Maternal Nutrition

Cheatsheet Content

### 1. Introduction to Maternal Nutrition #### Definitions - **Nutrition:** The science of food and its interaction with health, encompassing ingestion, digestion, absorption, transport, utilization, and excretion. Derived from Latin *nutricus* (to suckle). - **Maternal Nutrition:** Focuses on the nutritional status of women as mothers, specifically how it relates to bearing and nurturing children. - **Nutrients:** Specific dietary constituents (e.g., proteins, vitamins, minerals) required for physiological function. #### Significance - Adequate maternal nutrition is vital as the fetus and infant (for the first six months) derive all their nutrition from the mother. - A well-nourished mother secretes approximately **750–850 ml of milk per day**, while a severely malnourished mother may produce as little as **400 ml/day**. ### 2. Nutritional Requirements #### Energy (Calories) - Energy needs increase progressively throughout pregnancy to support maternal and fetal metabolism. - **First Trimester:** 100 to 200 kcal/day (minimal increase). - **Second Trimester:** +340 kcal/day. - **Third Trimester:** +452 kcal/day. - **Lactation:** +550 kcal/day during the first six months. #### Macronutrients and Micronutrients | Nutrient | Non-Pregnancy | Pregnant | Lactation | Key Sources | |-------------|---------------|------------|------------|--------------------------------------------------| | **Protein** | 46 g/day | 71 g/day | Extra required | Lean meat, poultry, fish, nuts, seeds, beans. | | **Iron** | 0.8-1 mg/day | 27 mg/day | 9 mg/day | Organ meat, fish, green vegetables, fortified cereals. | | **Folate** | 0.4 mg/day | 0.6 mg/day | 0.5 mg/day | Beans, peas, orange juice, green vegetables. | | **Calcium** | 1,000 mg/day | 1,000-1,300 mg/day | 1,000 mg/day | Milk, yogurt, cheese, fortified orange juice. | | **Vitamin C** | 75 mg/day | 85 mg/day | 120 mg/day | Citrus fruits, broccoli, peppers, strawberries. | | **Magnesium** | 310 mg/day | 360 mg/day | 320 mg/day | Whole seeds, nuts, legumes, grains. | *Note: Iron needs escalate by trimester: 0.8–1 mg (1st), 4–5 mg (2nd), and 6–10 mg (3rd).* ### 3. Pre-Pregnancy Diet - Many women enter pregnancy with suboptimal nutritional status. - A pre-pregnancy diet should be balanced and nutrient-dense: - **Grains:** At least half should be whole grains (whole-wheat, brown rice, oatmeal). - **Vegetables:** Vary types (dark green, red, orange, legumes, starchy). - **Fruits:** Fresh, frozen, or 100% juice (avoid added sugars). - **Dairy:** Fat-free or low-fat products high in calcium. - **Protein:** Lean meats, poultry, fish, nuts, and seeds. ### 4. Pregnancy and Adolescents #### Pregnancy Stages - **First Trimester (Weeks 1–12):** Begins with conception and implantation. The placenta forms to provide oxygen and nutrients. - **Second Trimester (Weeks 13–28):** Sex can be determined (18-20 weeks). Movement is felt (20 weeks). Survival rate at 28 weeks is ~92%. - **Third Trimester (Weeks 29–40):** Bones form (32 weeks). Full term is 39 weeks. #### Adolescent Specifics - Adolescence is a stage of rapid physical, emotional, and sexual maturation. - Pregnant adolescents face "nutrient competition" between their own growth spurt and the developing fetus. - **Growth Spurt:** Girls experience fat deposition and menstruation; boys experience increased muscle and bone mass. - **Nutrient Needs:** Higher requirements for Vitamin A, B6, D, E, C, Folic Acid, Iron, Calcium, Zinc, Magnesium, and Fiber. ### 5. Clinical Concerns and Risk Factors #### Weight Gain Recommendations | Pre-pregnancy BMI | Category | Singleton pregnancy | Twin pregnancy | |-------------------|-------------------|---------------------|----------------| | 4000g), preeclampsia, shoulder dystocia, stillbirth, and neonatal hypoglycemia. #### Preeclampsia - A serious blood pressure condition involving endothelial dysfunction after 20 weeks. ### 6. Iron Deficiency Anemia (IDA) in Pakistan #### Prevalence and Statistics - Pakistan faces a severe public health challenge with IDA. - Approximately **45% of pregnant women** are anemic. - **Urban vs. Rural:** Prevalence is ~26% in urban areas vs. 47% in rural areas. - **Hyderabad Study (n=1,366):** A landmark study showed a **90.5% overall anemia prevalence** among pregnant women. #### Risk Factors in Pakistan 1. **Dietary:** Low intake of red meat and eggs; high consumption of tea (inhibits iron absorption). 2. **Pica:** Consumption of clay or dirt during pregnancy. 3. **Socioeconomic:** Lack of formal education and low BMI.