1. Life Cycle Nutrition: Pregnancy, Lactation, & Infancy
Chapter 14

2. Pregnancy Nutrition may affect fertility Preparation before pregnancy
Achieve and maintain healthy body weight
Choose an adequate and balanced diet
Be physically active
Receive regular medical care
Manage chronic conditions
Avoid harmful influences

3. Stages of Embryonic and Fetal Development

4. The Placenta and Associated Structures

5. Growth and Development During Pregnancy
Critical periods
Times of intense development
Many happen in the first several weeks!
Mother’s nutritional status crucial beginning at moment of conception
About 1/2 of pregnancies are unplanned
Adverse influences on organ and tissue development
Alcohol, tobacco, and other substance use
Imbalances of key nutrients

6. Critical Periods of Development

7. Folate Status
Low: neural tube defects
Anacephaly
Brain either missing or fails to develop
Spina bifida
Incomplete closure of spinal cord & its bony encasement
400 micrograms/day of folic acid recommended, plus food sources
Neural tube develops in first 6 weeks

8. Neural Tube Development

9. Spina Bifida

10. Other Key Nutrients Pre-formed vitamin A Iron
Too much is teratogenic
UL: 3,000 mcg (10,000 IU)/day
Accutane and Retin-A: potent teratogens
Beta-carotene is safe!
Iron
Good status is important prior to conception
If low, mother can experience anemia during pregnancy
Omega-3 fatty acids: DHA/EPA
Crucial for neurological development
Sources: seafood, grass-fed beef, omega-3 eggs
Watch out for mercury
Limit: albacore tuna
Avoid: tilefish, shark, swordfish, king mackerel

11. Maternal Weight Underweight Overweight & obesity
Weight and health prior to conception
Influences fetal growth and pregnancy outcomes
Underweight
Increased rates of preterm births (before 37 weeks), low birth weight, and infant deaths
Increases child’s risk for heart disease or diabetes
Overweight & obesity
Medical complications: HTN, gestational diabetes, preeclampsia, prolonged labor, difficulty breastfeeding
Risks for infant

12. Recommended Weight Gains

13. Components of Weight Gain

14. Maternal Weight Weight loss after pregnancy: takes time!
Some lost in childbirth (~10 pounds)
Weeks after delivery: fluid volume returns to normal (about another 5 pounds)
Return to pre-pregnancy weight not typical during this time
Many retain a couple of pounds with each pregnancy (as body fat)
Retention of seven or more pounds
Diabetes and hypertension
Chronic diseases later in life
Breastfeeding helps significantly

15. Exercise During Pregnancy
Can continue exercise throughout pregnancy
Adjust duration and intensity
Benefits:
Prevention/management of gestational DM
Easier labor
Fewer discomforts during pregnancy
Reduced stress
Maintaining fitness can help with post-pregnancy weight loss
“Low-impact” activities
Avoid excessively high internal body temperature

17. Energy & Nutrient Needs: Pregnancy and Lactation
Needs tend to be higher than any other time in life
Increased BMR
Depositing and maintenance of new fetal and maternal tissues
Energy: 15 to 20% more energy than before pregnancy
Even greater increase in micronutrient needs
Choose nutrient-dense foods
Differences between pregnancy and lactation requirements
Many needs even greater in lactation

18. Macronutrients Carbohydrate Protein Essential fatty acids
Ample carbohydrate is necessary; fuels fetal brain during pregnancy
175 g or more/day (no less than 135 g/d)
Protein
RDA – additional 25 grams per day (or adjust to 1.1 g/kg)
Supplements are discouraged
Essential fatty acids
Omega-3 and omega-6 fatty acids for brain material

19. Micronutrients
Blood production, cell and tissue growth in mother and fetus
Needs for synthesis of DNA and new cells
Folate
Vitamin B12
Vitamin B6
Iron
Zinc
Bone and connective tissue
Calcium
Vitamin D
Vitamin C
Increased energy utilization
B vitamins
Some recommendations remain the same; others increase
Prenatal vitamin usually recommended
Does not take the place of a nutrient-rich diet!
Does not meet all needs

20. Water Water needs increase
Blood volume
Production of other fluids
Fluids for fetus
6-9 liters of water accumulated during pregnancy!
Increase intake from 2.7 liters to 3 liters/day

21. Needs During Lactation
Energy needs and exercise
Uses almost 500 extra kcalories per day
Need from food, the rest from fat stores
Minimum: 1800 kcal/day to meet all needs
Exercise is compatible with breastfeeding
Energy nutrients
Recommendations increase above pregnancy recommendations for carbohydrates and fibers
Micronutrients: relative to pregnancy, several increased recommendations for vitamins and minerals, some decreased
Water
1 additional liter of water per day to prevent dehydration

24. Bottle Feeding & Formula
Weak/small infants may have difficulty suckling
Bottles provide more forceful flow
Drugs and communicable diseases
Avoiding risk to infant health outweighs benefits of breast milk
Infant formula
Not milk or milk substitutes!!!
Most based on cow’s milk, some soy or elemental
Most fortified with iron
Some fortified with EFA--more expensive
Baby bottle tooth decay
Usually due to allowing baby to take bottle to bed

25. Nutritional Needs of Infancy
Growth more rapid than any other time of life
Kcal needs per kg of body weight are high
~100 kcal/kg/day vs. 30 in adults
Macronutrient proportions differ from adult needs
Small stomach
More fat needed to increase energy density
Type of fat also important to support nervous system development
DHA (n-3) and AA (n-6)
Both contained in breast milk
Addition of these is not required in formula in US

26. Macronutrient Distribution: Infant vs. Adult

27. Assessing Infant Growth