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
LIFE CYCLE
CYCLE
NUTRITION
NUTRITION
Each stage of the lifecycle has
nutritional concerns specific to the
physiological issues of that stage.
Nutrition in pregnancy: A mother’s nutritional
status before and during pregnancy can affect a
child’s health for the rest of its life.

PREGNANCY
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 c) ALDOSTERONE
SECRETIONS • Sodium retention
a) PROGESTERONE d) INSULIN
• Uterus smooth muscle • Energy production
relaxation and fat synthesis
• Gastric motility e) HUMAN CHORIONIC
• Prevents menstruation THYROTROPIN (HCT)
b)ESTROGEN • Thyroid hormone
• Uterus growth production
• Uterine contraction f) THYROXINE
• Triggers fetus • BMR (cellular
development and bone oxidation)
density
 PHYSIOLOGICAL
ADJUSTMENT
• I. HORMONAL g) Lutenizing Hormone
SECRETIONS (LH)
f) HUMAN CHORIONIC •Release of ovum from
GONADOTROPIN ovary
(HCG) • Develops corpus
• Pregnancy test (1wk) luteum
• Encourage estrogen h) HUMAN GROWTH
and progesterone HORMONE (HGH)
• Nitrogen retention
• Placenta (2nd
trimester) i) PARATHYROID
HORMONE (PTH)
• gonad development in
the fetus • 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.
 Weight
gain (lb)

Increase in breast size 2

Increase in mother's 4
fluid volume

Placenta 1

Increase in blood supply 4

to the placenta

Amniotic fluid 2

Infant at birth 7

Increase in size of 2
uterus and supporting
muscles

Mother's necessary 7
fat stores

1st trimester 2nd trimester 3rd trimester 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: – Other vitamins
– especially folate essential?
600ug and B12 2.6ug.
• B vitamins
• Deficiencies result
in neural tube • Vitamin C 
defects fetal tissue
(anencephaly; spina structure
bifida)
• Vitamin A
• Folic acid
supplementation 800ug 
prior to conception growth of
decreases risk of epithelial cells
brain and spinal cord
defects.
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. and “Hyperemesis
VIII. Mild nausea/vomiting Gravidarum”
• “Morning sickness” occurs • Occurs when the
most commonly in first nausea and vomiting
trimester.
becomes so severe
• Suggestions
– Eat dry crackers or dry
that it is life-
toast before rising threatening
– Eat small, frequent meals
– Avoid food with offensive
odors
– Avoid liquids at mealtime
 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.
 Head
Small head size

Forehead
Narrow, receding forehead

Nose
Short, upturned nose
Flattened nose bridge

Jaw
Underdeveloped jaw
Receding chin
Receding or flattened upper jaw

Eyes
Extra skin folds on eyelids
Drooping eyelids
Downward slant of eyes
Unusually small eyes and/or eye openings
Short-sightedness
Inability to focus (“wandering eyes”)

Ears
Uneven in placement and size
Poorly formed outer ear
Backward curve

Lips
Absence of groove in upper lip; flat upper lip
Thin upper lip
 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
Secretion of milk by
the mammary gland.
Commonly referred to
as “breastfeeding/
nursing”

LACTATION
 PHYSIOLOGY OF LACTATION:
Hormonal influence
• Establishment of • Prolactin or luteotropic
lactation maintained by hormone (LTH)
“neuroendocrine – Regulation of lactation
control mechanism” and continued milk
production or
• Estrogen and galactopoiesis 
progesterone (progesterone drop)
– breast development – Suckling stimulus
during pregnancy. • Oxytocin
– After parturition  – milk ejection reflex, or
level of estrogen and let-down reflex
progesterone? – 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 • Average energy content
needs? Pregnant or of human milk is about
Lactating mothers? 70kcal/100ml.
• CALORIE: • During lactation,
• Milk production mothers lose the extra
requires energy. fat stores. BUT low
• +500 calories/day are calorie intake will hold
needed for lactation back milk production.
– To fortify milk with • PROTEINS:Pregnant or
energy Lactating mothers?
– To support milk • +16 grams (1st 6 months
production
lactation) to 12 grams (7th
– For maternal adipose
month onwards)
tissue storage
 NUTRITIONAL
RECOMMENDATION
• FAT: • Minerals: Calcium,
• 20-35% of total Phosphorus, Iron,
calories or TER Iodine, Selenium, Zinc
• Choose high in • AVOID:
polyunsaturated fatty • Caffeine, alcohol,
acids  for infant smoking and most drugs
brain development except prescribed by
• FLUID INTAKE: the doctor. (Why still
• Average 2.5 L/day. to be avoided?)
• VITAMIN and MINERAL
• Increase intake of supplementation: Only
fluids to prevent lactating women with poor
dehydration diet and nutritional status.
Fig. 13-4, p. 486
 Human BREAST MILK:
Colostrum and Mature milk
• COLOSTRUM • Human milk is
• TRANSITIONAL formulated to meet
MILK the nutrient needs
• MATURE MILK of infants for the
first 6 months of
– FOREMILK
life.
– HIND MILK
• 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