Life Cycle: Maternal and Infant

Nutrition
BIOL 103, Chapter 12
 Today’s Topic
• Pregnancy
• Lactation
• Resources for Pregnant and Lactating Women
and their Children
• Infancy
 Pregnancy
• (Pg. 500)“Energy and nutrient needs both
increase, but needs for calories increases by a
smaller percentage than for most vitamins
and minerals. As a result, food choices during
pregnancy must be nutrient-dense.”
 Pregnancy
• Nutrition before conception
– Goals of preconception care is to provide:
1. Screening for risk
2. Health promotion and education
3. Intervention as needed
– Weight
• Maintain a healthy weight
• Low or high weight increases risk for poor outcome
– If low 
– If too high 
• Not a good time to “diet”
 Nutrition Before Conception
• Vitamins (Problem Set 12, Q 1a and 1b)
– 400-800 micrograms of synthetic folic acid/day
• Why?

– Avoid high doses of vitamin A (retinol)

• Why?

• Substance use
– Eliminate alcohol, tobacco, drugs, prior to pregnancy
 Physiology of Pregnancy
• Trimesters: 3 time periods of pregnancy, each
lasting ~13-14 weeks
• Stages of human fetal growth
1. Blastogenic stage: Weeks 0-2
• Cells differentiate into fetus and placenta
2. Embryonic stage: Weeks 2-8
• Development of organ systems
• Critical period of development
3. Fetal stage: Weeks 9 to delivery
• Growth
 Physiology of Pregnancy
• Maternal changes:
– Growth of maternal
tissues  weight gain
and lactation.

– Increase in maternal
blood volume
– Slower GI motility 
increases nutrient
absorption.
 Maternal Weight Gain
• Recommendations depend on BMI
– Table 12.3: Guidelines for weight gain during
pregnancy.
• Underweight  Gain 28-40 pounds
• Normal weight  Gain 25-35 pounds
• Obese  11-20 pounds
– Higher recommended gain for underweight
women, teens, and multiple fetuses
– Lower recommended gain for overweight and
obese women
Maternal Weight Gain
• Weight gain occurs mostly during 2nd and 3rd trimester.
• 40% of weight gain  fetus, placenta, amniotic fluid
• 60% of weight gain  maternal tissues (adipose stores, breast/uterine
growth, expanded blood and ECF)
 Energy and Nutrition During
Pregnancy
• Energy
– REE increases to support increased workload on
mother’s heart and lungs, and energy
requirements of fetus/placenta.
– Weight gain
• Nutrients to support pregnancy
– Well-balanced diet
– Often, pregnant women have difficulty consuming
enough folic acid and iron
 Energy and Nutrition During
Pregnancy
• Macronutrients
– Moderate-protein, low-fat, and high carbohydrate
• Protein
– Synthesis of new maternal, placental, and fetal tissues
– Additional 25 gram/day over non-pregnancy needs
• Fat
– Fuel for mother and development of placenta
– Stored fat supports breastfeeding
• Carbohydrates
– Main source of extra calories
– Complex carbohydrates
– Fiber-rich
 Energy and Nutrition During
Pregnancy
• Micronutrients
– Increased need for overall calories
– Increased needs for most vitamins and
minerals
• Support growth and development

– Q: How are B vitamins used during

pregnancy?
Food Choices for Pregnant Women
• Follow the USDA’s Daily Food Plan for Moms
– Variety
– Additional servings of grain, vegetable, fruit, and
low-fat milk
• Supplement with prenatal formula
– Herbal supplements?
– Multi-vitamin supplements?
 Food Choices for Pregnant Women

• Foods to avoid
1. Alcohol
2. Large fish
• Why?

3. Less than 300

milligrams of caffeine
per day
 Substance Use and Pregnancy
Outcome
1. Tobacco
– Risk for miscarriage, stillbirth, preterm
delivery, and low birth weight
2. Alcohol
– Risk for fetal alcohol syndrome

3. Drugs
– Risks for miscarriage, preterm delivery, low
birth weight, birth defects, and infant addiction
Strategies to Avoid GI Distress:
• Slowed GI movement nausea, heartburn and constipation
• Smaller/frequent meals, drinking liquids between meals, fiber and
fluids are recommended
 Special Situations During Pregnancy
• Food cravings and aversions
– Food cravings/aversions are rarely based on a
nutrient deficiency or a physiological condition.
– Pica
• Hypertension
– Preeclampsia:
• Can progress to eclampsia (seizures)
 Special Situations During Pregnancy
• Diabetes
– Adjust diet and insulin as needed
• Gestational diabetes:
– Hormones of pregnancy tend to counteract
insulin
• Often controlled through diet
• May require insulin
 Special Situations During Pregnancy
• HIV/AIDS
– Medical treatment to reduce risk of
transmission
– >90% of childhood HIV infections are from
mother-to-child transmission
– Many times, women with HIV or AIDS are
likely to have multiple nutrition problems:
 Special Situations During Pregnancy
• Adolescence
– Extra demands for growth and development
– Risk for preeclampsia, anemia, premature
birth, low-birth-weight babies, infant mortality,
and sexual transmitted disease
– Pre-pregnancy eating patterns a concern
– Weight gain toward upper limit recommended
– Need for supplements
 Lactation
• Breastfeeding trends
• Healthy People 2020 goals
– To increase the proportion of newborns who
are initially breastfed to almost 82%
– Current stats:
• 74% of infants breastfed initially
• 44% of infants still breastfed at 6 months
 Physiology of Lactation
• Changes during
adolescence and
pregnancy
– Increased breast tissue
– Maturation of structure 
ducts/glands and
secretory cells are formed
• After delivery
– Milk production and
secretion
• Colostrum
 Physiology of Lactation
• Hormonal controls
stimulated by infant
suckling:
– Prolactin
– Oxytocin
• “Let-down” reflex
 Summary of Lactation Physiology
• Infant suckling  pituitary gland release
prolactin  milk tissue production
• Infant suckling  pituitary gland release
oxytocin  release milk
• Thus, giving water or infant formula to the
baby reduces the time spent nursing at the
breast  milk production declines
 Nutrition for Breastfeeding
• Energy and protein
– Higher needs than during pregnancy
– Well-nourished pregnant women will lose
weight slowly 1 ¾ lbs/month after ~6 months.
• Vitamins and minerals
– Most are higher or same as during pregnancy
– Iron and folate needs are lower
• Water
– AI for total water = 3.8 liters/day
 Nutrition for Breastfeeding
• Food choices
– USDA’s Daily Food Plan for Moms
– ~2,200–2,800 Kcal/day
– Choose foods high in vitamins and minerals
and low in added sugar and solid fats
• Supplementation is generally not
necessary, unless…
– B12 for vegans
– Vitamin D for women with irregular sun
exposure
• Practices to avoid during lactation
– Smoking, Alcohol, Drugs
 Benefits of Breastfeeding (PS12, Q3a)
• Benefits for infants
1. Optimal nutrition
2. Builds stronger immune system: protects
infant from infections and illness including
diarrhea, ear infections, pneumonia, and
asthma
3. Convenience
Benefits of Breastfeeding (PS12, Q3b)
• Benefits for mother
1. Enhanced recovery of uterus size
2. Help women return to pre-pregnancy weight
faster
3. Convenience
• Contraindications to breastfeeding
– Infant or maternal disease (HIV)
– Damaged breast ducts
– Drug use
Resources for Pregnant and Lactating
Women and their Children
• Promote health of pregnant and
breastfeeding women and their children
• Special Supplemental Nutrition
Program for Women, Infants, and
Children (WIC)
– Service of USDA
– Provides food assistance
– Provides nutrition education
– Provides referrals
 Infancy
• Infancy: 0 -1 years old
• Growth is the best marker of nutritional status
– Evaluated using growth charts
1.Weight gain

2.Length gain (not height B/C infants can’t stand)

3.Head circumference measures brain growth and

development
Energy and Nutrient Needs During Infancy
• Requirements based on composition of breast
milk
– Energy and Protein
• Highest needs of any life stage
• 2x adult’s needs

– Carbohydrate and fat

• Both are major energy source
• Carbohydrates as simple sugars

– Water?
Energy and Nutrient Needs During Infancy

• Key vitamins and minerals

– Vitamin D
– Vitamin K
– Vitamin B12
• Folate metabolism and cell division
– Iron: if formula fed, need iron-fortified formula
– Fluoride: at 6 months
Energy and Nutrition needs during Infancy

• Newborn Breastfeeding
– Recommended as the ideal method of feeding
infants to achieve optimal growth and
development.

– AAP recommends that NO supplements of

formula or water be given to breastfed
neonates unless medically indicated
Energy and Nutrient Needs during Infancy

• Alternative feeding: Infant Formula

1. Standard infant formula
• Cow’s milk base
• “imperfect copy” of breastmilk
2. Soy-based formula
• Soy protein base
• Switched to soy-based if formula-fed
infants are having feeding problems
Energy and Nutrient Needs during Infancy
– Special formula for
formula-fed infants
who are:
• Allergic to milk/soy
• Premature babies
• Have rare defects in
metabolic
pathway
• Use medium-chain
triglycerides as the
fat source
Energy and Nutrient Needs during Infancy

• How much is enough?

– Guidelines for feeding infant
1. 6 or more wet diapers per day
2. 3 or more stools per day
3. Regain to birth weight within the first
week
– Best indicators that baby has enough to
eat?
 Introduction to Solid Foods
• Readiness for complimentary foods at ~6
months in addition to breast milk/infant formula
• Infants show:
1. Physiological readiness:
• Digestive enzymes
• Ability to maintain hydration
• Depletion of iron stores
2. Developmental readiness:
• Lack of extrusion reflex
• Head and body control
The Start Healthy Feeding Guidelines
• Feeding schedule for the first two years
 Feeding Problems during Infancy
1. Colic
– Crying and distress, perhaps from abdominal
cramping
– No clear effective treatment
2. Early childhood dental caries
3. Iron-deficiency anemia
– For older infants who do not eat enough iron-
rich foods.
 Feeding Problems during Infancy
4. Gastroesophageal reflux
– ~3% of newborns, usually male
– Usually disappears within 12–18 months
5. Diarrhea

6. Failure to thrive (FTT)

– Poor growth in absence of disease
– Can be due to shortage or improper
preparation of appropriate foods