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Life Cycle Nutrition: Pregnancy and Lactation

Chapter 15

Nutrition Prior to Pregnancy

Nutrition may affect fertility Preparation before pregnancy
Achieve and maintain healthy body weight Choose an adequate and balanced diet Be physically active Receive regular medical care Manage chronic conditions Avoid harmful influences

Growth and Development During Pregnancy

Placental development
Develops in uterus
Amniotic sac and umbilical cord

Expelled during childbirth Interweaving of fetal and maternal blood vessels Metabolically active organ
Requires energy and nutrients Produces hormones

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The Placenta and Associated Structures

Growth and Development During Pregnancy

Fetal growth and development
Fertilization of an ovum by a sperm Zygote
Rapidly divides to become blastocyst Implantation

Embryo
Eight weeks

Fetus
Full-term

Stages of Embryonic and Fetal Development

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Growth and Development During Pregnancy

Critical periods
Times of intense development
Cellular activities can occur only during these times

Adverse influences on organ and tissue development

The Concept of Critical Periods in Fetal Development

Critical Periods of Development

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Growth and Development During Pregnancy

Neural tube defects
Anacephaly
Brain either missing or fails to develop

Spina bifida
Incomplete closure of spinal cord & its bony encasement

Cause is unknown Risk factors Folate supplementation

Spina Bifida

Growth and Development During Pregnancy

Chronic diseases
Adverse influences at critical times during fetal development
Malnutrition type 2 diabetes Inadequate growth during placental & gestational development hypertension

Fetal programming
Mothers nutrition may change gene expression in fetus

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Maternal Weight
Birthweight is most reliable indicator of infants health Weight prior to conception
Influences fetal growth Underweight
Rates of preterm births and infant deaths

Overweight & obesity

Medical complications Risks for infant

Maternal Weight
Weight gain during pregnancy
Fetal growth and maternal health Correlates closely with infant birthweight
Predictor of health and development

Recommended weight gains

Number of fetuses Beginning weight

Recommended Weight Gains

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Maternal Weight
Weight gain patterns
3.5 pounds in first trimester 1 pound per week thereafter Large weight gain over short time
Preeclampsia

Components of weight gain

Placenta, uterus, blood, breasts, fluid volume, baby
Maternal fat stores

Recommended Prenatal Weight Gain Based on Prepregnancy Weight

Components of Weight Gain During Pregnancy

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Weight gain (lb) Increase in breast size Increase mother's fluid volume Placenta Increase in blood supply to the placenta Amniotic fluid Infant at birth Increase in size of uterus and supporting muscles Mother's necessary fat stores 2 4

1 1/2 4

2 7 1/2 2

7 30
Stepped Art

1st trimester

2nd trimester

3rd trimester

Figure 15-7 p478

Maternal Weight
Weight loss after pregnancy
Return to prepregnancy weight
Not typical

Retain a couple of pounds with each pregnancy Seven or more pounds; BMI increase 1 unit
Diabetes and hypertension Chronic diseases later in life

Exercise During Pregnancy

Can continue exercise throughout pregnancy
Adjust duration and intensity

Benefits Low-impact activities Fetal development

Excessively high internal body temperature Dehydration

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Exercise Guidelines during Pregnancy

Nutrition during Pregnancy

Dramatic changes Guidelines for a healthy pregnancy
Good nutrition Healthy weight gain Physical activity Prenatal supplements Avoiding harmful substances

Energy & Nutrient Needs During Pregnancy

Needs tend to be higher than any other time in life To meet needs
Make careful selections Body maximizes absorption Body minimizes losses

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Comparison of Nutrient Recommendations

Energy & Nutrient Needs During Pregnancy

Energy
Increase in basal metabolic rate
Second and third trimester

Food energy
15 to 20% more energy than before pregnancy Nutrient-dense foods

Daily Food Choices for Pregnancy & Lactation

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Energy & Nutrient Needs During Pregnancy

Carbohydrate
Ample carbohydrate is necessary

Protein
RDA additional 25 grams per day
Supplements are discouraged

Essential fatty acids

Omega-3 and omega-6 fatty acids for brain material

Energy & Nutrient Needs During Pregnancy

Blood production and cell growth
Fetal growth and development Maternal red blood cell mass Needs for synthesis of DNA and new cells
Folate Vitamin B12 Iron Zinc

Energy & Nutrient Needs During Pregnancy

Nutrients for bone development
Vitamin D
Deficiency interferes with calcium metabolism

Calcium
Absorption and retention increase Intake usually falls below recommendations

Other nutrients
Optimal interval between pregnancies

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Energy & Nutrient Needs During Pregnancy

Prenatal supplements
Calcium Folate Iron

Benefits of use

Vegetarian Diets During Pregnancy & Lactation

Can support healthy pregnancy and lactation
Well planned Food sources

Vegan diets
Additional supplementation Risks

Common Nutrition-Related Concerns of Pregnancy

Nausea
Morning sickness Hormonal changes

Constipation and hemorrhoids Heartburn Food cravings and aversions

Hormone-induced changes

Nonfood cravings

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Strategies to Alleviate Maternal Discomforts

High-Risk Pregnancies
Infants birthweight
Low birthweight (LBW)
5 pounds or less Risk of complications Relationship with socioeconomic status

Gestational age
Preterm Small-for-gestational age

High-Risk Pregnancy Factors

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High-Risk Pregnancies
Malnutrition and pregnancy
Fertility
Viable sperm Sexual interest Amenorrhea

Early pregnancy
Placenta development

Fetal development
Consequences

High-Risk Pregnancies
Food Assistance Programs
WIC
Nutrition education and nutritious foods Vulnerable populations who qualify for help Cost-benefit Remedial and preventive services

High-Risk Pregnancies
Maternal health
Preexisting diabetes
Risks associated with unmanaged diabetes

Gestational diabetes
Common consequences Dietary recommendations

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High-Risk Pregnancies
Maternal health
Chronic hypertension
Risks

Gestational hypertension Preeclampsia

Cause is unclear Risks for mother Risks for fetus

Eclampsia

High-Risk Pregnancies
Mothers age
Ideal childbearing age Adolescents
Risk of pregnancy complications Higher rates of stillbirths, preterm births, and LBW infants Weight gain recommendations Need to seek prenatal care

High-Risk Pregnancies
Maternal age
Older women
Complications often reflect chronic conditions Cesarean section rates increase Maternal death rates are higher Risks for fetus

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High-Risk Pregnancies
Alcohol consumption
Irreversible mental and physical retardation
Fetal alcohol syndrome (FAS)

Medicinal drugs
No medication use without consulting physician

Herbal supplements
Seek physician advice

High-Risk Pregnancies
Illicit drugs
Many drugs easily cross the placenta
Impair fetal growth and development

Other risks to fetus, infant, and child

Smoking and chewing tobacco

Harmful effects magnified during pregnancy Risks for mother and infant
SIDS

High-Risk Pregnancies
Environmental contaminants
Lead Mercury
Foods to avoid Supplements

Foodborne illness
Increased risk of listeriosis Risks associated with illness

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High-Risk Pregnancies
Vitamin-mineral megadoses
Excessive vitamin A
Fetal malformations

Caffeine
Miscarriage and fetal death Fetal growth

Restrictive dieting Sugar-substitutes

Lactation: A Physiological Process

Health benefits of breastfeeding Hormones promote growth and branching of duct system & milk-producing cells
Prolactin
Milk production

Oxytocin
Cause mammary glands to eject milk into ducts

Benefits of Breastfeeding

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Breastfeeding: A Learned Behavior

Lactation is an automatic, physiological process Breastfeeding is a learned behavior
Some decide not to breastfeed

Factors influencing breastfeeding and its success

Partner Adequate nutrition and rest

Tips for Successful Breastfeeding

Maternal Energy & Nutrient Needs During Lactation

Energy intake and exercise
Almost 500 extra kcalories per day Exercise is compatible with breastfeeding

Energy nutrients
Recommendations increase for carbohydrates and fibers

Water
Prevent dehydration

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Maternal Energy & Nutrient Needs During Lactation

Vitamins and minerals
Inadequacies reduce the quantity, not quality of breast milk
Quality maintained at expense of maternal stores

Prolonged inadequate intakes

Impacts several nutrients

Supplements
Iron

Maternal Energy & Nutrient Needs During Lactation

Food assistance programs
Participants are less likely to breastfeed WIC incentives to encourage breastfeeding

Particular foods
Flavors Allergies

Maternal Health
HIV infection and AIDS
Transmission through breastmilk
Medications

Diabetes type I Postpartum amenorrhea

Does not protect from pregnancy

Breast health
Breast cancer

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Practices Incompatible With Lactation

Alcohol
Easily enters breast milk Infants eat less when mother consumes alcohol

Medical drugs
Physician consultation

Illicit drugs
Risks

Practices Incompatible With Lactation

Smoking
Reduces milk volume Sleep less Passive smoking and SIDS

Environmental contaminants
DDT, PCBs, and dioxin

Caffeine
Iron bioavailability

Fetal Alcohol Syndrome

Highlight 15

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Introduction
Alcohol readily crosses the placenta
Deprives fetus of nutrients and oxygen

Fetal alcohol spectrum disorder

Fetal alcohol syndrome (FAS)
Cluster of physical, mental, and neurobehavioral symptoms

Alcohol-related neurodevelopmental disorder (ARND) Alcohol-related birth defects (ARBD)

Introduction
Abstinence from alcohol during pregnancy is recommended
Severe consequences FAS can only be prevented not treated

Abstinence is recommended for those who may become pregnant

Typical Facial Characteristics of FAS

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Drinking During Pregnancy

Direct damage
Intoxication

Indirect damage
Malnutrition

Alcohol interferes with tissue development during critical periods Fetal blood alcohol concentration (BAC) increase until even with maternal BAC levels

How Much Is Too Much?

Even one drink a day may threaten neurological development and behaviors Total alcohol intake
Average intakes

Drinking patterns
Frequency of consumption Quantity consumed Stage of fetal development

When Is the Damage Done?

First one to two months of pregnancy Critical periods and alcohol exposure Male alcohol ingestion
May affect fertility and fetal development Association with low infant birthweight

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