Normal and Therapeutic Nutrition

Normal and Therapeutic Nutrition 3(2+1)

Lesson 10:Maternal Nutrition

Complications of pregnancy

Morning sickness

• Nausea in pregnancy may be due to nervous disturbance, placental protein intoxication or due to derangement in carbohydrate metabolism.
• Morning sickness of early pregnancy can be improved by small and frequent meals. Liquids may best be taken between meals and not along with food.
• Skim milk is better tolerated than whole milk.
• Fruits and vegetables can be taken.
• Fatty foods, excessive seasoning, coffee in large amounts and strongly flavoured vegetables may be restricted or eliminated if nausea persists or if the patient complains of heartburn or gastric distress.
• Disturbance of physiological and biochemical balance and production of excessive hormones leads to gastro -intestinal upset, loss of appetite, nausea, and vomiting triggered by certain foods and excessive fluids.

Morning sickness can be relieved by:

• Use of high carbohydrate foods, dry foods
• Small, frequent meals
• Fluid intake between meals
• Avoid deep fried and fatty foods
• If severe vomiting occurs then I. V. feeding becomes necessary.

Constipation

• The pressure of the enlarging uterus on the lower portion of the intestine, in addition to the hormonal muscle relaxant effect of placental hormones on the gastrointestinal tract and physical inactivity may make excretion of feces difficult, resulting in constipation.
• Increased fluid intake and use of natural laxatives foods such as whole grains, dried fruits and other fruits and vegetables rich in fiber, and fruit juices usually induce regularity of bowels.
• Laxatives should be avoided. Regular habits of exercise and sleep are essential for proper elimination.

Constipation is common in the 2nd half of pregnancy due to
• Pressure exerted by growing foetus on digestive tract
• Decreased muscle tone of gastro intestinal tract
• Limited exercise
• Insufficient dietary bulk and
• Iron supplementation

Over weight

Pregnancy is a period of excellent appetite which may lead to excessive weight gain. It may lead to complications during delivery and may increase the incidence of toxaemia.

• Excess calorie intake should be restricted but nutrients should be balanced
• Calorie intake should not be below 1500k cal
• No weight loss programmes should be taken up during pregnancy.

Anaemia

Physiological changes in blood :

• Haemoglobin mass increases
• RBC volume increases
• Plasma volume increases by 50%
• Hb concentration drops from 13.4 to 11.6 g/ 100 ml which is considered to be normal level during pregnancy
• Severe anaemia increases morbidity and mortality

A pregnant woman is labelled anaemic if the haemoglobin is less than 10g per 100 ml of blood.

If Hb falls below 8g/ dl

• Very low birth weight due to increase in prematurity rate
• Intra-uterine growth retardation

Predominant cereal diet in tropics provides 40 mg iron per day

Severely anaemic pregnant women requires therapeutic doses of 120 to 200mg iron. Therefore administer 60 mg of elemental iron and 500 µg of folic acid/ day orally in the last trimester of pregnancy and oral therapy may be continued for 3-6 months after the anaemia is corrected in order to replenish depleted stores. Anaemia due to vitamin B12 deficiency is rare in pregnancy. A single injection of 40 ?g of vitamin B12 is administered to mothers vitamin B12 deficiency.

Consumption of fresh fruits, vegetables, non-vegetarian foods should be increased during pregnancy.

Pregnancy induced hypertension (toxaemia)

• Severe pregnancy induced hypertension (eclampsia) is associated with higher incidence of Vitamin A and protein deficiency resulting in poor pregnancy outcome.
• It is common among women subsisting on inadequate diets and poor prenatal care. The symptoms of pregnancy induced hypertension include hypertension, odema, albuminuria and convulsions or coma.

Optimal nutrition is fundamental aspect of therapy

Adequate protein, adequate salt and vitamins and minerals are required in optimal levels for correction and maintenance of metabolic balance

Nutritional therapy will concentrate on:

• Prevention of weight extremes i.e., obesity & under weight
• Correction of dietary deficiencies
• Maintenance of optimal nutrition
• Management of any pre existing diseases (eg., diabetes)
• Sodium intake should be moderate but should not be unduely restricted.

1. Diabetes mellitus

Glycosuria is common in pregnancy because of increased circulating blood volume and its metabolites. Most women revert back to normal glucose tolerance after delivery.

Prenatal exercises improve fitness, prevents gestational diabetes, facilitate labour and reduce stress.

2. Oedema and cramps
• Caused by pressure of enlarging uterus on veins, returning fluid from legs
• Due to sudden contractions of muscle and decline in serum calcium levels lead to calcium phosphorus imbalance.
• Normal oedema requires no sodium restriction or other dietary changes
• For prevention or relief of leg cramps – reduce milk intake (high phosphorus + high calcium beverage) and supplement with non phosphate calcium salts.
3. Heart burn

Common complaint in later part of pregnancy, due to effect of pressure of enlarged uterus on stomach results in regurgitation of contents of stomach into oesophagus. To avoid this

• Small frequent meals should be eaten.
• Limit the amount of food consumed at one time
• Drink fluids between meals
• Sit upright after meals for atleast 2 hours before lying down
4. Food cravings and aversion

Craving and aversion towards certain foods are powerful urges towards or away from foods. The most commonly craved foods are sweets and dairy products. The most common food aversions reported are alcohol, coffee, other caffeinated drinks, meat and strongly spiced foods.