Life Cycle Pregnancy

Life Cycle

Pregnancy

I Fetal Growth and Development
A. Embryo
1. 2 – 8 weeks
2. development of vital systems
B. Fetus
1. next 7 months
2. organs grow to maturity
3. from less than 1 ounce to 6.5-9 lbs
4. 20-21”
C. Critical periods: finite period of intense development and rapid cell division
1. neural tube defects
a. critical period is 17-30 days gestation (mother may not be aware of pregnancy at this point)
b. anencephaly affects brain development
c. spina bifida can lead to paralysis or meningitis
II Maternal Weight
A. Recommended weight gains
1. underweight <18.5> 30 BMI: 15 lbs maximum
5. twins: 35-45 lbs
B. Weight gain patterns:
1. first trimester: 3 ½ lbs
2. 1 lb per week thereafter
3. gain must be gradual, not sporadic (up and down)
C. Components of weight gain
1. increase in breast size = 2lbs
2. increase in mother’s fluid volume = 4lbs (most of the weight gain at the end of pregnancy is fluid)
3. placenta = 1 ½ lbs
4. increased blood supply = 4 lbs
5. amniotic fluid = 2 lbs
6. infant at birth = 7 ½ lbs
7. increase uterus and muscles = 2 lbs
8. mother’s fat stores = 7 lbs (fuel for lactation)
III Energy and Nutrient Needs during pregnancy
A. Energy
1. 2nd trimester increase 340 kcal/day
2. 3rd trimester increase 450 kcal/day


B. Protein
1. increase of 25 grams/day
2. Use food over supplements to avoid strain on the kidneys from vitamins.
C. Essential fatty acids
D. Folate
E. B12
F. Iron
G. Zinc
H. Ca and Vit D for bone development
I. Other nutrients support growth, development and health of mother, and fetus
IV Vegetarian diets during pregnancy and lactation
A. adequate energy is important
B. should include milk and milk products
C. should contain a variety of legumes, cereals, fruits, and vegetables
D. plant-only diets may cause problems during pregnancy
E. Supplements of iron, vitamin B12 (b/c only found in animal products), calcium(best absorbed from dairy products), and Vit D (best absorbed with milk/calcium) may be required
V Common nutrition related concerns of pregnancy
A. Nausea
1. morning (anytime) sickness
2. ranges from mild queasiness to debilitating nausea and vomiting
3. hormonal changes
VI High-Risk Pregnancies
A. Malnutrition
1. fetal growth retardation
2. congenital malformations
3. spontaneous abortion and stillbirth
4. premature birth
5. low infant birth weight
6. food assistance programs
a. supplemental nutrition program for Women, Infants, and Children (WIC)
b. nutrition education
c. food vouchers for nutritious foods only
B. Preexisting Diabetes (maternal)
1. proper management is important
2. risks include:
a. infertility
b. hypoglycemia
c. hyperglycemia
d. spontaneous abortions
e. pregnancy related hypertension
C. Gestational Diabetes
1. routine screening with glucose tolerance test
2. risk factors
a. age 25 or older
b. BMI > 25 or excessive weight gain
c. complications in previous pregnancies
d. symptoms of diabetes
e. family history of diabetes
f. Hispanic, African American, Native American, South or East Asian, Pacific Islander or indigenous Australian
3. consequences
a. complications during labor and delivery
b. high-birth weight infant (Mother’s sugar needs to be metabolized by fetus, but because no room for the fetus to burn it off it gets stored as fat.)
c. chance of mother developing Stage II diabetes later in life
D. Preexisting hypertension
1. heart attack and stroke
2. low birthweight infant
3. separation of placenta from wall of uterus resulting in a stillbirth
E. Transient Hypertension of pregnancy (occurs because of pregnancy)
1. develops during 2nd half of preganancy
2. usually mild
3. returns to normal after birth
F. Pre eclampsia
1. high bp
2. protein in the urine
3. edema all over the body
4. affects all organs
5. retards fetal growth
G. Eclampsia (aka Toxemia…most severe stage)
1. severe stage of pre eclampsia
2. seizures and coma
3. maternal death














Life Cycle

Infants

I Infant feeding
A. first milk: colostrum
1. 2-3 days
2. high antibodies and white blood cells
B. breast milk
1. lactalbumin – easily digested protein
2. correct proportions of vitamins and minerals
3. calcium is well absorbed
4. high bioavailability of iron and zinc
5. lower in fat, higher in carbs
6. some colostrum still included in small amounts
C. Benefits of breastfeeding
1. for infants
a. appropriate composition and balance of nutrients with high bioavailability
b. hormones that provide physiological development (colostrum still present in small amounts)
c. improves cognitive development
d. protects against infections
e. may protect against some chronic diseases
f. protects against food allergies
2. for mothers
a. contracts the uterus
b. delays the return of ovulation, thus lengthening birth intervals
c. conserves iron stores because no ovulation/menstruation
d. may protect against breast and ovarian cancer
e. weight loss, the act of nursing burns 500 calories a day
3. other benefits
a. cost savings
b. environmental savings
c. do not have to purchase or prepare formula
II Fetal alcohol syndrome
A. symptoms
1. prenatal and postnatal growth retardation
2. impairment of brain and central nervous system
3. abnormalities of face and skull and birth defects






Life Cycle

Adolescence

I Nutrition during adolescence
A. another rapid state of growth
B. nutrient needs rise, iron (menses) and calcium (to prevent osteoporosis) are especially important
C. busy lifestyles make it challenging to meet nutrient needs and develop healthy habits
D. peer pressure is significant among adolescents
E. energy needs vary
1. depends on activity
2. weight gain possible, especially females
F. Vitamin and mineral needs increase from 1. iron deficiency anemia (poor diet and menses)
2. calcium and vit D

The Aging Process

I Physiological Changes
A. immune system
1. compromised immune systems can occur with age because a lot of immunity is involved in the intestines and peristalsis slows down.
2. incidences of infectious disease increase
B. GI tract
1. slower motility (peristalsis) resulting in constipation
2. atrophic gastritis impairs digestion and absorption of nutrients due to:
a. stomach inflammation
b. bacterial overgrowth (cause ulcers)
c. lack of HCl and intrinsic factor (affects B12 which is the extrinsic factor that cooperates with the intrinsic factor)
3. dysphagia: difficulties in swallowing and can result in nutritional deficiencies or aspiration
C. Dental problems
1. tooth loss and gum disease can interfere with food intake
2. edentulous: lack of teeth
3. conditions that require dental care:
a. dry mouth
b. eating difficulty (chewing)
c. no dental care in 2 years
d. tooth or mouth pain
e. altered food selections
f. lesions, sores or lumps in mouth
4. ill fitting dentures
5. dental caries


D. Sensory losses and other physical problems
1. vision problems can make driving a shopping difficult
2. taste and smell sensitivities may diminish
a. intolerance of food
3. physical limitations
a. limited mobility
E. Prescriptions and over the counter drugs
1. drug nutrient interactions
2. more than 6 drugs a day will lower appetite because they fill up the stomach
II Other changes
A. psychological changes
1. depression and loss of appetite commonly occur together
2. support and companionship of family and friends are helpful
B. economic changes
1. older adults have lower incomes and are at risk for poverty
2. only 1/3 receive aid from federal assistance programs
3. economic limitations
a. they may think they are going to outlive their money
b. programs provide nutrition education
C. social changes
1. loneliness is directly related to low energy intakes
2. malnutrition is common
III Energy and Nutrient needs in aging
A. water (very important)
1. dehydration increases risks for:
a. urinary tract infections
b. pneumonia
c. pressure ulcers
d. confusion and disorientation
2. fluid needs are not recognized
3. mobility and bladder problems
B. Energy and energy nutrients
1. energy needs increase
2. protein to protect muscle mass, boost the immune system, and to optimize bone mass (size/weight has nothing to do with protein/muscle mass malnutrition)
3. carbohydrate for energy
4. fiber and water to reduce constipation
5. fat to enhance flavors of foods and provide valuable nutrients
6. vitamin and minerals to meet needs
C. Nutrient needs (a recap of above)
1. energy: decreased BMR because not as active
2. protein: needs do not decline. May have less muscle more fat.
3. fats: 20-35% energy needs (standard for adults)
4. fiber: because peristalsis decreases
5. water: monitor intake and output because medication can interfere
6. vitamins: B6 and B12 (because of anemia), D and Calcium
7. antioxidants: Vit E, C, B-carotene
IV Food choices and eating habits of older adults
A. food assistance programs
1. congregate meals are group settings at community centers
2. meals on wheels is a home delivered meal program
3. the Senior Farmers Market Nutrition Program allows low income older adults to exchange coupons for fruit, vegetables, and herbs
B. Medical nutrition therapy education to inform them what to eat
V Government Programs
A. Federal Older American Act (OAA) title III
1. serves at least one meal five days a week to persons 60 and older
2. money given to community centers, congregations, etc
3. sponsored by the Federal Government
B. Nutrition Screening Initiative: National program that promotes nutritional screening and more attention to nutrition in all health-care and social-service settings that provide for older adults.


D: determine if
E: eating poorly
T: tooth loss or mouth pain
E: economic hardship
R: reduced social support (senior centers etc.)
M: multiple medicines
I: involuntary weight gain or loss (may be retaining fluid, or underlying disease)
N: needs assistance in self care (home health aide?)
E: elder, above 80