© 2007 Thomson - Wadsworth Chapter 10 Nutrition Through the Life Span: Pregnancy and Infancy

© 2007 Thomson - Wadsworth Nutrition Prior to Pregnancy Achieve & maintain a healthy body weight Choose an adequate & balanced diet Be physically active Avoid harmful substances

© 2007 Thomson - Wadsworth Prepregnancy Weight Underweight or overweight before pregnancy presents medical risks

© 2007 Thomson - Wadsworth Underweight High risk of having a low- birthweight baby Low-birthweight More risk for disease 40 times more likely to die in first month Long-term effects Risk for obesity & hypertension later in life Lower adult IQ Short stature Educational disadvantages

© 2007 Thomson - Wadsworth Causes of Low-Birthweight Mother’s Poor nutrition Heredity Disease conditions Smoking Drug & alcohol use

© 2007 Thomson - Wadsworth Overweight & Obesity Babies Are larger Twice as likely to have neural tube deficits Greater risk of heart defects Mom More likely to need labor induced May need C-section More post-partum hypertension, infections, & gestational diabetes

© 2007 Thomson - Wadsworth Healthy Support Tissues Prepregnancy nutrition needed to support growth of a healthy placenta Placenta Supply depot Waste-removal system Umbilical cord Pipeline from placenta to fetus Amniotic sac Surrounds baby Cushions it with fluids

© 2007 Thomson - Wadsworth The Events of Pregnancy Newly fertilized ovum called a zygote Implants in uterine wall in 2 weeks Placenta begins to grow Crucial time period Adverse influences can lead to Failure to implant Neural tube deficits Smoking Drug abuse Malnutrition

© 2007 Thomson - Wadsworth The Embryo & Fetus Embryo develops into a fetus At 8 weeks fetus has Complete CNS Beating heart Fully formed digestive tract Well-defined fingers & toes Beginning facial features Last 7 months Grows 50 times heavier & 20 times longer Pregnancy weeks duration Infant Weight 6 ½ - 9 pounds

© 2007 Thomson - Wadsworth

Critical Periods Development of each organ takes place at a certain time (critical period) Effects of malnutrition at a critical period are irreversible

© 2007 Thomson - Wadsworth Effects of Malnutrition Nervous system defects of the embryo Child’s poor dental health Adolescent’s & adult’s vulnerability to infection Higher risk of diabetes, hypertension, stroke, or heart disease

© 2007 Thomson - Wadsworth

Nutrient Needs During Pregnancy Some increase Must make careful choices Woman’s body Maximizes absorption Minimizes losses

© 2007 Thomson - Wadsworth Nutrient Needs Energy (kcalories) Additional 340 in 2 nd trimester Additional 450 in 3 rd trimester Select nutrient-dense foods Carbohydrates Additional 175 g Fiber for constipation Protein Additional 25 g Protein supplements are discouraged Fats Little room for oil, margarine, & butter Need essential fatty acids

© 2007 Thomson - Wadsworth Special Interest Folate Role in cell reproduction Increased from mcg/day Prevents neural tube deficits Spina bifida Anencephaly Supplements, fortified foods or both Vitamin B 12 Needed to assist folate in manufacture of new cells Found in animal products Vegans need fortified foods or supplements

© 2007 Thomson - Wadsworth

Nutrients for Bones Vitamin D, calcium, phosphorus, magnesium Intestinal absorption of calcium doubles early in pregnancy Final weeks, more than 300 mg transferred to fetus Increase milk products May need supplements Calcium-fortified soy milk & orange juice

© 2007 Thomson - Wadsworth Fluoride Mineralization of teeth begins in 5 th month Fluoride supplements Recommended if do not have fluoridated water Not recommended if have fluoridated water

© 2007 Thomson - Wadsworth Iron Absorption of iron increases threefold Fetus draws heavily on mother’s stores Daily supplement 30 mg iron 2 nd & 3 rd trimester Iron-rich food Liver, oysters Meat, fish Dried fruits Legumes Dark green vegetables Vitamin C-rich foods enhance absorption

© 2007 Thomson - Wadsworth Zinc Needed for DNA, RNA & protein synthesis Deficiency predicts low birthweight Found in foods of high protein content Iron interferes with zinc absorption May need zinc supplements

© 2007 Thomson - Wadsworth Nutrient Supplements Prenatal supplements provide more Folate Iron Calcium Reduce risks of Preterm delivery Low birthweight Birth defects Needed for Those with poor diet High-risk pregnancies Multiple fetuses Cigarette smokers Alcohol & drug abusers

© 2007 Thomson - Wadsworth Food Assistance Programs Women, Infants, Children (WIC) Vouchers for nutritious food Food education Iron-fortified formula Federal Food Stamps Nutrition education American Dietetic Association American Diabetes Association Local hospitals

© 2007 Thomson - Wadsworth Weight Gain Essential for healthy pregnancy Normal-weight woman 3 ½ pounds first trimester 1 pound/week thereafter

© 2007 Thomson - Wadsworth Physical Activity Very important Improves her fitness Facilitates labor Helps to prevent or manage gestational diabetes Reduces psychological stress Low-impact activities Avoid Activities with potential for falls or being hit by others Saunas Steam rooms Whirlpools

© 2007 Thomson - Wadsworth Common Nutrition-Related Concerns Food sensitivities Nausea Heartburn Constipation

© 2007 Thomson - Wadsworth Food Cravings & Aversions Cravings Do not seem to reflect physiological needs Cravings & aversions Probably due to Hormone-induced changes in taste Sensitivities to smells

© 2007 Thomson - Wadsworth Nonfood Cravings Pica Craving items such as laundry starch, clay, soil, or ice. Common among African American women Often associated with iron deficiency

© 2007 Thomson - Wadsworth Other Concerns Morning Sickness Comes from hormonal changes in early pregnancy Mild queasiness to debilitating nausea Smells often trigger it Heartburn Fetus puts pressure on woman’s stomach Acid may back up Constipation High-fiber diet Physical activity Plentiful fluids

© 2007 Thomson - Wadsworth Problems in Pregnancy Gestational Diabetes Usually resolves after the birth Often leads to surgical birth & high infant birthweight Hypertension Pre-existing Risk of low-birthweight infant Separation of placenta Transient Usually resolves after the birth

© 2007 Thomson - Wadsworth Preeclampsia Symptoms Hypertension Protein in the urine Whole body edema Usually first pregnancy After 20 weeks May experience convulsions Eclampsia Need prompt medical attention

© 2007 Thomson - Wadsworth Avoid Cigarette Smoking Nicotine & cyanide are toxic to a fetus Second-hand smoke is also problematic Blood flow is restricted Slows fetal growth Low birthweight Behavioral or intellectual problems later in life Implicated in SIDS (sudden infant death syndrome) More complicated births

© 2007 Thomson - Wadsworth Avoid Medicinal drugs No over-the-counter No medicines not prescribed No aspirin or ibuprofen in last 3 months Herbal supplements Almost none have been tested for safety during pregnancy Drugs of abuse Cross the placenta Impair growth & development Environmental contaminants Lead & mercury Avoid certain types of fish

© 2007 Thomson - Wadsworth Avoid Foodborne illness Listeriosis Can cause miscarriage, stillbirth Severe brain injury, other infections to fetus & newborn Vitamin-mineral megadoses Many are toxic in excess Need care with vitamin A Dieting Hazardous during pregnancy Sugar substitutes Use in moderation Caffeine Limit to one cup coffee or two 12-oz colas

© 2007 Thomson - Wadsworth Alcohol Fetal alcohol syndrome (FAS) Irreversible brain damage Mental retardation Facial abnormalities Vision abnormalities No amount is safe

© 2007 Thomson - Wadsworth Adolescent Pregnancy Intense nutrient needs Often deficient before pregnancy Encouraged to gain about 35 pounds Risks for Low-birthweight Miscarriage Stillbirth Death of infant in first year

© 2007 Thomson - Wadsworth Breastfeeding Recommendation Exclusive breastfeeding for 6 months Then breastfeeding with complementary foods through 12 months

© 2007 Thomson - Wadsworth Nutrition During Lactation Eat nutrient- dense foods Enjoy ample food & fluids at frequent intervals

© 2007 Thomson - Wadsworth Nutrition Needs Energy An extra 330 kcalories/day Weight loss 1 pound/week Water Need about 13 cups/day Vitamins & minerals Milk quality is maintained at expense of maternal stores Undernourished may need supplements Particular foods Some might bother baby

© 2007 Thomson - Wadsworth Contraindications to Breastfeeding Alcohol Caffeine Cigarette smoke Medications Illicit drugs Some maternal illnesses May reduce milk production May enter breast milk & impair infant development

© 2007 Thomson - Wadsworth Nutrition of the Infant Affects later development Sets the stage for eating habits Provide a nurturing, relaxing environment

© 2007 Thomson - Wadsworth Nutrients to Support Growth Weight doubles by 4-5 months Triples by 1 year BMR is very high Need 100 kcalories/kg Adequate vitamin A, D, & calcium Adequate water Dose of vitamin K at birth

© 2007 Thomson - Wadsworth Breast Milk Energy nutrients Carbohydrates Lactose Enhances calcium absorption Lipids Generous amount of essential fatty acids Protein Alpha-lactalbumin Easily digestible Vitamins & Minerals Vitamin D supplement needed If breastfed If not on vitamin D- fortified formula Lower in sodium Highly absorbable iron & zinc

© 2007 Thomson - Wadsworth

Supplements for Infants After 6 months may need Vitamin D Iron Fluoride

© 2007 Thomson - Wadsworth Benefits of Breast Milk Immunological protection Colostrum (premilk substance) Maternal immune factors Enzymes that offer protection Infant has less Stomach & intestinal disorders Middle ear infections Respiratory illness

© 2007 Thomson - Wadsworth Other Potential Benefits May protect Against adult obesity Cardiovascular disease May have a positive effect On later intelligence

© 2007 Thomson - Wadsworth Infant Formula Can offer the same Closeness Warmth Stimulation

© 2007 Thomson - Wadsworth Formula Composition Similar to breast milk Offers no immunity Standards have been set All need to be iron fortified Are special formulas for allergies & lactose intolerance Risks of over-dilution & contamination

© 2007 Thomson - Wadsworth Nursing Bottle Tooth Decay Do not put infant to bed with a bottle Can cause Dental caries Bucktoothed profile

© 2007 Thomson - Wadsworth Transition to Cow’s Milk Not appropriate in first year 1-2 years need whole milk 2-5 years can transition to lower fat Cow’s milk Is a poor source of iron Higher in calcium but lower in vitamin C (inhibits iron absorption) Higher protein can stress infant’s kidneys

© 2007 Thomson - Wadsworth Introducing First Foods First foods can be introduced between 4-6 months Can sit with support & control head movements

© 2007 Thomson - Wadsworth Foods to Provide Iron & Vitamin C Breast milk & iron- fortified formula Iron-fortified cereals Meat & meat alternatives Fruits & vegetables for vitamin C

© 2007 Thomson - Wadsworth Physical Readiness 4-6 months can swallow solids 8-12 months Can handle finger foods Begins to teethe Hard crackers can be introduced

© 2007 Thomson - Wadsworth Infant Feeding Allergy-causing foods Introduce foods one at a time Rice cereal first Wheat last Choice of foods Baby foods Blenderized table food Foods to omit Sweets of any kind No canned vegetables High in sodium Honey Risk of botulism Foods that cause risk for choking Foods at 1 year Same foods as rest of family

© 2007 Thomson - Wadsworth Looking Ahead Introduce a variety of nutritious foods Don’t force to finish food & drink Avoid food as A reward Comfort for unhappiness Deprivation for punishment

© 2007 Thomson - Wadsworth Feeding Guidelines for Mealtime Discourage unacceptable behavior Let the child explore & enjoy food Don’t force food on children Strictly limit sweets