Pregnancy Objectives

NUTR 526: Maternal and Infant Nutrition

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Students will be able to:

Preconceptual Nutrition

List major nutritional factors associated with infertility
List components of ideal preconceptual nutrition assessment
Describe effects of maternal under and overweight on maternal and fetal outcomes
List preconceptual recommendations for fathers and possible pathophysiology associated with failure to comply with these recommendations.

Intergenerational Effects of Maternal and Infant Nutrition

List chronic diseases of adulthood that some studies suggest may be related to fetal nutrition

Explain the major tenants of Barker’s "fetal origins" hypothesis of the role of fetal nutrition in preventing chronic diseases of adulthood.

Describe effects of acute undernutrition as experienced by women in the Dutch famine study on both infant and adult outcomes of those exposed in utero according to trimester of exposure.
Describe the relationship between the pregnant woman’s own birth weight and the expected birth weight of her infant. Discuss possible explanations for this relationship.

Physiology of Pregnancy

Describe the role of the yolk sac in early fetal nutrition and the effects of maternal hyperglycemia and low folate and B₁₂ status on fetal nutrition
Describe the concept of "critical periods" of fetal development in light of nutritional insults.
List mechanisms of placental nutrient transfer for fatty acids, steroids, electrolytes, fat soluble vitamins, monosacharides, amino acids, and water soluble vitamins.
Describe in a general way, the need for steroids as precursors and the functions of placental hormones during pregnancy.
Understand role of the placenta as mediator of transport of nutrients and metabolic wastes, user of oxygen and glucose, separator of maternal and fetal blood, and communicator of messages from concepts to mother.
Identify major maternal adaptations to pregnancy as regards to:
- CV: blood and plasma volume, blood pressure
- Respiratory: oxygen carrying capacity, tidal volume, diaphragm
- Renal: GFR, presence of nutrients in urine
- GI: motility, GER, gastric emptying time, smooth muscle relaxation, constipation, cholestasis

Define the terms, Small for Gestational Age (SGA), Large for Gestational Age (LGA), Low Birth Weight (LBW), and Very Low Birthweight (VLBW).

Psychology of Pregnancy

List Lederman's developmental tasks of pregnancy and discuss possible nutrition related implications of progress towards achieving these tasks.
Discuss implications of intendedness of pregnancy as they relate to nutrition and health behaviors in pregnancy.
State current trends in pregnancy intendedness in the US in relation to the past and to other western democracies.

Energy

Identify RDA for energy for pregnancy and US food consumption data for actual energy intake in pregnant women
List components of energy costs in pregnancy (i.e. fetus, placental, expanded maternal tissues, maternal fat, BMR)
Discuss clinical implications of current knowledge of energy requirements in pregnancy in light of recommendations for individual women.
Discuss current thinking about metabolic adaptations to pregnancy in terms of energy for each of the following:
- A thin woman in a developing country who has limited access to food, and must continue to do physical labor during pregnancy.
- A "normal" weight women in a developed country who has easy access to food and the option of cutting back physical activity in pregnancy
- An obese woman in a developed country who has easy access to food.

Weight Gain

Identify ranges for optimal outcomes of pregnancy in current US studies
Identify IOM guidelines for weight gain for women with low, normal, and high BMIs.
Discuss concerns about the following groups of women in regards to weight gain in pregnancy: teens within 2 years of menarche, women less than 62" tall, African American women, women who smoke.
State risks of high weight gain in pregnancy
List components that contribute to total weight gain in pregnancy.

Protein

Identify RDA for protein needs in pregnancy
Be aware of concerns about excessive protein supplementation in pregnancy.

Lipids

Describe current thinking about maternal serum cholesterol and triglyceride levels in pregnancy.
List dietary sources of essential fatty acids from the omega 6 and omega 3 families.
Identify dietary sources of preformed DHA.
State current thinking about the importance of DHA to fetal brain development and ways of ensuring adequate fetal DHA.
Describe possible mechanisms for the ratio of omega 6 fatty acids to omega 3 fatty acids to play a role in pregnancy induced hypertension and length of gestation.
State potential danger of fish oil supplementation in pregnancy.
State potential problem with excessive maternal intake of trans fatty acids during pregnancy and lactation.

Iron

List components of iron requirements for pregnancy
State average amount of absorbed daily iron required to meet iron requirements for pregnancy.
Describe maternal-fetal iron metabolism in regard to maternal serum transferrin, placental transferrin receptors, and placental ferritin.
Describe relationship between maternal iron status and fetal iron status.
Identify diagnostic criteria for anemia for hematocrit and hemoglobin for each trimester.
Identify diagnostic criteria for low iron stores using serum ferritin values in pregnancy.
Describe the relationship of iron absorption to stage of pregnancy and dose of iron in supplement.
Describe relationship between maternal hemoglobin concentration and fetal abnormalities and death.
Describe potential pathways for iron deficiency in pregnancy to have an effect on cognitive development of the infant and young child.
Describe potential adverse consequences of iron supplementation
State IOM and PHS recommendations for iron supplementation in pregnancy and describe reasoning for recommendations.

Calcium

Identify total amount of calcium that is transferred to the average fetus.
Describe patterns of calcium absorption and fetal transfer in pregnancy
Identify results of calcium balance studies in terms calcium intakes that provide both the upper limits of maternal accretion of calcium and the point at which mothers may have a negative calcium balance in pregnancy.
State current recommendations for calcium intake in pregnancy.
Identify IOM recommendations for calcium supplementation in pregnancy

Folic Acid

Identify CDC recommendations for folic acid supplementation for women who have previously delivered a baby with a neural tube defect.
State the proportion of neural tube defects that are currently thought to be preventable with adequate folate intake.
Discuss concern about excessive fortification of the food supply with folic acid and state levels of individual intake that the FDA has considered to be problematic for the population.
Identify major dietary sources of folate.
List three methods of increasing folate in the population of women with child bearing potential.
Identify current recommendations for folate intakes in women who have child bearing potential who have not previously delivered an infant with a neural tube defect.

Vitamins and Minerals - General

List vitamins for which there are increased requirements due to increased energy metabolism in pregnancy.
Identify vitamins and minerals for which there are substantially increased needs in pregnancy and describe the reasons for these increased needs.
List vitamins and minerals that may be of concern due to population based data indicating higher rates of inadequate intake.
Identify risk factors associated with low levels of vitamin and mineral intakes
Identify potentially toxic levels of vitamins A, D, and B₆ and list affects of toxicity.
Identify high risk women for whom the IOM has recommended vitamin and mineral supplements
Understand current thinking about role of zinc in pregnancy in US: RDA, actual intakes, interaction with Fe supplements, adverse outcomes associated with zinc deficiency.

Adolescent Pregnancy

Describe psychosocial factors that may impact nutritional status in pregnant adolescents
List adolescent food patterns that may impact nutritional status of pregnant adolescents.
Identify the NIH consensus statement on Optimal Calcium Intake recommendations for adolescents.
Identify the IOM recommendation for young women who are consuming no calcium rich products.

Lifestyle Concerns

List ACOG Guidelines for exercise in pregnancy
Describe the relationship between maternal cigarette smoking and fetal weight gain.
Describe current understandings and recommendations for caffeine, herbal tea, and aspartame intake in pregnancy.
Define pica and list some potential adverse consequences in women who practice pica.
Define fetal alcohol syndrome and possible fetal alcohol effect
List potential findings in infants and children exposed to alcohol in utero.
List current recommendations for alcohol use during pregnancy.

Discomforts

List nutritional interventions that may be helpful in alleviating discomfort in pregnancy due to nausea and vomiting, constipation, and heartburn.

Maternal complications and disease conditions

Define pregnancy induced hypertension (PIH), preeclampsia, eclampsia and identify diagnostic criteria for each.
List nutrients that are currently of interest in terms of their association with PIH, and discuss current thinking about the strength of those associations.
Define gestational diabetes.
State current recommendations for screening for gestational diabetes, and identify diagnostic criteria.
List components of nutritional therapy for women with diabetes during pregnancy.
List potential adverse consequences of poor diabetes control during pregnancy.
Define hyperemesis gravidarum.
List potential fetal, child and maternal complications that have been reported for women diagnosed with anorexia and bulimia nervosa.
Discuss meanings of weight gain in pregnancy, post partum weight, and body image in light of cultural norms for body size.

Nutrition Assessment

Be able to determine appropriate weight gain recommendations for women in pregnancy based on prenatal weight, age, height, smoking status, and ethnicity.
Be able to make appropriate recommendations for vitamin and mineral supplementation in pregnancy.
Be able to identify appropriate lab values for hemoglobin, hematocrit, and ferritin for each trimester of pregnancy.
List potential personal risk factors that may affect nutritional status in pregnancy.
Identify nutritional risks that may be identified with the following components of obstetrical history: parity, infant birth weight, maternal weight changes, and interconceptual period.

Nutrition Counseling

Suggest an appropriate dietary pattern for healthy pregnant women based on the food guide pyramid.
Suggest dietary sources of calcium for women who consume no dairy products.
Suggest potential interventions for both inadequate and excessive weight gain

Services and Education for Pregnancy

List positive health outcomes that have been associated with nutrition intervention programs for child bearing women.
List components of nutrition intervention programs that appear to contribute to the success of the programs.
Identify potential resources for women who experience difficulties with access to appropriate foods.

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