Clinical Practice Guidelines Antenatal Care — Module II
Download 2.59 Mb.
|
- Navigate this page:
- Risks associated with nutrition during pregnancy
- Discussing nutrition 8
- Foods that should be limited
- Maternal diet and infant allergy
- Discussing nutritional supplements
- Other nutritional supplements
- Practice summary: nutrition
5.1NutritionConsuming a wide variety of nutritious foods during pregnancy is important to ensure that the nutritional requirements of both mother and baby are met. In some situations, supplementation of particular vitamins or minerals may be advisable. BackgroundThe nutritional status of a woman before and during pregnancy plays a vital role in fetal growth and development. While requirements for some nutrients (eg iron, folic acid) increase, the basic principles of healthy eating remain the same. Risks associated with nutrition during pregnancyOver and under-nutrition: Too little weight gain during pregnancy increases the risk of a low birth weight infant. Excess weight gain during pregnancy increases the risk of gestational diabetes and of the baby being large for gestational age. It is also associated with increased risk of obesity and metabolic syndrome in infants later in life. Food safety: As the immune system in pregnancy is suppressed, pregnant women are more susceptible to foodborne illnesses, such as listeriosis, which can be transmitted to the unborn child and may cause miscarriage, premature birth or stillbirth (Pezdirc et al 2012). Fetal exposure to high levels of mercury (eg from maternal consumption of some fish species) may cause developmental delays (FSANZ 2011). Access to healthy foodGeographical location: The decreased availability of nutritious foods (such as fresh fruit and vegetables, wholegrain bread and low fat milk products) in remote and regional areas in Australia has been described frequently. The cost of nutritious foods in these areas is also over 30% higher than in major cities and may affect food choices (NHMRC 2000; NT DHCS 2007; Harrison et al 2010; Landrigan & Pollard 2011). Socioeconomic status: In some urban centres, people in lower socioeconomic groups have less access to supermarkets and greater access to fast food outlets than more advantaged groups (Burns & Inglis 2007; Ball et al 2009). Supermarkets generally offer a wider variety of food products, as well as fresh raw food. Migrant and refugee women: Following migration, food habits may change out of choice, because of the limited availability of traditional and familiar foods, or because of change in economic circumstances in Australia. Similarly, financial and language difficulties may affect access to education and employment opportunities which then affects income, health and nutrition literacy, and access to nutritious foods. Some migrants experience disadvantages such as social isolation and poor housing, which can affect access to safe food and safe preparation of food, and are generally in a relatively vulnerable position in their new environments, regardless of the type of migration (WHO 2010). Discussing nutrition8Healthy eating during pregnancy and breastfeedingConsuming a variety of nutritious foods is particularly important during pregnancy and breastfeeding. Vegetables, legumes/beans and fruit: Vegetable and fruit consumption before and during pregnancy makes an important contribution to health outcomes for women and their children. Grain (cereal) foods: Wholegrain foods are a valuable source of iron and zinc and fibre. Bread in Australia is fortified with folic acid and made with iodised salt. Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans: Lean red meat and chicken is a good source of protein, iron and zinc. Maternal consumption of fish during pregnancy is likely to have a number of health benefits for women and their children but the fish should be low in mercury. Nuts and seeds and legumes/beans are important foods for people who choose vegetarian or vegan dietary patterns and meals without meat as they can provide an alternative source of nutrients. For several nutrients, including iron, calcium and vitamin B12, animal foods are highly bioavailable sources and care needs to be taken to ensure a variety of alternatives if these foods are excluded. Milk, yoghurt and cheese and/or their alternatives: Milk, yoghurt and cheese or their alternatives are good sources of calcium. Reduced fat milk, yoghurt and cheese products are recommended during pregnancy. Water: Pregnant women have an increased water requirement because of expanding extracellular fluid space and the needs of the baby and the amniotic fluid. Practice point f Eating the recommended number of daily serves of the five food groups and drinking plenty of water is important during pregnancy and breastfeeding. Table 5.2: Recommended number of daily serves during pregnancy
Source: (NHMRC 2013). Table 5 : Practical advice on nutritious foods during pregnancy
Source: (NHMRC 2013). Foods that should be limitedFoods containing saturated fat, added salt, added sugars: Intake of these foods should be limited in general and during pregnancy. The additional energy requirements of pregnancy should be met through additional serves of foods from the five food groups rather than energy-dense foods. Alcohol: Not drinking alcohol is the safest option during pregnancy (see Module I; Section 10.2). Maternal diet and infant allergyMaternal diet during pregnancy and while breastfeeding does not appear to affect the risk of asthma, eczema or other allergy symptoms in infants (Hattevig et al 1989; Chatzi et al 2008; De Batlle et al 2008; Shaheen et al 2009; Lange et al 2010). CaffeineThere is insufficient evidence to confirm or refute the effectiveness of caffeine avoidance on birth weight or other pregnancy outcomes (Jahanfar & Sharifah 2009; Peck et al 2010; Milne et al 2011). The Australian Department of Health suggests limiting intake during pregnancy to around three cups of coffee or six cups of tea a day (eg 300 mg of caffeine) (DoHA 2009). Other caffeinated beverages (eg colas, energy drinks, green tea) should also be limited. Recommendation 4 Grade C Reassure women that small to moderate amounts of caffeine are unlikely to harm the pregnancy.
Appropriate weight gainAppropriate, steady weight gain during pregnancy is important to optimise the health outcomes (short and long term) for the infant and mother (NHMRC 2013). Calculation of body mass index (BMI) at the first antenatal visit (see Module I, Section 7.2) allows appropriate advice about nutrition to be given early in pregnancy as the optimal amount of weight gained depends on the woman’s pre-pregnancy BMI. The evidence on dietary interventions to prevent excessive weight gain during pregnancy is inconsistent. Systematic reviews have found: insufficient evidence to recommend any one intervention for preventing excessive weight gain during pregnancy (Muktabhant et al 2012); and that diet-based interventions were more effective in reducing excessive gestational weight gain than physical activity or a combined intervention (Thangaratinam et al 2012). Practice point g For women who are underweight, additional serves of the five food groups may contribute to healthy weight gain. Practice point h For women who are overweight or obese, limiting additional serves and avoiding energy-dense foods may limit excessive weight gain. Weight loss diets are not recommended during pregnancy. Discussing nutritional supplementsThere is evidence to support routine supplementation with folic acid preconception and in the first trimester (see Module I, Section 10.4) and to support iodine supplementation preconception and during pregnancy and breastfeeding (see Module I, Section 10.4.3). Iron supplementation may prevent iron deficiency in women with limited dietary iron intake. Vitamin B12 supplementation may be needed if a woman has a vegetarian or vegan diet. Vitamin D supplementation may be a consideration for women identified as deficient (see Module I, Section 8.9). Other nutritional supplements do not appear to be of benefit unless there is an identified deficiency. Summary of the evidenceIronDemand for iron increases during pregnancy and insufficient iron intake or absorption or blood loss (eg due to gastrointestinal parasites) can result in deficiency or anaemia. Iron-rich staple foods can help women reach dietary targets for iron (Bokhari et al 2012). Absorption is aided by vitamin C and limited by tea and coffee (Marsh et al 2009). Where iron-rich foods are not available (eg due to geographical location or socioeconomic factors), women may be at high risk of iron deficiency. Ferritin concentrations should be checked and supplementation considered if iron stores are low or if they are normal but dietary intake is likely to remain low. Practice point i Women at risk of iron deficiency due to limited access to dietary iron may benefit from practical advice on increasing intake of iron-rich foods. Daily supplementation with iron during pregnancy reduces the risk of maternal iron deficiency and anaemia and low birth weight (Pena-Rosas et al 2012b; Haider et al 2013) but is associated with side effects (constipation, nausea, vomiting and diarrhoea and an increased risk of high haemoglobin concentration at term) (Pena-Rosas et al 2012b). These effects need to be weighed against the risks of iron deficiency (Pena-Rosas et al 2012b). Intermittent iron+folic acid regimens produce similar maternal and infant outcomes at birth and are associated with fewer side effects (Pena-Rosas et al 2012a). Recommendation 5 Grade B Advise women with low dietary iron intake that intermittent supplementation is as effective as daily supplementation in preventing iron-deficiency anaemia, with fewer side effects. Identifying and treating iron-deficiency anaemia is discussed in Section 8.2. Other mineralsIdentifying and treating iron: deficiency anaemia is discussed in section 8.1 Calcium: While calcium supplements are useful in decreasing pre-eclampsia risk if dietary intake is low (see Section 6.7), they do not appear to be of benefit in preventing preterm birth or low infant birth weight (Buppasiri et al 2011). Magnesium: There is insufficient evidence to show whether dietary magnesium supplementation during pregnancy is beneficial (Makrides & Crowther 2001). Zinc: While some studies have found benefits from zinc supplementation among women in areas of high perinatal mortality (Wieringa et al 2010; Mori et al 2012), these results may not be generalisable to the Australian context. VitaminsThere is insufficient evidence on supplementation during pregnancy of vitamin C (Rumbold & Crowther 2005b), vitamin E (Rumbold & Crowther 2005a), vitamin A (van den Broek et al 2010) or vitamin B6 (Thaver et al 2006) to show whether these are beneficial. However, supplementation has been associated with: preterm birth (500–1,000 mg vitamin C per day) (Rumbold & Crowther 2005b); perinatal death and preterm rupture of the membranes (1,000 mg vitamin C and 400 IU vitamin E per day) (Xu et al 2010); and congenital malformation (vitamin A) (Oakley & Erickson 1995; Rothman et al 1995; Dolk et al 1999). Other nutritional supplementsMultiple micronutrients: While multiple micronutrients improve nutrient status of pregnant women (Brough et al 2010) and reduced rates of small-for-gestational-age (Haider et al 2011) and low birth weight babies (Haider & Bhutta 2012), more evidence is needed to understand which groups of women may benefit from these supplements. Omega-3 fatty acids: While there is emerging evidence of benefits associated with supplementing omega-3 fatty acids during pregnancy (eg reduced risk of early preterm birth) (Makrides et al 2010; Leung et al 2011; Imhoff-Kunsch et al 2012; Larque et al 2012; Mozurkewich & Klemens 2012), the benefits of routine supplementation are not known. Probiotics: While there is also emerging evidence on the benefits of probiotics combined with dietary counselling during pregnancy (eg improved blood glucose control) (Laitinen et al 2009; Luoto et al 2010; Ilmonen et al 2011), again the benefits of routine supplementation are not known. Multivitamins: An observational study has shown an association between risk of preterm birth and multivitamins and minerals if taken daily in the third trimester by women who were unlikely to be deficient in these nutrients (Alwan et al 2010). Practice summary: nutrition
Directory: internet -> main -> publishing.nsf -> Content internet -> 3G300m-how to setup the 3g router Mode? Product line: 3g question categories: Function configurations Note internet -> Installation Work has never been simpler or easier Content -> Mbs review Taskforce Newsletter Message from the Chair Content -> National pathology accreditation advisory council Content -> National Framework for Action to Promote Eye Health and Content -> Review of the National Mental Health Commission Content -> Australia Ingredients Report Download 2.59 Mb. Share with your friends:
|