Nutrition in pregnancyK.AndelovaThe Institute for the Mother and ChildPrague

Nutrition in pregnancyThe undeveloped countries with poor nutritional status of mothersThe developed countries with the owerweight and obesity and micronutrient deficienses

Macronutrients-energetic substrates-carbohydrates,proteins,fatMicronutrients minerals,trace elements,vitamins,folic acid,-3 fatty acids (?)

The influence of mother nutrition

Perinatal mortalityPerinatal morbidityIntrauterine growth retardation(IUGR) versus large for gestational age(LGA) babies

Fetal programming of later diseases in childhood and in adulthood

Important data Sociodemografic dataPersonal medical history (obstetric history)Dietary habits and weight changesAbusesPhysical routine examination and laboratory screeningPhysical activityUsing of nutritional supplements

Maternal metabolic changes

Gastric motility and gut motilityThe changes in absorption of nutrientsThe changes of kidney functionsThe changes of plasma levels of proteins,minerals,aminoacids,hormonesThe changes of apetiteThe vomiting in pregnancy

Weight gain in pregnancyNormal weight gain in singleton pregnancy-12kg Normal weight gain in multiple pregnancy- up to 18 kg75%-fetus,placenta,amniotic fluid,uterus,expanded volume of circulating fluid,blood elements,breasts25%- adipose tissue

Macronutrients

Recommended energy intake 2500 kcal/day (200-600kcal increasing)No extreme reducing diet in course of pregnancy----------------------------------------------------------------Carbohydrates(50-60%)-the main energetic substrate for fetus is glucoseProteins(20-25%)-lean body massFat(20-25%)-energy supply

MicronutrientsVitamines(B 12,B 6,A,D)Minerals(Ca)Trace elements(Iron,Iodine,Zinc,Selenium,Copper)Folic acid-3 FFA

Vitamines B12 vit.-IUGR,impaired b-cell function,CV riskA vit.-excessive intake-fetal malformationE vit.-placental transport of hormonesD vit.-cofactor for Ca homeostasis,reduced intrauterine growth of long bones,shorter gestation,lower birth weight and reduced bone mass in childhood,kidney maturationB6,B1-less importance

Trace elements(1% of body mass)Iron-anemia(plasma level,ferritin,transferin)Very common in pregnancy(second nad third trimester)Preterm delivery,postpartum inflammative complications,The fetus is partly protected Factors indicate the increased risk history of strong menstrual bleeding,low meat diet,blood donors,aspirin use,multiple gestation,teenager pregnancy

Trace elements

Iodine essential part of thyroid hormones(thyroxine ,triiothyronine)Mental disturbances,hypothyreosis,stillbirth,abortions,congenital malformationsUrinary iodine excretionContent of iodine in soilAddition of iodine in table salt

Trace elementsZinc-component of many enzymesSigns of depletion-growth restriction,impaired healing,skin lesions,diarrhea,impaired imunne functions,behavioral disturbances,teratiigenic effect,preterm delivery,hypertensionIncreased risk for zinc depletion in smokersSelenium-part of enzymes(gluthatione peroxidase)Cardiomyopathy(Keshan disease)No special supplementation reccommended

Calcium and sodiumCalcium-99% in bones and teethBone developementCardiovascular diseaseHypertension Preeclamsia Sodium-decreased excretion,no special supplementation necessaryConnection to hypertensive disorders

Folic acidPericonceptional supplementation of folic acidAvoiding of neural tube defects and other congenital malformationsNormal fetal growthAntibody formationEpilepsy in pregnancy-supplementation Sterility and infertilityFuture disease-cardiovascular,renal

Recommended supplementationVitamin D 1ug/dayIron 30-120mg/day-normal diet has 6mg/1000 kcalIodine 200mg/day (250)Zinc 15mg/dayCalcium 1200mg/dayFolate 500ug/day

The special dietary counselingObese womenDiabetic pregnant patientsPatients with liver diseaseHypertensionPatients with metabolic diseasePatients with intestinal diseaseVegetariansThe patients with nutritional disturbances bulimia or anorexiaThe other special health conditions

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