NUTRITION
THROUGH THE
LIFESPAN
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PRE-PREGNANCY
AND
PREGNANCY
TEXT CH 15
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Pregnancy can be a very special time for a couple. Along with the
responsibility of shaping a child’s health and personality comes
the prospective exhilaration of watching the child develop and
grow.
These parents often feel an overriding desire to produce a healthy
baby, which opens them up to new nutrition and health
information.
The parents-to-be usually want to do everything possible to
maximise their chances of having a robust, lively newborn.
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Producing a healthy baby is not just a matter of luck. True, some
aspects of foetal and newborn health are beyond a parent’s
control.
Still, conscious decisions about health, social and nutritional
factors significantly affect the baby’s health and future. What
the parents do relates directly to the likelihood of having a
healthy newborn. Then choosing to breastfeed the infant adds
further benefit.
Wardlaw: Perspectives In Nutrition. 4th Edition
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Fertility is achieved and maintained by carefully orchestrated,
complex processes that can be disrupted by a number of factors
related to body composition and dietary intake.
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Of particular interest is the gestational time of chemical
exposure, nutritional deficiency or excesses as exposure to these
at the various embryonic and feotal developmental stages
influences the genetic expression and predisposes the infant to
diseases later in life.
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Influencing Factors
Weight outside of the HWR places both genders at risk of altered
fertility
 Overweight & obese men – low sperm count and altered
hormonal function
o
In women – altered menstrual regularity, ovary function
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Altered foetal development – increased risk of diseases in adulthood.
The health status of each parent
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Different diseases places them at risk, more so the mother
CVD and circulation, diabetes, Blood pressure, PCOS
Stress, emotional issues
Bowel function
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Exposure to environmental, and internal metabolic toxins.
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The type of work they do,
Where they live
Stress
Medication, recreational drugs including caffeine, smoking
OTC, stimulants – V drinks etc
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Type of foods eaten
o Adequate total nutritional intake and macronutrient ratio
o Adequate vitamins and minerals
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In particular Iodine, folate, B12, zinc, iron
Water
EFA
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BGL control
Hormonal balance
Study in South Hampton Shows…
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Few women adhere to the nutrition and lifestyle
recommendations for planning a pregnancy.
No significant improvements in compliance in relation to
smoking and diet among women in the time leading up to
pregnancy.
Folic acid was taken in sufficient quantities by only a small
percentage of women, and supplementation in the
periconceptional period is considered important for the
prevention of neural tube defects.
Study cont
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Almost half of those who became pregnant within three months
reported drinking at levels above the recommended limit for
those planning a pregnancy that was in operation at the time of
the study
Only 7.6% of those who became pregnant within three months
were not drinking any alcohol at the time of the interview, and
it is only these women who would comply fully with the current
recommendations for alcohol intake
Greater efforts are needed to improve compliance with the
recommendations BMJ 2009;338:b481
Highlights the need for screening of all females of reproductive
age to help maximise understanding and nutrition
One Food Example
The following points are taken from Wolmuth, H, Pharmacognosy and Medicinal Plant
Pharmacology pp.20-21
Caffeine containing beverages are widely consumed, the
physiological effects of this alkaloid have been the focus of
much research. Some of the more interesting effects of caffeine
are:
 Caffeine in 1 – 2 cups of coffee stimulates the central nervous
system, promotes clear and fast thinking and it reduces mental
tiredness and sleepiness.
 Larger doses: 2 – 3 cups of coffee or more have a negative
impact on contraction, thought processes and muscle
coordination and can cause tachycardia, insomnia, nausea,
anxiety and headache.
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Caffeine stimulates skeletal muscle, increasing muscle
contractility and reducing muscle fatigue. Caffeine is
considered to be a performance enhancing drug in sport.
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Caffeine is metabolised in the liver and has a half-life in
healthy adults of 3 – 4 hours. The half life is doubled in
women who take the OCP and during the later stage of
pregnancy. In the newborn, caffeine has a half-life of 80
hours.
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Consumption of coffee up to one hour after a meal can
reduce the absorption of iron from the meal by up to 39%.
Caffeine increases both total serum cholesterol and LDLcholesterol.
Caffeine stimulates the secretion of gastric acid and pepsin 
coffee drinkers were found an increased risk of developing
peptic ulcer than non-coffee drinkers.
Caffeine increases the basal metabolic rate by 10 – 25% 
the reason for its inclusion in slimming pills.
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Caffeine increases the risk of spontaneous abortion: a study
involving 3000 American women showed that a caffeine intake
of 150mg daily doubled the risk of spontaneous abortion late in
the first trimester and in the second trimester. In women with a
history of spontaneous abortion, caffeine increased the risk
four-fold.
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Caffeine enters the breast milk; irritability and poor sleeping
habits in lactating infants can be caused by maternal caffeine
intake (the very long half-life of caffeine in neonates means that
caffeine is likely to accumulate).
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Pre-conception nutritional status
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Women who avoid known risks and eat well before (during and
after) pregnancy tend to have larger, healthier babies and
experience fewer complications
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Poor nutrition can result in low birth weight babies who have
impaired intelligence and a greater risk of disease both earlier
and later in life
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The quality of the father’s sperm can be influenced by both
nutritional and toxic factors
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Cont.
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Excessive burdens of toxic metals such as lead, mercury and
cadmium can adversely influence the quality of sperm and
subsequent conception.
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Effects of xenoestrogens, particularly in men alters fertility and
is contributing to the change in population distribution.
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Environmental or recreational toxins also contributes to altered
sperm development, DNA strength and overall wellbeing
o
Smoking and alcohol can increase the number of sperm
abnormalities and can reduce sperm count
Female impaired fertility
Brown,J. 2008, Nutrition through the life cycle 3rd Edition, Thomson USA P.53
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Recent oral contraceptive use (within 2 months)
Anorexia nervosa / bulimia nervosa
Amenorrhea
High coffee / caffeine intake
High fibre intake
Vegetarian diets (controversial but a strong hormonal
connection)
Age > 35 years
Pelvic inflammatory disease (PID)
STDs, particularly Chlamydia
Endometriosis
Poor iron status
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Male impaired fertility
Brown,J. 2008, Nutrition through the life cycle 3rd Edition, Thomson USA P.53
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Inadequate zinc status
Inadequate antioxidant status
Heavy metal exposure  lead, mercury, cadmium, manganese
Halogen (in some pesticides) and glycol exposure (in antifreeze
and de-icers)
Xenoestrogen exposure (in DDT, PCB’s)
Chromosomal abnormalities in sperm
Sperm defects
Excessive heat to testes
Steroid abuse
Poor Vitamin D status (controversial)
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Shared Factors of Infertility
Brown,J. 2008, Nutrition through the life cycle 3rd Edition, Thomson USA P.53
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Weight loss > 15% of normal weight
Negative energy balance
Inadequate body fat
Excessive body fat, especially central fat
Extreme levels of exercise
High alcohol intake
Endocrine disorders  hypothyroidism, Cushing’s disease,
altered sex and supporting sex hormones
Structural abnormalities of the reproductive tract
Coeliac disease
Severe stress
STD’s
Diabetes
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High Risk Pregnancies text pg 521:526
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Definition: a pregnancy characterised by indicators that make it
likely the birth will be surrounded by problems such as
premature delivery, difficult birth, retarded growth, birth
defects and early infant death. View table 15-3
The more factors that apply, the higher the risk to mother and
foetus.
Risk Factors for Pregnancy
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Low socioeconomic status
Malnutrition, limited food choices/groups.
Mother’s age – adolescents and older women
Lifestyle choices,
Some medications
Previous medical conditions such as
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Diabetes all types
Hypertension
Developing during pregnancy
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Gestational diabetes
Transient hypertension during presentation
Pre-eclampsia and eclampsia
Nutrition & contraceptives
Brown,J. 2008, Nutrition through the life cycle 3rd Edition, Thomson USA P.59
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Oral contraceptives
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Contraceptive injections (Depo-provera)
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↑ blood levels of HDL cholesterol
↑ blood levels of triglycerides (30%) and LDL cholesterol
↑ risk of venous thromboembolism (Blood clots)
↓ blood levels of vitamin B12 (33%)
↑ blood levels of copper (34- 55%)  related to the ↑ risk of
clots
Weight gain
↑ blood levels of LDL and insulin
↓ blood levels of HDL cholesterol
↓ bone density
Contraceptive implants (Norplant)
o
Weight gain
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Potential Nutritional risk factors
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Poor diet, including
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too little folate or poor iron intake  ↑ the risk of embryonic
development of neural tube defects
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B Vitamins: in particular B6, B12 and folate. B6 for the growth and
development of the baby’s nervous system; B12 for cell growth
and normal development; folate for DNA synthesis, increased
blood volume, cell division and healthy tissue development.
Multiple pregnancies, long term use of the OCP and anaemia
increase the B12 requirements.
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Vitamin C: tissue development; absorption of iron; interaction
with other nutrients; prevention of pre-eclampsia. (p.116)
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Calcium: healthy teeth and bones; particularly important for
women under 25 (p.470 and notes)
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Vitamin D: bone and teeth development via calcium absorption;
RDI 400I.U. (p.727)
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Vitamin E: prevention of pre-eclampsia, high blood pressure and
the build up of free radicals (p.116)
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Magnesium: pain and discomfort of leg cramps
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Examples of Interactions
Peri-nutrition and Adult Diabetes
Conceptual framework for how maternal diet and micronutrient status may affect the
development of chronic disease in the offspring.
Christian P , Stewart C P J. Nutr. 2010;140:437-445
©2010 by American Society for Nutrition
Over or incorrect supplement use
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including
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excessive vitamin A intake  ↑ the risk the fetus will develop
facial or heart abnormalities
High maternal blood levels of lead ↑ the risk of mental
retardation
Iodine deficiency ↑ the risk that children will experience impaired
mental and physical development (page 574 and notes)
Iron deficiency ↑ the risk of early delivery and the development
of iron deficiency within the first few years of life
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Nutrient imbalance: e.g.
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a) elevated copper suppresses zinc and can  miscarriage
b) refined carbohydrates and excess sugar  reduced levels of
zinc, B complex and chromium, candida and high acidity levels
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Poor management of diabetes or hypertension
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Poorly controlled glucose levels early in pregnancy
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Increase the risk of foetal malformations
Excessive infant size at birth
The development of diabetes in the offspring later in life
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Women with gestational diabetes tend to be overweight or obese
and excess central body fat.
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All forms of hypertension in pregnancy are related to
inflammation, oxidative stress and damage to the endothelium 
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Over time, oxidative stress within the endothelium leads to
endothelial dysfunction
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Preeclampsia is a syndrome characterised by:
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Consequences of endothelial dysfunction include
 Impaired blood flow
 An increased tendency for the blood to clot
 Plaque formation
Oxidative stress, inflammation and endothelial dysfunction
Blood vessel spasm and constriction
Increased blood pressure
Nutritional preventative measures for preeclampsia:
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Calcium  has been shown to
Magnesium
Vitamin C and E
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o
A number of nutritional and other environmental factors are
related to oxidative stress (Brown,J. 2008, Nutrition through the life cycle 3 Edition, Thomson USA
rd
.p131):
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Trans fats
Inadequate intake of antioxidants nutrients (vitamin C, E,
carotinoids, selenium) and antioxidant phytochemicals from
plants
Habitual consumption of high-glycaemic-index carbohydrates,
elevated blood glucose levels
Excess body fat
Physical inactivity
smoking
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Smoking
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low birth weight
more susceptible to respiratory illness
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Environmental toxins: may cross the placenta and affect its
health. Be wary of lead, cadmium, aluminium, copper, mercury,
nickel (used in body piercing) and home renovations.
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Aspartame use:
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Phenylalanine (Nutrasweet and Equal) can affect foetal brain
development in some people.
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Age younger than 18: considered high risk pregnancies
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Body weight and weight gain:
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obesity  hypertension, diabetes, complications during delivery
and birth defects.
Inadequate weight gain  low birth weight and often is a sign of
poor nutritional status
Prenatal ketosis:
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lows foetal brain development.
Be wary of crash diets or fasting.
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Listeria infection: can 
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spontaneous abortions or serious blood infections.
Be wary of unpasteurised milk, soft cheeses made from raw milk
and raw cabbage.
Homocysteine: elevated levels can cause recurrent miscarriage
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in 26 out of 84 Dutch patients (study group) who experienced
placental abruption and foetal growth retardation as compared to
7% of 46 controls.
Serum and red cell folate, serum vitamin B12 and B6 were
significantly lower in the study group compared with the controls.
(Goddijn-Wessel, TAW., Wouters, MGAJ., Molen, EFvd., Spuijbroek,MDEH., Steegers-Theunissen, RPM., Blom,HJ.,
Boers, GHJ., ESkes, TKAB. 1996, ‘Hyperhomocysteinaemia: a risk factor for placental abruption or infarction’,
European Journal of Obstetrics & Gynaecology and Reproductive Biology, vol.66, no.1, pp.23-29)
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Radiation:
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a) ionizing radiation i.e. flying, x-rays and radioactive materials
b) non-ionizing i.e. computers, mobile phones, microwaves,
ultraviolet light, radar
c) electromagnetic i.e. waterbeds, electric blankets, clock radios,
fuse boxes.
Taxoplasmosis: avoid contact with cats litter, garden soil,
potting mix, and raw or uncooked meat
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Stress
Drug use
HIV or AIDS
Medications
Excessive caffeine intake
Job related hazards
MERCURY
Brain development begins early in foetal life and continues into
adolescence. The developing brain, therefore, is uniquely
susceptible to exposure to neurotoxic compounds. Mercury is
one of those neurotoxins that particularly affects this brain
development.
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How does it all work?
Mercury is released into the environment largely from fossil fuels (mainly coal) and
from incinerators
This inorganic mercury becomes airborne and may be carried for miles before being
deposited in soil or water
This inorganic form of mercury is then converted to a toxic form (methylmercury) by
chemical reactions or by bacteria
This MeHg is then absorbed by aquatic micro-organisms that are eaten by fish
This then accumulates up the aquatic food chain
Humans are exposed through fish consumption and transmission occurs from mothers
to infants.
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Both natural and manmade emissions are metabolised into
forms more directly harmful to human beings. All forms of
mercury are toxic, but the various forms are more or less
available for absorption by animals and humans.
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Methylmercury, the organic form of mercury often found in
fish, is easily absorbed by the body and is highly toxic. It is the
main form of mercury found in the brain.
Elemental mercury is highly volatile, and inhaling elemental
mercury vapour can present a serious health risk, as often
occurs when mercury metal is spilled indoors.
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•
Common bacteria of the soil and water have adapted to the
presence of mercury. They have developed methods to detoxify
its organic compounds and salts to the elemental form of
mercury. Elemental mercury can be transported long distances
via the atmosphere. Once it reaches inland aquatic
environments however, elemental mercury can again
accumulate and be transformed into methylmercury, the toxic
form that bioaccumulates in fish, animals, and humans.
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Mercury compounds are a significant threat to human health,
particularly to pregnant women, women of childbearing age,
developing foetuses and breast-fed infants.
Chien,LC., Han,BC., Hsu,CS., Jiang,CB., You,HJ., Shieh,MJ., Yeh,CY. 2006, ‘Analysis of the health risk of exposure to breast milk mercury in infants
in Taiwan’, Chemosphere, article in press
They concluded that even though fish has recognised health
benefits, to reduce the body burden of mercury in their infants,
women of childbearing age, should be concerned about mercury
levels accumulated in fish.
Chien,LC., Han,BC., Hsu,CS., Jiang,CB., You,HJ., Shieh,MJ., Yeh,CY. 2006, ‘Analysis of the health risk of exposure to breast
milk mercury in infants in Taiwan’, Chemosphere, article in press
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In Australia, fish that contain higher levels of mercury
include:
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Shark
Ray
Swordfish
Barramundi
Gemfish
Orange roughy
Ling
Southern bluefin tuna.
Fish that contain lower levels of mercury include:
 Shellfish including prawns, lobsters and
oysters
 Salmon
 Canned tuna.
http://www.disability.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Mercury_in_fish?open
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The authors of this 2006 study found that while breast
milk concentrations of mercury were high
 They were significantly lower in those who took vitamins than
those who didn’t
 They decreased with selenium intake
This confirms previous studies:
 In Austria, a significant positive correlation was found between
breast milk mercury concentration and vitamin
supplementation.
Chien,LC., Han,BC., Hsu,CS., Jiang,CB., You,HJ., Shieh,MJ., Yeh,CY. 2006, ‘Analysis of the health risk of exposure to breast milk mercury in infants
in Taiwan’, Chemosphere, article in press
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Moral: be aware of potential environmental sources of heavy
metals and advise the client of these.
Consider sources of EFA, and possibly a certified tested
supplement to minimise contamination
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Activity
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Based on the information you have learnt, make a list of
recommendations you might give a client either male or female
if they came to see you for pregnancy
What Can Be Done
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Encourage all of pregnancy age to consider a healthy lifestyle.
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In particular couples who are seeking pre- or periconception
care to ensure their lifestyle, eating, stress and overall health is
optimised.
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Allow a minimum of 3 months pre conception to prepare and
optimise sperm and uterine health.
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Endorse the use of other contraceptive methods during this
time to minimise the risk of accidental conception.
Dietary Recommendations
Women
Cereals
Vegies
Fruit
Diary
Lean
Meat etc
Extras
19-60
4-9
5
2
2
1
0-2.5
60+
4-7
5
2
2
1
0-2
Pregnant
4-6
5-6
4
2
1.5
0-2.5
Lactating
5-7
7
5
2
1
1-2.5
Text pg 517
Structured Recommendations
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Nutritional requirements, while they increase, foods must be
nutrient rich – fresh, lean foods, along with healthy oils.
Energy requirements increase in the 2nd trimester by
1400Kj/day and 1900Kj/day in the 3rd trimester
Protein increase by 14 g/day in the 2nd and 3rd trimesters
EFA from fish, polyunsaturated oils
Achieve and maintain a healthy body weight
Be physically active
Receive regular medical care
Manage chronic conditions
Avoid harmful influences
Cont..
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Follow the dietary guidelines for all Australians – so adjust the
client’s eating plan to match this. Consider their stage of
pregnancy and increase identified nutrients and energy.
Encourage adequate water intake.
Limit foods/chemicals that could interfere with health
Help the client to structure a workable meal plan to meet their
dietary needs and their food tolerances. Adapt as the
pregnancy develops.
Educate and support your client with adverse discomforts and
symptoms as suggested on pg 520 of text.
Consider a good multivitamin suitable for pregnancy.