Special Nutrition Concerns

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hypoglycemia: low blood sugar level edema: accumulation of fluid in the tissues protein: complex molecule composed of amino acids that performs vital functions in the cell; necessary part of the diet nausea: unpleasant sensation in the gut that precedes vomiting dehydration: loss of water constipation: difficulty passing feces antibody: immune system protein that protects against infection allergy: immune system reaction against substances that are otherwise harmless cancer: uncontrolled cell growth tuberculosis: bacterial infection, usually of the lungs, caused by Mycobacterium tuberculosis

Food cravings during pregnancy are common and are not cause for concern, provided other nutrient needs are met and weight gain is in the target range. Pica—the ingestion of nonfood substances of nutritional value—is associated with anemia and can be a source of lead poisoning, bacterial infection, and dental problems. Pregnant women should be encouraged to avoid pica and discuss it with their medical provider.

Gestational diabetes is associated with high prepregnancy BMI and excess pregnancy weight gain. Infants of gestational-diabetic mothers are usually born large for gestational age (macrosomia) and are at higher risk for cesarean delivery and hypoglycemia postpartum.

Symptoms of toxemia of pregnancy, also known as preeclampsia, include swelling (edema) and proteinuria (excess protein in the urine). The cause of toxemia has not been determined, but the risk is associated with first pregnancies, advanced maternal age, African-American ethnicity, and women with a past history of diabetes, hypertension, or kidney disease. In severe cases, delivery is frequently induced.

Tips for common pregnancy discomforts include avoidance of offending foods (and their odor) when nausea and heartburn occur. Many pregnant women find that spicy, fatty foods can increase problems with nausea and heartburn. Frequent, small, and blander meals are often better tolerated. Some women find eating dry crackers before rising from bed in the morning helpful for nausea. However, since nausea and vomiting usually subside by the end of the first trimester, they do not have a significant impact on the final weight gain in most pregnancies. Hyperemesis gravidarum, or intractable vomiting during pregnancy, can rapidly result in dehydration, so medical intervention is required.

When constipation is a concern, increased consumption of whole grains, fruits, and vegetables is advisable, as well as increased fluid intake and physical activity.

Breastfeeding is the recommended method of infant nutrition, with a few exceptions. It benefits both mother and infant by providing protective antibodies to human disease, and breastfed babies are generally healthier and have higher I.Q. levels than bottle-fed babies. The development of jaw alignment problems and allergies are also far less likely in breastfed babies, while mothers who breastfeed have less postpartum complications and are considered to be at lower risk for breast cancer.

In the United States, women with HIV infection should not breastfeed. This is not a contraindication in developing countries, however, as the benefits may outweigh the possibility of infection. Untreated tuberculosis is also a contraindication for breastfeeding, while hepatitis C is currently not a contraindication for breastfeeding.

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