2. DR RENU CHAWLA
She is graduate and post graduate from
LHMC and SSKH DELHI.
She has been practicing as Obstetrician and
Gynecologist since 1991 with keen interest
in high risk obstetrics.
She has been joint secretary EDGF. Currently
she is treasurer of EDGF.
3.
4.
5. Eat right in pregnancy
FIRST 1000 DAYS
• The first 1000 days of life is the time spanning between
conception and second birthday is a period when
foundation of optimum health , growth and
neurodevelopment are established
• Period of rapid physical growth and accelerated mental
development
• Nutrition is a key modifiable factor that affects birth
outcomes and has long-term effects on the health of
offspring
6. According to the WHO, the ideal
weight gain during pregnancy for
four BMI categories for Asians
• Underweight (BMI <18.5), weight gain 12.5to18 .0 kg
• Normal weight (BMI 18.5-24.9kg), weight gain 11.5to16 .0 kg
• Overweight (bmi 25- 29.9), weight gain 7.0to11 .5 kg
• Obese (BMI ≥30), weight gain 5.0to9 .0 kg
The incidence of pregnancy complications is higher at the
upper and lower extremes of weight gain
7. History taking and its relevance
• Past history of nutrition-what was she eating?
• Use of supplements
• Food avoidances/special diets/skipping meals
• Eating disorders
• Lack of resources for adequate nutrition
• Low intake of nutrient-dense foods (fruits and vegetables)
• High intake of added sugars and fats (fried foods, processed
foods, desserts)
• Overweight or obesity
• Medical history of bariatric surgery or other conditions that
cause malabsorption
• Substance misuse
8. Nutrition in pregnancy
• Women should be counseled to eat a healthy diet during pregnancy.
• This includes plenty of fruits and vegetables, whole grains, low-fat
dairy, and a variety of proteins.
• Nutrient-dense foods should be encouraged, and empty calories
should be minimized or avoided
• Optimum nutrition is of great importance for women, due to their
special nutritional needs associated with physiological changes such as
menstruation, pregnancy, lactation and menopause.
9. Women IN Developing Countries
• Women in Africa and Asia between the ages of 15
& 45 spent 50% of their life time in being
pregnant or lactating
J NursWomens Health 2017: J119
10. Nutrition in Critical period of
Development
• Neurological development is extremely rapid during the first 1000 days
of life
11.
12. Essential Fatty Acids
• Essential as not synthesized by body
• There are two families of EFAs
Omega 6-Fatty acids e.g. Linoleic acid
Omega 3-Fatty acids e.g. DHA
• Adequate intake of omega 3 fatty acid is essential in maintaining the
balance production of hormone like substances called Prostaglandins
• During pregnancy and breastfeeding the benefits of EPA and DHA
include
-Healthy development of foetal brain , eye and nervous system,
-Healthy birth weight and gestational length
-Healthy immune system
-Mood elevation in postpartum period
• This rapid growth of the fetus is mainly sustained by the release of free
fatty acids and glycerol from maternal adipose tissue
12
14. DHA during Pregnancy and
Lactation
• Fetus depends completely on maternal sources of DHA
• Placenta selectively and substantially transport fatty acid
from mother to the fetus
• During 3rd trimester – there is an avid accretion of DHA in
the liver, brain & retina of fetus ( at rate 0.59gm/day)
• Pregnancy leads to progressive depletion in maternal DHA
status
• After delivery maternal stores are replaced slowly or
incompletely over a period of 6 months
14
Ind J Pediatr. 2005;72(3):239-242
15. DHA & Pregnant Mother
15
• In the last three months of pregnancy, there is rapid accumulation of
DHA in the eyes & brain of the foetus
• Fetus accrues up to 70 mg DHA per day during the last trimester
• At term (40 weeks)
o21% in skeletal muscle
o23% in brain tissue
o50% fetal adipose tissue
• DHA adipose content serves as a
reservoir for DHA that can be
utilized in infant development
DHA accumulation in foetal brain
Proc Nutr Soc 2008;67:19–27
Nutrients. 2012;4:799-840
Nancy L. Morse et al. Nutrients 2012, 4
Journal of Nutrition & Intermediary Metabolism. 5;2016, Pages 23-33
16. DHA for Fetal Growth and
Development
• Fetal DHA demand increases exponentially with increasing
gestational age
• Fetus requires approximately 50 mg/kg/d of omega-3 fatty
acids
16
Eur J Nutr. 2014;53(5):1147–54.
DHA plays an important role:
Birth Weight & fetal development
Neural & retinal development
Central nervous system, improve
cognitive and spatial memory
development
Child’s pre and postnatal growth
17. DHA for Fetal Growth and
Development
• DHA make up around 30% of brain and 50% of retina’s structure
• DHA is critically important for optimal development of dopaminergic
signaling and once the window for development is past deficits are not
later reversible
17
Rev Obstet Gynecol. 2008 Fall; 1(4): 162–169.
Nutritional Health 2.4 (2018): 43-50.
18. 18
IN PREGNANCY
Pregnancy leads to
progressive
depletion in
maternal DHA status
LAST TRIMESTER
Accretion of DHA in
the liver, brain &
retina of fetus
POST-PARTUM
Breast milk provides
DHA to baby
Maternal stores are
replaced slowly or
incompletely over a
period of 6 months
Ind J Pediatr. 2005;72(3):239-242
19. DHA & Lactating Mother
• There is linear correlation between the dietary
intake of DHA by nursing mother and DHA
content of her breast milk
• DHA supplementation with at least
300mg/day is associated with ↑ breast milk
content by 0.20-0.34 wt%
• A daily intake up to 3 gm/day during
pregnancy has been demonstrated to be safe
19
Proc Nutr Soc 2008;67:19–27
Ind J Pediatr. 2005;72(3):239-242
Prostaglandins Leukot Essent Fatty Acids. 81:171-174
20. MATERNAL AND FETAL
BENEFTIS OF LCFA
• Mothers who have healthy intakes of DHA give birth to infants
with more bloodstream DHA and better visual function as
measured by visual evoked potentials
• The continued intake of EPA and DHA are also important for the
maintenance of the mother’s cardiovascular health
• The level of omega-3 fatty acids in the mother’s bloodstream
during pregnancy has been shown to correlate with insulin levels
and adiposity
Nutrients 2019, 11, 2891;doi:10.3390/nu11122891
21. Cognitive Development
• All meta-analyses in this area are limited by a large degree
of heterogeneity
• There is a trend toward a greater likelihood of benefit with
higher dosages (DHA ≥0.32% and AA ≥0.66%) and a longer
duration of a higher postnatal LC-PUFA supplementation (up
to 1 year of age)
Ann Nutr Metab. 2014;65(1):49-80
22. effect of maternal and fetal DHA
status on general health
• Higher cord plasma DHA was associated with lower body mass
index (BMI) scores, waist circumference, and leptin levels
• Prenatal DHA status may also contribute to improved sustained
attention in preschool children
Mun JG et al. Nutrients. 2019;11(5):1125.
23. Maternal DHA
status during fetal
development can
have lasting
impacts on brain
and eye health
throughout life as
evident by key
recommendations
for DHA intakes
during the first
1000 days of life
Notas del editor
Saturated fats have no double bonds in their chemical structure.
Unsaturated
What Is Unsaturated Fat?
Unsaturated fats are typically liquid at room temperature. They differ from saturated fats in that their chemical structure contains one or more double bonds. They can be further categorized as:
Monounsaturated fats: This type of unsaturated fat contains only one double bond in its structure. Monounsaturated fats are typically liquid at room temperature and include canola oil and olive oil.
Polyunsaturated fats: This type of unsaturated fat contains two or more double bonds in their structure. They are liquid at room temperature. Polyunsaturated fats include safflower oil, sunflower oil, and corn oil.
omega−3 fatty acid acids that have in common a final carbon-carbon double bond in the n-3 position
ALA (18 carbons and 3 double bonds)
EPA (20 carbons and 5 double bonds)
DHA (22 carbons and 6 double bonds)
Omega-6 fatty acids that have in common a final carbon-carbon double bond in the n-6 position
Omega-9 fatty carbon–carbon double bond in the omega−9 position; that is, the ninth bond from the methyl end of the fatty acid.
During pregnancy they are required for growth of the mammary glands, anplacenta, uterus d fetus. In the last three months of pregnancy, there is rapid accumulation of DHA in the eyes and brain of the foetus (Figure 1) [2] and its brain weight increases, making it increasing important that the mother has
an adequate DHA intake at this time.
After birth, the baby’s nervous system continues to grow very rapidly and DHA supplied primarily through breast milk, is required as a structural component. Consequently, maternal body stores can become depleted resulting in health risks for her including post natal depression [14–16]. During the last trimester, a foetus accrues about 67 mg of DHA per day from the mother, and during breast feeding the need increases to 70–80 mg daily [17]. This huge demand for DHA particularly
during breast feeding depletes maternal stores to below pre-pregnancy levels and this deficit can take months to even partially correct.
Spatial memory is that part of the memory responsible for the recording of information about one's environment and spatial orientation.
