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Nutritional Care in Pregnancy

The expected date of delivery (EDD) is 40 weeks counting from the first day of the last menstrual period (LMP), and birth usually occurs between 37 and 42 weeks. Though pregnancy begins at implantation, it is more convenient to date from the first day of a woman's last menstrual period, or from the date of conception if known. Starting from one of these dates, the expected date of delivery can be calculated using the Naegele's rule for estimating date of delivery. A more sophisticated algorithm takes into account other variables, such as whether this is the first or subsequent child (i.e., pregnant woman is a primip or a multip, respectively), ethnicity, parental age, length of menstrual cycle, and menstrual regularity.
 

Pregnancy Overview
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Physiology of Pregnancy
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Diagnosis of Pregnancy
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Duration of Pregnancy
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Nutritional Care in Pregnancy
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Childbirth
 

A balanced, nutritious diet is an important aspect of a healthy pregnancy. Eating a healthy diet, balancing carbohydrates, fat, and proteins, and eating a variety of fruits and vegetables, usually ensures good nutrition. Those whose diets are affected by health issues, religious requirements, or ethical beliefs may choose to consult a health professional for specific advice.

Adequate periconceptional folic acid (also called folate or Vitamin B9) intake has been proven to limit fetal neural tube defects, preventing spina bifida, a very serious birth defect. The neural tube develops during the first 28 days of pregnancy, explaining the necessity to guarantee adequate periconceptional folate intake. Folates (from folia, leaf) are abundant in spinach (fresh, frozen, or canned), and are found in green leafy vegetables e.g. salads, beets, broccoli, asparagus, citrus fruits and melons, chickpeas (i.e. in the form of hummus or falafel), and eggs. In the United States and Canada, most wheat products (flour, noodles) are fortified with folic acid.

DHA omega-3 is a major structural fatty acid in the brain and retina, and is naturally found in breast milk. It is important for the woman to consume adequate amounts of DHA during pregnancy and while nursing to support her well-being and the health of her infant. Developing infants cannot produce DHA efficiently, and must receive this vital nutrient from the woman through the placenta during pregnancy and in breast milk after birth.
Several micronutrients are important for the health of the developing fetus, especially in areas of the world where insufficient nutrition is prevalent. In developed areas, such as Western Europe and the United States, certain nutrients such as Vitamin D and calcium, required for bone development, may require supplementation. A 2011 study examined cord blood of healthy neonates and found that low levels of vitamin D are associated with increased risk of lower respiratory tract infection the first year of life.

Dangerous bacteria or parasites may contaminate foods, particularly Listeria and toxoplasma, toxoplasmosis agent. Careful washing of fruits and raw vegetables may remove these pathogens, as may thoroughly cooking leftovers, meat, or processed meat. Soft cheeses may contain Listeria; if milk is raw, the risk may increase. Pregnant women are also more prone to Salmonella infections from eggs and poultry, which should be thoroughly cooked. Practicing good hygiene in the kitchen can reduce these risks.

WEIGHT GAIN
Caloric intake must be increased to ensure proper development of the fetus. The amount of weight gained during a single pregnancy varies among women. The Institute of Medicine recommends an overall pregnancy weight gain for women starting pregnancy at a normal weight, with a body mass index of 18.5-24.9, of 25-35 pounds (11.4-15.9 kg). Women who are underweight, with a BMI of less than 18.5, may need to gain between 28-40 lbs. Overweight women are advised to gain between 15-25 lbs, whereas an obese woman may expect to gain between 11-20 lbs. Doctors and dietitians may make different, or more individualized, recommendations for specific patients, based on factors including low maternal age, nutritional status, fetal development, and morbid obesity.
During pregnancy, insufficient or excessive weight gain can compromise the health of the mother and fetus. All women are encouraged to choose a healthy diet regardless of pre-pregnancy weight. Exercise during pregnancy, such as walking and swimming, is recommended for healthy pregnancies. Exercise has notable health benefits for both mother and baby, including preventing excessive weight gain.


EXPOSURE TO TOXINS
Various toxins pose a significant hazard to fetuses during development:
 
Alcohol ingestion during pregnancy may cause fetal alcohol syndrome, a permanent and often devastating birth-defect syndrome. A number of studies have shown that light to moderate drinking during pregnancy might not pose a risk to the fetus, although no amount of alcohol during pregnancy can be guaranteed to be absolutely safe.
Numerous studies show that children exposed to prenatal cigarette smoke may experience a wide range of behavioral, neurological, and physical difficulties.
Elemental mercury and methylmercury are two forms of mercury that may pose risks in pregnancy. Methylmercury, a worldwide contaminant of seafood and freshwater fish, is known to produce adverse nervous system effects, especially during brain development. Eating fish is the main source of mercury exposure in humans and some fish may contain enough mercury to harm an unborn baby's developing nervous system, sometimes leading to learning disabilities. Mercury is present in many types of fish, but it is mostly found in certain large fish. The United States Food and Drug Administration and the Environmental Protection Agency advise pregnant women not to eat swordfish, shark, king mackerel and tilefish and limit consumption of albacore tuna to 6 ounces or less a week.
The Center for Children's Environmental Health reports studies that demonstrate that exposure to air pollution during pregnancy is related to adverse birth outcomes including low birth weight, premature delivery, and heart malformations. Cord blood of exposed babies shows DNA damage that has been linked to cancer. Follow-up studies show a higher level of developmental delays at age three, lower scores on IQ tests and increased behavioral problems at ages six and eight.
According to the U.S. Centers for Disease Control, the developing nervous system of the fetus is particularly vulnerable to lead toxicity. Neurological toxicity is observed in children of exposed women as a result of the ability of lead to cross the placental barrier and to cause neurological impairment in the fetus. A special concern for pregnant women is that some of the bone lead accumulation is released into the blood during pregnancy. Several studies have provided evidence that even low maternal exposures to lead produce intellectual and behavioral deficits in children.
A 2006 study found that children who were exposed prenatally to the insecticide chlorpyrifos had significantly poorer mental and motor development by three years of age and increased risk for behavior problems. A 2007 study using a mouse model suggested that exposure to polycyclic aromatic hydrocarbons prior to conceiving and when lactating reduces the number of eggs in the ovaries of female offspring by two-thirds. A 2009 study of pregnant women exposed to tetrachloroethylene in drinking water found an increased risk of oral clefts and neural tube defects in their children. A 2009 study found that prenatal exposure to phthalates, the chemical compounds used as plasticizers in a wide variety of personal care products, children's toys, and medical devices, may be an environmental risk factor for low birth weight in infants." A 2010 study found that prenatal exposure to flame retardant compounds called polybrominated diphenyl ethers is associated with adverse neurodevelopmental effects in young children.


NUTRITION AND PREGNANCY
refers to the nutrient intake, and dietary planning that is undertaken before, during and after pregnancy.

In a precursory study into the link between nutrition and pregnancy in 1950 women who consumed minimal amounts over the eight week period had a higher mortality or disorder rate concerning their offspring than women who ate regularly, because children born to well-fed mothers had less restriction within the womb.

Not only have physical disorders been linked with poor nutrition before and during pregnancy, but neurological disorders and handicaps are a risk that is run by mothers, who are malnourished, a condition which can also lead to the child becoming more susceptible to later degenerative disease(s).


Beneficial pre-pregnancy nutrients

As with most diets, there are chances of over-supplementing, however, as general advice, both state and medical recommendations are that mothers follow instructions listed on particular vitamin packaging as to the correct or recommended daily allowance (RDA).

Magnesium and zinc supplementation for the binding of hormones at their receptor sites.
Folic acid supplementation, or dietary requirement of foods containing it for the regular growth of the follicle.
Regular Vitamin D supplementation decreases the chances of deficiencies in adolescence. More importantly, it is known to reduce the likelihood of rickets with pelvic malformations which make normal delivery impossible.
Regular Vitamin B12 supplementation, again is known to reduce the chances of infertility and ill health.
 Omega-3 fatty acids can increase blood flow to reproductive organs and may help regulate reproductive hormones. Consumption is also known to help prevent premature delivery and low birth weight. The best dietary source of omega-3 fatty acids is oily fish. Some other omega-3 fatty acids not found in fish can be found in foods such as flaxseeds, walnuts, pumpkin seeds, and enriched eggs.


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