delivery and lack of...

Physiological changes in pregnancy

Physiological Changes During Pregnancy

Under the influence of estrogen, progesterone, and elastin, pregnancy is associated with generalized connective tissue laxity, potentially leading to ligament and joint instability 1 . Additional strain on the musculoskeletal system comes from the change in the body's center of gravity, resulting in progressive lordosis accentuation of the lumbar curvature of the spine and kyphosis curvature of the upper spine 7 . The change in center of gravity requires greater muscular effort with certain...

Index

Acceptable Macronutrient Distribution Range AMDR , 164 Acetylcholine synthesis, 293 ACOG. See American College of Obstetricians and Gynecologists Acquired immune deficiency syndrome AIDS , 161 ACSM. See American College of Sports Medicine Actaea racemosa, 205 ADA. See American Dietetic Association Adequate intake AI level, definition of, 193, 264 Adjustable gastric band AGB , 82 Adolescent pregnancy caffeine, 105 counseling, 108 development of, 102-103 health care and nutrition recommendations...

Daniel M Herron and Amy Fleishman

Summary The dramatic increase in the incidence of obesity has resulted in an overwhelming increase in the number of bariatric, or weight loss, operations performed in the United States. These operations induce long-term weight loss through a combination of volume restriction and malabsorption. As a result, bariatric surgery patients may suffer from nutritional deficiencies over the long term and need to be followed extremely closely before, during, and after pregnancy. Bariatric patients are...

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...

Maternal Anemia and Maternal Mortality

Anemic Pregnant Female Pakistan

The relationship between maternal anemia and the risk of mortality have been examined in two previous reviews 13, 14 . No randomized controlled trials to date provide data on the impact of iron supplementation on maternal mortality as the outcome. The likelihood of such trials being conducted in the future is low, mainly due to ethical and feasibility considerations. Observational studies conducted in Africa and Asia, primarily among pregnant women presenting at hospitals, provide evidence for...

Screening and Diagnosis of Gestational Diabetes Mellitus

Two approaches are used to screen and diagnose for GDM, the two-step and the one-step method 3 . The two-step method is used primarily in the United States. The first step is the oral glucose challenge test OGCT . A solution containing 50 g glucose is consumed, and the plasma glucose level is checked 1 h later. If the test is gt 140 mg dl, the second step, the oral glucose tolerance test OGTT is administered after 3 days of unrestricted carbohydrates at least 150 g day and unlimited physical...

Amniotic Fluid

The environment in which the fetus lives, the amnion, can indeed be odorous. Its odor can indicate certain disease states, such as maple syrup disease or trimethylaminuria 36, 37 . In 1985, a case study report was published describing four infants who presented with peculiar body odors on delivery. Although each infant tested negative for syndromes that are associated with peculiar body odors, all were born to women who had ingested a spicy meal e.g., cumin, fenugreek, curry prior to delivery...

Nutritional Assessment

A baseline assessment should be made at the first prenatal visit and follow-up care should be provided at subsequent visits. The initial nutritional assessment should include baseline anthropometric measurement such as weight, height, BMI height cm kg m2 , and mid-upper arm circumference MUAC 23 . The BMI will indicate whether the woman is at an appropriate weight or is underweight or overweight at onset of pregnancy. This information will enable the provider to make specific weight gain...

Ann Reed Mangels

Summary A vegetarian diet, defined as an eating style that avoids meat, fish, and poultry, can be healthful and nutritionally adequate for a pregnant woman. Some vegetarians, called vegans, avoid dairy products and eggs as well as meat, fish, and poultry. Vegan diets can also be healthful and nutritionally adequate for pregnancy. Vegetarian diets can provide numerous long-term health benefits including a lower risk of cardiovascular disease, some forms of cancer, and hypertension. Key nutrients...

Folate requirements during pregnancy

Dietary reference intakes DRIs are recommendations for nutrient intakes used to plan and assess the adequacy of diets for healthy people 7 . The DRIs include a number of reference values including Estimated Average Requirement, Recommended Dietary Allowance RDA , Adequate Intake, and Tolerable Upper Intake Level. For the purposes of planning and assessing a diet for a healthy individual, clinicians should generally utilize the RDA 7 . The RDA for folate for pregnant women is the average daily...

Katherine Kunstel

Summary Women are among the fastest growing populations of those infected with HIV and AIDS, and most infected women are of childbearing age. Women who are both HIV-positive and pregnant are faced with a double burden both in terms of immunity and nutrition. The HIV-infected pregnant woman is at increased nutritional risk compared to the HIV-uninfected pregnant woman. HIV-infected pregnant women tend to gain less weight during pregnancy. Macronutrient needs are increased to cover the increased...

Management of preeclampsia

Childbirth is the cure for preeclampsia as the disease process usually resolves within days of delivery. Delivery is always preferable from the perspective of maternal health. However, decisions on induction of labor or cesarean delivery must include a consideration of prematurity-related neonatal risks and the severity of the preeclampsia. Women with mild preeclampsia should be carefully followed until they are close to term and delivered at 37-39 weeks 30 . Women with severe preeclampsia may...