Times of Critical Nutrient Needs Pre-conception folate, Vitamin B12, B6 o Achieve and maintain healthy body weight o Good

od dietary habits, exercise regularly o 400 ug folic acid supplement synthesis of DNA bases Goal = 600 ug of folate per day ALL women should take a folic acid supplement 1st trimester 2nd trimester calories 3rd trimester protein, carb, fat, vitamins Neural Tube Closure Days 18-28 o Day 18 neural crest forms o Day 23 neural tube closes from center out o Day 28 cranial and caudal openings close last Embryo formation Neural tube day 20 Heart day 18-42 Arms/legs day 24-44 Eyes day 24 50 Ears day 24 59 Teeth/palate day 39-59 External genitalia day 42-62 Nutrient Transfer to Fetus Yolk sac method of feeding fetus before week 12 o Active/passive transport o Resembles renal vessels feeding into/out of kidney Amniotic fluid immediately around fetus Chorionic fluid outside of amniotic fluid (contained by chroion) Placenta Main route of nutrient transfer/waste removal after week 12 Separates maternal blood from fetal blood Produces hCG, placental lactone, prolactin Fat Soluble vitamins Not readily absorbed Vitamin E syntrophoblast via lipoprotiens Vitamin A retinol-binding protein (RBP) Vitamin D Vitamin D-binding protein (VBP) Iron Transports oxygen Binds to transferrin in blood

 Fetal

Iron absorption efficiency increases during pregnancy o Placenta expresses transferrin receptors 80% of newborns iron supply accumulates during the 3rd trimester Vitamin C enhances iron absorption Black tea and whole grains reduce iron absorption vs. Maternal nutrients Iron fetal need takes precedence Protein, B12 mother and fetus compete Vitamin A excess is more harmful to fetus

Nutrient Increases during pregnancy NO INCREASE NEEDED: Vitamins D, E, K, calcium, phosphorus 50% increase folate, iron 30-40% increase iodine, B6, protein <30% increase riboflavin, calories, B12 caffeine enhances calcium excretion spinach prevents calcium absorption protein goal = 71 g/day 340/450 kcal/day (2nd/3rd trimesters) Protein in Pregnancy 15% total energy intake should come from protein Accumulation rate peaks towards end of pregnancy (5 g/day @ 40 weeks) Protein used for building tissues is ~70% Transfer of Amino Acids to Fetus Concentration of amino acids is higher in fetus Nutrients flow more readily towards the fetus Transporters in the syntrophoblast (placenta) move amino acids from maternal side to fetus Syntrophoblast oxidizes and interconverts amino acids Carbohydrates 45-55% of maternal energy needs (250-300g of carbs/day) Glucose is main energy source for fetus Fetus receives most of its glucose from the mother (because it has low glycogen stores and low rates of gluconeogenesis) Transfer of Glucose to Fetus As pregnancy progresses o Fetal use of glucose increases o Maternal sensitivity to insulin decreases Steep concentration gradient created that shunts glucose to the fetus Fetal demand exceeds maternal intake o Mother uses tissue proteins for gluconeogenesis o Fatty acids energy for maternal muscle

o Fats

Ketones from FA beta-oxidation in the liver fuel for maternal brain

Should be 20-35% of energy (53-93g/day) Need omega-6 FA to absorb fat soluble vitamins (A, D, E, and K) DHA is important Fetus uses long chain omega-3 FA (DHA) for brain development Syntrophoblast takes up free FA and lipids from maternal blood B-oxidation of FA ketones cross placenta easily (energy)

Weight Gain Breast tissue (+1.25 kg) Blood volume (+1.4 kg) Maternal fat (+3.5 kg) Uterine enlargement (+0.9 kg) Amniotic fluid/placenta (+1.5 kg) Infant (+3.4 kg) Recommended Total Gains o BMI <19.8 28-40lb o BMI 19.8-26 25-35lb o BMI 26-29 15-25lb o BMI >29 15lb Normal rates of Weight Gain 1st trimester 3-4 lb Peaks in 2nd trimester (12-14 lb) 3rd trimester 8-10 lb (1lb/week, may lose 1-2lb in the final 2 weeks) Optimal infant birth weight 6.6-8.8lb Optimal gestational age 39-41 weeks Excess Maternal Weight Gain/obesity prior to pregnancy Excess birth weight (>10 lb) Preeclampsia Pregnancy induced hypertension Placental insufficiency DIETING IS INAPPROPRIATE FOR ALL PREGNANT WOMEN (regardless of their weight) Maternal Malnutrition Growth retardation energy, protein, carb, vitamins Brain development energy, vitamins Inadequate storage of nutrients vitamins Protein negative outcomes in adulthood, altered enzyme activity Caffeine Limit to <300 mg (6oz coffee, 12oz soda) Increases calcium excretion from body

Diuretic Causes intrauterine growth retardation Not metabolized by the fetus/placenta & stimulates CNS

Fiber Increase to 28 g/day AND increase fluid intake Pregnancy reduces intestinal motility Nutrient Goals Grains: 8 oz (240 g/day) Vegetables: 3 cups/day Fruit: 2 cups/day Oils: 7 tsp/day Milk: 3 cups/day Meat/beans: 6.5 oz/day Nutritional Management of Physiological Changes Heartburn drink liquids between meals Constipation liquids, fiber Hypertension 1-2g calcium/day, adequate vitamins Hyperemesis (nausea) Small frequent meals reduces nausea Pica Eating nonfood items Macrosomia Excessive growth of fetus