Features of a woman's nutrition during pregnancy. Nutrition during pregnancy: how to balance your diet
16. Basics of rational nutrition for pregnant women, regime and personal hygiene of pregnant women.
Nutrition for pregnant women.
During pregnancy, a woman's body undergoes a restructuring of metabolic processes, therefore, special attention should be paid to a balanced diet, which is one of the main conditions for a favorable course and outcome of pregnancy, childbirth, fetal development and unborn child. It plays an essential role in the prevention of anemia, toxicosis of pregnant women, intrauterine fetal malnutrition, abnormalities of labor and other complications.
Balanced diet - a complete set of various food products in accordance with the gestational age and the correct distribution of the diet throughout the day. The diet is compiled individually, taking into account the height and body weight of the pregnant woman, the size of the fetus, the nature of the course of pregnancy and the woman's labor activity.
The basal metabolic rate during pregnancy increases by about 10%, and the total energy consumption is 2500 kcal per day. This is due to increased oxygen consumption and fetal activity. Energy costs are associated with the growth of the fetus, placenta, uterus, mammary glands. With the onset of pregnancy, the amount of consumed energy constantly increases up to 30 weeks, then some decrease is observed. The additional costs incurred during pregnancy are covered mainly by fat (50%) and carbohydrates (about 33%). Proteins are used almost exclusively for the formation of fetal tissues and only about 6.5% is spent on energy expenditure.
With excess weight, the diet should be formulated so as to prevent unwanted weight gain, i.e. reduce its calorie content due to carbohydrates and fats; pregnant women with low body weight need to increase the calorie intake while maintaining the necessary ratios between the main ingredients. On average, in the second half of pregnancy, weight gain should not exceed 250-300 g per week.
The increase in body weight by the end of pregnancy in women is 8-12 kg:
Due to the fruit - 3.5 kg
Masses of the uterus and amniotic fluid - 650-900 g
Breast augmentation - 400 g
Increase in the volume of circulating blood and intercellular fluid - 1.2-1.8 kg
By increasing fat and other reserves of the mother's body - 1.6 kg.
An essential condition for a balanced diet - compliance with a certain diet, the violation of which not only harms the mother's body, but also adversely affects the development of the fetus and newborn.
In the first half During pregnancy, a woman's diet should not differ significantly from that before pregnancy. It should be remembered that in the first trimester the fetal organs are laid (the period of organogenesis), therefore, it is especially important that a sufficient intake of high-grade proteins, vitamins, and minerals in the body of a pregnant woman. The most rational regimen of four meals a day.
In the second half pregnancy, the need for proteins increases, not only their quantity (2 g per 1 kg of pregnant weight) is important, but also the quality. The completeness of a protein is determined by the content of essential amino acids in it. The diet includes 50% animal protein and 50% vegetable protein. The need for carbohydrates is met by foods rich in plant fiber, which contain vitamins, trace elements, and mineral salts. With an overweight pregnant woman, the amount of carbohydrates decreases to 300-400 g per day, since carbohydrates are the main source of fat formation. Fat per day for a pregnant woman needs 100-110 g. It is recommended to use vegetable fats (up to 40% of the total) - sunflower, corn and olive oil, from animal fats, preferably butter and ghee. It is advisable to eat 5-6 times a day. Breakfast should be 30% of the calorie content of the daily diet, second breakfast - 15, lunch - 40, afternoon tea - 5 and dinner - 10%. It is recommended to compose the menu taking into account the season. Dishes containing extractives (broths, spices, smoked meats), salty and spicy foods are not recommended, alcoholic beverages are not allowed, since alcohol quickly passes through the placenta and negatively affects the fetus.
Liquid (water, soups, compotes, tea, juices, milk, jelly) in the first half of pregnancy is almost unlimited. You can use it up to 1.5 liters per day. In the second half of pregnancy, fluid intake is limited to 1-1.2 liters, and in recent weeks - up to 0.7-0.8 liters per day. Table salt is limited in the second half of pregnancy to 8 g per day (norm 12-15 g).
The daily dose of calcium in the first half of pregnancy is 1 g, then - 1.5 g, and at the end of pregnancy - 2.5 g.
Phosphorus is spent on the formation of the fetal skeleton, its nervous tissue. It is found in nuts, bread, cereals, milk, meat, liver. The daily dose of phosphorus is 2 g.
The daily requirement for iron is 15-20 mg, in magnesium 0.3-0.5 mg, in cobalt - 5 μg.
Vitamins - biocatalysts that regulate the functions of many organs and systems of the human body. Vitamins are especially important for the body of a pregnant woman.
Vitamin A (carotene) is found in liver, kidney, butter, milk, eggs, carrots, fish oil, apricots, and cheese. Its daily dose is 500 IU (about 1.5 mg). In the last 2 months of pregnancy, the daily dose may be increased to 10,000-20,000 IU.
Vitamin C (ascorbic acid) is found in many fruits, berries, vegetables, especially a lot of it in rose hips, black currants, lemon, green onions. The daily requirement of a pregnant and lactating woman is 100-200 mg of this vitamin. In the second half of pregnancy, the need for it increases significantly, and ready-made vitamin C preparations in pills or tablets can be prescribed.
Vitamin B 1 (thiamine) is found in liver, kidneys, milk, egg yolk, bread and brewer's yeast. The daily requirement is at least 10-20 mg.
Vitamin B 2 (riboflavin) is found in yeast, liver, kidneys, meat, eggs, dairy products. The daily dose is at least 2-3 mg. Vitamin B 2 is essential for the normal course of pregnancy and childbirth.
Vitamin B 6 (pyridoxine) is found in wholemeal bread. The daily dose is at least 5 mg, it is necessary for normal metabolism.
Vitamin B 12 (cyanocobalamin) is involved in the formation of nucleic acids, has a beneficial effect on the functions of the liver, nervous system, is contained in buckwheat, yeast, and liver. The daily dose is 0.003 mg.
Vitamin PP (nicotinic acid) is found in yeast, rye bread, meat, liver, lungs, wheat grains, potatoes. The average daily requirement of a pregnant and lactating woman is 18-23 mg.
Hygiene of pregnant women.
Physiological changes that occur during pregnancy have a beneficial effect on the body of a healthy woman, contributing to the full development of the most important functional systems. Under these conditions, pregnancy is usually easily tolerated. However, hygiene disorders, poor nutrition, excessive mental and physical stress can cause disruption of physiological processes and the occurrence of complications of pregnancy. In women with signs of delayed development of the reproductive system who have undergone abortions, gynecological and extragenital diseases, stressful situations and other pathological conditions, a violation of the physiological processes inherent in pregnancy can occur even with minor violations of the general regimen and hygiene rules.
A pregnant woman should follow the rules of hygiene that promote the maintenance of health, normal development of the fetus, and prevention of complications of pregnancy and childbirth.
With the correct lifestyle of a pregnant woman, there is no need to make significant changes to the general regimen. Healthy pregnant women perform routine physical and mental work, which is the need of every person. Work contributes to the proper functioning of the nervous, cardiovascular, muscular, endocrine and other systems, muscles, joints, ligaments, etc. Labor, especially when associated with physical activity, is necessary for normal metabolism. Exercise should be recommended that has a positive effect on pregnancy and childbirth. At the same time, the pregnant woman should avoid increased stress that causes physical and mental fatigue.
The antenatal clinic doctor monitors the implementation of the legislation protecting the health of the expectant mother. Pregnant women are not involved in night work, overtime work, as well as associated with lifting and moving heavy objects, vibration, exposure to high temperatures, radiation, a number of chemicals and other agents that can have a harmful effect on the body of the mother and fetus. Pregnant women are prohibited from riding bicycles and other types of transport, associated with vibration and shaking of the body, all sports related to running, jumping, sudden movements and emotional stress.
It is recommended to go for walks at any time of the year, as well as to use other opportunities for a long stay in the fresh air. The duration and pace of walking should be commensurate with the fitness level, age and health of the pregnant woman.
A good sleep of at least 8 hours a day is very important. In the case of sleep disorders, hygienic measures are preferable (walks before bedtime, optimal temperature and fresh air in the room, etc.) The use of hypnotics is undesirable due to the possibility of their effect on the fetus. According to indications, motherwort and valerian preparations are prescribed.
Issues of sexual hygiene deserve attention. Abstinence from sexual activity during the entire pregnancy is theoretically justified, because significant fluctuations in hemodynamics in the vascular basin of the reproductive system cannot be considered physiological. Moreover, they can contribute to the termination of pregnancy, especially in women with signs of infantilism, who have had inflammatory and other diseases of the genital organs, and have a complicated obstetric history. However, a complete rejection of sexual activity is almost unrealistic, so you should limit it during the first 2-3 months and stop in the last months of pregnancy.
Hyperemia of the genitals, loosening of the mucous membranes of the vagina and cervix contribute to the development of inflammatory diseases in the case of the introduction of pathogenic flora during sexual intercourse.
A pregnant woman should avoid contact with patients with general and focal infectious diseases. It is necessary to eliminate all foci of infection that arose before and during pregnancy (tonsillitis, tonsillitis, caries and other inflammatory diseases of the dental profile, colpitis, furunculosis, etc.).
Skin care during pregnancy is very important. To ensure the complex functions of the skin, it is necessary to monitor its cleanliness (shower, bath, rubdown). It promotes the implementation of excretory, respiratory and other functions of the skin, has a beneficial effect on the vascular and nervous system, regulates sleep and other types of body activities. Air and sun baths are recommended for healthy pregnant women. The duration of the air baths is at first 5-10 minutes, and during hardening - 15-20 minutes at an air temperature of 20-25 ° C. Under other temperature conditions and depending on the degree of fitness, the air bath regime changes (or they are not recommended). Avoid intense exposure to sunlight. In winter, general ultraviolet irradiation is desirable under the supervision of a physiotherapist.
In the antenatal clinic, prevention of nipple cracks and mastitis begins. Basically, it comes down to daily washing the mammary glands with water at room temperature with soap (for children) and subsequent wiping with a hard towel. With dry skin, 2-3 weeks before childbirth, it is useful to daily lubricate the skin of the mammary glands, including the areola, with a neutral cream (for children, etc.). Air baths for the mammary glands are carried out for 10-15 minutes several times a day. For flat and inverted nipples, massage is recommended, which the woman is taught by a doctor or midwife. You should wear comfortable bras (preferably cotton) that do not constrain the chest. To avoid congestion, the mammary glands should be in an elevated position.
In order to prevent mastitis, it is necessary to identify pregnant women who have previously suffered from this disease, with the presence of a purulent infection of any localization during this pregnancy, with mastopathy and other pathology of the mammary glands. In the exchange card of such pregnant women, the risk of mastitis is noted.
Pregnant woman's clothes should be comfortable, not constrict the chest and abdomen. Cottons are preferred and can be changed and washed frequently. You should not wear clothing made of fabrics that hinder the respiratory, excretory, thermoregulatory and other functions of the skin (from acetate, viscose and other fibers). In the second half of pregnancy, it is recommended to wear a bandage.
Proper nutrition during pregnancy is the key to the health of the unborn child. It is very important that protein is present in the diet, because it is he who is the basis for the rapidly growing baby's body. A number of products that can cause serious harm should be discarded altogether.
When planning meals for pregnant women, nutritionists start from the gestational age, because at each stage, the female body needs different nutrients. Therefore, during each of the periods of pregnancy, the menu of the expectant mother must be adjusted.
- The diet of a mother who is at the initial stage of pregnancy does not actually differ from the usual diet. Of course, the menu should be complete and enriched with the necessary nutrients. This approach to nutrition is explained by the fact that, despite the formation of all the most important organs of the baby, he is still too small for him and his future mother, the usual amount of food is enough for full development. The only feature should be the emphasis on consuming as many foods as possible, which contain the right amount of calcium.
- With the onset of the second trimester of pregnancy, the child begins to grow rapidly and here you cannot do without food with a high protein content. It is extremely important not only to increase the amount of food consumed, but to choose exactly those foods that contain an increased amount of nutrients for the child.
- With the onset of the third trimester, the child has the formation of the skeleton, all internal organs and the development of the nervous system. It is during this period that it is necessary to focus on food with a high content of calcium, minerals and vitamins.
Based on all of the above, the conclusion follows - the proper nutrition of the mother should depend on the duration of her pregnancy and satisfy all the physiological needs of the unborn child.
In the first months of pregnancy, a woman may not change her usual diet, which includes 3 to 4 meals a day. The only point to which you need to pay attention should be the balance of calories. You need to distribute it as follows:
- Your first meal can be about 30 percent of your daily calorie intake.
- Second breakfast can contain up to 15 percent of your daily calorie intake
- Lunch should be the densest meal of the day. Its calorie content can be as high as 35 percent of the daily value.
- Dinner should be lighter. Its calorie content should not exceed 25 percent of the daily value.
Starting from the 4th - 5th month, meals should be more frequent, about 6 times during the day, but the weight of each serving should be slightly reduced. This change in diet is due to the fact that an overly full mother's stomach can put pressure on the developing fetus. For this reason, it is highly undesirable to pass it on to future mothers.
The products that the expectant mother consumes during the day also need to be correctly distributed. During breakfast and lunch, you should select foods rich in protein. This includes various types of fish, eggs and not too fatty meat. These foods have a stimulating effect on the nervous system and take longer to be absorbed. Dinner should consist of lighter foods such as dairy products or vegetables.
A woman in a position should make it a rule that she needs to have dinner no later than 3 hours before bedtime. Eating too much before bed is extremely harmful. If hunger seems completely unbearable, you can afford a glass of warmed milk or kefir, or eat a small pear or apple.
Another important nutritional feature is the inclusion in the diet of foods that have a positive effect on intestinal peristalsis. Systematic bowel cleansing is very important for maintaining the health of the mother and her unborn child. Such products include:
- Apples and various types of dried fruits
- Fresh carrots
- All kinds of cereals
- Bread baked from wholemeal flour with the addition of bran.
Regular use of fruit juices, always with pulp, will help to achieve a positive effect. Adequate fiber helps the body to cleanse itself.
Proper nutrition during pregnancy to avoid gaining excess weight?
The nutrition of a woman waiting for a little miracle should be based on the following rules:
Proper nutrition in the 1st trimester of pregnancy
The main purpose of feeding pregnant women in the first few weeks of fetal formation is to provide the baby with the necessary amount of calcium. In this regard, the menu should contain such products as:
- Green vegetables. Broccoli cabbage will be the most useful.
- Milk and dairy products.
- Fresh juices.
Another important element for the body of the future mother is manganese, since the correct formation of the fetal membrane and the placenta depends on it. The following products will help to replenish manganese reserves:
- Pork
- Spinach
- Turkey
- Bananas
- Oatmeal
Starting from the 5th week of pregnancy, many women develop toxicosis. To reduce the manifestations of toxicosis, a woman should eat a not too sweet cracker or a small crouton and drink a few small sips of water. A prerequisite is that you should eat without getting out of bed.
During the day, instead of eating heavy foods, a woman suffering from toxicosis should choose lighter foods, which include vegetables and fruits. You can add soy, nuts, legumes, yoghurts (preferably homemade) and various types of cheeses to the diet.
In addition, during the period of toxicosis, you can make an exception and eat a small amount of pickled cucumbers, pickled apples, or sauerkraut. These foods help to awaken appetite.
To stimulate intestinal motility and obtain a sufficient amount of fiber, you should diversify the diet of the future mom with products such as:
- Fresh kefir
- Beet
- Porridge and whole grain bread
- Dried apricots and prunes.
In the first trimester of pregnancy, it is advisable to listen carefully to the body's prompts. The well-known "whims" of pregnant women are nothing more than a signal from the body about the lack of certain substances. Satisfying whims (within reasonable limits) will not have a negative impact on the health of the mother and her unborn child.
Going out into the street, a woman suffering from toxicosis should take water, an apple, or a lemon with her. All this can help to cope with the next bout of nausea.
Proper nutrition in the 2nd trimester
With the onset of the second trimester, the daily amount of calories should increase. The increase in calories is due to the rapid growth of the child, who desperately needs an impressive amount of protein. If the expectant mother suffered from toxicosis, then at the new stage of pregnancy she will most likely experience a constant feeling of hunger, which threatens to gain excess weight. In such a situation, overeating should be avoided. It is necessary to monitor your own weight not only for beauty, but also for the prevention of the onset of diabetes in pregnant women.
Another nutritional feature should be the replenishment of iron stores. For this purpose, the diet should include:
- Tomato juice
- Buckwheat porridge
- Liver
- Meat.
For an easy pregnancy, the body must contain a sufficient amount of vitamin B9, which are rich in:
- Asparagus and green beans
- Parsley, lettuce, spinach
- Avocado and citrus
- Fresh green peas.
At the end of the second trimester, the unborn child develops the organs of sight and hearing. For the proper development of these organs, you need to choose foods with a high content of vitamin A and beta-carotene. These substances are in:
- Carrots
- Cabbage
- The pepper is yellow.
Proper nutrition in the 3rd trimester of pregnancy
A correctly composed diet at the last stage of pregnancy can save a woman from the development of late toxicosis. This condition is extremely dangerous and is characterized by a decrease in the performance of the kidneys, which entails the appearance of severe edema and surges in blood pressure. To avoid edema, salt should be practically avoided in the last trimester.
Mommies' nutrition should be extremely healthy. The diet can include:
- Whole grain cereals.
You will have to forget about your favorite pasta and all kinds of buns for a while. In addition, you should completely abandon fried, salted, smoked, canned and spicy foods. It is strictly forbidden to eat peanuts, all types of citrus fruits and chocolate (except white). The use of these products can provoke the development of allergies in a baby.
To avoid such a problem as constipation, you should include dried fruits and figs in the menu. You can also drink a glass of kefir a day.
To protect yourself from heartburn, which often appears during this period, it is advisable to eat:
- Boiled poultry
- Lean meat
- Fruits and vegetables (previously heat-treated)
- Cottage cheese (the main thing is not fat)
- Dried bread
- Eggs (preferably soft-boiled).
Starting from the eighth month, the diet should be dominated by foods that contain a large amount of calcium and fatty acids. The change in diet is due to the fact that the child is actively forming bones and developing the brain. The expectant mother is recommended to pay attention to:
- Red meat
- Various nuts
- Fatty fish
- Green vegetables.
In the last few weeks, the mom-to-be should begin preparing the body for the childbirth process. At this stage of pregnancy, porridge and vegetables become the main food of a woman.
Proper nutrition of the expectant mother with pyelonephritis
Unfortunately, pyelonephritis is a very common ailment among pregnant women. With pyelonephritis, a pathogenic microflora penetrates the kidneys. During treatment, you must adhere to the strictest diet.
- The diet of a woman diagnosed with pyelonephritis should consist of pasta, various cereals and uncomfortable pastries.
- Not fatty meat, fish and poultry
- Fresh or cooked vegetables. The most useful are zucchini and eggplant.
- Sour cream, cottage cheese or yogurt, with a low percentage of fat.
If pyelonephritis is detected, it is advisable to completely abandon smoked meats, fatty or pickled foods, it is categorically impossible to eat baked goods, fresh bread, puff pastry and all types of cakes. Meat, mushrooms, fish and various types of cheeses should also be strictly prohibited.
- Apples, gooseberries, pears, grapes, and also plums will be most useful for expectant mothers who are diagnosed with pyelonephritis.
- The most optimal cooking methods during the treatment period are boiling or steaming.
- If the expectant mother is diagnosed with pyelonephritis, but there is no swelling at all, the diet should not be changed.
Studies of recent decades have proven the existence of a connection between the nutrition of the fetus and young children and the state of health in the future over long periods of time and have led to the creation of a unified concept of nutritional programming, according to which the nature of nutrition programs the characteristics of metabolism throughout subsequent adult life and can cause various metabolic disorders such as obesity, diabetes mellitus, hypertension and others.
From the moment of conception to adulthood, a child at different stages of development receives various types of nutrition, replacing each other in stages: histotrophic nutrition of the embryo (due to the yolk sac), hemotrophic nutrition (through the vessels of the placenta), amniotrophic nutrition (ingestion of amniotic fluid and digestion of their ingredients) , lactotrophic nutrition of a newborn and an infant (mother's milk or breast milk substitutes), lactotrophic – differential from 4–6 months of life to 12–18 months (transition period from milk nutrition to a common meal) and definitive nutrition of children and adults.
Therefore, the nutrition of a pregnant woman from the moment of conception to childbirth is of particular importance. It is not for nothing that the professor of the St. Petersburg midwife institute N.M. Maksimovich (Ambodik) said “A pregnant wife, as soon as she feels that she has conceived in the womb, is strictly obliged to observe a decent life in every possible way and good conduct in all her condition is decent; for she should not only care about the preservation of her own health, but also take care of the observance of the fetus she carries ”.
But there are 2 sides of the problem: on the one hand, the growth and proper development of the fetus require a sufficient supply of energy and nutritional factors, both interchangeable and not, and on the other, full provision of the pregnant woman herself is necessary, taking into account the physiological changes occurring in the body.
Thus, there are three principles of rational nutrition for pregnant women:
1. Satisfaction of the physiological needs of the fetus in basic nutrients and energy necessary for its optimal growth and development.
2. Satisfaction of the physiological needs of a pregnant woman in basic nutrients and energy to maintain her health.
3. Ensuring a comfortable state of health, good mood and high activity of a woman at all stages of pregnancy.
So, for adequate growth and development, certain and balanced foods are necessary, which are a kind of building blocks. But it is worth remembering that unfavorable, and first of all, terratogenic, effects entail not only a deficiency, but also an excess of nutrients (Table 1).
There are basic rules for the nutrition of women during pregnancy:
1. Full satisfaction of the physiological needs of women for energy and nutrients, including amino acids, fatty acids, vitamins, mineral salts, trace elements.
2. The maximum variety of food diets for women, including all food groups.
3. Preservation of food stereotypes, if the woman's nutrition was sufficiently adequate before pregnancy.
4. Providing additional food intake:
Energy for the growth of the fetus, the formation and growth of the placenta, for the restructuring of metabolic processes in the woman's body;
Protein for the growth of the fetus, placenta, uterus, mammary glands;
Calcium and iron, necessary for the calcification of the fetal skeleton and the formation of an iron depot in the mother and fetus;
Plant fiber required for intestinal motility.
5. Additional intake of vitamin and mineral preparations.
6. A limited intake of salt and salty foods, as well as fluids, contributing to the development of edema.
7. Limitation of foods with high sensitizing activity (obligate allergens), as well as foods containing essential oils (onions, garlic), spices and herbs, a significant number of artificial preservatives, dyes and stabilizers.
8. Gentle culinary treatment.
9. Maximum consideration of the individual needs of women.
10. Extensive use of specialized food products enriched with protein, essential fatty acids, vitamins, mineral salts.
It should be noted that points 4, 6-8, mentioned above, are more relevant for the third trimester of pregnancy, because the second half of pregnancy is characterized by significant changes in physiological processes and an increase in the need for energy and nutrients, due to an increase in the size of the fetus, the need to provide it with additional nutrients and energy, as well as the growth of the placenta. For good nutrition, therefore, the amounts of energy and nutrient requirements should be known, which are presented in table 2.
Therefore, taking vitamins and mineral complexes is the most natural and effective method for the prevention and treatment of the listed complications of the gestational period in a woman, as well as diseases of the fetus and newborn. For good nutrition and prevention of major deficiencies during pregnancy (especially iron and calcium), a balanced diet containing products of plant and animal origin is required (Table 3). In addition, there are specialized products for pregnant women that meet all the needs of this population group. I would especially like to note the products of the FrutoNyanya company, namely juices for two, rich in their assortment of tastes, which are an ideal option for the prevention of anemia in pregnant women, one of the most common complications of pregnancy. the volume of circulating blood increases, therefore, more oxygen is required to saturate it. Oxygen is carried to tissues by hemoglobin, which cannot be produced without iron. Iron deficiency leads to anemia. The consequences of anemia for a child are growth retardation and mental retardation. For the mother - constant fatigue, increased morbidity. In the second half of pregnancy, a woman needs to receive 30 mg of iron per day. This amount cannot be provided even with a properly constructed diet, since only 10% of iron is absorbed from food. Its additional reception is required. The juice contains iron + vitamins C, B2, B6, without which iron is not fully absorbed, as well as vitamin B12 and folic acid, which provide oxygen from the lungs to all body tissues.
The chemical composition of the diet:
Proteins - 96 g (including animals - 65 g);
Fat - 95 g (including vegetable fats - 26 g);
Carbohydrates - 329 g.
With proper, balanced nutrition and the rhythm of life necessary for a pregnant woman, a healthy child is born, which every sane and loving mother will try to feed with mother's milk. And at this stage, women sometimes forget that due to the production of a large amount of nutrients by the mammary glands, these losses should be replenished. Thus, the nutrition of a lactating woman should provide:
1. Satisfaction of all physiological needs of the body for energy and basic nutrients.
2. The additional supply of energy and nutrients required to produce sufficient milk with high nutritional value.
3. Preventing the intake of products containing obligate allergens, histamliberators and compounds that can irritate the mucous membrane of the digestive tract (essential oils, peroxides of fatty acids, etc.) into the child's body by mother's milk.
An approximate set of foods for lactating women is presented in table 4.
Physical overwork, nervous tension, anxiety, depression, mother's stress;
Violations of the regime and technique of breastfeeding;
Lactation crises.
To maintain and stimulate lactation, mothers are advised to drink herbal teas from plants that stimulate lactation - nettle, mint, anise, caraway seeds, lettuce and dill (fennel) seeds, oregano. In addition, you need an increased intake of fruits and vegetables for a nutritious diet. After all, this is the required amount of vitamins and minerals. With their lack, both the production of milk itself and its qualitative composition suffer. An element especially valuable for lactation is folic acid. During feeding, the need for it increases 2 times. The juice is enriched with folic acid, and also contains a complex of B vitamins, vitamin E and calcium. Vitamin E: A baby is born with low levels of this vitamin and must quickly replenish it from breast milk. Calcium: The baby gets it from the mother's body, so she needs to increase the supply to keep her bones and teeth healthy.
B vitamins: help the absorption and assimilation of calcium by the body.
Literature
1. Nutrition of children of the first year of life, part 1. Natural feeding. Teaching aid of the Department of Propedeutics of Childhood Diseases, GOU VPO RGMU Roszdrav, ed. professors, d.m.s. V.A. Filin, Associate Professor, Ph.D. TG Vereshchagina - Moscow 2009, pp. 73–74.
2. NM Maksimovich (Ambodik), professor of the St. Petersburg midwife institute, "The art of obvivaniya" (1784-1786).
3. Nutrition for a healthy and sick child. A guide for doctors, ed. V.A.Tutelyan, I.Y.Konya, B.S. Koganova. M., 2007. S. 41–47.
4. Fofanova I.Yu. Multivitamins for Pregnancy: What's New? Gynecology, 2008; 2 (10): 20-24.
5. Site 6. Murashko AV, Al-Seikal TS. The basics of a healthy diet for a pregnant woman. Gynecology, 2003; 5 (3): 117–21.
Proper nutrition is critical in the life of every person, the more its importance increases during pregnancy. There are special reasons for this. Let's discuss some of them. The basal metabolic rate in healthy, non-pregnant women is approximately 1,500 kcal per day with an additional energy requirement of 800 kcal per day, for a total of 2,300 kcal. During pregnancy, the basal metabolic rate increases by about 10%, which is due to increased oxygen consumption and fetal activity, so that the total energy costs are about 2500 kcal per day. Energy costs for physical activity are increasing, but to a small extent, since various types of physical activity in a woman decrease during pregnancy. But energy is spent on the growth of the fetus, placenta, uterus, mammary glands. The amount of energy required for their growth is constantly increasing until the 30th week, after which there is a slight decrease. That is why a pregnant woman needs a properly balanced diet. There is no discussion about the fact that a pregnant woman should not consume any alcoholic beverages, either in large quantities, or allow their "normal", socially conditioned consumption. After all, the placenta is not able to protect the fetus from the penetration of alcohol from the mother's blood, leading to alcohol poisoning.
An indispensable condition for a healthy diet for a pregnant woman is compliance with a certain regimen of food intake. Violation of the diet harms not only the mother's body, but also the normal development of the fetus and newborn.
Physiologically, the most rational in the first half of pregnancy is five meals a day: the first breakfast is at 8-9 am (about 30% of the energy value of the daily diet), the second breakfast is at 11-12 hours (20%), lunch is at 14-15 hours (before 30%) and dinner - at 19-20 h (20%) and at 22 h - 1 glass of kefir, yogurt or an apple. A pregnant woman should not lie down after eating. Rest should be active, it is better to sit for 30-40 minutes or even walk.
In the second half of pregnancy, it is advisable to take food fractionally, 5-6 times a day, distribute it in such a way that the maximum amount falls on the first half of the day. Breakfast should be 30% of the energy value of the daily diet, second breakfast - 15%, lunch - 30%, afternoon tea - 5% and dinner - 20%.
It is important to properly distribute food products throughout the day. It is known that foods rich in protein increase metabolism, excite the nervous system, and stay in the stomach longer. Therefore, meat, fish, chickens should be included in the daily meals (breakfast, lunch). For dinner, it is better to use dairy and vegetable dishes. Plentiful food in the evening negatively affects the health of the pregnant woman, disrupts normal sleep and rest.
Food should be fresh, well cooked, tasty, not very hot. If it is stored for a long time and then warmed up, then it loses not only its taste, but also a large amount of vitamins.
The menu should be modified according to the season. The variety of food is of great importance, which largely depends on the ability to correctly compose the menu, so that the same dishes are repeated as rarely as possible. The correct selection of food products in the organization of rational nutrition can also be judged by the increase in body weight, which the pregnant woman herself should first of all monitor. In the normal course of pregnancy, the increase in body weight in the second half should not exceed 300-350 g per week, and its increase over the entire pregnancy should be 8-10 kg. With more intense weight gain, it is important to find out its cause, accordingly organizing the diet and adjusting the diet. If a pregnant woman is on bed rest for any reason, the calorie content of the diet is reduced by 20-40%.
In general, starting from the early stages and during the first half of pregnancy, the diet for women of average body weight (55-60 kg), average height (155-165 cm) should contain 10.048 - 11.304 kJ (2400 - 2700 kcal), including 110 g protein, 75 g fat and 350 g carbohydrates. For pregnant women of taller height with greater body weight, the daily ration increases to 11.304 - 12.142 kJ (2700 - 2900 kcal). It is necessary to pay attention to the balance of food ingredients in the diet.
In the second half of pregnancy, due to the growth of the uterus and fetus, the need for proteins increases. Therefore, the amount of protein in the food of pregnant women of standard weight and height should be increased to 110-120 g, including 60 g of animal proteins, up to 85 g of fat and up to 400 g of carbohydrates. The energy value increases to 11.723 - 15.560 kJ (2800 - 3000 kcal), and for tall pregnant women - up to 12.560 - 13.816 kJ (3000 - 3300 kcal), including at least 120 g of proteins, 85-100 g of fat, 410-440 g carbohydrates.
The body's daily need for fluid is about 35 g per 1 kg of body weight, that is, with a weight of 60 kg - about 2 liters. A significant part of this amount is found in food. Therefore, with rational nutrition, liquid in the form of tea, milk, jelly, compote, juice, soup should be no more than 1 - 1.2 liters in the diet. Excessive fluid intake increases the stress on the cardiovascular system, which should always be remembered.
Nutritional therapy for major acute and chronic diseases
FEATURES OF NUTRITION OF PREGNANT WOMEN, PARENTS AND NURSING MOTHERS
Rational nutrition is an important condition for the normal course of pregnancy, childbirth, development of the fetus and newborn.
Food healthy pregnant women depends on the timing of pregnancy, the nature of work, height, body weight and other factors. In the first half of pregnancy, the need for nutrients and energy corresponds to that for women of different groups of labor intensity (see "Physiological nutritional standards for different groups of the adult population"). By the end of this period, the daily energy requirement increases by 0.4-0.6 MJ (100-150 kcal), and in the second half of pregnancy (5-9 months) - by 1.3-2.1 MJ (300-500 kcal), reaching an average of 12.1 MJ (2900 kcal) per day. If a pregnant woman becomes sedentary, this energy consumption can be excessive and lead to obesity. In particular, this applies to the period of prenatal leave. The control is body weight. The average increase in body weight in the second half of pregnancy should not exceed 300-350 g per week, and for the entire period of pregnancy - 8-10 kg. Higher weight gain indicates excess nutrition or swelling. If a pregnant woman is on bed rest for health reasons, the need for energy is reduced by 20-30%.
In the second half of pregnancy, due to an increase in fetal weight, growth of the uterus, placenta, mammary glands, the need for proteins increases to 100 g per day, of which 60% should be full-fledged animal proteins: from meat and fish, about 30%, dairy products - 25%, eggs - 5%. The amount of fats and carbohydrates in this period is respectively 100-105 g and 400-420 g per day. Vegetable fat should be 30% of the total fat. With an overweight pregnant woman, the energy content of the diet is reduced due to fats and carbohydrates. With obesity, pregnancy and childbirth are more difficult, and excess nutrition during pregnancy predisposes the child to obesity. The considered values \u200b\u200bof the need for energy, proteins, fats and carbohydrates refer to women of average height - 160 cm.With low (150 cm) or high (170-175 cm) growth, these values \u200b\u200brespectively decrease or increase - on average by 10%.
In the second half of pregnancy, the need for vitamins increases by 20-30%, and in folacin and vitamin D - by 3 and 5 times, respectively, compared with the norms for non-pregnant women of the 1st group of labor intensity (see Table 6). The variety of the food set provides the need for vitamins, if the pregnant woman does not abuse refined products (sugar, confectionery, bread made from premium flour, etc.). It is advisable to include in the diet a decoction of wild rose (see Cinnamon rosehip) and wheat bran (see Soft wheat), a yeast drink, taking 1-2 tablets of multivitamins (gendevit, etc.) per day in the winter-spring period. Excessive intake of vitamin preparations is harmful to pregnant women.
During pregnancy, the need for minerals increases: calcium - up to 1 g, phosphorus - up to 1.5 g, magnesium - up to 0.45 g per day. An adequate intake of iron is important - 20 mg per day, subject to the necessary content in the diet of meat and meat products, fish, fruits, berries (see "Mineral substances"). Insufficient consumption of sources of easily digestible iron, complete proteins, vitamins often leads to anemia in pregnant women. The consumption of sodium chloride is limited in the second half of pregnancy to 8-10 g (exclude very salty foods), and in the last 1-2 months - up to 6 g per day (food is not salted enough). At the same time, free liquid (water, tea, soups, compotes, etc.) is also limited - up to 1-1.2 liters per day, and in the last 1-2 months - up to 0.8 liters. The source of free liquid should be primarily fruit and berry juices, milk and fermented milk drinks. Limiting the amount of sodium chloride and free fluid is especially important when pregnant women are prone to edema.
In the first half of pregnancy, 4 meals a day are recommended, in the second - 5 meals a day with the exception of abundant (more than 30-35% of daily energy value and weight) meals. After eating, you should not lie down, rest should be active. In the last 1-2 months of pregnancy, a 6 meals a day is desirable.
For healthy pregnant women, there are no prohibited foods (excluding all alcoholic beverages), there are only more or less preferred ones. So, the body of pregnant women is better at using easily digestible milk fats and vegetable oils. The latter are not only a source of essential linoleic acid, but also vitamin E, which has a positive effect on the course of pregnancy. Refractory animal fats and, accordingly, fatty meat and meat products are limited in the diet of pregnant women. Even with normal pregnancy, the motor function of the intestines may decrease, which is accompanied by constipation, therefore the diet should be enriched with sources of dietary fiber (fiber, pectins, etc.) - vegetables and fruits, wholemeal bread, buckwheat and oatmeal, etc. In the second half pregnancy, it is necessary to limit the consumption of sugar, confectionery, as well as products from premium flour, rice, semolina. Easily digestible carbohydrates contribute to an excessive increase in the body weight of the pregnant woman and the fetus. In the last months of pregnancy, the liver and kidneys function with tension due to the neutralization and excretion of metabolic products of the fetus, therefore, extractive substances of meat and fish (broths, fried meat and fish) should be limited in the diet.
Approximate daily food set for the second half of pregnancy:
- meat - 120 g.
- fish - 100 g,
- cottage cheese - 150 g,
- milk and sour milk drinks - 450 g,
- butter - 15 g
- sour cream - 30 g,
- eggs - 1 pc.,
- vegetable oil - 25 g,
- sugar - 50 g
- rye and wheat bread - 100 g each,
- flour products (cookies, bun, etc.) - 100 g,
- cereals and pasta - 60 g,
- potatoes - 200 g,
- various vegetables - 550 g,
- fruits, berries or their juices - 200 g.
Nutrition for women in labor.
Energy consumption during childbirth is 14.6 MJ (3500 kcal) and more per day. Eating food during the normal course of childbirth is optional, and sometimes even worsens the condition of women in labor. Meals are organized for childbirth lasting more than 15-16 hours. The diet should consist of a food set recommended for maternity hospitals and a food supplement, including easily digestible carbohydrates, complete proteins, sources of vitamins and minerals. An example of a food supplement: cottage cheese - 100 g, oatmeal - 100 g, sugar - 50 g, fruit or berry juice - 200 g, broth of wild rose and wheat bran - 200 g.
Nutritional nature nursing mothers is of particular importance for the formation of breast milk (lactation) and its composition. The daily ration should contain an average of 112 g of protein (60% - of animal origin), 115 g of fat (30 g - vegetable oils), 450 carbohydrates; 13.4 MJ (3200 kcal). The need for minerals corresponds to that in the second half of pregnancy, except for iron, the need for which increases to 25 mg per day. Compared with the second half of pregnancy, the need for vitamins B1, B2, B6, PP, C and A increases (Table 6 of the section "Physiological nutritional norms for various groups of the adult population"). The diet should contain up to 2.5 liters of free liquid, including at least 0.5 liters of milk or fermented milk drinks. Reception write - 5-6 times a day. Strong tea and coffee, spices, any alcoholic beverages are excluded from the diet. In case of insufficient lactation, the diet additionally includes milk and dairy products (cheese, sour cream, cream), honey, fruit and berry juices.
In cases of diseases of pregnant women, in which medical nutrition is required, a numbered system of diets is used, changing their energy value and chemical composition, taking into account the principles of rational nutrition for pregnant women. The latter is permissible in cases where there is no contradiction in the diet therapy of specific diseases and the patient is not on strict bed rest. However, diseases that are characteristic only of pregnancy and are combined by the concept of "toxicosis of pregnant women" are possible. Distinguish between early and late toxicosis - respectively, in the first months and in the last 2-3 months of pregnancy. Early toxicosis is characterized by nausea, vomiting, salivation; for the late - metabolic disorders, kidney, liver, cardiovascular system, edema.
When early toxicosisaccompanied by frequent vomiting, the body becomes dehydrated, body weight is lost. With severe vomiting (20-30 times a day), food intake is impossible and intravenous (parenteral) nutrition is necessary. In milder cases, nutrition is recommended, prescribed in the second half of pregnancy, but with a restriction of 20-25% carbohydrates and an increase in the content of table salt (15 g). Food is boiled well and cooked mostly pureed. It should be taken every 2-3 hours, in small portions, slightly warmed up, preferably lying down. Liquid and dense foods are best consumed separately. The liquid is not limited, but the drink should be given in small portions (50-100 g). Fasting days are advisable: apple (in the form of mashed potatoes), compote, curd-sour cream.
When late toxicosis the diet should contain the amount of protein required for pregnant women, but not an excess amount, primarily from dairy products, especially cottage cheese. Fats are limited to 60-80 g per day, and with a pronounced violation of fat metabolism - up to 40-50 g. Refractory fats are excluded. Due to the shift in the acid-base state of the body to the acidic side (metabolic acidosis), a predominantly lactic-vegetable diet with a high content of vegetables and fruits is desirable. It is advisable to replace sugar with honey. In case of impaired renal function, arterial hypertension, edema, a salt-free diet is prescribed, free fluid is limited to 0.6-0.8 liters per day, potassium-rich foods are increased in the diet. In these cases, the most appropriate diet is No. 7, with an increase in the content of animal (especially milk) protein to the needs of pregnant women. With the predominance of disorders in the liver, nutrition is based on diets No. 5a and No. 5. With late toxicosis, unloading and special diets are useful 1-2 times every 10 days (see "Unloading and special diets").
The expectant mother and the doctors who will look after her often have many problems.
Before pregnancy, it is necessary to identify and eliminate maternal risk factors as much as possible (chronic diseases, medication, smoking, alcohol, immunization, sexually transmitted diseases, environmental or occupational hazards, living conditions).
In the presence of a disease, it is necessary to choose a treatment that would not interfere with a normal pregnancy, etc.
A well-planned pregnancy should include an initial health survey 8 to 12 weeks before conception. This initial period of 60 to 90 days of observation is necessary to monitor the condition of the expectant mother. For example, if a woman wishes to have a baby in January, her preparation for pregnancy must begin in January of the previous year and end at least 6 weeks after delivery. This regimen spans 54 weeks or more when the woman stops all forms of non-barrier contraception. It is advisable to have two or more normal, self-sustaining menstrual periods after contraception prior to planned pregnancy.
Likewise, after delivery, it will take time for postpartum involution.
The situation is special for young girls who have recently started menstruating. It takes a certain time (about 5 years) for the body to become ready to carry a normal pregnancy. Thus, a 14-year-old girl becomes biologically mature if she begins to menstruate at the age of 9. Of course, emotionally, psychologically, economically she cannot be mature as a woman after 20 years. Otherwise, if a 14-year-old girl becomes pregnant in the first year of her appearance menarche, then it is not yet biologically mature. This may end up with an unwanted miscarriage and other consequences for her.
The first task that a doctor decides when starting to work with an expectant mother is to assess the state of health and identify risk factors. Among the risk factors, we are interested in the nutritional status and the nature of the diet, which will allow us to determine the nutritional deficit or its surplus, the deficit in the consumption (intake) of certain nutrients.
To do this, you need to carry out:1. Detailed nutritional assessment, which includes:
- physical examination;
- dietary assessment of nutrient intake (based on the use of a food diary).
2. The main anthropometric measurements: height, weight, skinfold thickness, which will determine body mass index (BMI) and most accurately plan for possible weight gain during pregnancy.
3. Biochemical assessment of nutritional parameters. All these measurements in full during an obstetric examination are most often not required. But evaluation is necessary for every patient who presents with any significant nutritional problems. Before pregnancy, BMI should be in the range of 20-25 kg / m2, since maternal and child mortality increases with an increase or decrease in these indicators.
Evaluating a food diary, or the quality and quantity of nutrients consumed, hemoglobin levels, the presence of unwanted ingredients, and the identification of wasting or obesity may require specific dietary advice.
If patients had certain types of metabolic disorders, for example, diabetes mellitus, metabolic disorders of phenylalanine, special diets in childhood, then they must strictly follow the diet for the entire period of observation (before and the entire period of pregnancy). The likelihood of developing any form of congenital malformations in such patients is high and reaches 80% or more. Therefore, all patients should be asked whether they are currently or have been on special diets in the past.
Therefore, the assessment of the actual energy needs of the body takes into account: 1) basic needs in terms of basic metabolism;
2) additional needs related:
- with pregnancy,
- with lactation,
- physical activity,
- changes in body temperature,
- with the presence of concomitant diseases.
Basic requirements are determined using the Harris and Benedict formula:
The last indicators are entered as coefficients.
At the same time, the amendments for determining energy expenditure are somewhat modified in connection with the peculiarities of the damage factors for pregnant and lactating women.
During pregnancy, the needs of a woman's body for proteins, fats, carbohydrates, vitamins, macro- and microelements increase significantly. The value of a full, balanced nutrition of a pregnant woman for the normal development of the fetus, a favorable course and outcome of pregnancy has been proven by numerous studies. The most demonstrative in this respect are the data comparing the body weight of children born during the blockade of Leningrad in 1942.
The body weight of full-term newborns was 550 g less than the body weight of newborns in 1940, and more than 40% of children were born prematurely. Extreme living conditions and, above all, starvation of pregnant women led to the high mortality rate of newborns in blockaded Leningrad. Malnutrition of the mother negatively affects not only the weight, but also the length of the fetus. In fact, a constant low-calorie diet may be the main cause of infertility in some women. Women with low body weight during pregnancy are more likely to have disorders of the cardiovascular and respiratory systems.
Eating disorders at different stages of pregnancy affect the condition of the fetus in different ways. Much depends on both the qualitative and quantitative indicators of malnutrition and its duration. Short-term malnutrition may not affect fetal development due to the mother's nutrient stores. But prolonged fasting can cause significant disruption. An overweight woman during pregnancy increases the risk of gestational diabetes and increases blood pressure. In addition, the likelihood of having an overly large child increases with the ensuing consequences.
Insufficient quantitative protein content in the diet of a pregnant woman due to changes in the biochemical composition of the blood, myometrium, significantly increases the risk of spontaneous abortion, premature birth, increased perinatal mortality, and the likelihood of anemia.
A change in the qualitative composition of protein also affects the course of pregnancy. The predominance of only plant or animal protein can lead to various disorders: biosynthesis of RNA and DNA, changes in the duration of pregnancy, the nature of labor, etc. Particular importance is attached to such amino acids as valine, histidine, isoleucine, leucine, lysine, methionine, taurine, threonine , tryptophan, phenylalanine.
But if at the end of summer there is an improvement in the supply of vitamin C, carotenoids and fat-soluble vitamins, then the deficiency of B vitamins, the main sources of which are animal products, does not disappear. According to the survey results, it is noted that there are practically no women who are provided with all vitamins. Most of the surveyed (70-80%) have a combined deficiency of three vitamins or more, that is, polyhypovitaminosis states are found regardless of age, season, place of residence and professional affiliation.
Deficiency of vitamins disrupts the course of pregnancy, leads to various disorders of fetal development. Deficiency of vitamin B6 often leads to certain types of toxicosis in pregnant women contributing to the destruction of tooth enamel. Lack of vitamin B6 and vitamin B12 is one of the reasons for the development of anemia in pregnant women. With a deficiency of vitamins in the fetus, a wide variety of disorders can be observed (from some types of metabolic disorders, for example, lipid with a deficiency of riboflavin, to anomalies of development and death of the fetus with a deficiency of thiamine, pyridoxine, niacin, retinol, tocopherol, and others). Excessive intake of vitamins also negatively affects the health of pregnant women and the fetus.
It should be emphasized the importance of providing the body of a pregnant woman with vitamin C. A lack of vitamin C can cause premature birth, miscarriages, the birth of inferior children, and an excess of vitamin C in the diet in the early stages of pregnancy can have an abortive effect.
Folic acid deficiency is associated with an increased incidence of low birth weight babies, nervous system defects, and maternal megaloblastic anemia. Adequate amounts of folic acid should be consumed as early as the first six weeks of pregnancy, which is before most women know they are pregnant. An increase in the rate of folate metabolism in pregnant women has been found to result in an additional dietary folate requirement of approximately 200 to 300 mg per day.
Excessive consumption of folic acid (more than 1000 mg per day) can lead to an imbalance (deficiency) of vitamin B12. This deficiency can lead to irreversible neurological consequences. According to a recent Gallup poll, only 15% of women aged 18-45 are aware of the 400 micrograms daily folate requirement. Special reviews show that the average intake of folate in women is approximately 230 mcg / day.
An excess or deficiency of macro- and microelements also adversely affects the state of the body of the pregnant woman and the fetus. These substances have a regulating effect on acid-base metabolism, the activity of enzyme systems and hormones. The human need for trace elements (zinc, copper, magnesium, cobalt, selenium, etc.) does not exceed 0.1-10 mg / day, but they are needed constantly. Their lack causes a decrease in the growth rate and weight of the fetus, leads to an increase in the development of deformities.
Copper affects erythropoiesis. An insufficient content of copper in the blood is combined with a decrease in the level of reticulocytes.
Iron is part of hemoglobin and is involved in oxidative processes in both the pregnant woman and the fetus. Therefore, a lack of iron and copper in the diet can lead to the development of anemia in pregnant women, especially in late pregnancy.
Low hemoglobin levels are the most common problem obstetricians face in their daily work. Among pregnant women, iron deficiency anemia occurs in 15-20% of cases. Severe anemia during pregnancy can lead to premature birth, recurrent miscarriage, weight loss of the newborn and even fetal death, especially if it manifests itself in the first half of pregnancy.
The main causes of anemia in pregnant women are hemodilution caused by an increase in blood volume and a true deficiency of dietary iron.
If "food" anemia develops, then the following reasons for its development should be considered:
- inadequate intake of foods containing iron, folic acid, vitamin B12;
- the presence of bleeding;
- inadequate content of iron stores required to maintain a certain level of hemoglobin;
- increased iron consumption;
- violation of absorption in the intestine (malabsorption);
- insufficient content of it in a regular diet;
- a way of processing food with the loss of vitamins necessary for assimilation (folic acid, vitamins B12, B6, C);
- inadequate folate stores to support erythropoiesis;
- increased requirements for iron in a pregnant woman or fetus with adequate intake.
Magnesium deficiency predisposes to the destruction of tooth enamel and the development of caries.
Phosphorus, like calcium, is involved in the formation of fetal bone tissue and its normal growth. The ratio of calcium and phosphorus in the diet of a pregnant woman should be 1: 1.5.
Insufficient calcium in the diet of a pregnant woman and increased calcium intake by the fetus often leads to the development of calcium deficiency in a pregnant woman with bone demineralization.
Calcium and zinc improve maternal fertility. Additional calcium (2000 mg) per day reduces systolic and diastolic blood pressure, as well as the development of toxicosis in pregnant women.
Experimental work has also shown that with a significant zinc deficiency in the body, growth retardation and a decrease in fetal weight, as well as the death of females during childbirth, are noted. Adding 20 mg of zinc per day to a pregnant woman is associated with a lower incidence of placental abruption and lower perinatal mortality.
Indispensable inorganic minerals are sodium, potassium, calcium, chlorine, phosphorus, magnesium, cobalt, chromium, manganese, molybdenum and selenium.
Excess sodium intake can lead to an increase in blood pressure, fluid accumulation, the appearance of edema, etc. But insufficient sodium intake can also adversely affect the health of the pregnant woman and the fetus. Salt restriction during pregnancy limits the normal increase in blood volume, with undesirable consequences.
Depending on the degree of sodium deficiency and the subsequent decrease in blood volume in the placenta, the following processes can occur:
- slowdown in growth, or its complete stop;
- placental infarction;
- violation of the transport of nutrients to the fetus;
- placental abruption, causing bleeding.
An important feature in water-salt metabolism in pregnant women is the tendency to retain sodium and fluid in the body. This is due to the mineralocorticoid function of the adrenal cortex. The accumulation of fluid within physiological limits is an important adaptive function of the pregnant woman's body.
During pregnancy, there is a thinning of the blood and an increase in the permeability of the blood vessels, which creates the preconditions for the formation of edema.
An increase in the volume of circulating blood, mainly due to plasma, leads to a relative decrease in the content of hemoglobin and erythrocytes, as well as plasma proteins.
In recent years, great importance has been attached to iodine deficiency, which leads to pathology of the gestational period, impaired fetal maturation and thyroid insufficiency in the newborn. This is especially important in areas related to the centers of iodine deficiency. In conditions of even mild iodine deficiency, secondary thyroid insufficiency is formed, which serves as the main prerequisite for the development of various deviations from the central nervous system in a child (neurological cretinism and subcretinism) and thyroid maladjustment proper in the neonatal period (transient neonatal endemic hypothyroidism, diffuse endemic goiter).
For more than a decade, endocrinologists of the world have known that in endemic regions, in comparison with iodine-rich regions, the frequency of spontaneous miscarriages and stillbirths is significantly increased in pregnant women, and in their offspring not only a decrease in the intellectual index is recorded, but also a high risk of congenital malformations (heart, etc.) ), respiratory distress syndrome, perinatal and early infant mortality.
Children from mothers with endemic goiter are more often born in asphyxia, with signs of intrauterine malnutrition, with reduced Apgar scores, and breastfeeding is received according to the severity of the condition from a later date. From the first days of life, they have manifestations of a weakened nonspecific immunity.
Thus, malnutrition in the form of an excess or lack of certain nutrients affects both the health of the pregnant woman herself and the health of the child.
On the other hand, an increase in the average daily energy content of a pregnant woman's diet can affect the development of the fetus. In the diet of pregnant women who have given birth to large children, an increased content of fat and easily digestible carbohydrates and a reduced content of vegetables and fruits are noted. The ratio of the main food ingredients (proteins, fats and carbohydrates) in the diet was violated and amounted to 1: 1.4: 5.5, and in women who gave birth to children with an average weight - 1: 1: 3.7. It was also established that at birth with a large fetus in the diet of pregnant women, the amount of minerals (in particular, phosphorus, calcium and copper) and vitamins B1, B2, PP and C was reduced.
Thus, large babies are born to mothers who consume more carbohydrates and fats with the same protein intake. A direct relationship was established between fetal body weight and carbohydrate content in the diet. In the third trimester of pregnancy, women who have given birth to children with greater body weight and who consumed more carbohydrates and fats show a significant increase in blood glucose, cholesterol, and low density lipoproteins. These women had an increased content of under-oxidized metabolic products in the blood (pyruvate and lactate).
Having a large baby creates problems for both the mother during childbirth and the baby. Birth trauma, asphyxia develop more often, the risk of postnatal death is higher. In the future, these children have developmental delays, neurological complications, obesity, arterial hypertension, an accelerated rate of atherosclerosis development, oncological problems, etc. It is noted that the larger the newborns, the less often they have harmonious physical development, in particular, weight-weight indicators.
The problem of obesity in women is also associated with age:in 10% obesity is observed at the age from 15-19 years and up to 60% in the age group from 40 to 44 years. A much higher correlation exists between obesity and the number of pregnancies: 16% of obesity among those who have never been pregnant, and 50-68% among women who have multiparty. With each pregnancy, a woman's body weight increases by an average of 2.5 kg.
Lactation does not help the mother return to her original body weight.
Thus, the diet of a pregnant woman in the content of basic nutrients (proteins, fats, carbohydrates), vitamins, minerals, trace elements and fluids should correspond to the basic physiological needs.
- the age of the pregnant woman;
- its constitution;
- being obese or undernourished;
- period of pregnancy or lactation;
- gestational age;
- physiological energy consumption;
- season of the year;
- excess weight gain (more than 300-350 g per week);
- edema of a pregnant woman;
- features of professional activity;
- cultural, racial characteristics;
- concomitant pathology;
- preeclampsia and eclampsia.
Complete nutrition is called when it ensures the normal functioning of all systems and organs of both the pregnant woman herself and the unborn child.
Considering that both the energy value of food and its qualitative composition affect the course and consequences of pregnancy, the introduction of certain dietary recommendations can significantly affect the health of a pregnant woman and her unborn child.
67. Nutritional features of pregnant and lactating women
Proper nutrition is critical in the life of every person, the more its importance increases during pregnancy. There are special reasons for this. Let's discuss some of them. The basal metabolic rate in healthy, non-pregnant women is approximately 1,500 kcal per day with an additional energy requirement of 800 kcal per day, for a total of 2,300 kcal. During pregnancy, the basal metabolic rate increases by about 10%, which is due to increased oxygen consumption and fetal activity, so that the total energy costs are about 2500 kcal per day. Energy costs for physical activity are increasing, but to a small extent, since various types of physical activity in a woman decrease during pregnancy. But energy is spent on the growth of the fetus, placenta, uterus, mammary glands. The amount of energy required for their growth is constantly increasing until the 30th week, after which there is a slight decrease. That is why a pregnant woman needs a properly balanced diet. There is no discussion about the fact that a pregnant woman should not consume any alcoholic beverages, either in large quantities, or allow their "normal", socially conditioned consumption. After all, the placenta is not able to protect the fetus from the penetration of alcohol from the mother's blood, leading to alcohol poisoning.
An indispensable condition for a healthy diet for a pregnant woman is compliance with a certain regimen of food intake. Violation of the diet harms not only the mother's body, but also the normal development of the fetus and newborn.
Physiologically, the most rational in the first half of pregnancy is five meals a day: the first breakfast is at 8-9 am (about 30% of the energy value of the daily diet), the second breakfast is at 11-12 hours (20%), lunch is at 14-15 hours (before 30%) and dinner - at 19-20 h (20%) and at 22 h - 1 glass of kefir, yogurt or an apple. A pregnant woman should not lie down after eating. Rest should be active, it is better to sit for 30-40 minutes or even walk.
In the second half of pregnancy, it is advisable to take food fractionally, 5-6 times a day, distribute it in such a way that the maximum amount falls on the first half of the day. Breakfast should be 30% of the energy value of the daily diet, second breakfast - 15%, lunch - 30%, afternoon tea - 5% and dinner - 20%.
It is important to properly distribute food products throughout the day. It is known that foods rich in protein increase metabolism, excite the nervous system, and stay in the stomach longer. Therefore, meat, fish, chickens should be included in the daily meals (breakfast, lunch). For dinner, it is better to use dairy and vegetable dishes. Plentiful food in the evening negatively affects the health of the pregnant woman, disrupts normal sleep and rest.
Food should be fresh, well cooked, tasty, not very hot. If it is stored for a long time and then warmed up, then it loses not only its taste, but also a large amount of vitamins.
The menu should be modified according to the season. The variety of food is of great importance, which largely depends on the ability to correctly compose the menu, so that the same dishes are repeated as rarely as possible. The correct selection of food products in the organization of rational nutrition can also be judged by the increase in body weight, which the pregnant woman herself should first of all monitor. In the normal course of pregnancy, the increase in body weight in the second half should not exceed 300-350 g per week, and its increase over the entire pregnancy should be 8-10 kg. With more intense weight gain, it is important to find out its cause, accordingly organizing the diet and adjusting the diet. If a pregnant woman is on bed rest for any reason, the calorie content of the diet is reduced by 20-40%.
In general, starting from the early stages and during the first half of pregnancy, the diet for women of average body weight (55-60 kg), average height (155-165 cm) should contain 10.048 - 11.304 kJ (2400 - 2700 kcal), including 110 g protein, 75 g fat and 350 g carbohydrates. For pregnant women of taller height with greater body weight, the daily ration increases to 11.304 - 12.142 kJ (2700 - 2900 kcal). It is necessary to pay attention to the balance of food ingredients in the diet.
In the second half of pregnancy, due to the growth of the uterus and fetus, the need for proteins increases. Therefore, the amount of protein in the food of pregnant women of standard weight and height should be increased to 110-120 g, including 60 g of animal proteins, up to 85 g of fat and up to 400 g of carbohydrates. The energy value increases to 11.723 - 15.560 kJ (2800 - 3000 kcal), and for tall pregnant women - up to 12.560 - 13.816 kJ (3000 - 3300 kcal), including at least 120 g of proteins, 85-100 g of fat, 410-440 g carbohydrates.
The body's daily need for fluid is about 35 g per 1 kg of body weight, that is, with a weight of 60 kg - about 2 liters. A significant part of this amount is found in food. Therefore, with rational nutrition, liquid in the form of tea, milk, jelly, compote, juice, soup should be no more than 1 - 1.2 liters in the diet. Excessive fluid intake increases the stress on the cardiovascular system, which should always be remembered.
