Pregnancy: 1000mg

NPNL:1000mg

Pregnancy RDA: 70-75 g/d

Twin Pregnancy RDA: 95-105 g/day

NPNL RDA:45-50 g/d 

Mimum of 175 g/d carbohydrates 

28 g/d dietary fiber 

30 g/d fiber recommended to reduce incidence of constipation (consume fresh fruits and vegetables as well as whole granes with adequate fluids) 

1st Trimester: 0 additional calories needed

2nd Trimester: +340 kcal/d 

3rd Trimester: +450 kcal/d

+1000 mg of Iron are used during pregnancy. The iron distribution is as follows:

450 mg=>increase in RBC mass

350mg=>fetus and placenta

250mg=>blood loss at delivery

RDA for Vitamin D during pregnancy vs NPNL?

What are the risk factors for Vit D inadequacy in pregancy?

Pregnancy RDA: 600 IU = 15 ug

NPNL RDA: 600 IU = 15 ug

Risk factors: 

• vegan diet or low intake vit D fortified milk
• limited sum exposure, dark skin or consistent use of sunblock
• obesity
• Lack of Vit D will interfere with calcuim absorption

RDA for Choline in Pregnant vs NPNL ?

Can the body make choline? Explain.

What is a good source?

RDA for choline in preg: 450mg 

RDA for choline non preg: 425 mg

The body can make choline but it is conditionally essential as it can not be produced in enough quatities fast enough. A great source of choline is egg yolk and meat therefore it is a concern in vegan diets. 

RDA for Iron during Pregnancy: 27 mg

RDA for Iron in NPNL women: 18 mg

RDA for Vitamin A during pregnancy and NPNL?

What sources of Vitamin A are recommended and Why?

Pregnancy RDA for Vitamin A: 770 ug

NPNL RDA for Vitamin A: 700 ug

Betacarotine sources of Vitamin A found in fruits and vegetables are recommended as they are safer and have not been shown to cause toxicity. Some acne medications containig retinol are not good during pregnancy because they can cause Vitamin A toxicity in the fetus. 

• linoleic acid RDA: 13 g/d (not difficult to get in an american diet)
• alpha lenolenic acid (omega 3) RDA: 1.4 g/d (harder to get)
• Sucessive forms of omega 3 include DHA and EPA which should be consumed at 300 mg/d 
• 8-12 oz/ week of fish recommended

Anthropometric- the amount and pattern of weight gain 

Biochemical- anemia and glucose tolerance

Clinical- risk factors: age income BMI smoking drinking high parity anemia presense of chronic disease

Dietary- adequacy of food intake and my plate; cultural factors; pica; supplements; common concerns

Economic- WIC

number of years past menarch

GA<3 = much greater risk for baby and mom

Menarche occus at the end of growth spurt

2-4 more inches in growth following menarche

the pelvis contiues to grow until 18 years of age (provides and issue when giving birth, pelvis may not be wide enough for the baby to fit so my have to get a cesarian section)

Low birth weight (an increase in premature births)

Preeclampsia

yes the growing mom <19 years of age competes with the fetus for nutrients and wins 

teenagers who grow during pregnancy have smaller babies ( growth of teen accurately measured by length of lower leg) 

Chronic hypertension is hypertension that is present before preganancy or diagnosed before 20 weeks of pregnancy as well as hypertension diagnosed during pregnancy that does not disappear after pregnancy. 

systolic ≥140 mm Hg

or

diastoic ≥ 90 mm Hg

Gestational Hypertension is diagnosed when elevated blood pressure occurs after mid-pregnancy. This condition is NOT accompanied by proteinuria. 

If blood pressure returns to normal 12 weeks postpartum then it is called TRANSIENT HYPERTENSION if it does not return to normal it is then diagnosed as chronic hypertension. 

Preeclampsia is a condition that only occurs during pregnacy usually after 20 weeks gestation marked by increased BP systolic:≥140 mm Hg or diastolic≥90 mm Hg

it is accompanied by proteinuria (>0.3 g protein in 24 hr urine sample) 

• african american
• obese
• >35 years of age

Mother

• Early delivery by cesarean section
• acute kidney dysfunction
• increased risk for gestational diabetes, hypertension, and type 2 diabetes later in life

Baby

• Growth restriction
• Respiratiory distress syndrome 

• First preganancy in the young and old 
• Obesity and insulin resistance
• underweight
• multiple fetuses
• history of preeclampsia 
• poor calcium and vitamin D status
• Pro-inflamitory, pro-oxidant stress diet ( diet lacking antioxidants) 

• increased blood pressure, and proteinuria
• decreased plasma volume  expansion (hypovolimeia) 

Energy: +500-600 kcal/day

Protein: +50g protein/day => 95-100 g/day 

Insulin is an anabolic hormone.

Note: even though insulin effects entire metabolism we measure glucose as a marker for insulin abnormalities. 

Gestational Diabetes Mellitus is defined as glucose intolerance that is first detected during pregnancy.

Note: if glucose intoleracnce does not go away after pregnacy it is NOT GDM

The maternal risks due to Gestational Diabetes Mellitus include:

• Gestational Hypertension or Preeclampsia
• C-Sectopm due to LGA infant 
• Development of Type 2 DM later in life (60% of women develop type 2 DM 10 yrs following GDM occurance) 

Fetal Risks due to Maternal Hyperglycemia:

Conception to Perinatal

Neonatal 

Long term 

Fetal risks of maternal hyperglycemia 

• Conception to Perinatal: LGA trauma, congenital anomalies, miscarraige
• Neonatal: hypoglycemia, hypocalcimia, respiratory distress syndrome
• Long term: increased risk of childhood obesity, Type 2 DM, obesity and hypertension later in life 

Risk factors for Gestaional Diabetes Mellitus

• > 35 years old
• obese, over weight 
• history of glucose intolerance 
• runs in family 
• Previous LGA infant 
• Member of a high risk ethnic group: African americans, native americans, hispanics 

Note: about half of women with GDM did not have the above risks