1. Nutrition Through the Life Cycle: Pregnancy and the First Year of Life16
Nutrition Through the Life Cycle: Pregnancy and the First Year of Life

2. Nutrition Before Conception
Adequate nutrition is essential for tissue formation, neurological development, bone growth, modeling, and remodeling
Helps to achieve peak physical and intellectual potential in adult life

3. Nutrition Before Conception
Problems related to nutrient deficiency develop early
Neural tube defects:
Related to inadequate folate status
Effects the embryo in the first few weeks
Adequate folate (400 µg daily) before conception can reduce the risks

4. Nutrition Before Conception
Avoid teratogens that cause birth defects: alcohol and illegal drugs
Consult physician about consumption of caffeine, medications, herbs, supplements
Quit smoking

5. Nutrition Before Conception
A healthful diet and appropriate levels of physical activity before conception
Promote optimal body weight
BMI 19.8 to 26.0: best chance of uncomplicated pregnancy and delivery
Lower risk of negative outcomes such as prolonged labor, cesarean section, gestational diabetes, and hypertension

6. Nutrition Before Conception
A man’s nutrition before conception is also important
Sperm number and motility (ability to move) are reduced by alcohol consumption and certain prescription and illegal drugs
Adequate nutrition keeps the immune system strong and promotes fertility

7. Nutrition During Pregnancy
A balanced, nourishing diet throughout pregnancy provides the nutrients needed and:
Supports fetal growth and development
Provides the mother with the nutrients she needs
Minimizes the risks of excess energy intake

8. Nutrition During Pregnancy
Full-term pregnancy (gestation) lasts 38 to 42 weeks:
Three trimesters lasting 13 to 14 weeks each
Zygote: a single, fertilized cell
Embryo: weeks 3 to 8 after fertilization
Fetus: week 9 to birth

9. First Trimester
Zygote travels through the fallopian tube and implants in the wall of the uterus
Development of organs, limb buds, facial features, placenta
Vulnerable to teratogens during this time
Spontaneous abortion (miscarriage)
Placenta provides nutrients via the umbilical cord

14. Second Trimester Continued growth and maturation
Growth from ~3 inches to over a foot long by the end of the second trimester
Some babies born prematurely (the end of second trimester) survive with intensive neonatal care

15. Third Trimester Time of intense growth and maturation
Fetus gains ½ to ¾ of its weight
Brain growth is also extensive
Lungs become fully mature
A balanced, adequate diet for the mother continues to be critical

17. Low-Birth-Weight Infants
Likely among undernourished mothers
Low birth weight: baby born weighing <5.5 lb
Increased risk of infections, learning disabilities, impaired physical development, and death in the first year of life
Preterm babies are born before 38 weeks
Infants that are small for gestational age (SGA) are full-term but weigh less than expected for age

19. Weight Gain During Pregnancy
Typically 25−35 lb
Too much weight gain is also risky
Pattern of weight gain is important:
First trimester: 3−5 lb
Second and third trimesters: average 1 lb per week
Weight loss during pregnancy may deprive the fetus of critical nutrients

22. Nutrition During Pregnancy
The requirement for nearly all nutrients increases during pregnancy
Select foods high in nutrient density
MyPyramid Plan for Moms is a useful tool
Pay attention to intakes of:
Macronutrients (energy)
Micronutrients
Fluids

23. Macronutrients Energy Proteins and Carbohydrates
Second and third trimesters: add 350−450 calories/day
Maximize nutrient density
Safe and physician-approved program of regular moderate physical activity
Proteins and Carbohydrates
1.1 gm/kg body weight/day of protein
175 grams/day minimum of carbohydrates

24. Macronutrients Fat Same percentage of calories as in non-pregnancy
Limit saturated fat; avoid trans fats
Fat helps newborn regulate body temperature
Omega-3 polyunsaturated fatty acid docosahexaenoic acid (DHA) is critical for neurologic and eye development

25. Micronutrients
Micronutrients that are most critical during pregnancy include:
Folate
Vitamin B12
Vitamin C
Vitamin A
Vitamin D
Calcium
Iron
Zinc
Sodium
Iodine

27. Folate Required for cell division
Critical for development of the neural tube (future brain and spinal cord)
Deficiency is associated with neural tube defects (spina bifida, anencephaly) and macrocytic anemia (immature blood cells)
RDA = 400 µg/day for sexually active women
RDA = 600 µg/day for pregnant women

29. Vitamin B12 Regenerates the active form of folate
RDA = 2.6 µg/day during pregnancy
Absorption more efficient during pregnancy
Sources: animal foods
Fortified foods or supplementation for women on vegan diets

30. Vitamin C Synthesis of collagen (connective tissues)
Decreased concentration in maternal blood: increased blood volume, vitamin transferred to fetus
Deficiency: preterm births, complications
RDA: 85 mg/day; more if smoking (lowers serum and amniotic fluid levels of vitamin C)

31. Vitamin A Needs increased by 10% in pregnancy
Deficiency linked to an increased risk of low birth weight, growth problems, preterm delivery
Excess preformed vitamin A exerts teratogenic effects

32. Vitamin D AI does not increase during pregnancy
Supplements recommended for pregnant women with darkly pigmented skin and/or limited sun exposure who do not regularly drink milk
Excessive vitamin D can cause developmental disabilities in newborns

33. Calcium RDA = 1,000 mg/day, same as for non-pregnant women
RDA = 1,300 mg/day for pregnant adolescents
Pregnant women absorb calcium more efficiently
Pregnant lactose-intolerant women: calcium-fortified or low-lactose foods

34. Iron Increased demand for red blood cells
Need increases (third trimester): stores iron in the liver for use during the first few months of life
Iron-deficiency anemia: fetus takes maternal iron
Deficiency increases rate of low birth weight, preterm birth, stillbirth, and death
Heme-rich foods (meat, fish, and poultry), iron-rich legumes, iron-fortified foods with vitamin-C rich foods, iron and vitamin C supplements
RDA for iron during pregnancy: 27 mg per day

35. Zinc Need increases 38% during pregnancy
Critical for DNA, RNA, protein synthesis
Deficiency: fetal malformations, premature birth, decreased birth size, extended labor
Absorption of zinc from supplements is inhibited by high intakes of non-heme iron (found in iron supplements)
Sources: red meats, shellfish, fortified cereals

36. Sodium RDA = 1,500 mg/day, same as for non-pregnant women
Excess: fluid retention, bloating, high blood pressure
Increased body fluids are a normal and necessary part of pregnancy
Some sodium needed for fluid balance

37. Iodine Need for iodine increases significantly
220 µg/day can be obtained from iodized salt
Sprinkling salt onto food at the table is unnecessary
Balanced, healthful diet will provide all the iodine needed during pregnancy

38. Supplements During Pregnancy
Prenatal multivitamin-mineral supplements are not strictly necessary
Recommended by most doctors
Meeting all nutrient needs requires careful and complex dietary planning
Good insurance for vegans, adolescents
Supplements: to be taken in addition to, not as a substitute for, a nutrient-rich diet

39. Fluids During Pregnancy
Fluid need increases to 3 liters per day
Increased blood volume of mother
Body temperature regulation
Amniotic fluid: protects and cushions fetus
Combat fluid retention, constipation, and dehydration (morning sickness/vomiting)
Prevent urinary tract infections

40. Nutrition-Related Concerns
Morning sickness
Cravings and aversions
Heartburn
Constipation and hemorrhoids
Gestational diabetes
Preeclampsia

41. Morning Sickness Nausea and vomiting associated with pregnancy
Can occur at any time; often lasts all day
No cure, but symptoms can be reduced
Eat small, frequent meals and snacks
Consume fluids between meals
Well-tolerated: frozen ice pops, gelatin desserts, watermelon, and mild broths

42. Cravings and Aversions
Most crave a certain type of food (sweet, salty) rather than a particular food
Little evidence supports the claim that cravings indicate a deficiency
Pica: craving non-foods (chalk, clay)
Food aversions are common
Strongly woven into family’s belief system

43. Heartburn Pregnancy hormones relax lower esophageal smooth muscle
Enlarged uterus pushes on the stomach
Avoid excessive weight gain
Eat small, frequent meals; chew food slowly
Wait 1 hour after eating before lying down
Sleep with your head elevated

44. Constipation Pregnancy hormones cause smooth muscle to relax
Slow colonic movement of food residue
Eat 25−35 g/day of fiber
Drink plenty of fluids
Keep physically active

45. Gestational Diabetes
Insufficient insulin production or insulin resistance increases blood glucose levels
Requires strict diet, physical activity, and/or medication
Risk of delivering a large baby; risk of type 2 diabetes and overweight later in life

46. Hypertensive Disorders
Gestational hypertension: no symptoms
Preeclampsia: sudden increase in maternal blood pressure
Can be fatal if left untreated
Deficiencies in vitamins C and E, calcium, magnesium increase the risk
Treatment: bed rest, medical oversight
The only cure is childbirth

47. Nutrition-Related Concerns
Adolescent pregnancy
Vegetarianism
Caffeine
Alcohol
Smoking
Illegal drugs
Food safety
Exercise

48. Adolescent Pregnancy Full physical stature: not yet attained
Higher needs for calories and bone-related nutrients (calcium, phosphorus, magnesium)
Inadequate maternal weight gain
Poor prenatal care; higher rates of prenatal alcohol and drug use
Higher rates of preterm births, low-birth-weight babies, and other complications

49. Vegetarianism Vegans need more attention to:
Vitamin D (unless regularly exposed to sunlight throughout the pregnancy)
Vitamins B6 and B12
Calcium, iron, zinc
Supplements containing these nutrients are usually necessary

50. Consumption of Caffeine
Caffeine is a stimulant that crosses the placenta and reaches the fetus
1 or 2 cups of coffee (200 mg of caffeine) per day is not likely to harm the fetus
Higher amounts may slightly increase the risk of miscarriage and impair fetal growth
Can make one feel full
Considerable calories (if sweetened)

51. Consumption of Alcohol
Alcohol is a known teratogen that crosses the placenta
Immature liver cannot metabolize alcohol
Fetal alcohol syndrome (FAS)
Effects: spontaneous abortion, complications during delivery, low birth weight, sudden infant death syndrome
Abstain: no known safe level

52. Smoking
Exposure to toxins: lead, cadmium, cyanide, nicotine, and carbon monoxide
Fetal blood flow is reduced
Increased complications: miscarriage, stillbirth, placental abnormalities, growth retardation, preterm, low birth weight
Infants with higher rates of sudden infant death syndrome, neonatal mortality, respiratory illnesses, and allergies

53. Illegal Drugs Pass through the placenta
Accumulate in fetal tissues and organs
Impaired placental blood flow (reduced transfer of oxygen and nutrients to fetus)
Effects: low birth weight, premature delivery, placental defects, and miscarriage
Children: risk for developmental delays, impaired learning, behavioral problems
No safe level of use for illegal drugs

54. Food Safety
Avoid raw or partially cooked eggs, raw or undercooked meat/fish/poultry, raw sprouts, and unpasteurized juices and milk
Avoid large fish such as shark, swordfish, and king mackerel and limit canned albacore tuna (high mercury content)

55. Exercise Keeps mother physically fit Enhances mood
Helps mother feel more in control of changing body
Reduces risk of gestational diabetes
Lowers blood pressure (preeclampsia)
Lessens lower back pain
Shortens the duration of active labor

57. Breastfeeding Lactation: production of breast milk
Prolactin: responsible for milk synthesis
Oxytocin: “let-down” of milk
Colostrum: first milk produced
Rich in proteins, antibodies, vitamins, minerals
“Friendly” bacteria in the infant’s GI tract
ABC Video Breastfeeding

59. Nutrient Needs Milk production requires 700–800 kcal/day
Lactating women should consume 330−400 kcal/day above pre-pregnancy needs
Gradual weight loss (1–4 lb/month)
Increased needs: protein, carbohydrates, DHA, vitamins, minerals (calcium), fluid
Supplements: not substitute for proper nutrition

60. Advantages of Breastfeeding
High-quality nutrition: protein, DHA
Absorbable iron, calcium, magnesium
Antibodies prevent allergies and infections
Assists mother in weight loss
Suppresses ovulation
Opportunity for bonding
Convenient, cost-efficient

61. Challenges to Breastfeeding
Technique requires patience and practice
Harmful substances are passed into breast milk: drugs, caffeine, alcohol, pesticides, mercury
HIV is transmitted through breast milk
Conflicts with mother’s employment
Social concerns

62. Infant Nutrition Optimal nutrition is important in the first year
The baby’s organs and nervous system continue to develop and mature
Growth charts track growth: main tools for assessing an infant’s nutritional status

63. Infant Growth and Activity Patterns
In the first year, an infant grows about 10 inches in length and triples in weight
Energy needs are very high to support growth and basal metabolic rates
Large body surface area of a baby increases its loss of body heat
Consistency over time is a consideration
Limitations to using growth charts

66. Nutrient Needs for Infants
Characteristics of infants make their nutritional needs unique:
High energy needs per unit body weight to support rapid growth
Their immature digestive tracts and kidneys
Their small size

67. Nutrient Needs for Infants
Infants need 40−50 kcal/lb body weight/day
40−50% of calories from fat
Specific fatty acids: arachidonic acid (AA) and docosahexaenoic acid (DHA) for brain growth, maturation of the retina of the eye, and nervous system
No more than 20% of calories from protein

68. Nutrient Needs for Infants
High need for iron, vitamin D, zinc, fluoride, B12 (vegans)
Routine vitamin K injections
Fluids: at greater risk of dehydration
2 ounces of fluid per pound of body weight
Breast milk/formula: almost always adequate
Avoid sugar water, fruit juices, or sweetened beverages in a bottle (tooth decay)

69. Infant Formula
Formulas cannot duplicate immune factors, enzymes, and other unique components of human milk
Soy-based formulas: effective alternatives for infants who are lactose intolerant
Specialized formulas for specific medical conditions
Cow’s milk introduced after 1 year of age

71. Starting Solid Foods
Declining nutrient stores (iron) and continued growth: complementary (solid) foods are needed around 6 months
Extrusion reflex begins to lessen at 4 or 5 months
Must have muscular control of the head and neck and must be able to sit up (prevent choking)
Sufficient maturity of the digestive and kidney systems

73. What Not to Feed an Infant
Foods that could cause choking
Corn syrup or honey
Goat’s milk
Cow’s milk
Large quantities of fruit juices
Too much salt and sugar
Too much breast milk or formula

74. Nutrition-Related Concerns
Allergies
Colic
Gastroesophageal reflux
Failure to thrive
Anemia
Dehydration
Nursing bottle syndrome
Lead poisoning

75. Allergies Many foods can stimulate an allergic reaction
Breastfeeding reduces the risk of allergy
Delay introducing solid foods until 6 months
Every food should be introduced in isolation to identify allergic reaction
Symptoms of allergic reaction: gastrointestinal distress (diarrhea, vomiting), rashes, hives, runny nose, sneezing, difficulty breathing

76. Colic Relentless crying spells Tend to occur at the same time of day
Precise cause unknown: overstimulation of the nervous system, feeding too rapidly, swallowing of air, intestinal gas pain
Determine offending food in mother’s diet
Change in type of formula
Most cases disappear spontaneously

77. Gastroesophageal Reflux
Regurgitation of stomach contents into the esophagus often results in “spitting up”
Common in preterm infants
Avoid overfeeding, keep infant upright after feeding, watch for choking or gagging

78. Failure to Thrive (FIT)
Inappropriate plateau or decline in growth
Weight is below the third percentile
Stunting (low height-for-age) from acute malnutrition results in wasting, low weight-for-height, and chronic malnutrition
Psychosocial factors: poverty, inadequate knowledge, extreme nutritional beliefs, social isolation, domestic violence, and/or substance abuse

79. Anemia Full-term infants are born with enough iron for 6 months
Iron-deficiency anemia causes pallor, lethargy, and impaired growth
Iron sources: iron-fortified formula and rice cereal, pureed meats (for older infants)
Overconsumption of cow’s milk remains a common cause

80. Dehydration Extremely dangerous to infants
Caused by diarrhea, vomiting, prolonged fever, or inadequate fluid intake
Physician may recommend pediatric electrolyte solution

81. Nursing Bottle Syndrome
Infants should never be left alone with a bottle
High-carbohydrate fluids (breast milk, formula, juice) provide an optimal food source for cavity-causing bacteria
Encourage using a cup by 8 months
Wean from bottle by 18 months

82. Lead Poisoning
Especially toxic to infants since the brain and nervous system are still developing
Can result in decreased mental capacity, behavioral problems, anemia-impaired growth
Allow tap water to run a minute before use to clear pipes of lead-contaminated water
Use only cold tap water for drinking, cooking, and infant formula preparation
Professionally remove lead-based paint