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 ± is any factor, chemical or physical, that adversely affects the fertilized
ovum, embryo, or fetus.


Several factors influence the amount of damage a teratogen can cause.

½ The strength of the teratogen

O For example, radiation is a known teratogen.
½ The timing of the teratogenic insult
O If a teratogen is introduced before implantation, either the zygote is
destroyed or it appears unaffected. If the insult occurs when the
main body systems are being formed, a fetus is very vulnerable to
injury.
O Two exceptions to the rule that deformities usually occur in early
embryonic life are the effects caused by the organisms of syphilis
and toxoplasmosis.
½ The teratogen¶s affinity for specific tissue.
O Lead, for instance, attacks and disables nervous tissues.
O Thalidomide causes limb defects.
O Tetracycline causes tooth enamel deficiencies and, possibly, long
bone deformities.
O Rubella virus, can affect many organs: the eyes, ears, heart, and
brain are the four most commonly attacked.

Teratogenic maternal infections can involve either sexually transmitted or
systemic infections. Organisms that cross the placenta can be viral, bacterial, or
protozoan. Most cause relatively mild flulike symptoms in a woman but can have much
more serious effects on a fetus or newborn. Preventing and predicting fetal injury from
infection is complicated because a disease may be subclinical and yet may injure a
fetus. When diseases that are known to cross the placenta and cause fettal harm are
tested for, they are described collectively under the umbrella term TORCH, an
abbreviation for toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus.
(Some sources identify the O with ³other infections´, which could include syphilis,
hepatitis b virus [HBV], and human immunodeficiency virus [HIV]). The TORCH screen
is an immunologic survey to determine whether these infections exist in either the
pregnant woman or the newborn.
c
  

- A protozoan infection that is spread most commonly through contact with

uncooked meat, although it may also be contracted through handling cat stool
in soil or cat litter.


- Rubella virus usually causes only a mild rash and mild systemic illness in the
mother, but the teratogenic effects on a fetus can be devastating.


  

- A member of the herpes virus family is another teratogen that can cause
extensive damage to a fetus while causing few symptoms in a woman.

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- A primary, first-episode genital herpes infection in a pregnant woman poses a

substantial risk to a fetus. The first time a woman contracts a genital herpes
 infection, systemic involvement occurs. The virus spreads into the
bloodstream and crosses the placenta to a fetus.


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- A sexually transmitted infection is of great concern for the maternal-fetal

population despite the availability of accurate screening tests and proven
medical treatment, as it places a fetus at risk for intrauterine or congenital
syphilis.


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- A multisystem disease caused by the spirochete -

 


, is
spread by the bite of a deer tick.
%%
A number of infections are not teratogenic to a fetus during pregnancy but are
harmful if they are present at the time of birth. Gonorrhoea, candidiasis, Chlamydia,
streptococcus B, and hepatitis b infections are examples of these.




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 Live virus vaccines, such as measles, mumps, rubella, and poliomyelitis are
contraindicated during pregnancy because they may transmit the viral infection to a
fetus.
$
 Many women, assuming that the rule of being cautious with drugs during
pregnancy applies only to prescription drugs, take over-the-counter drugs or herbal
supplements freely. Although not all drugs cross the placenta most do. Also, even
though most herbs are safe, ginseng, for example, used to improved general well-being,
or senna, used to relieve constipation, may not be safe.
To identify drugs that are unsafe for ingestion during pregnancy, the U.S. Food
and Drug Administration (FDA) has established five categories of safety. Two principles
govern drug intake during pregnancy:
Î Any drug or herbal supplement, under certain circumstances, may be detrimental
to fetal welfare. Therefore, during pregnancy, women should not take any drug or
supplement not specifically prescribed or approved by their physician or nurse-
midwife.
Î A woman of childbearing age and ability should take no drugs other than those
prescribed by a physician or nurse-midwife to avoid exposure to a drug should
she become pregnant.



 

Evidenced over the years has shown that when women consume a large quantity
of alcohol during pregnancy, their babies show a high incidence of congenital
deformities and cognitive impairment. It was assumed that these defects were results of
the mother¶s poor nutritional status, not necessarily the direct result of the alcohol.
However, alcohol has now been firmly isolated as a teratogen. Fetuses cannot remove
the breakdown products of alcohol from their body. The large build-up of these leads to
vitamin B deficiency and accompanying neurologic damage.





 Cigarette smoking is associated with infertility in women. Cigarette smoking by a
pregnant woman has been shown to have teratogenic effects on a fetus, especially
growth restriction. In addition, these children may be at greater risk than others for
sudden infant death syndrome. Low birth weight in infants of smoking mothers results
from vasoconstriction of the uterine vessels, an effect of nicotine that limits the blood
supply to a fetus.

 



 
 Teratogens from environmental sources can be as damaging to a fetus as those
that are directly or deliberately ingested. Women can be exposed to these through
contacts at home or at work sites. For example, washing children¶s hair with shampoo
such as lindane (Kwell) to remove lice should be limited to two exposures because of
potential toxicity.
&%' (&
Pesticides and carbon monoxide such as from automobile exhaust are examples
of chemical teratogens that are harmful and so should be avoided. Arsenic, a by-
product of copper and lead smelting, used in pesticides, paints, and leather processing;
formaldehyde, used in paper manufacturing; and mercury, used in the manufacture of
electrical apparatuses, are all teratogens that can be contacted at work sites.
&
 Rapidly growing cells are extremely vulnerable to destruction by radiation. It has
been proven to be a potent teratogen to unborn children because of the high proportion
of rapidly growing cells present.
)"%'& )"%'
 Hyperthermia to a fetus may be detrimental to growth because it interferes with
cell metabolism. Hyperthermia can occur from the use of saunas, hot tubs, or tanning
beds or from a work environment next to a furnace, such as in welding or steel making.
The effect of hypothermia on pregnancy is not well known. Because the uterus is
an internal organ, a woman¶s body temperature would have to be lowered significantly
before a great deal of fetal change would result.
 
 Common sense and awareness of fetal-maternal physiology have dispelled these
superstitions. There is some evidence, one filled with anxiety and worry beyond the
usual amount, could produce physiologic changes through its effect on the sympathetic
division of the autonomic nervous system.

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%" %
During pregnancy, a woman must eat adequately to supply enough nutrients to
the fetus, so it can grow, as well as to support her own nutrition. Adequate protein
intake is vital because so much is needed by a fetus.
''&&*%&c)
A weight gain of 11.2 to 15.9 kg (25 to 35 lb) is currently recommended as an
average weight gain in pregnancy. If a woman is at high risk for nutritional deficits, a
more precise estimation of adequate weight gain can be calculated. This is done by
computing +&)'&, (BMI), the ratio of weight to height. Women who are high
or low in weight for their height (BMI below 18.5 or above 25) need to have expected
outcomes for weight gain adjusted.

'" %)%c*'
&
 The DRI of calories for women of childbearing age is 2,200. An additional 300
calories, or a total caloric intake of 2,500 calories, is recommended to meet the
increased needs of pregnancy.
c&
 The DRI for protein in women is 44 to 50 g. during pregnancy, the need for
protein increases to 60 g daily. If protein needs are met, overall nutritional needs are
likely to be met as well because of high incorporation of other nutrients with protein
foods.
&
Only linoleic acid, an essential fatty acid necessary for new cell growth, cannot
be manufactured in the body from other sources. Because linoleic acid must be
obtained from food, women must be sure to consume a source of this nutrient during
pregnancy. Vegetable oils are a good source.

&
Minerals are necessary for new cell building in a fetus. Because they are found in
so many foods and because mineral absorption improves during pregnancy, mineral
deficiency, with the exceptions of calcium, iodine, and iron are rare.
' & c%"% ± the skeleton and teeth constitute a major portion of a
fetus. Tooth formation begins as early as 8 weeks in utero. Bones begin to calcify at 12
weeks. The recommended amount of calcium during pregnancy is 1,200 to 1,500 mg.
& ± is essential for the formation of thyroxine and, therefore, for the proper
functioning of the thyroid gland. The DRI for iodine is 175 µg daily during pregnancy.
± a fetus at term has a haemoglobin level of 17 to 21 g per 100 ml of blood, a level
that is necessary to oxygenate the blood during intrauterine life. The DRI for iron for
pregnant women is 30 mg. An average diet supplies about 6 mg iron per 1,000 calories.
& ± because fluoride aids in the formation of sound teeth, a pregnant woman
should drink fluoridated water.
&' ± is the major electrolyte that acts to maintain fluid in the body: when sodium is
retained rather than excreted by the kidneys, an equal or balancing amount of fluid is
also retained.
- ± is necessary for the synthesis of DNA and RNA. The DRI for zinc during
pregnancy is 15 mg, or an increase of 3 mg over pregnancy needs.

&&
Extra amounts of water are needed during pregnancy to promote kidney function
because a woman must excrete waste products for two. Two glasses of fluid daily over
and above a daily quart of milk is a common recommendation (a total of six glasses).
+&
 Constipation can occur during pregnancy from slowed peristalsis due to the
pressure of the uterus on the intestine. Eating fiber-rich foods this way is a better choice
for preventing constipation than taking a fiber laxative.

& .&c)
&/%
A daily intake of caffeine or two or three cups of coffee have not been associated
with low birth weight, but drinking over eight cups is associated with an increased rate of
stillbirth.
 /
Are used to improve the taste and limit the caloric content of foods. Federal
regulations control the addition of these ingredients, but it is probably safest for
pregnant women to reduce their intake.
*%
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 As a rule, reducing diets and calorie restrictions are contraindicated during
pregnancy because they may lead to fetal ketoacidosis and poor growth.


 



 
 The best method for assessing nutritional intake is to ask for a ³typical day´
history or a 24-hour nutrition recall to isolate usual patterns and possible nutritional risk
factors.
To strengthen history findings, assess a woman¶s pre-pregnancy weight and
calculate her BMI. Haemoglobin or hematocrit determinations are also important
assessments of good nutrition.

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'
 Be certain that plans for improving nutritional patterns take into account a
woman¶s lifestyle, family preferences, financial resources, customs, and cultural desires,
because she and her family must follow them for 9 months.
')&
 Meal planning is best if it involves the entire family because even if a woman is
receptive to changing her eating habits, she may have difficulty carrying out
recommendations if her family resists the change.
&
Food is costly, so to provide the extra servings required during pregnancy, a
woman must spend more on food for herself per week than she is used to spending.
Women generally view this increased expense as an investment in their child¶s health
and do not regard it as a burden.
&
When helping plan nutrition during pregnancy, try to suggest foods that are
individually or culturally favoured, as these are the foods women tend to enjoy and will
eat most consistently.

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 As many as 50% of pregnant women report nausea and vomiting. No definite
cause has been established for this symptom of early pregnancy, but it may be related
to:
U Sensitivity to the high level of chorionic gonadotropin hormone produced by the
trophoblast cells.
U High etrogen or progesterone levels
U Lowered maternal blood sugar levels caused by the needs of the developing
embryo.
U Lack of pyridoxine (vitamin B6)
U Diminished gastric motility.
.

Cravings for food or aversions to certain foods during pregnancy are so common
that they are considered a normal part of adaptation to pregnancy. It was formerly
considered that these strange desires for food reflected a woman¶s need to call
attention to the pregnancy or were a reaction to her imposed dependent state.
c)!%+#

 Is a burning sensation along the esophagus caused by regurgitation of gastric

contents into the lower esophagus. In pregnancy, it may accompany early nausea, but it
may persist beyond the resolution of nausea and even increase in severity as
pregnancy advances.
)"%'

During pregnancy, increasing progesterone levels cause a further elevation of

cholesterol. Combined with intrahepatic cholestasis, this can lead to an increased risk
for gallstone formation (cholelithiasis) and cardiovascular disease.
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The pregnant adolescent needs a higher caloric intake (2,500 calories per day) to
supply energy for her high level of activity and growth than mature women. The
nutrients most often lacking from a typical adolescent diet tend to be calcium, iron, folic
acid, and total calories.
*'. 01

Today, many women are older than 40 by the time they have their first child, and
many more are older than 40 when they have their second and third child. The
nutritional needs of women in this age group are poorly studied, but it is obvious these
women should maintain the same careful pregnancy nutrition as younger women.
*'/%$& 

 A woman with high parity or a short interval between pregnancies or one who
has been dieting rigorously to lose weight before pregnancy may enter pregnancy with
such depleted nutritional reserves that she has little to draw on during the first part of
pregnancy.
*'/%&/%

A woman who enters a pregnancy underweight, however, needs nutritional

counselling just as much as any pregnant client. &/%is defined as a state in
which a woman¶s weight is 10% to 15% less than the ideal weight for her height, or a
BMI of less than 18.5.
*'/%./%
A woman is considered ./% if she is 20% above ideal weight or has a
BMI over 25. She is considered + if she weighs more than 200 pounds, she is 50%
above ideal body weight for height, or her BMI is above 30. Obesity in pregnancy is
serious because it is associated with an increased incidence of gestational diabetes and
pregnancy-induced hypertension.
*'/%
 Most women vegetarians are closer to their ideal weight and have lower serum
cholesterol levels and lower blood pressure levels than women who eat a more typical
American diet. There are many different types of vegetarians: lacto-ovo-vegetarians (no
animal flesh or fish is eaten, but dairy products and eggs are), lacto-vegetarians (no
meat, fish or eggs are eaten, but dairy products are), and vegans (nothing derived from
an animal is eaten).
*'/% '2$ %

 These substances can lead to general nutrition problems because a woman is

ingesting these substances rather than eating nutritious foods.
*'/% %c+'

 Any health concern that requires rigid salt, protein, or carbohydrate restriction
poses a potential threat to fetal nutrition during pregnancy. Women who have medical
problems such as kidney disease, diabetes, tuberculosis, bulimia, inflammatory bowel
disease, celiac disease, or anorexia nervosa should consult their primary care provider
before pregnancy because of the specific metabolic disorders that occur with these
diseases.
 *'/%)3&

 As many 90% of women of childbearing age work at least part-time outside their
homes. This means that nutritional counselling must involve helping women who rely on
packed lunches or fast-food meals to maintain adequate pregnancy nutrition.
*'/%


 The sugar in milk is lactose. In the intestine, lactose is broken down into glucose
and galactose by the enzyme . In most of the world¶s population, lactase is
present in infants but disappears by school age. After this point, many people have
difficulty digesting lactose or are lactose intolerant.
*'/% )"'.&'!".'#

 Is nausea and vomiting of pregnancy that is prolonged past week 12 of

pregnancy or is so severe that dehydration, ketonuria, and significant weight loss occur
within the first 12 weeks of pregnancy. It occurs at an incidence of 1 in 200 to 300
women. The cause is unknown , but women with the disorder may have increased
thyroid function due to the thyroid-stimulating properties of human chorionic
gonadotropin. It is associated with º  
 
 the same bacteria that causes
ulcer.