Chapter 15 pregnancy and lactation

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Nutrition Prior to Pregnancy

• Risks with both overweight and underweight

• 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

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Growth and Development

During Pregnancy

• Develops in uterus

• Expelled during childbirth

• Interweaving of fetal and maternal blood vessels

• Metabolically active organ

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The Placenta and Associated

Structures

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Fetal Growth and Development

• Organs grow to maturity

• Full term is 39 to 40 weeks

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Stages of Embryonic and Fetal

Development

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consequences for fetus’ life and health

• Between 17-30 days of gestation

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The Concept of Critical Periods

in Fetal Development

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Graph of Critical Development Periods

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Growth and Development

During Pregnancy, Part 2

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development → hypertension

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Maternal Weight

• Most reliable indicator of infant health

• Influences fetal growth

• Underweight

• Overweight and obese

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Weight Gain During Pregnancy

• Fetal growth and maternal health

• Depend on sufficient maternal weight gain

• Correlates closely with infant birth

weight

• Predictor of health and development

• Recommended weight gains

• Number of fetuses

• Beginning weight

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Recommended Weight Gains

Prepregnancy Weight

Recommended Weight Gain for single birth

Recommended Weight Gain for twin birth

(7.0 to 11.5 kg)

31 to 50 lb (14.0 to 23.0 kg) Obese (BMI ≥=30) 11 to 20 lb

(5.0 to 9.0 kg)

25 to 42 lb (11.0 to 19.0 kg)

SOURCE: Institute of Medicine, Weight Gain during Pregnancy: Reexamining the Guidelines (Washington, D.C.: National

Academies Press, 2009).

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Weight Gain Patterns

• Placenta, uterus, blood, breasts, fluid volume, and baby

• Maternal fat stores provide energy for labor and lactation

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Components of Weight Gain

During Pregnancy

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Stepped Art

Weight gain (lb.)

1st trimester 2nd trimester 3rd trimester

2

Increase in breast size Increase mother's fluid volume

4

Placenta 1 1/2

Increase in blood supply

to the placenta

4

Amniotic fluid 2 Infant at birth 7 1/2

Increase in size

of uterus and supporting muscles

2

Mother's necessary fat stores

7 30

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Weight Loss after Pregnancy

• Depends on whether mother stayed within gain recommendations

pounds with each pregnancy

• Diabetes and hypertension

• Chronic diseases later in life

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Exercise During Pregnancy

• Adjust duration and intensity

• Swimming and water aerobics allow body to

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Exercise Guidelines during

Pregnancy

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Nutrition During Pregnancy

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Nutrient Needs During

Pregnancy

• Than at other times in life

• Make careful selections

• Body maximizes absorption

• Body minimizes losses

• Basal metabolic rate increases

• 15 to 20 percent more energy

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Comparison of Nutrient

Recommendations

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Energy and Nutrient Needs

• Omega-3 and omega-6 fatty acids for brain material

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Blood Production and

Cell Growth

• Folate

• Vitamin B12

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Nutrients for Bone

Development

• Deficiency interferes with calcium metabolism

• Absorption and retention increase

• Intake usually falls below recommendations

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Vegetarian Diets During Pregnancy and Lactation

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Common Nutrition-Related Concerns of Pregnancy

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High-Risk Pregnancies

• Low birth weight (LBW)

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High-Risk Pregnancy Factors

Maternal weight - Prior to pregnancy Prepregnancy BMI either <18.5 or ≥25

Maternal weight - During pregnancy Insufficient or excessive pregnancy weight gain (see Table 15-1, p 481)

Maternal nutrition Nutrient deficiencies or toxicities: eating disorders

Socioeconomic status Poverty, lack of family support, low level of education, limited food available

Lifestyle habits Smoking, alcohol or other drug use

Age Teens, especially 15 years or younger, women 35 years or older

Number of previous pregnancies

Many previous pregnancies (3 or more to mothers younger than age 20; 4 or more

to mothers age 20 or older) Interval of previous pregnancies Short or long intervals between pregnancies (< 18 months or >59 months)

Outcomes of previous pregnancies Previous history of problems

Multiple births from previous

pregnancies

Twins or triplets

Birth weight of previous pregnancies Low- or high-birth weight infants

Maternal health - High blood

pressure

Development of gestational hypertension

Maternal health – Diabetes Development of gestational diabetes

Maternal health - Chronic diseases Diabetes; heart, respiratory, and kidney disease; certain genetic disorders; special

diets and medications

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Malnutrition and Pregnancy

• Inability to produce viable sperm

• Loss of sexual interest

• Prevents placenta from developing fully

• Consequences

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Food Assistance Programs

• Nutrition education and nutritious foods

• Vulnerable populations who qualify for help

• Cost-benefit

• Remedial and preventive services

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Age of the Mother

• 20 to 25

• Risk of pregnancy complications

• Higher rates of stillbirths, preterm births, and low birth weight infants

• Weight gain recommendations

• Need to seek prenatal care

• Need for economic, social, and physical support

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Pregnancies in Older Women

• One in 50 pregnancies results in genetic

abnormalities

• Risk of infant with Down syndrome

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Practices Incompatible with

Pregnancy

• Irreversible mental and physical retardation

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Other Dangerous Practices

• Harmful effects magnified during pregnancy

• Increased risk of listeriosis

• Risks associated with illness

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Risky Behaviors

• Excessive vitamin A causes fetal malformations

• High intakes: risk of miscarriage and fetal death

• Low intakes appear safe

• Low carbohydrate diets can deprive fetal brain of needed glucose

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Lactation

duct system and milk-producing cells

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Benefits of Breastfeeding

For Infants

• Provides the appropriate composition and balance of nutrients with high bioavailability

• Provides hormones that promote physiological development

• Improves cognitive development

• Protects against a variety of infections and illnesses, including diarrhea, ear infections, and pneumonia

• May protect against some chronic diseases—such as diabetes (both types), obesity, atherosclerosis, asthma, and

hypertension—later in life

• Protects against food allergies

• Reduces the risk of SIDs

• Supports healthy weight

For Mothers

• Contracts the uterus

• Delays the return of regular ovulation, thus lengthening birth intervals (this is not, however, a dependable method of

contraception)

• Conserves iron stores (by prolonging amenorrhea)

• May protect against breast and ovarian cancer and reduce the risk of diabetes (type 2)

• Increases energy expenditure, which may contribute to weight loss

Other

• Cost and time savings from not needing medical treatment for childhood illnesses or leaving work to care for sick infants

• Cost and time savings from not needing to purchase and prepare formula (even after adjusting for added foods in the diet of a lactating mother) a

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Breastfeeding: A Learned

Behavior

process

• Some decide not to breastfeed

• Partner

• Adequate nutrition and rest

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Maternal Energy and Nutrient

Needs During Lactation

• Almost 500 extra kcalories per day

• Exercise is compatible with breastfeeding

• Recommendations increase for carbohydrates and fibers

quality of breast milk

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Food Assistance Programs,

Part 2

• May alter breast milk flavor

• Allergies

• Where safe infant formula is available

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Practices Incompatible With

Lactation

• Easily enters breast milk

• Infants eat less when mother consumes alcohol

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Fetal Alcohol Syndrome

Highlight 15

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• Deprives fetus of nutrients and oxygen

• Fetal alcohol syndrome (FAS)

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may become pregnant

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Typical Facial Characteristics

of FAS

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Drinking During Pregnancy

• Intoxication

• Malnutrition

during critical periods

increases until equal to maternal BAC levels

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How Much Is Too Much?

development and behaviors

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When Is the Damage Done?

• Body and brain growth may be retarded

• Studies show impacts on both fertility and fetal development

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