Life Cycle: Maternal and

Infant Nutrition

Chapter

16

Pregnancy

• Nutrition before conception• Risk assessment, health

promotion, intervention• Weight

• Maintain a healthy weight• Vitamins

• 400 micrograms folic acid/day• Avoid high doses of retinol

• Substance use• Eliminate prior to pregnancy © Photodisc

Pregnancy• Physiology of pregnancy

• Stages of human fetal growth• Blastogenic stage: first 2 weeks

• Cells differentiate into fetus, placenta• Embryonic stage: weeks 3–8

• Development of organ systems

• Fetal stage: week 9–delivery

• Growth

Pregnancy• Physiology of

pregnancy• Maternal changes

• Growth of adipose, breast, uterine tissues

• Increase blood volume

• GI changes

Pregnancy

• Maternal weight gain• Recommendations depend on BMI

• Normal weight (BMI = 19.8–26 kg/m2)• Gain 25–35 pounds

• Energy and nutrition during pregnancy• Energy

• Nutrients to Support Pregnancy• Macronutrients

• Low-fat, moderate-protein, high-carbohydrate

Pregnancy• Energy and nutrition during pregnancy

• Micronutrients• Increase need for most vitamins and minerals• Highest increase for iron and folate

• Food choices for pregnant women• Pyramid-style diet• Supplements of iron and folate• Foods to avoid

• Substance use• Risk for birth defects,

low birth weight, preterm delivery

Special Situations During Pregnancy

Special Situations During Pregnancy

• Food cravings and aversions• Hypertension• Diabetes• Gestational diabetes• HIV/AIDS• Adolescence

© Iakov Filimonov/Shutterstock,Inc.

Lactation• Physiology of lactation• Changes during pregnancy

• Increased breast tissue• Maturation of structure

• After delivery• Hormonal controls

• Prolactin• Oxytocin

Lactation• Nutrition for breastfeeding women

• Energy• Protein

• Higher needs than pregnancy• Vitamins and minerals

• Most are higher or same as pregnancy

• Iron and folate needs are lower• Water• Food choices

Lactation

• Supplementation• Practices to avoid while breastfeeding

• Alcohol, drugs, smoking, excess caffeine

Lactation

• Benefits of breastfeeding• Benefits for infants

• Optimal nutrition• Reduced incidence of

respiratory, GI, and ear infections

• Convenience• Other benefits

© Mikhail Tchkheidze/ShutterStock, Inc.

Lactation

• Benefits of breastfeeding• Benefits for mother

• Convenience• Enhanced recovery of uterus size• Other benefits

• Contraindications to breastfeeding

Resources for Pregnant and Lactating Women and Their Children

• Agencies and education programs• March of Dimes• La Leche League• WIC

Infancy

• Growth is the best marker of nutritional status • Evaluated using growth charts

• Weight gain• Double birth weight by 4–6 months• Triple birth weight by 12 months

• Length gain• Increase length by 50 percent by 12 months

• Head circumference

Infancy• Energy and nutrient needs of infants

• Based on composition of breast milk• Energy

• Highest needs of any life stage• Protein

• Highest needs of any life stage• Carbohydrate and fat

• Fat: major energy source• Carbohydrates: simple sugars

• Water

Infancy

• Energy and nutrient needs of infants• Key vitamins and minerals

• Vitamin D• Vitamin K• Vitamin B12

• Iron• Fluoride

© Photodisc

Infancy

• Newborn breastfeeding• Alternative feeding: Infant formula

• Standard • Soy-based • Other• Formula preparation

Infancy

• Breast Milk or Formula: How Much Is Enough?• Feeding Technique

Infancy

• Introduction of solid foods• Readiness for solids

• Increased digestive enzymes• Loss of extrusion reflex• Able to sit without support• Age of about 4–6 months

Infancy

• Developmental Readiness for Solid Foods• Start Healthy Feeding Guidelines

• Baby rice cereal• Strained fruits, vegetables, and meats• Add one food at a time

Infancy

• Feeding Problems During Infancy• Colic• Early childhood caries• Iron-deficiency anemia: milk anemia• Gastroesophageal reflux• Diarrhea• Failure to thrive

Promoting and Supporting Breastfeeding

• It is the position of the Academy of Nutrition and Dietetics (AND) that exclusive breastfeeding provides optimal nutrition and health protection for the first 6 months of life, and breastfeeding with complementary foods for at least 12 months is the ideal feeding pattern for infants. Breastfeeding is also a public health strategy for improving infant and child health survival, improving maternal morbidity, controlling health care costs, and conserving natural resources.

Eating for Two

• Pregnant women do not obtain adequate iron from diet alone, and should follow current recommendations for iron supplementation during pregnancy.

• For other nutrients, the mother’s diet quality should be evaluated before recommending nutrient supplements.

• Most pregnant women probably need folic acid supplements to meet increased requirements of pregnancy.

Energy-Yielding Nutrients for Infants

• To support growth, protein needs (per kg body weight) are higher in infancy than in any other life stage.

• The best diets for infants are high in fat and moderate in carbohydrate.

Nutrition to Prepare for Pregnancy

• Ideally, the time to prepare nutritionally for pregnancy is well before conception. A woman who has adequate nutrient stores, particularly of folic acid, and is at a healthy weight can reduce the risk for maternal and fetal complications during pregnancy.

• In addition to healthful diet selections, avoiding cigarettes, alcohol, and other drugs is important when contemplating pregnancy.

Cow’s Milk and Iron Deficiency

• The use of cow’s milk for children younger than 1 year is a common cause of iron deficiency.

• Cow’s milk is low in iron, and drinking cow’s milk can cause intestinal bleeding in infants.

• The amount of iron in breast milk is low, but this iron is highly bioavailable.

ADA: Key Recommendations

• Women of childbearing age who may become pregnant. Eat foods high in heme iron and/or consume iron-rich plant foods or iron-fortified foods with an enhancer of iron absorption, such as vitamin C-rich foods.

• Women of childbearing age who may become pregnant and those in the first trimester of pregnancy. Consume adequate synthetic folic acid daily (from fortified foods or supplements) in addition to food forms of folate from a varied diet.

Weight During Pregnancy

• Maternal obesity can complicate pregnancy and delivery and may compromise a baby’s health. Being too thin, meanwhile, carries its own risks.

• Lean women with a BMI less than 20 kg/m2 have increased risks of preterm delivery and delivering a low-birth-weight infant.

Weight During Pregnancy• Overweight and obese women have increased risks

of several problems, including preterm delivery and stillbirth.

• In addition, obese women are at higher risk for:• high blood pressure• gestational diabetes (a form of diabetes that is

associated with pregnancy; it often is controlled through diet alone)

• preeclampsia (a condition marked by high blood pressure, fluid retention, and protein in the urine)

• prolonged labor• unplanned cesarean section • difficulty initiating and continuing breastfeeding