Energy Requirements
T/F You should eat twice as much in pregnancy because you are eating for 2
False! "Eating for 1.1" - Metabolic rate (kcal demand) increases by only ~15%
This macronutrient is required to support synthesis of maternal and fetal tissues
Protein
Bonus: list 5 good sources of protein that are not meat
T/F Prenatal vitamins are standardized to provide certain amounts of micronutrients
False
This vitamin has diverse biologic functions, most commonly known for its importance in bone health and aiding in absorption of calcium & phosphorus.
Vitamin D - 600 IU daily; this was increased in 2010 from the previously recommended 200 IU daily - many experts and the Endocrine Society argue optimal serum concentrations are higher than current standards and the RDA should be 4000 IU daily for pregnant women
Iron
Bonus: what enhances iron absorption and what decreases iron absorption?
Best is heme form - red meat, poultry, fish, seafood (especially oysters)
Non-heme - beans, spinach, lentils, tofu, fortified cereals
Enhance: Vitamin C
Decreases: calcium, phytates, tannins
Calorie needs increase by __ in the first trimester
0
Kcal provided by this macronutrient should make up 10-35% of total kcal needs, or about 1-1.2 g/kg/day.
Protein! Bonus: how many kcal/g protein?
1. This mineral is is needed for oxygen transport, DNA synthesis, and ATP synthesis. Deficiency of this mineral in pregnancy is associated with IUGR, preterm delivery, and increased fetal & neonatal mortality. Early deficiency also affects fetal brain development.
2. What is the RDA for this mineral?
1. Iron
2. 27mg (18mg) - avg intake 17mg
This vitamin is important for cellular differentiation, ocular development, immune function, lung development and maturity, as well as gene expression. Excess of this vitamin can result in birth defects however high intake of the beta-carotene form is NOT associated with increased risk of congenital anomalies.
Vitamin A - beta-carotene is pre Vitamin A
Fish and seafood are a good source, with white fish being higher in this mineral than oily fish.
Iodine
Also iodized salt
Calorie needs increase by __ in the second trimester
~340 kcal
This is the minimum CHO requirement in pregnancy (in grams), with this much being fiber.
175 g/day - 45-65% of total kcal requirements
28-36g fiber (14g/1000kcal)
1. Mild deficiency of this mineral can lead to impaired fetal growth and brain development, as well as impaired immune function. Severe deficiency is associated with acrodermatitis enteropathica and increased risk of miscarriage.
2. What is the RDA for this mineral?
1. Zinc
2. 11-12 mg (8-9 mg)
Low levels of this vitamin are associated with miscarriages, LBW, and preterm birth, and first trimester deficiency is associated with increased incidence of congenital malformations including NTDs, orofacial clefts, and congenital heart defects.
Folate (aka Vitamin B9)
RDA: 600 mcg folate daily; recommend supplementing 400-800 mcg FOLIC ACID 1-3 months before conception (folate, natural form, is 50% bioavailable; folic acid, synthetic form, is 100% bioavailable).
Vitamin C
(other than citrus!)
Strawberries, tomatoes, broccoli, bell peppers, kiwi
Calorie needs increase by __ in the third trimester
~452
This Omega-3 fatty acid is of particular importance in pregnancy and women should consume 200mg extra daily when pregnant
DHA - 100-200mg on top of daily recommendations for 250mg DHA + EPA
Despite its important role in the formation of the fetal skeleton, intake needs do not increase in pregnancy for this mineral.
Calcium - 1000 - 1300 mg daily. Maternal absorption increases during pregnancy so intakes do not have to increase. Full term skeleton contains 30g calcium, 3/4 of which are deposited during the last trimester.
This vitamin is of particular concern for vegetarians, vegans, people with malabsorption (ex. Crohn's involving the terminal ileum and h/o gastric bypass), people using PPIs, and people taking metformin.
Vitamin B12 - required for enzyme reactions, the generation of methionine and tetrahydrofolate, formation of RBCs, and for maintaining nervous system health. RDA is 2.6 mcg/day, many women get 5.6 mcg/day.
Grain products have been fortified with the synthetic version of this micronutrient due to its profound effect on preventing NTDs; and what foods contain the natural version?
Folate (Folic Acid)
Folate naturally found in green leafy vegetables, dark yellow fruits and vegetables, beans, peas, nuts.
These are the 2 biggest determinants for average range of kcal needs during pregnancy
pre-pregnancy BMI & physical activity level
This is not a macronutrient, but an organic compound that is involved in neurogenesis, synapse & cell membrane formation, & nervous system signaling, and is associated with improved processing speed in offspring. Supplementation in women who drank alcohol during pregnancy revealed improvements in infant attention and memory tasks, as well as enhancements in basic information processing at 6 months old.
Choline - 450 mg daily, 90% of pregnant women in US do not meet recommended intake levels.
An egg a day!
Because thyroid hormone synthesis increases by 50% during pregnancy, this mineral requirements increase to 220-250 mcg. Severe deficiency is associated with an increased risk of miscarriage, congenital anomalies, fetal goiter, and decreased IQ; and excessive levels can lead to fetal deficiency and congenital hypothyroidism.
Iodine - prenatal vitamin supplements usually contain 150 mcg, rest should be consumed in diet.
Some is good, but more is not always better!
This vitamin is important for healthy gums, teeth, and bones. Requirements increase especially for people who smoke, engage in substance abuse, and take ASA.
Vitamin C - 85mg (75mg not preg); +35mg for smokers
T/F Healthy fats found in nuts/seeds like walnuts, flax seeds, and chia seeds are good sources of the omega-3 fatty acid DHA
False! Plant based omega-3s (with the exception of algae) provide ALA, not DHA.
The body can convert ALA to DHA, but with a conversion rate of only about 5%.
Fish and seafood, especially cold water/fatty fish, and algae are only sources of DHA.