The future mother and the doctors who will observe her often face many problems, according to the online publication for girls and women from 14 to 35 years old Pannochka. net Prior to pregnancy, maternal risk factors should be identified and eliminated as much as possible (chronic illness, 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 study 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 should begin in January of the previous year and end at least 6 weeks after delivery.. This regimen covers 54 weeks or more when a woman stops all forms of non-barrier contraception.. It is desirable to have two or more normal, independent menstrual cycles after using contraception before a planned pregnancy.
Similarly, postpartum involution will take time after delivery..
In a special way, the situation is in young girls who have recently begun menstruation.. It takes a certain time (about 5 years) for the body to become ready for carrying a normal pregnancy.. So, a 14-year-old girl becomes biologically mature if she began menstruating at the age of 9.. Of course, she emotionally, psychologically, economically cannot be mature as a woman after 20 years.. In another case, if a 14-year-old girl became pregnant in the first year of menarche, then she is not yet biologically mature.. This may end for her in an unwanted miscarriage and other consequences..
The first task that the doctor solves when starting to work with the 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 nature of nutrition, which will allow us to determine the deficiency of nutrition or its excess, the deficiency in the consumption (intake) of certain nutrients..
To do this, you need to:.
Detailed nutritional assessment, which includes:.
• physical examination;
• dietary assessment of nutrient intake (based on the use of a food diary).
Basic anthropometric measurements: height, weight, skinfold thickness, which will allow you to determine the body mass index (BMI) and most accurately plan a possible weight gain during pregnancy.
Biochemical assessment of nutritional parameters.
All these measurements in full during obstetric examination are most often not required.. But evaluation is necessary for every patient who has 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.
Evaluation of the food diary or the quality and quantity of nutrients consumed, hemoglobin levels, the presence of undesirable ingredients, the identification of malnutrition or obesity may require specific dietary recommendations..
If patients had certain types of metabolic disorders, such as diabetes mellitus, phenylalanine metabolism disorders, special diets in childhood, then they must strictly follow the diet during the entire observation period (before and throughout the pregnancy). The probability 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..
Assessment of nutritional status and energy needs of pregnant and lactating mothers.
Features of the assessment of pregnant women is the inability to use many traditional research methods. This is due to the constant changes that occur in the body of a pregnant woman..
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 needs are determined by the formula of Harris and Benedict:.
UOO \\u003d 655 + (9.6 x MT) + (1.8 x P) - (4.7 x B),.
where BMR is the basal metabolic rate (kcal/day); BW - body weight (kg); P - height (cm); B - age (years).
At the same time, the corrections for determining energy consumption are somewhat modified due to the peculiarities of the damage factors for pregnant and lactating women..
RE \\u003d UOO x FA x FB x TF x PF,.
where RE is actual energy expenditure, BMR is basal metabolic rate (kcal/day), FA is physical activity, FB is pregnancy factor, TF is body temperature, FP is damage factor.
The latest indicators are entered as coefficients.
UOO \\u003d 655 + (9.6 x MT) + (1.8 x P) - (4.7 x B),.
where BMR is the basal metabolic rate (kcal/day); BW - body weight (kg); P - height (cm); B - age (years).
At the same time, the corrections for determining energy consumption are somewhat modified due to the peculiarities of the damage factors for pregnant and lactating women..
RE \\u003d UOO x FA x FB x TF x PF,.
where RE is actual energy expenditure, EOO is basal metabolic energy requirement (kcal/day), FA is motor activity, FB is pregnancy factor, TF is body temperature, FP is damage factor.
FA - activity factor PF - damage factor TF - temperature factor FB - pregnancy factor Bed rest - 1.2 Ward rest - 1.25 General regimen - 1.3 none - 1.0 complicated labor - 1.2 caesarean section - 1,.
sepsis - 1.5.
excess increase.
body weight - 0.85.
eclampsia - 0.7 38°C - 1.1 39°C - 1.2 40°C - 1.3 41°C - 1.4.
before childbirth - 1.3, after childbirth -1.4 During pregnancy, the needs of a woman's body for proteins, fats, carbohydrates, vitamins, macro- and microelements increase significantly. The importance of a complete, balanced diet for 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 regard are the comparison data of 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 a high mortality of newborns in besieged Leningrad. Malnutrition of the mother negatively affects not only the weight, but also the length of the body of the fetus.. In fact, a persistent low-calorie diet may be a major 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.
Nutritional disorders at different stages of pregnancy affect the fetus in different ways. Much depends on both the qualitative and quantitative indicators of malnutrition and its duration.. Brief nutritional disturbances may not affect the development of the fetus due to the nutrient reserves in the mother's body.. But prolonged fasting can cause significant impairment. Being overweight during pregnancy increases the risk of developing gestational diabetes, increased blood pressure. In addition, the likelihood of having an overly large child with the ensuing consequences increases..
Squirrels.
Even a temporary protein deficiency leads to a delay in the development of the fetus and a decrease in its body weight, the weight of the brain, liver, and heart decreases.. During starvation of the mother, globulins are primarily used to feed the fetus.. Violation of the ratio of albumin and globulins in the blood serum of pregnant women can affect embryogenesis.
Insufficient quantitative content of protein in the diet of a pregnant woman due to changes in the biochemical composition of blood, myometrium, significantly increases the risk of spontaneous abortions, premature births, increased perinatal mortality, and the likelihood of anemia.
A change in the qualitative composition of the protein also affects the course of pregnancy.. The predominance of only vegetable or animal protein can lead to various disorders: RNA and DNA biosynthesis, changes in the duration of pregnancy, the nature of labor, etc.. Particular importance is attached to amino acids such as valine, histidine, isoleucine, leucine, lysine, methionine, taurine, threonine, tryptophan, phenylalanine..
Fats.
The development of offspring is influenced by quantitative and qualitative indicators of the composition of fat in the diet of pregnant women.. The lack of total fat affects the weight of the newborn, the content of certain lipids in the blood plasma, which affects their further development.. Importance is attached to linoleic and linolenic polyunsaturated fatty acids. The lack of certain polyunsaturated fatty acids leads to significant changes in the development of the nervous system..
Carbohydrates.
An excess of carbohydrates in the diet of a pregnant woman, especially easily digestible ones, significantly increases the frequency of intrauterine fetal death.. In pregnant women with impaired glucose tolerance, this is of particular importance.. With insufficient carbohydrate intake and a higher rate of glucose oxidation in pregnant women, especially in the last period of pregnancy, a decrease in blood glucose occurs.. This leads to increased protein catabolism in the fetus and adversely affects its development..
Vitamins and minerals.
During pregnancy, the need for vitamins and minerals increases significantly.. This is especially true for vitamins of group B (B1), D. An analysis of the actual nutrition of lactating women showed that the intake of vitamins A, C, B1 and B2 does not reach the recommended norms.. This is due to a number of reasons: a monotonous diet, the use of canned and refined foods, insufficient vitamin content in foods during certain periods of the year, losses during cooking, etc.. For example, depending on the type of product, the way it is processed, the loss of vitamins can range from 10-30 to 40-90%.
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 the vitamins.. Most of the surveyed (70-80%) have a combined deficiency of three or more vitamins, that is, polyhypovitaminous conditions are found regardless of age, season, place of residence and professional affiliation.
Vitamin deficiency disrupts the course of pregnancy, leads to various developmental disorders of the fetus. Vitamin B6 deficiency often leads to some types of toxicosis of pregnant women contributes to the destruction of tooth enamel. The lack of vitamin B6 and vitamin B12 is one of the causes of anemia in pregnant women.. With a deficiency of vitamins in the fetus, a variety of disorders can be observed (from some types of metabolic disorders, for example, lipid with a deficiency of riboflavin, to anomalies in the development and death of the fetus with a deficiency of thiamine, pyridoxine, niacin, retinol, tocopherol and others). The health of pregnant women and the fetus is also adversely affected by excessive intake of vitamins..
The importance of providing the body of a pregnant woman with vitamin C should be emphasized.. A lack of vitamin C can cause premature birth, miscarriage, the birth of handicapped 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 infants, neurodevelopmental defects, and maternal megaloblastic anemia.. Adequate amounts of folic acid should be taken during the first six weeks of pregnancy, i.e. 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 requirement of folate of approximately 200 to 300 mg per day..
Excessive intake 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 recommended daily folate requirement of 400 micrograms.. Special reviews show that the average folic acid intake for 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 regulatory effect on acid-base metabolism, the activity of enzyme systems and hormones.. Human need for trace elements (zinc, copper, magnesium, cobalt, selenium, etc.). ) does not exceed 0.1-10 mg / day, but they are constantly needed. Their deficiency causes a decrease in the growth rate and weight of the fetus, leads to an increase in the incidence of deformities..
Copper affects erythropoiesis. Insufficient copper content 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 in the newborn, and even fetal death, especially if it occurs in the first half of pregnancy..
The main causes of anemia in pregnancy are hemodilution caused by an increase in blood volume and a true dietary iron deficiency..
If "
• inadequate intake of products containing iron, folic acid, vitamin B12;
• the presence of bleeding;
• inadequate content of iron stores necessary to maintain a certain level of hemoglobin;
•increased consumption of iron;
• malabsorption in the intestine (malabsorption);
• insufficient content of it in the normal diet;
• a way of processing food with a loss of vitamins necessary for assimilation (folic acid, vitamins B12, B6, C);
• inadequate folate stores to support erythropoiesis;
• increased iron requirements 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 fetal body often leads to the development of its deficiency in a pregnant woman with bone demineralization.
Calcium and zinc improve maternal fertility. Additional administration of calcium (2000 mg) per day reduces systolic and diastolic blood pressure, as well as the development of toxicosis of 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, were noted.. Maternal supplementation with 20 mg zinc daily is associated with a lower incidence of placental abruption and lower perinatal mortality..
Essential inorganic minerals are sodium, potassium, calcium, chlorine, phosphorus, magnesium, cobalt, chromium, manganese, molybdenum and selenium..
Excess sodium intake can lead to increased blood pressure, fluid accumulation, edema, etc.. But insufficient sodium intake can also adversely affect the health of the pregnant woman and the fetus.. Salt restriction during pregnancy limits normal blood volume expansion, 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:.
• growth slowdown, or its complete stop;
•placental infarctions;
• violation of the transport of nutrients to the fetus;
•placental abruption causing bleeding.
An important feature in the 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 body of a pregnant woman..
During pregnancy, blood thinning and an increase in the permeability of blood vessels are observed, which creates prerequisites 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 foci of iodine deficiency.. In conditions of even mild iodine deficiency, the formation of secondary thyroid insufficiency occurs, which serves as the main prerequisite for the development in a child of various deviations from the central nervous system (neurological cretinism and subcretinism) and proper thyroid disadaptation 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-supplemented regions, pregnant women have a significantly increased frequency of spontaneous miscarriages, stillbirths, and their offspring not only have a decrease in the intellectual index, but also have 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. They have manifestations of weakened nonspecific immunity from the first days of life..
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, the development of the fetus may be affected by an increase in the average daily energy value of the diet of a pregnant woman.. In the diet of pregnant women who gave birth to large children, there was an increased content of fat and easily digestible carbohydrates and a reduced content of vegetables and fruits.. The ratio of the main food ingredients (proteins, fats and carbohydrates) in the diet was disturbed 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 the birth of 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 for the same protein intake.. A direct relationship has been established between the body weight of the fetus and the content of carbohydrates in the diet. In the third trimester of pregnancy, women who gave birth to children with greater body weight and consumed more carbohydrates and fats showed a significant increase in blood glucose, cholesterol, and low-density lipoprotein levels.. These women had an increased content of under-oxidized metabolic products in the blood (pyruvate and lactate).
The birth of a large child creates problems for both the mother during childbirth and for the child. More often develop birth trauma, asphyxia, higher risk of postnatal death. In the future, such children have a developmental delay, neurological complications, obesity, arterial hypertension, an accelerated rate of development of atherosclerosis, oncological problems, etc.. It is noted that the larger the newborns, the less often they have harmonious physical development, in particular, growth and weight indicators..
The problem of obesity in women is also related to age: in 10% of obesity is observed at the age of 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% obesity among those who have never been pregnant, and 50-68% among multiparous women. 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 must meet the basic physiological needs..
A pregnant diet should be considered complete, which includes these ingredients in optimal quantities and ratios, taking into account:.
• the age of the pregnant woman;
•its constitution;
•presence of obesity or malnutrition;
• the period of pregnancy or lactation;
• gestational age;
•physiological energy expenditure;
• seasons;
• excessive 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.
Good nutrition is called when it ensures the normal functioning of all systems and organs of both the pregnant woman and the unborn child..
Given 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..
Baranovsky.
medbe. en.