1. Life Cycle: Maternal and Infant Nutrition
BIOL 103, Chapter 12

2. Today’s Topic Pregnancy Lactation
Resources for Pregnant and Lactating Women and their Children
Infancy

3. Pregnancy
(Pg. 500)“Energy and nutrient needs both increase, but needs for calories increases by a smaller percentage than for most vitamins and minerals. As a result, food choices during pregnancy must be nutrient-dense.”

4. Pregnancy Nutrition before conception
Goals of preconception care is to provide:
Screening for risk
Health promotion and education
Intervention as needed
Weight
Maintain a healthy weight
Low or high weight increases risk for poor outcome
If low 
If too high 
Not a good time to “diet”

5. Nutrition Before Conception
Vitamins (Problem Set 12, Q 1a and 1b)
micrograms of synthetic folic acid/day
Why?
Avoid high doses of vitamin A (retinol)
Substance use
Eliminate alcohol, tobacco, drugs, prior to pregnancy

6. Physiology of Pregnancy
Trimesters: 3 time periods of pregnancy, each lasting ~13-14 weeks
Stages of human fetal growth
Blastogenic stage: Weeks 0-2
Cells differentiate into fetus and placenta
Embryonic stage: Weeks 2-8
Development of organ systems
Critical period of development
Fetal stage: Weeks 9 to delivery
Growth

7. Physiology of Pregnancy
Maternal changes:
Growth of maternal tissues  weight gain and lactation.
Increase in maternal blood volume
Slower GI motility  increases nutrient absorption.

8. Maternal Weight Gain Recommendations depend on BMI
Table 12.3: Guidelines for weight gain during pregnancy.
Underweight  Gain pounds
Normal weight  Gain pounds
Obese  pounds
Higher recommended gain for underweight women, teens, and multiple fetuses
Lower recommended gain for overweight and obese women

9. Maternal Weight Gain
Weight gain occurs mostly during 2nd and 3rd trimester.
40% of weight gain  fetus, placenta, amniotic fluid
60% of weight gain  maternal tissues (adipose stores, breast/uterine growth, expanded blood and ECF)

10. Energy and Nutrition During Pregnancy
REE increases to support increased workload on mother’s heart and lungs, and energy requirements of fetus/placenta.
Weight gain
Nutrients to support pregnancy
Well-balanced diet
Often, pregnant women have difficulty consuming enough folic acid and iron

11. Energy and Nutrition During Pregnancy
Macronutrients
Moderate-protein, low-fat, and high carbohydrate
Protein
Synthesis of new maternal, placental, and fetal tissues
Additional 25 gram/day over non-pregnancy needs
Fat
Fuel for mother and development of placenta
Stored fat supports breastfeeding
Carbohydrates
Main source of extra calories
Complex carbohydrates
Fiber-rich

12. Energy and Nutrition During Pregnancy
Micronutrients
Increased need for overall calories
Increased needs for most vitamins and minerals
Support growth and development
Q: How are B vitamins used during pregnancy?

13. Food Choices for Pregnant Women
Follow the USDA’s Daily Food Plan for Moms
Variety
Additional servings of grain, vegetable, fruit, and low-fat milk
Supplement with prenatal formula
Herbal supplements?
Multi-vitamin supplements?

14. Food Choices for Pregnant Women
Foods to avoid
Alcohol
Large fish
Why?
Less than 300 milligrams of caffeine per day

15. Substance Use and Pregnancy Outcome
Tobacco
Risk for miscarriage, stillbirth, preterm delivery, and low birth weight
Alcohol
Risk for fetal alcohol syndrome
Drugs
Risks for miscarriage, preterm delivery, low birth weight, birth defects, and infant addiction

16. Strategies to Avoid GI Distress:
Slowed GI movement nausea, heartburn and constipation
Smaller/frequent meals, drinking liquids between meals, fiber and fluids are recommended

17. Special Situations During Pregnancy
Food cravings and aversions
Food cravings/aversions are rarely based on a nutrient deficiency or a physiological condition.
Pica
Hypertension
Preeclampsia:
Can progress to eclampsia (seizures)

18. Special Situations During Pregnancy
Diabetes
Adjust diet and insulin as needed
Gestational diabetes:
Hormones of pregnancy tend to counteract insulin
Often controlled through diet
May require insulin

19. Special Situations During Pregnancy
HIV/AIDS
Medical treatment to reduce risk of transmission
>90% of childhood HIV infections are from mother-to-child transmission
Many times, women with HIV or AIDS are likely to have multiple nutrition problems:

20. Special Situations During Pregnancy
Adolescence
Extra demands for growth and development
Risk for preeclampsia, anemia, premature birth, low-birth-weight babies, infant mortality, and sexual transmitted disease
Pre-pregnancy eating patterns a concern
Weight gain toward upper limit recommended
Need for supplements

21. Lactation Breastfeeding trends Healthy People 2020 goals
To increase the proportion of newborns who are initially breastfed to almost 82%
Current stats:
74% of infants breastfed initially
44% of infants still breastfed at 6 months

22. Physiology of Lactation
Changes during adolescence and pregnancy
Increased breast tissue
Maturation of structure  ducts/glands and secretory cells are formed
After delivery
Milk production and secretion
Colostrum

23. Physiology of Lactation
Hormonal controls stimulated by infant suckling:
Prolactin
Oxytocin
“Let-down” reflex

24. Summary of Lactation Physiology
Infant suckling  pituitary gland release prolactin  milk tissue production
Infant suckling  pituitary gland release oxytocin  release milk
Thus, giving water or infant formula to the baby reduces the time spent nursing at the breast  milk production declines

25. Nutrition for Breastfeeding
Energy and protein
Higher needs than during pregnancy
Well-nourished pregnant women will lose weight slowly 1 ¾ lbs/month after ~6 months.
Vitamins and minerals
Most are higher or same as during pregnancy
Iron and folate needs are lower
Water
AI for total water = 3.8 liters/day

26. Nutrition for Breastfeeding
Food choices
USDA’s Daily Food Plan for Moms
~2,200–2,800 Kcal/day
Choose foods high in vitamins and minerals and low in added sugar and solid fats
Supplementation is generally not necessary, unless…
B12 for vegans
Vitamin D for women with irregular sun exposure
Practices to avoid during lactation
Smoking, Alcohol, Drugs

27. Benefits of Breastfeeding (PS12, Q3a)
Benefits for infants
Optimal nutrition
Builds stronger immune system: protects infant from infections and illness including diarrhea, ear infections, pneumonia, and asthma
Convenience

28. Benefits of Breastfeeding (PS12, Q3b)
Benefits for mother
Enhanced recovery of uterus size
Help women return to pre-pregnancy weight faster
Convenience
Contraindications to breastfeeding
Infant or maternal disease (HIV)
Damaged breast ducts
Drug use

29. Resources for Pregnant and Lactating Women and their Children
Promote health of pregnant and breastfeeding women and their children
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Service of USDA
Provides food assistance
Provides nutrition education
Provides referrals

30. Infancy Infancy: 0 -1 years old
Growth is the best marker of nutritional status
Evaluated using growth charts
Weight gain
Length gain (not height B/C infants can’t stand)
Head circumference measures brain growth and development

31. Energy and Nutrient Needs During Infancy
Requirements based on composition of breast milk
Energy and Protein
Highest needs of any life stage
2x adult’s needs
Carbohydrate and fat
Both are major energy source
Carbohydrates as simple sugars
Water?

32. Energy and Nutrient Needs During Infancy
Key vitamins and minerals
Vitamin D
Vitamin K
Vitamin B12
Folate metabolism and cell division
Iron: if formula fed, need iron-fortified formula
Fluoride: at 6 months

33. Energy and Nutrition needs during Infancy
Newborn Breastfeeding
Recommended as the ideal method of feeding infants to achieve optimal growth and development.
AAP recommends that NO supplements of formula or water be given to breastfed neonates unless medically indicated

34. Energy and Nutrient Needs during Infancy
Alternative feeding: Infant Formula
Standard infant formula
Cow’s milk base
“imperfect copy” of breastmilk
Soy-based formula
Soy protein base
Switched to soy-based if formula-fed infants are having feeding problems

35. Energy and Nutrient Needs during Infancy
Special formula for formula-fed infants who are:
Allergic to milk/soy
Premature babies
Have rare defects in metabolic pathway
Use medium-chain triglycerides as the fat source

36. Energy and Nutrient Needs during Infancy
How much is enough?
Guidelines for feeding infant
6 or more wet diapers per day
3 or more stools per day
Regain to birth weight within the first week
Best indicators that baby has enough to eat?

37. Introduction to Solid Foods
Readiness for complimentary foods at ~6 months in addition to breast milk/infant formula
Infants show:
Physiological readiness:
Digestive enzymes
Ability to maintain hydration
Depletion of iron stores
Developmental readiness:
Lack of extrusion reflex
Head and body control

38. The Start Healthy Feeding Guidelines
Feeding schedule for the first two years

39. Feeding Problems during Infancy
Colic
Crying and distress, perhaps from abdominal cramping
No clear effective treatment
Early childhood dental caries
Iron-deficiency anemia
For older infants who do not eat enough iron-rich foods.

40. Feeding Problems during Infancy
Gastroesophageal reflux
~3% of newborns, usually male
Usually disappears within 12–18 months
Diarrhea
Failure to thrive (FTT)
Poor growth in absence of disease
Can be due to shortage or improper preparation of appropriate foods