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

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

Delaying Cord Clamping After Birth May Preserve Iron Status

Pregnancy Umbilical cord Placenta Uterus

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

Prenatal Development

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

Changing Nutritional Needs

Changing Nutritional Needs

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

Birth Weight and Gestational Age

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Breastfeeding

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

Breast Milk Benefits

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

Challenges to Breast-Feeding

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

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

Nutrition for the Growing Child

Introducing Solid Foods

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

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

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

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