1. Chapter 17: Life Cycle Nutrition: Pregnancy through Infancy

2. Stages of Pregnancy and Importance of the Placenta
During pregnancy, the diet must support the health of a woman and her growing baby
Full-term pregnancy averages 38 weeks from conception to birth (divided into three trimesters)

3. Stages of Pregnancy and Fetal Development
Figure 17.1

4. Stages of Pregnancy and Importance of the Placenta
Nutrients are delivered to and wastes are transported from the developing embryo through the placenta
Prevents passage of red blood cells, bacteria, and many large proteins from mother to fetus
Alcohol, drugs, and other potentially harmful substances can cross the placenta
Releases hormones required to support the physiological changes of pregnancy

5. The Placenta
Figure 17.2

6. Stages of Pregnancy and Importance of the Placenta
Critical periods impact fetal development
Periods of rapid cellular activity are highly vulnerable to nutritional deficiencies, toxins, and other insults
Famine associated with a high cumulative incidence of heart disease
Inadequate iron during early pregnancy associated with poor cognitive development
Metabolic or fetal programming may be able to alter how genes are expressed during critical periods of development

7. Critical Periods of Development
Figure 17.3

8. Quick Review
A healthy pregnancy lasts 38 weeks and is divided into three trimesters
The placenta is the site through which the developing fetus accesses the mother’s organ systems for respiration, absorption, and excretory purposes
Harmful toxins or inadequate nutrition can cause irreversible damage to the fetus, especially during critical periods
Metabolic programming examines the interaction of the prenatal environment on genetic and other factors to produce permanent change

9. Nutrients and Behaviors Are Important for a Healthy Pregnancy—The Father
Before conception, fathers-to-be need to eat well for healthy sperm production
Smoking, alcohol and drug abuse, and obesity are associated with decreased sperm production and function
Zinc, folate, and antioxidants are associated with healthy sperm

10. Nutrients and Behaviors Are Important for a Healthy Pregnancy—The Mother
Before conception, mothers need to adopt a healthy lifestyle
Attain a healthy weight before conception
Obesity and overweight are associated with infertility, pregnancy complications, potential birth defects
Underweight women are at risk of delivering low birth weight or small for gestational age babies
Get plenty of folic acid–400 micrograms daily
Reduces risk of neural tube defects
Moderate fish and caffeine consumption

11. Nutrients and Behaviors Are Important for a Healthy Pregnancy—The Mother
Avoid cigarettes, alcohol, and illicit drugs
Smoking increases the risk of infertility, a low birth weight baby, stunted growth or intellectual development, and sudden infant death syndrome (SIDS)
Drinking alcohol during pregnancy can lead to fetal alcohol spectrum disorders (FASD); pregnant women are advised to abstain completely from alcohol

12. Nutrients and Behaviors Are Important for a Healthy Pregnancy
Managing chronic conditions
Diabetes, hypertension, PKU or sexually transmitted disease can increase maternal and fetal complications if not controlled before conception
Medications may be contraindicated during pregnancy, so prepregnancy counseling is essential

13. Quick Review
Good nutrition and healthy lifestyle habits before conception are important for both men and women
Factors such as smoking, alcohol abuse, and obesity decrease sperm production and function
Conception is easier for women if they are at a healthy body weight
Getting plenty of folic acid, avoiding fish high in methylmercury, limiting caffeine consumption, avoiding cigarettes, alcohol and drugs, and managing chronic conditions are essential for a healthy pregnancy
Proper nutrition and a healthy lifestyle can prevent birth defects and may reduce future health risks

14. Nutrition During the First Trimester
Morning sickness
Begins during the first trimester and often ends by the 20th week of pregnancy
Cause is unknown, but estrogen is thought to play a role
Small, frequent meals, avoiding an empty stomach, high carbohydrate foods, ginger, and salty foods combined with sour and tart beverages help manage nausea
Vitamin B6 may reduce nausea and vomiting
In rare cases, women experience hyperemesis gravadarum, severe vomiting which can lead to dehydration, electrolyte imbalances, weight loss and may require hospitalization

15. Nutrition During the First Trimester
Cravings
Researchers have not found a physiological explanation for food cravings
Pica is the abnormal, compulsive intake of nonedible items such as laundry starch, burnt matches, clay, dirt, paint chips, and/or baking soda
More common in African-American women and associated with low blood levels of iron

16. Nutrition During the First Trimester
Avoiding botanicals
Botanicals are parts of a plant believed to have medicinal or therapeutic effects
Herbs such as blue cohosh, juniper, goldenseal and raspberry tea may cause contractions of the uterus leading to miscarrage or premature labor

18. Components of Weight Gain During Pregnancy
Figure 17.5

19. Nutrition During the First Trimester
Dietary considerations
50% increase in needs for folate, zinc, and iron
Kilocalorie needs are not significantly increased during the first trimester
Focus should be on intake of nutrient-dense foods
A prenatal supplement is necessary
Vegetarians and vegans should be mindful of meeting needs for essential fatty acids and vitamin B12
Drink milk to meet needs for calcium and vitamin D

20. Nutrition During the First Trimester
Foodborne illness
The immune system is weakened during pregnancy, so mother and baby are at greater risk
Listeria monocytogenes may cause miscarriage, premature labor, low birth weight, developmental problems, or infant death
Pregnant women should avoid raw or undercooked meats, fish, or poultry; unpasteurized milk, cheese, and juices; and raw sprouts

21. Quick Review
Women commonly experience morning sickness and cravings during the first trimester of pregnancy
Recommended weight gain during pregnancy depends on prepregnancy weight
The needs for many nutrients are increased during pregnancy, but most can be met with a balanced diet
It is difficult to consume adequate iron from foods during pregnancy, so a supplement is often prescribed
Pregnant women should avoid excess amounts of preformed vitamin A and D
Risk of foodborne illness is increased during pregnancy, so women should handle raw foods carefully and avoid certain raw, undercooked, or unpasteurized foods

22. Nutrition During the Second Trimester
Consume adequate kilocalories, carbohydrate, and protein
An additional 340 kcals daily is needed during the second trimester
Need a minimum of 175 grams carbohydrate per day
Protein needs increase 35% to about 71 grams daily

23. Activity During the Second Trimester
30 minutes or more of moderate exercise on most days is recommended
Low-impact activities pose less risk for injury to mother or baby
Must take care to avoid significant increases in body core temperature and drink plenty of fluids to avoid dehydration

25. Complications During the Second Trimester
Potential complications: gestational diabetes and hypertension
Gestational diabetes occurs when a woman develops high blood glucose levels during her pregnancy
May result in macrosomia, jaundice, breathing problems, birth defects, or hypoglycemia after birth
Eating healthfully, maintaining a healthy weight, and exercising regularly can reduce risk

26. Complications During the Second Trimester
Pregnancy-induced hypertension includes three categories
Gestational hypertension – occurs early in pregnancy in women with no history of hypertension
Preeclampsia – characterized by hypertension, severe edema and protein losses in the urine; deprives fetus of oxygen and nutrient rich blood from the placenta
Eclampsia – can cause seizures and is a major cause of death of women during pregnancy
The only cure for preeclampsia and eclampsia is to deliver the baby

27. Quick Review
Pregnant women need to consume an additional 340 kcals during the second trimester
Exercise can provide numerous benefits during pregnancy, but should be limited to low-impact activities to reduce risk of injury to Mom or baby
Complications that often appear during the second trimester of pregnancy include gestational diabetes and pregnancy induced hypertension; women with these conditions should be closely monitored by a health care professional

28. Nutrition During the Third Trimester
Eating frequent small meals and a high-fiber diet can help with heartburn and constipation
An extra 450 kcals are needed during the third trimester
The growing baby exerts pressure on the Mom’s intestines and stomach which can cause heartburn
Hormonal changes slow movement of food through the GI tract which may cause constipation

29. Special Concerns of Younger or Older Mothers-to-Be
Teenage mothers
Still growing, therefore nutrient needs are even higher than an adult woman, yet more likely to have an unbalanced diet
More likely to develop pregnancy-induced hypertension, iron-deficiency anemia, and deliver premature babies
Older mothers
Higher risk for complications including gestational diabetes and pregnancy-induced hypertension
Babies are more likely to have Down syndrome or other developmental disabilities

31. Breast-Feeding
Lactation is the production of milk in a woman’s body after birth
The “breast is best” when nourishing an infant
Breast-feeding provides physical, emotional, and financial benefits for mothers
Helps stimulate recovery from pregnancy including contraction of the uterus and weight loss
May reduce risk of certain chronic diseases later in life
Less expensive and more convenient than formula
Reduces stress and promotes bonding

32. The Letdown Response
Figure 17.8

33. Benefits of Breast-Feeding
Breast-feeding provides nutritional and health benefits for infants
Nutritional composition of breast milk changes as the infant grows
Colostrum is lower in fat, higher in protein, vitamin A, minerals, and antibodies
Breast milk is high in lactose, fat, B vitamins and lower in fat-soluble vitamins, sodium, and other minerals
The American Academy of Pediatrics recommends supplementing breast-fed babies with vitamin D drops to meet needs

34. Benefits of Breast-Feeding
Breast-feeding protects against infections, allergies, and chronic disease and may enhance brain development
Provides beneficial compounds including antioxidants, hormones, enzymes, and growth factors
If continued beyond six months, may reduce risk of childhood obesity
Breast milk is rich in docosahexaenoic acid (DHA) and arachidonic acid (AA) which are important for development of vision and the central nervous system
The American Dietetic Association recommends exclusive breast feeding until 6 months of age and continuation to at least one year with appropriate solid foods

35. Quick Review
Breast-feeding provides numerous benefits to mothers and their babies
It can help mothers recover from pregnancy and may help prevent certain chronic diseases later in life
It is the least expensive and most convenient way to nourish an infant and promotes bonding between Mom and baby
Human milk is rich in nutrients, antibodies, and other compounds that can protect against infection, allergies, and chronic disease, and may enhance cognitive development
Women are advised to breast-feed exclusively for the first six months and then breast-feed to supplement solid foods for the first year

36. Nutrient Needs and Habits for a Breast-Feeding Mother
Should drink 13 cups of fluid per day to meet increased fluid needs
Needs additional kcals
A well-balanced diet should meet nutrient needs during lactation
Substances in the mother’s body are transmitted through breast milk; nursing Moms should avoid alcohol, drugs, tobacco, and limit caffeine
Children from families with a strong family history of foods allergies may benefit from breast-feeding

37. Formula Is an Alternative to Breast Milk
Some women may not be able to breast-feed
Women with AIDS, human T-cell leukemia, or active tuberculosis, who are receiving chemotherapy and/or radiation, or who use illegal drugs should not breast-feed
Infants with galactosemia cannot metabolize lactose and should not be breast-fed

38. Formula Is an Alternative to Breast Milk
Formula can be a healthy alternative to breast-feeding
Developed to be as similar as possible to breast milk
Standard formula is made from cow’s milk.
Unmodified cow’s milk it too high in protein, sodium, potassium, and too low in fat and linoleic acid for infants
To avoid nursing bottle tooth decay and risk of ear infections, infants should not be allowed to sleep with a bottle containing sugary liquids
Figure 17.9

39. Quick Review
If a women is unable or chooses not to breast-feed, formula is the only healthy alternative for babies
Commercially made formulas are modified from soy or cow’s milk and designed to resemble human breast milk
Cow’s milk should not be given before age 1, as it is too high in protein and certain minerals and too low in fat
Powdered and concentrated formula should be diluted and mixed carefully to ensure babies are getting the correct calories and nutrients
To avoid tooth decay and ear infections, babies should not be put to sleep with bottles

40. Nutrient Needs of Infants
Infants grow at an accelerated rate
Doubles birth weight by 6 months of age and triples it by 12 months
Length doubles by 1 year of age
Significant intellectual and social development occurs during infancy
Adequate nutrition is needed to meet physical, social and intellectual milestones
Failure to thrive (FTT) occurs when a child is delayed in physical growth or size or does not gain enough weight
Growth charts are used to track physical development

41. Growth Chart
Figure 17.11

42. Quick Review
Growth occurs at a dramatic rate during the first year of life
Infant growth can be monitored by tracking developmental milestones and using growth charts
Nutrient needs during the first year of life are substantial, and supplements may be needed in some circumstances

43. Switching to Solid Foods
Solid foods are introduced around 4–6 months of age once certain milestones are met
Solid foods should be introduced gradually
Parents should watch for signs of allergies after a new food is introduced

44. Food Allergy

45. Switching to Solid Foods
Certain foods are dangerous and should be avoided
Egg whites, cow’s milk, and peanut butter
Honey may carry Clostridium botulinum and cause botulism in infants
Seasonings are not needed
Juice often displaces necessary nutrients and should be limited to 100% juice and given in moderation
Infants should never be put on weight-loss diets

46. Quick Review
An infant must be physically, physiologically, and nutritionally ready before being introduced to solid foods
Solid foods should be introduced gradually and cautiously
Foods that may pose a choking hazard should be avoided and infants should always be supervised when eating
Common food allergens, honey, and herbal teas should be avoided for the first year of life and seasonings should not be added to infant food
To keep their children healthy parents need to educate themselves about foods that are safe and appropriate for infants

47. Summary of Nutritional Guidelines
Figure 17.12

48. Putting It All Together
Both the father and mother should make healthy diet and lifestyle changes prior to pregnancy
During pregnancy, nutrients, oxygen and waste products are exchanged between mother and fetus through the placenta; harmful toxins or inadequate nutrition can cause irreversible damage to the fetus, especially during critical periods
Recommended weight gain during pregnancy depends on prepregnancy weight; caloric needs are increased during the second and third trimester of pregnancy to support weight gain; a prenatal supplement is needed for iron
Breast-feeding is the gold standard for infant nutrition; it provides physical, emotional, convenience, and financial benefits to Mom and nutritional and health benefits to baby
Infancy is characterized by rapid growth and important developmental milestones