1. Nutrition for Pregnancy, Breast-feeding, and Infancy
Jamie Pope, Steven Nizielski, and Alison McCook
NUTRITION
for a Changing World
FIRST EDITION
Chapter 17
Nutrition for Pregnancy, Breast-feeding, and Infancy
Nourishing Mother and Baby
© 2016 by W. H. Freeman and Company & Scientific American

2. Chapter 17
Objectives
Discuss the recommendations and rationale for appropriate weight gain during pregnancy
Define and describe consequences of birth weight that is small for the gestational age
Compare energy and nutrient needs during pregnancy and lactation
Identify foods and beverages that should be avoided during pregnancy
Identify at least five benefits infants derive from breast-feeding
Describe appropriate growth patterns in the first two years of life
Discuss timing and rationale for the introduction of solid foods into an infant’s diet

3. Delaying Cord Clamping After Birth May Preserve Iron Status

4. Pregnancy
Umbilical cord
Placenta
Uterus

5. Prenatal Development Embryo Fetus Gestation Trimesters
Between 2 to 10 weeks after conception
Fetus
After 10 weeks
Gestation
Trimesters

6. Prenatal Development

7. Changing Nutritional Needs
A pregnant woman’s body changes
Increased blood volume
Increased energy demands and needs

8. Changing Nutritional Needs

9. Changing Nutritional Needs

10. Birth Weight and Gestational Age
Premature
Small for gestational age (SGA)
At risk for stillbirth and dying
Increased risk of hypertension, diabetes, and heart disease as adults
Low birth weight

11. Birth Weight and Gestational Age

12. Infant Birth Weight Main factors that influence birth weight
The duration of the pregnancy
The weight status of the mother before conception
The amount of weight gained during pregnancy
Whether the mother smoked during pregnancy

13. Healthy Pregnancy Healthy prenatal lifestyle includes the following
Being physically active
Eating well
Making responsible choices
Getting regular medical care
Fertility improved with healthy lifestyle
Pregnant woman
Increase calorie and nutrient needs
Increase to 340 kcal/day in the second trimester
Increase to 450 kcal/day in the third trimester
Increase calories more for underweight woman
Increase calories less for overweight woman
Monitor weight gain rather than counting daily calories in pregnancy

14. Resource
Health and nutrition information for pregnant and breast-feeding women
United States Department of Agriculture (USDA)
ChooseMyPlate.gov
Personalized daily food plan

15. Pregnancy Needs 15% more total calories 50% more of some nutrients
Protein, folate, zinc, iodine, and iron
Consuming inadequate nutrients or excess amounts can put the baby at risk for birth defects and other anomalies, especially during critical periods

16. Supplements Follow advice of doctor or midwife
Focus on supplements such as
Iron
Only universally recommended supplement
Prenatal multivitamin/mineral supplements
For inadequate diet or high-risk pregnancies
Vegans should consider additional vitamin D, iron, and vitamin B12

17. Important Nutrients During Pregnancy
Folate
Development of new cells
Women 15 to 45 years of age, even if not pregnant, need 400 mcg/day
During pregnancy women need 600 mcg/day
Folate deficiency leads to
Birth defects, fetal growth problems, autism, neural tube defects
In 1998 U.S. FDA began requiring grain fortification

18. Important Nutrients During Pregnancy
Vitamin A
Need 770 mcg/day during pregnancy
Not exceed the UL of 3,000 mcg/day
Stop taking medications that contain vitamin A
Too little can lead to developmental problems
Too much can lead to birth defects; this is not associated with beta-carotene

19. Important Nutrients During Pregnancy
Iron
Is the most common deficiency
Need 27 mg/day during pregnancy
Most woman consume just over half this amount
Supplements of 30 mg/day recommended during the second and third trimesters
Without enough, mothers risk iron-deficiency anemia and babies with low birth weight

20. Important Nutrients During Pregnancy
Calcium
1,000 mg/day
Vitamin D
600 IU/day
Iodine
220 mcg/day
Omega-3 fatty acids
No official recommendations

21. Issues During Pregnancy
Morning sickness
Nausea and vomiting
Pica
May be a sign of anemia
Gestational diabetes
Elevated blood sugar
Risk of large-for-gestational-age infant
Resolves after pregnancy
Can increase risk of type 2 diabetes later in life

22. Food Safety During Pregnancy
Fish
Mercury in fish may cause central nervous system defects and slow cognitive development
Encourage 8 to 12 ounces of low-mercury fish
Salmon, cod, shrimp, sardines, anchovies, trout
Limit tuna to 6 oz/week
Avoid fish that potentially have high mercury
Shark, swordfish, king mackerel, tilefish
Alcohol
Can cause fetal alcohol syndrome
There is no safe level of alcohol consumption during pregnancy

23. Food Safety During Pregnancy
Caffeine
WHO recommends intake below 300 mg per day
American College of Obstetricians and Gynecologists recommends less than 200 mg/day
Brewed coffee contains 135 mg per 8-oz cup
Caffeine-containing soda has 40 to 50 mg per 12-oz can
Microbial-contaminated foods
Listeria caused by Listeria monocytogenes
Can cause premature birth, miscarriage, fetal death, and newborn illness
Can be due to unpasteurized cheeses, unpasteurized milks and juices, unheated luncheon meats, pâté, and meat spreads

24. Food Safety During Pregnancy
Foods to avoid
Unpasteurized milk and cheeses
Undercooked chicken and poultry (and other meat)
Marlin, shark, tilefish, swordfish, king mackerel
Alcoholic beverages
Foods to be cautious with
Raw, fresh produce
Deli meats, hot dogs
Albacore tuna

25. Postnatal Nutrition
Lactation creates increased energy need because of milk production
The American Academy of Pediatrics recommends
Breast-feeding exclusively through age of 6months
Continue breast-feeding until 1 year or beyond, while introducing solid foods at 6 months

26. Breastfeeding

27. Breast Milk Components
Water, carbohydrates, fats, proteins, vitamins, and minerals
Antibodies to fight infections and enhance immunity
Foremilk
Lactose, protein, and water
Hindmilk
More fat than foremilk

28. Breast Milk Benefits

29. Challenges to Breast-Feeding
Conditions that preclude breast-feeding
HIV/AIDS
Herpes simplex or chicken pox lesions on nipples
Alcohol or drug addiction
Nipples that have been removed and replaced
Cancer treated with cytotoxic drugs

30. Challenges to Breast-Feeding

31. Formula Feeding Designed for infants
Nutritious addition to or replacement for breast milk
Lacks antibodies and other components in breast milk
Is expensive
Should not be diluted
Consult physician to select appropriate formula

32. Nutrition for the Growing Child
Newborn
Vitamin K injection at birth
0 to 6 months of age
Exclusively breast-fed or formula-fed
Vitamin D supplements of 400 IU
6 to 12 months of age
Introduce solid foods
Continue breast-feeding or formula-feeding
1 to 2 years of age
Will only gain about five pounds

33. Nutrition for the Growing Child

34. Introducing Solid Foods

35. Iron Deficiency and Cord Clamping
Delaying cord clamping by 2 to 3 minutes
Significantly decreased iron deficiency at the age of 4 to 6 months
Rarely practiced unless specifically requested by the parent

36. Summary
During the 38 to 42 weeks of pregnancy, the developing fetus is supplied with nutrients and oxygen from the mother through the umbilical cord, which connects the fetus to the placenta, which is attached to the uterus
A woman’s nutrient needs change during pregnancy to support growth of the developing fetus and maternal support tissues
A woman’s energy needs gradually increase as pregnancy advances, with an average increase of 15%. Nutrient needs increase by as much as 50% for some vitamins and minerals
The Institute of Medicine provides guidelines for appropriate weight gain during pregnancy based on BMI at conception, to reduce complications during pregnancy and at delivery, as well as to promote the healthy birth weight of a baby

37. Summary (Cont’d)
Birth weight is influenced by several factors. Infants who are born preterm or are small for gestational age have increased risk of death, complications, and certain medical conditions as adults
Insufficient intake of essential nutrients can increase the risk of birth defects, particularly during critical periods of accelerated fetal development
Folate plays an important role in the prevention of neural tube defects
Iron needs are increased by 50% during pregnancy, which often warrants supplementation to prevent iron-deficiency anemia that affects oxygen supply and iron status of the fetus
To reduce the risk of the developing fetus, pregnant woman are advised to avoid alcohol, limit their intake of certain fish because of potential mercury contamination, and avoid microbial-contaminated foods

38. Summary (Cont’d)
The American Academy of Pediatrics recommends that mothers exclusively breast-feed their babies through 6 months of age and then continue breast-feeding (ideally to 1 year of age or beyond) while also introducing complementary solid foods according to the infant’s developmental readiness
Breast-feeding supplies the growing infant with essential nutrients in appropriate proportions, provides antibodies to strengthen immunity, and has many additional benefits for both the mother and baby
Breast milk may not supply sufficient vitamin D, therefore supplementation for breast-fed infants is recommended. Infants who are exclusively breast-fed after 6 months of age may require iron supplementation
Women who are breast-feeding have increased energy and nutrient needs for milk production, as well as for replenishing nutrient stores
Infants develop rapidly in the first year of life and require a consistent supply of energy and essential nutrients. Growth is an important indicator of adequate nutrition