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Optimal wt gain in PG
Maternal normal wt: 25 - 35lbs
- Maternal underweight: 28 - 40lbs
- Maternal overweight: 15 - 25lbs
- Maternal obesity: 11 - 20lbs
Twins: 35 - 45lbs
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Weight gain distribution
11lbs + Fetus, placenta, amn fluid
- 2lbs Uterus growth
- 4lbs Increased blood volume
- 3lbs Breast changes
- 5-10lbs Maternal stores and ECF increae
- 25+lbs
Should not restrict calories to lose wt in PG (ketosis) dangerous to fetus.
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Pattern of Wt Gain in PG
"Rule of 1/3, 1/26"
- 1lb per MONTH, first 3 months
- 1lb per WEEK next 26 weeks
>2lb / wk is excessive and should be evaluated
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Poor wt gain during first 20 wks causes
- SGA infant
- Small for Gestational Age
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Poor wt gain 2nd 20 wks causes:
Preterm birth risks
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Obesity and PG Risks
- Major health concern - "high risk " PG
- Increased risk for:
- SAB (spontaneous abortion)
- Gestational DM
- Preeclampsia
- Induction of labor
- Cecarean birth
- Fetal anomalies
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Recommended supplenents during PG
- Folic acid - before and during pregnancy
- Iron (2nd/3rd trimester)
- Daily vitamin supplement
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Iron supplementation in PG
- Anemia = PTL and SGA infants
- Sources of Fe: lean meat, dark leafy green vegs, eggs, whole grains, dried fruits, legumes, shell fish, molasses, prune juice
- Fe absorption better from meats vs. vegs
- Vit C incr Fe absorption
- Fe better abs at HS w/food
- Physiologic anemia of PG "dilutional effect" more fluids
- Anemic Hct<33%; Hgb<11
- Compare CBC, H&H from 1st to 3rd trimester
- Every woman will have dilutional
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Folic Acid (folate)
- Deficient folic acid = neural tube defects (NTD's): Spina bifida, Anecephaly
- 400mcg daily
- 4mg daily (high risk group)
Sources: fresh green leafys, nuts, legumes, OJ, whole grains
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PKU (Phenylketonuria)
- Avoid all sources of aspartame/nutrasweet/equal during PG
- Read labels
- Lack enz to digest phenylalanine byproducts
- Accumulates in body
- Affects baby brain, causes MR
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Fluids
64 - 80 oz daily / half or more water
- Dehydration: contractions, cramping, PTL
- Decreased amn fluid
- Faffeinated bevs = diuretic, vasoconstriction
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Mecury in Fish
- Fish/shelfish contain trace mercury
- Developing fetal brain/young child vulnerable
- High levels: swordfish, shark, tilefish, mackerel, albacore tuna
- Low levels: canned light tuna, shrimp, salmon, catfish, pollack
- Avoid: >6oz fish/wk
- Need some fish - omega 3's!
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Food Warnings
- Raw eggs - Salmonella
- Unpasteurized milk or un heated ready to eat foods - Listeriosis (hot dogs, deli meats, poultry, etc.)
Lactose intolerant - lactase deficiency
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Increased calories needed during PG
- +300 calories/day PG
- +500 calories/day Lactating (2500 - 2700/day)
- If lactating:
- Protein - 62 - 65g/day
- Calcium +1g/day
- Fluids +++
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Fat soluble vitamins
ADEK
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Water soluble vitamins
- C
- B's: thiamine (B1), riboflavin (B2), niacin, folic acid, pantothenic, B6 & B12
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GRAS
Generally Recognized as Safe (during pregnancy)
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