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Healthy Eating for
Healthy Babies
Chapter 11
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Healthy Eating for Healthy Babies
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An optimal diet before and during pregnancy can improve the chance of a healthy newborn
baby, a healthy mom, and a healthy future for both
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Recent studies suggest that nutritional deficiencies during the first trimester increase the risk of
certain chronic diseases later in the infant’s life
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An optimal diet provides enough, but not too many, calories and nutrients to optimize maternal
and fetal health
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Prepregnancy Nutrition
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Basic principles of healthy eating are appropriate before, during, and after pregnancy
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Many experts recommend that synthetic folic acid be consumed prior to pregnancy to prevent
neural tube defects
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Other preconception care recommendations include controlling obesity
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Prepregnancy Nutrition (cont’d)
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Folic acid supplementation
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It has been well established that daily supplements of folic acid taken prior to pregnancy
decrease the risk of neural tube defects by as much as two thirds
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Recommended: 400 micrograms of synthetic folic acid every day
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Synthetic folic acid in supplements and fortified foods is recommended
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Prepregnancy Nutrition (cont’d)
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Obesity control
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The CDC recommends that overweight women try to get within 15 pounds of their ideal
weight prior to conception
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Prepregnancy BMI is the strongest predictor of excess gestational weight gain and
future obesity
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Once a woman becomes pregnant, weight reduction should never be undertaken
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Question
Is the following statement true or false?
Recent studies suggest that nutritional deficiencies during the second trimester increase the risk
of chronic diseases later in the infant’s life.
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Answer
False.
Rationale: Recent studies suggest that nutritional deficiencies during the first trimester increase
the risk of certain chronic diseases later in the infant’s life (Fowles, 2006).
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Nutrition and Lifestyle During Pregnancy
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Key recommendations
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Increase synthetic folic acid intake to 600 micrograms/ day
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Eat a variety of nutrient-dense food and beverages among the basic food groups
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Limit the intake of saturated fat, trans fats, cholesterol, added sugars, salt, and alcohol
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Meet recommended intakes for nutrients within calorie needs
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Eat a balanced plan, such as an individualized MyPyramid food plan
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Nutrition and Lifestyle During Pregnancy (cont’d)
Key recommendations (cont’d)
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Women of childbearing age who may become pregnant:
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Consume adequate synthetic folic acid daily (from fortified foods or
supplements) in addition to food forms of folate from a varied diet
o
Eat foods high in heme-iron and/or consume iron-rich plant foods or ironfortified foods with an enhancer of iron absorption, such as vitamin-C–rich
foods
o
Alcoholic beverages should not be consumed
Most nutrient requirements increase during pregnancy but can be met with an
adequate and varied diet
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Nutrition and Lifestyle During Pregnancy (cont’d)
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Key recommendations (cont’d)
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Pregnant women:
o
Ensure appropriate weight gain as specified by a health care provider
o
In absence of medical or obstetric complications, incorporate 30 minutes or
more of moderate-intensity physical activity on most, if not all, days of the
week; avoid activities with a high risk of falling or abdominal trauma
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Nutrition and Lifestyle During Pregnancy (cont’d)
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Key recommendations (cont’d)
o
o
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Pregnant women (cont’d):
o
Alcoholic beverages should not be consumed
o
Do not eat or drink unpasteurized milk or any products made from
unpasteurized milk, raw or partially cooked eggs or foods containing
raw eggs, raw or undercooked meat and poultry, raw or undercooked
fish or shellfish, unpasteurized juices, and raw sprouts
o
Eat only certain deli meats and frankfurters that have been reheated to
steaming hot
Nutrition and Lifestyle During Pregnancy (cont’d)
Key recommendations (cont’d)
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Breastfeeding women:
o
Moderate weight reduction is safe and does not compromise weight gain of the
nursing infant
o
Be aware that neither acute nor regular exercise adversely affects the mother’s
ability to successfully breastfeed
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Nutrition and Lifestyle During Pregnancy (cont’d)
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Amount of weight fain
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Based on prepregnancy BMI
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Recommended weight gain
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25 to 35 pounds in women of normal weight
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28 to 40 pounds for underweight women
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15 to 25 pounds for overweight women
o
At least 15 pounds for women who are obese at the time of conception
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Nutrition and Lifestyle During Pregnancy (cont’d)
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Amount of weight gain (cont’d)
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There is concern that the guidelines encourage too much weight gain during pregnancy
and may result in heavy birth weights and an increased risk of overweight in the
offspring
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Guidelines currently being revised
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Nutrition and Lifestyle During Pregnancy (cont’d)
Amount of weight gain (cont’d)
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Overweight women are more likely to gain more than the recommended amount
o
Increases risk to mother for:
o
o
Gestational diabetes, cesarean deliveries, complications during delivery,
and postpartum weight retention
Increases risk to fetus for:
o
Hypoglycemia, large-for-gestational age, a low Apgar score, seizures,
and childhood obesity
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Nutrition and Lifestyle During Pregnancy (cont’d)
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Amount of weight gain (cont’d)
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Underweight women are more likely to gain less than recommended amount
o
Increases risk of a low–birth-weight (LBW) infant
o
LBW infants have a high incidence of postnatal complications and
mortality
o
Increased risk for coronary heart disease, type 2 diabetes, and
hyperlipidemia later in life
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Nutrition and Lifestyle During Pregnancy (cont’d)
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Weight gain pattern
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Women who begin pregnancy at a healthy weight
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2- to 4-pound weight gain in first trimester
o
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Underweight women
o
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Gain 1 pound/week in the second and third trimesters
Overweight women
o
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3- to 4-pound gain/month thereafter
Gain about 0.66 pounds/week
Nutrition and Lifestyle During Pregnancy (cont’d)
Calorie requirements
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Calorie requirements do not increase until the second trimester of pregnancy
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During the second trimester, normal-weight women need approximately 340 extra
calories/day
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Third-trimester normal-weight women need approximately 450 extra calories/day
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Most pregnant women need a total of 2,200 to 2,900 calories/day
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Nutrition and Lifestyle During Pregnancy (cont’d)
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Vitamin and mineral supplements
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Most nutrients are needed in greater amounts during pregnancy
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Exceptions
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Folic Acid
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Iron
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Question
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Mrs. M, a 30-year-old, presents at the labor and delivery suite in active labor. Her prenatal
history reveals that Mrs. M was underweight at conception and has not gained the
recommended amount of weight during her pregnancy. What is her infant at risk for later in
life?
a. Iron deficiency anemia
b. Type 1 diabetes mellitus
c. Hyperlipidemia
d. Hypocholesterolemia
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Answer
c. Hyperlipidemia
Rationale: In contrast, underweight women are more likely to gain less than the recommended
amount of weight, which increases the risk of a low–birth-weight (LBW) infant. LBW infants have a high
incidence of postnatal complications and mortality and are at increased risk for coronary heart disease,
type 2 diabetes, and hyperlipidemia later in life (Hanson, et al., 2004).
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Nutrition and Lifestyle During Pregnancy (cont’d)
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Vitamin and mineral supplements (cont’d)
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Iron
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Dietary reference intake for iron increases by 50% during pregnancy
o
Infants born to women who have iron deficiency anemia are at:
 Increased risk of low birth weight and possibly preterm delivery and
perinatal mortality
o
Recommended that pregnant women take an iron supplement of 27 mg of iron
daily
o
Anemic women may need 60 mg of iron daily
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Nutrition and Lifestyle During Pregnancy (cont’d)
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Vitamin and mineral supplements (cont’d)
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Iron (cont’d)
o
Pica
 A craving for nonfood items such as laundry starch, clay, or ice
 Can be a strongly rooted social tradition
 More prevalent among African Americans and rural residents
 Iron deficiency may be a consequence
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Nutrition and Lifestyle During Pregnancy (cont’d)
Vitamin and mineral supplements (cont’d)
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Other supplements
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A multivitamin and mineral supplement is recommended for pregnant women
who (ADA, 2008):
 Have iron-deficiency anemia
 Consume a poor quality diet
 Do not consume enough foods from animal sources
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Nutrition and Lifestyle During Pregnancy (cont’d)
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A multivitamin and mineral supplement is recommended for pregnant women who (cont’d):
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Smoke or abuse alcohol or drugs
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Are carrying 2 or more fetuses
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Have HIV, especially if access to antiretroviral treatment is limited
Specific supplements may be needed based on individual circumstances
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Alcohol
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Nutrition and Lifestyle During Pregnancy (cont’d)
Alcohol use during pregnancy can cause:
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Physical and neurodevelopmental problems
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Fetal alcohol syndrome
Avoiding foodborne illness
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Foodborne risks are more dangerous for pregnant women than for most other adults
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May lead to miscarriage, stillbirth, premature delivery, or neonatal infection
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Pregnant women are 20 times more likely to get listeriosis
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Nutrition and Lifestyle During Pregnancy (cont’d)
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Avoiding foodborne illness (cont’d)
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To reduce the risk of listeriosis, pregnant women should not consume
o
Unpasteurized milk or products made with unpasteurized milk
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Raw or undercooked meat, poultry, eggs, fish, or shellfish
o
Refrigerated pâtés or meat spreads
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o
Certain soft cheeses such as feta, Brie, bleu, and Camembert
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Leftover foods and ready-to-eat foods, including hot dogs and deli meats, unless
heated until steaming hot
Nutrition and Lifestyle During Pregnancy (cont’d)
Avoiding foodborne illness (cont’d)
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Toxoplasma gondii (parasite)
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Eating raw meat is the cause
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To prevent transmission to fetus:
 Cook meat thoroughly
 Peel or wash fresh fruits and vegetables before eating
 Avoid cross contamination in the kitchen by cleaning surfaces and
utensils exposed to raw food
 Avoid changing cat litter (cats pass an environmentally resistant form of
the organism in their feces)
 Nutrition and Lifestyle During Pregnancy (cont’d)
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Caffeine
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A high caffeine intake is associated with:
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Spontaneous miscarriage
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Low birth weight
Nonnutritive sweeteners
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Has been studied extensively
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All deemed to be safe during pregnancy when consumed at levels within the U.S. Food
and Drug Administration (FDA) acceptable daily intake (ADI) guidelines
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Nutrition and Lifestyle During Pregnancy (cont’d)
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Herbal supplements
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Generally recommended that they not be used during pregnancy and lactation
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Little animal or human testing has been done to determine if herbs can cause birth
defects or potentially harm mothers and infants
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Nutrition and Lifestyle During Pregnancy (cont’d)
Fish
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FDA has issued advisories regarding fish and shellfish consumption during pregnancy
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Nearly all fish contain trace amounts of mercury; it accumulates in humans primarily by
eating fish
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Mercury poisoning in a fetus can result in learning delays in walking or talking to more
severe problems such as cerebral palsy, seizures, and mental retardation
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Nutrition and Lifestyle During Pregnancy (cont’d)
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Fish (cont’d)
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To reduce the risk of methylmercury poisoning, it is recommended that pregnant
women, lactating women, and women who may become pregnant:
o
Not eat shark, swordfish, king mackerel, and tilefish
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Limit total intake of seafood to 12 oz./week
o
Limit albacore (“white”) tuna to 6 oz./week
o
Check with the local health department or Environmental Protection Agency to
determine which fish from local waters are safe to eat
Nutrition and Lifestyle During Pregnancy (cont’d)
Physical activity
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Healthy pregnant women who do not have medical or obstetric complications are urged
to follow the advice for all healthy adults:
o
Get at least 30 minutes of moderate exercise on most days of the week
o
Pay attention to fall risk and avoiding supine positions during the second and
third trimesters
These measures may help prevent and/or manage gestational diabetes and fetal
macrosomia
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Nutrition and Lifestyle During Pregnancy (cont’d)
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Maternal health
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Common complaints associated with pregnancy, such as nausea, heartburn, and
constipation, may be prevented or alleviated by nutritional interventions
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More serious health conditions in the mother, whether preexisting or gestational, can
greatly impact the course of pregnancy and infant health
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Nutrition and Lifestyle During Pregnancy (cont’d)
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Maternal health (cont’d)
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Diabetes mellitus
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Preexisting diabetes increases the risk of congenital malformations
o
Gestational diabetes
 Appears in the latter half (after 24 weeks) of pregnancy
 Increases the risk of macrosomia
 Can make delivery difficult, increasing the risk of infant shoulder
dislocation and need for cesarean birth
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Nutrition and Lifestyle During Pregnancy (cont’d)
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Maternal health (cont’d)
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Diabetes mellitus
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Gestational diabetes (cont’d)
 Mother is at high risk for type 2 diabetes later in life
 Child at increased risk for hypertension and high BMI in childhood
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o
Diabetes mellitus requires nutrition management
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Women with preexisting diabetes should achieve glycemic control prior to
conception
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Nutrition and Lifestyle During Pregnancy (cont’d)
Maternal health (cont’d)
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Gestational hypertension
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Disease develops in 5% to 8% of pregnancies
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Defined as a systolic blood pressure of ≥140 or a diastolic reading of ≥90 with
onset after 20 weeks’ gestation
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Approximately one quarter of the gestational hypertension cases progress to
preeclampsia
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Nutrition and Lifestyle During Pregnancy (cont’d)
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Maternal health (cont’d)
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Gestational hypertension (cont’d)
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Edema of the hands and face, weight gain ≥5 pounds/week, visual disturbances,
severe headaches, dizziness, and pain in the upper right abdominal quadrant
may occur
o
Preeclampsia can progress to eclampsia
o
Risk factors for eclampsia
 History of chronic hypertension or preeclampsia in a prior pregnancy,
primiparity, multiple pregnancy, maternal age of <20 or ≥35 years,
African-American race, and maternal obesity
o
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Nutrition and Lifestyle During Pregnancy (cont’d)
Maternal health (cont’d)
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Maternal PKU
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Very high blood levels of phenylalanine are devastating to the fetus
o
Causes mental retardation and many infants also develop microcephaly, heart
defects, and low birth weight
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Most infants do not inherit PKU
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Prevention includes a rigid low-phenylalanine diet for at least 3 months before
conception and throughout the duration of the pregnancy
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Nutrition and Lifestyle During Pregnancy (cont’d)
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Nutrition care: assessment and counseling
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First prenatal visit should identify clients who present with a high-risk pregnancy
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Monitoring continues throughout pregnancy to identify high-risk criteria
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All women should receive prenatal nutrition advice that includes guidelines for
healthy eating and diet strategies for preventing or treating common problems,
as appropriate
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Question
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When does gestational diabetes usually occur during a pregnancy?
a. After 16 weeks
b. After 20 weeks
c. After 24 weeks
d. After 30 weeks
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Answer
c. After 24 weeks
Rationale: Gestational diabetes, which appears in the latter half (after 24 weeks) of pregnancy,
increases the risk of macrosomia and can make delivery difficult, increasing the risk of infant shoulder
dislocation and cesarean birth.
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Nutrition for Lactation
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World Health Organization recommends:
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Infants be exclusively breastfed for the first 6 months of life
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Introduction of complementary foods thereafter
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Breastfeeding continues for the first 2 years of life (WHO, 2003)
In the U.S., both the American Academy of Pediatrics and the American Dietetic Association
recommend:
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Infants be exclusively breastfed for the first 6 months of life
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Breastfeeding continue with complementary foods until 1 year of age
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Nutrition for Lactation (cont’d)
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Promoting breastfeeding
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Almost all women have the potential to successfully breastfeed
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It is a learned behavior, not a physiologic response
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It can be positively impacted by counseling
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Preparation for breastfeeding should begin prenatally
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Nutrition for Lactation (cont’d)
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Promoting breastfeeding (cont’d)
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Contraindications
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Galactosemia in the infant
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Illegal drug use in the mother
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Active tuberculosis
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HIV/AIDS (in some countries, the risk of infant mortality from not breastfeeding
may outweigh the risk of acquiring HIV through breast milk)
o
Use of certain drugs, such as radioactive isotopes, antimetabolites, cancer
chemotherapy agents, lithium, and ergotamine
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Nutrition for Lactation (cont’d)
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Maternal diet
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Nutritional needs during lactation are based on:
o
Nutritional content of breast milk
o
Energy “cost” of producing milk
Food Guide Pyramid for
Pregnancy and Lactation
Food Group
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Bread, cereal, rice, and pasta
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Vegetable
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Fruit
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Milk
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Meat, poultry, fish, dry beans,
eggs, and nuts
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Nutrition for Lactation (cont’d)
# Daily Servings
7-11
4-5
3–4
3-4
3
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Calories
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Women use approximately 500 calories above their normal total daily calorie needs to
produce breast milk
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Adequacy of calorie intake is determined by changes in a woman’s weight
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Most women need at least 1,800 calories/day to obtain adequate amounts of nutrients
needed during lactation
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Nutrition for Lactation (cont’d)
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Fluid
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Another nutritional consideration during lactation is fluid intake
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It is suggested that breastfeeding mothers drink a glass of fluid every time the baby
nurses and with all meals
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Fluids consumed in excess of thirst quenching do not increase milk volume
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Nutrition for Lactation (cont’d)
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Vitamins and minerals
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For many vitamins and minerals, requirements during lactation are higher than during
pregnancy
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An inadequate maternal diet decreases the quantity of milk produced, not the quality
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Maternal supplements can correct inadequacies
o
Their use may be prudent for the majority of lactating women in developing and
industrialized nations
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Nutrition for Lactation (cont’d)
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Attaining healthy BMI
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Highest incidence of obesity in women is during the childbearing years
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Excess weight gain during pregnancy, insufficient weight loss at 6 months’ postpartum,
and high prepregnancy BMI were predictive of BMI 15 years later
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6 weeks’ postpartum over two thirds of women have not achieved their prepregnancy
weight
Nutrition for Lactation (cont’d)
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Suggestions for managing postpartum weight are to (Krummel, 2006):
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Assess readiness to change
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Assess lactation status, dietary intake, and activity levels
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Assess for stress or depressive symptoms, which complicate weight management