Life Cycle Nutrition:
Pregnancy, Lactation, &
Infancy
Chapter 14
Pregnancy
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
Nutrition may affect fertility
Preparation before pregnancy
 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
Stages of Embryonic and
Fetal Development
The Placenta and Associated
Structures
Growth and Development
During Pregnancy

Critical periods
 Times of intense development
 Many happen in the first several weeks!
 Mother’s nutritional status crucial
beginning at moment of conception
 About 1/2 of pregnancies are unplanned
 Adverse influences on organ and tissue
development
 Alcohol, tobacco, and other substance use
 Imbalances of key nutrients
Critical Periods of
Development
Folate Status

Low: neural tube defects
 Anacephaly
 Brain either missing or fails to develop
 Spina bifida
 Incomplete closure of spinal cord & its
bony encasement


400 micrograms/day of folic acid
recommended, plus food sources
Neural tube develops in first 6 weeks
Neural Tube Development
Spina Bifida
Other Key Nutrients

Pre-formed vitamin A
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–
–
–
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Too much is teratogenic
UL: 3,000 mcg (10,000 IU)/day
Accutane and Retin-A: potent teratogens
Beta-carotene is safe!
Iron
– Good status is important prior to conception
– If low, mother can experience anemia during
pregnancy

Omega-3 fatty acids: DHA/EPA
– Crucial for neurological development
– Sources: seafood, grass-fed beef, omega-3 eggs
– Watch out for mercury
• Limit: albacore tuna
• Avoid: tilefish, shark, swordfish, king mackerel
Maternal Weight

Weight and health prior to conception
 Influences fetal growth and pregnancy
outcomes

Underweight
 Increased rates of preterm births (before 37
weeks), low birth weight, and infant deaths
 Increases child’s risk for heart disease or
diabetes

Overweight & obesity
 Medical complications: HTN, gestational
diabetes, preeclampsia, prolonged labor,
difficulty breastfeeding
 Risks for infant
Recommended Weight Gains
Components of Weight Gain
Maternal Weight

Weight loss after pregnancy: takes time!
 Some lost in childbirth (~10 pounds)
 Weeks after delivery: fluid volume returns to
normal (about another 5 pounds)
 Return to pre-pregnancy weight not typical during this
time
 Many retain a couple of pounds with each pregnancy
(as body fat)
 Retention of seven or more pounds
 Diabetes and hypertension
 Chronic diseases later in life

Breastfeeding helps significantly
Exercise During Pregnancy

Can continue exercise throughout pregnancy
 Adjust duration and intensity
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Benefits:
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Prevention/management of gestational DM
Easier labor
Fewer discomforts during pregnancy
Reduced stress
Maintaining fitness can help with post-pregnancy
weight loss
“Low-impact” activities
Avoid excessively high internal body
temperature
Energy & Nutrient Needs:
Pregnancy and Lactation

Needs tend to be higher than any other time
in life
 Increased BMR
 Depositing and maintenance of new fetal and
maternal tissues
 Energy: 15 to 20% more energy than before
pregnancy
 Even greater increase in micronutrient needs
 Choose nutrient-dense foods

Differences between pregnancy and lactation
requirements
 Many needs even greater in lactation
Macronutrients

Carbohydrate
 Ample carbohydrate is necessary; fuels
fetal brain during pregnancy
 175 g or more/day (no less than 135 g/d)

Protein
 RDA – additional 25 grams per day (or
adjust to 1.1 g/kg)
 Supplements are discouraged

Essential fatty acids
 Omega-3 and omega-6 fatty acids for
brain material
Micronutrients

Blood production, cell and
tissue growth in mother and
fetus
 Needs for synthesis of
DNA and new cells
 Folate
 Vitamin B12
 Vitamin B6
 Iron
 Zinc
 Bone and connective
tissue
 Calcium
 Vitamin D
 Vitamin C



Increased energy utilization
 B vitamins
Some recommendations
remain the same; others
increase
Prenatal vitamin usually
recommended
 Does not take the place
of a nutrient-rich diet!
 Does not meet all needs
Water

Water needs increase
– Blood volume
– Production of other fluids
– Fluids for fetus
6-9 liters of water accumulated during
pregnancy!
 Increase intake from 2.7 liters to 3
liters/day

Needs During Lactation

Energy needs and exercise
 Uses almost 500 extra kcalories per day
 Need 330-400 from food, the rest from fat stores
 Minimum: 1800 kcal/day to meet all needs

Exercise is compatible with breastfeeding
 Energy nutrients
 Recommendations increase above pregnancy
recommendations for carbohydrates and fibers
 Micronutrients: relative to pregnancy, several
increased recommendations for vitamins and
minerals, some decreased
 Water
 1 additional liter of water per day to prevent
dehydration
Bottle Feeding & Formula

Weak/small infants may have difficulty
suckling
– Bottles provide more forceful flow

Drugs and communicable diseases
– Avoiding risk to infant health outweighs benefits of
breast milk

Infant formula
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–
–
–

Not milk or milk substitutes!!!
Most based on cow’s milk, some soy or elemental
Most fortified with iron
Some fortified with EFA--more expensive
Baby bottle tooth decay
– Usually due to allowing baby to take bottle to bed
Nutritional Needs of Infancy

Growth more rapid than any other time of life
 Kcal needs per kg of body weight are high
~100 kcal/kg/day vs. 30 in adults

Macronutrient proportions differ from adult
needs
– Small stomach
– More fat needed to increase energy density
– Type of fat also important to support nervous
system development
• DHA (n-3) and AA (n-6)
• Both contained in breast milk
• Addition of these is not required in formula in US
Macronutrient Distribution:
Infant vs. Adult
Assessing
Infant
Growth