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NUTR 337 (6)

Summary Pregnancy

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Nutrition and Dietetics
NUTR 337
Stan Kubow

Electrolyte About Regular Pregnancy Reasoning Requirements Potassium -Lowers bp AI no change Potassium accretion during pregnancy is very -Blunts adverse bp effects of salt ♂♀4.7g/d small intake No data to suggest that a requirement for K is -reduces the risk of kidney stones No UL different -Potentially reducing bone loss (Western diet= acidic environment from sulphyr aa and K is in organic base containing foods and Na also inc. Ca urinary excretion.) Sodium Requirements allow XS Na loss in AI no change Pregnancy requires an extra 2.1-2.3g: sweat by unacclimatized persons ♂♀sedentary 1. Maintains the inc. in plasma volume exposed to high Ts or who are mod. 1.5g/d 2. Provides for the products of conception physically active. (>if active with no 3. This accumulation occurs over 9 mo UL) Additional needs=0.07g/d= negligeable UL 2.3g/d Sulfur Present in the aas in proteins (mostly none established none -Component of Glutathione- a potent anti- animal proteins- methionine, cysteine typically exceeds established oxidant involved in the detox rxns of drugs and and cystine) needs in NA toxins (inc. homocysteine and dec. [] in vegan diet->should inc. nut/soy intake -Keeps anabolic state (prevents lbm degradation linked with oxidative stress which damages proteins and induces catabolism via proteosomes) Thiamin (B1) -Functions as coenzyme in RDA RDA -Requirement is inc. by 30%= metabolism of CHO (TPP) & BCAA. ♂>19yr 1.2mg/d 1.4mg/d Growth in maternal and fetal compartments -Requirement based: ♀ >19yr 1.1mg/d (20%) + 1. To achieve & maintain rbc -10% diff sexes Small inc. in E ultilization (10%) tansketolase activity based on E 2. Without excessive thiamin excretion utilization and size difference. Electrolyte About Regular Pregnancy Reasoning Requirements Riboflavin (B2) -Coenzyme in # oxidation-reduction RDA RDA Additional riboflavin requirement 0.3mg/d based multivitamin- rxns ♂>19yr 1.3mg/d 1.4mg/d on excrete excess= -Requirement based: ♀>19yr 1.1mg/d 1. inc. growth in maternal & fetal compartments bright yellow urine 1. erythrocyte glutathione reductase 2. small inc. in E utilization activity coefficient 2. rbc [riboflavin] 3. urinary excretion -derived from: signs of clin. df. (kelosis- cracks at mouth corners), biochem. values, urinary exceration in relation to intake->occurs before appearance of overt signs of df. Niacin (B3) -Cosubstrate or coenzyme for transfer RDA RDA -no direct evidence to suggest change of the hydride ion with numerous ♂>19yr 16mg/d 18mg/d of -estimated that need inc. by 3mg/d of NEs to dehydrogenases ♀>19yr 16mg/d NE cover inc. E utilization and growth. -Primary criterion for RDA= urinary -No bioavailability adjustments (expressed in excretion of niacin metabolites NE allowing for some conversion of the aa tryptophan to niacin (this ability varies with individual) Vitamin B6 -Coenzyme in the met. of aas, RDA RDA -Significant fetal uptake of vit. (fetus & placenta (pyrodoxine and glycogen and sphingoid bases ♂♀ 19-50yr 1.9mg/d accumulates about 25mg) related -Primary RDA criteria: maintenance of 1.3mg/d =0.1mg/d avg over gestation (40wks) compounds) adequate blood 5‘-pyridoxal Assume +Allowances for inc. met. needs & mother wgt phosphate levels 75% -Maintenance of [] requires: bioavailability2mg/d extra B6 in 1st trim + in food B6 4-10mg/d in the 3rd trim. => not clear if changes reflect df or hemodilution/normal pregnancy change Biotin -Functions as a coenzyme in AI no change -Recent studies have detected low plama bicarbonate-dependent carboxylation ♂♀>19yr 30Ug/d [biotin] while others have not rxns -Inc. biotin metabolite (3-hydroxyisovaleric acid) -Estimates of intake are used to set AI in > half of healthy preg. women by the 3rd trim. (insuff data) (don’t know if changes are normal for preg women or indicate low biotin intake relative to need). Electrolyte About Regular Pregnancy Reasoning Requirements Folate -Coenzyme in single-C transfers in the RDA RDA -Marked acceleration in single-C transfer rxns metabolism of nucleic and aas. ♂♀>19yr 14-50yr such as those required for nucleotide synth and -Primary RDA indicator: 400Ug/d 600Ug/d thus cell division: 1. Erythrocyte folate (stores) Aging not 1. Uterine enlargement 2. Blood [homocysteine] (inc. in df in associated with Based on 2. Placental Development matter of days) and [folate] ->short red. ability to use Erythrocyte 3. Expansion of maternal erythrocyte # term measures folate folate 4. Fetal growth 3. Lymphocyte DNA- hypomethylation maintenance -Folate is actively transferred to the fetus (inc. within couple wks in df-> more (reflects [folate] in cord blood vs maternal blood) sophisticated test tissue stores) -Inadequate intake: -Based of dietary folate equivalence 1. Maternal serum and erythrocyte [] dec. (DFEs) 2. Megaloblastic marrow changes may occur 1Ug DFE 3. Megaloblastic anemia may develop if =0.6 folic acid from fortified food or continues suppl. with meal -Low diet folate + 100Ug suppl. (=200Ug) =1Ug of food folate inadequate to maintain normal status in sig. % =0.5Ug of supplement take on empty of pop=RDA+200Ug stomach -To dec. risk of NTD for women capable of becoming pregnant- 400Ug/d from fortified foods, supplements or both in addition to consuming food folate from a varied diet Vitamin B12 -Functions: RDA RDA -Absorption may inc. during preg. via an inc. # 1. Coenzyme for a critical methyl ♂♀>19yr 2.4ug 14-50yr intrinsic factor B12 receptors transfer reaction that converts 2.6ug/d -Serum total [B12] begin to dec. early in 1st trim homocysteine to methionine -RDA based on # (more than hemodilution can account for) 2. A separate rxn that converts L- to maintain -3 yrs veg -Further dec. through the 6th mo to about 1/2 of methylmalonyl coenzyme A (CoA) hematological (mom)=df 4- [nonpreg] (some of later dec. due to to succinyl-CoA status and normal 6mo old hemodilution) blood vit B12 infants -Only newly absorbed B12 is readily transported values across the placenta (maternal liver stores are a less imp source of the vit for the fetus) -Fetal deposition of 0.1-0.2ug/d throughout preg.+ inc.maternal absorption-> EAR inc. by 0.2ug/d Electrolyte About Regular Pregnancy Reasoning Requirements Choline -Precursor for acetylcholine, AI AI -Large amounts of choline are delivered to the in nuts, dairy, phsopholipids and the methyl donor ♂>19yr 550mg/d 14-50yr fetus through the placenta (depletes maternal meats and eggs betaine (prevent NTD) ♀>19yr 425mg/d 450mg/d stores) available as -Primary AI criterion: -May be esp. imp. during embryogenesis and -free choline preventing liver damage as assessed only 2 studies perinatal dev. (in rats, extra intake= long-lasting -bound as esters by serum alanine aminotransferase published (too enhancement of spatial memory) such as levels little for RDA) phosphocholine, (df=don’t form VLDL, inadequate glycerophosphoch excretion of lipids in liver= fatty liver= oline, release enzyme alanine phingomyelin, or aminotransferase when liver is phsophatidylcholin damaged) e (lecithin- to treat-Need varies with gender, preg., high BCH-remove lactation, and stage of development from tissues) (may endogenously synth at some stages), and availability of methionine and folate in the diet Pantothenic Acid -Component of Coenzyme A & AI AI -No Info showing that usual intakes in US & phosphopantetheine (fa met) ♂♀>19yr 5mg/d 14-50yr Canada are inadequate to support a healthy -Widely distributed in foods (df only as-Usual intake 4- 6mg/d pregnancy outcome. result of feeding semisynth. diets or 7mg/d- no proof an antagonist to the vitamin) inadequate -Round up from the avg intake -Main criterion: Replace urinary exc. Vitamin E -No specific role found for a required ♂♀ 15mg/d of 2R no change -Deficiency can occur in premature newborns- Forms not metabolic function stereoisomeric >hemolytic anemia interconvertible in -Major function: non-specific chain- forms ɑ- -No reports of df during pregnancy human breaking antioxidant preventing the tocopherol=RRR-, -No evidence that maternal supplementaiton [Plasma] depends propagation of lipid peroxidation RSR-,RRS-,RSS would prevent df symptoms in premature on affinity of (30mg/d of all rac- offspring hepatic ɑ- ɑ-tocopherol tocopheral transfer protein (ɑ-TT)- 2S -most people do forms and β,?▯, and not reach this δ fail to bind Electrolyte About Regular Pregnancy Reasoning Requirements Vitamin C -Functions: RDA RDA -Maternal plansma [vitC] dec. with progression 1. Water-soluble antioxidant ♂>19yr 90mg/d 14-18yr of pregnancy due to: 2. Cofactor for enzymes involved in ♀>19yr 75mg/d 80mg/d 1. Hemodilution biosynth of collagen, carnitine, and No diff needs with >19yr 2. Active transfer to the fetus (no precise data) nts age (lower blood 85mg/d -7mg/d vit.C prevent young infants from -RDA based: levels in elderly developing scurvy thus EAR for pregnancy 1. Maintain near-max [neutrophil] due to low intake, estimated to inc. 10mg/d 2. With min. urinary excretion of chronic disease, -Subpops of pregnant women may have ascorbate etc.) increased requirements: -Assumed need less for women (even 1. Users of street drugs and cigs (>20 cig/d=2x though no data) due to: requirement due to inc. free radical 1. dec. lbm production) 2. loss tot body water 2. Heavy users of alcohol 3. Women maintain higher plasma 3. Regular users of aspirin (inc. urinary levels then men at a given intake excretion) 4. smaller body size =>approx. extra 30-40mg needed Vitamin A -Important for: RDA RDA -EAR based on: 1. Normal vision ♂>19yr 900Ug/d 14-18yr 1. Accumulation in the liver of the fetus during 2. Gene expression ♀>19yr 700Ug/d 750RAE/d gestation 3. Reproduction of Retinol activity 19-50yr 2. Assumption that liver contains about 1/2 4. Embryonic Dvpmt equivalents (RAE) 770ugRAE/d body’s vitamin A when liver stores are low, as 5. Growth in the case of newborns 6. Immune function β/ɑ-carotene and CV=20% -Maternal absorption=70% -Preformed vitamin A abundant in β-cyptoxanthin (liver vit. A -Accumulates mostly in the last 90d some animal-derived food (inc. RAEs= 12, 24 1/2 -Mother’s requirement would inc. by 50ug/d bioavailability) and 24 life)=140%EA during last trimester (give extra 50ug for entire -Provitamin A carotenoids abundant in -RAE (considers R rounded to pregnancy period) darkly colored f&vs, oily fruits &palm absorption)=1/2R nearest 10ug oil E (suppl) Vitamin K coenzyme for synth of various AI (based on AI Phylloquinone: major form of vitamin K in diet proteins involved in blood coagulation dietary intake of >19yr 90μg/d Menaquinones- produced by bacteria in the and bone metabolism healthy inds) lower bowel ♂>19 yr 120μg/d ♀>19 yr 90μg/d Electrolyte About Regular Pregnancy Reasoning Requirements Vitamin D -Enhances absorption efficiency of RDA no change -Quantities of 25(OH)D transferred to fetus are -Vitamin small intestine (Ca, P) ♂♀ 19-70yr 600IU small and don’t affect overall vit D status of D2=ergocalciferal =maintain blood []s >70yr pregnant woman from yeast and -Potent antiproliferative & 800IU -Intake of 10Ug (400IU) (supplied in prenatal plant sterols prodifferentiation effects in a variety of vitamin supplements) would not be excessive. -Vitamin D3 tissues Blood levels: (cholecalciferal) -RDA: looks at bone health only ideally ≥20ng/mL from 7- serum [25- dehydrocholesterol Hydroxyvitamin , when D- first synthesized in the hydroxylated skin product from liver) -found in few foods Macronutrient About Regular Pregnancy Reasoning Requirements Calcium -Ca balance studies: AI AI -25-30g Ca transferred to fetus (mostly in 3rd intakes at which small gains in 1000mg(25mmol) 14-18yr-1300mg/d trim) bone mineral content can be Only 13% males 19-50yr-1000mg/d -Increased efficiency in intestinal absorption achieved above 60 and 4% (blood [1,25(OH)2D and Ca excretion -dec. risk osteoporosis, htn, and females achieved increase] colon cancer 1200mg. (low -> no change in need dairy intake) Phosphorus - 85% in adult bone RDA RDA -Intestinal absorption increases by 10% -Occurs as - Occurs as phospholipids, ♂>19yr 700mg 14-18yr 1250mg/d -No increase need phosphate nucleotides & nucleic acids (22.6mmol/d) 19-30yr 700mg/d - Buffers acid or alkali ♀ >19yr 700mg 31-50yr 700mg/d - Temporary storage and transfer (22.6mmol)/d of the E derived from the CV 10% metabolic fuels Based on 60-65% - Required for phosphorylation, theabsorption (mixed activation of many catalytic diet) proteins Iron -Component of a number of EAR RDA -Requirement for absorbed Fe= proteins, inc. enzymes and Hb: ♂6mg/d 14-18yr 27mg/d basal losses (250mg) +Fe deposited in fetus studies consistently 1. almost 2/3 of Fe found in Hb ♀19-50yr 8.1mg/d 19-30yr 27mg/d & related tissues (320mg) + Fe in expansion show a high present in circulating rbcs >50yr 5mg/d 31-50yr 27mg/d of Hb mass (500mg)= 1070mg incidence of Fe df 2. 15% myoglobin in muscle tissue -2nd and 3rd trimester- 25% absorption vs anemia among preg 3. Variety of enzymes necessary assume 18% CV 10% 18% and nonpreg women. for oxidative metabolism and bioavailability Hard to meet -> -Maternal anemia associated with premature many other critical functions (mixed diet) Supplementation: delivery, lbw, inc. perinat
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