Life Cycle Nutrition: Pregnancy and Lactation

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Life Cycle Nutrition Pregnancy and Lactation

• Chapter 15

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Nutrition Prior to Pregnancy

• Nutrition can affect fertility
• Preparation before pregnancy
• Achieve and maintain healthy body weight
• Choose an adequate and balanced diet
• Take a multivitamin for the folate (one of the
  DGAs)
• Be physically active
• Receive regular medical care
• Manage chronic conditions
• Avoid harmful influences (drugs, tobacco, excess
  alcohol)

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Growth and Development During Pregnancy

• Placental development
• Develops in uterus in the early days
  post-conception
• Amniotic sac and umbilical cord
• Expelled during childbirth
• Interweaving of fetal and maternal blood vessels
  delivering O2 and nutrients and carrying out
  waste
• Metabolically active organ
• Yes, its an organ
• Requires energy and nutrients
• Produces hormones that maintain pregnancy and
  prep for lactation

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The Placenta and Associated Structures
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The arrows indicate the direction of blood flow.

Umbilical cord
Uterine wall
Placenta
Amniotic sac
In the placenta, maternal blood vessels lie side
by side with fetal blood vessels that reach the
fetus through the umbilical cord.
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Pool of mother's blood
Fetal artery
Fetal vein
Fingerlike projections (called placental villi)
contain fetal blood vessels and extend into the
pool of mothers blood. No actual mingling of
fetal and maternal blood occurs, but substances
pass back and forth.
Umbilical cord
Thus, oxygen and nutrients from the mothers
blood enter fetal vessels, and waste products are
removed.
Umbilical vein
Umbilical arteries
Mothers veins carry fetal wastes away.
Mothers arteries bring fresh blood with oxygen
and nutrients to the fetus.
Fetal portion of placenta
Maternal portion of placenta
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Growth and Development During Pregnancy

• Fetal growth and development
• Fertilization of an ovum by a sperm
• Zygote during 1st week
• Rapid division to become blastocyst
• Implantation in uterine wall
• Embryo- 2-8 weeks
• 1-1/4 inch at 8 weeks has CNS, CVS, GI tract,
  fingers, toes
• Fetus- 8-40 weeks
• Full-term at 38-42 weeks, avg. 6.5-8 lbs

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Stages of Embryonic and Fetal Development
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1) A newly fertilized ovum is about the size of
a period at the end of this sentence. This zygote
at less than one week after fertilization is not
much bigger and is ready for implantation.
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2) After implantation, the placenta develops and
begins to provide nourishment to the developing
embryo. An embryo 5 weeks after fertilization is
about 1 / 2 inch long.
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3) A fetus after 11 weeks of development is just
over an inch long. Notice the umbilical cord and
blood vessels connecting the fetus with the
placenta.
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4) A newborn infant after nine months of
development measures close to 20 inches in
length. From 8 weeks to term, this infant grew
20 times longer and 50 times heavier.
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Growth and Development During Pregnancy

• Critical periods
• Times of intense development, rapid cell division
• Critical periods occur early in pregnancy
• Certain cellular activities can occur only during
  these times
• Adverse influences on organ and tissue
  development
• Each organ has its own critical period

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An adverse influence felt late temporarily
impairs development, but a full recovery is
possible.

Normal development
An adverse influence felt early permanently
impairs development, and a full recovery never
occurs.
Time
Critical period
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Critical Periods of Development
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Growth and Development During Pregnancy

• Neural tube defects gt300,000 births/yr
  worldwide
• 1) Anacephaly
• Brain either missing or fails to develop
• 2) Spina bifida
• Incomplete closure of spinal cord its bony
  encasement
• Varying degrees of paralysis ? death
• Clubfoot, dislocated hip, curved spine,
  retardation, motor /sensory loss
• - Research on root causes gene-gene,
  gene-nutrient, gene-environment
• - Risk factors- family hx, maternal DM or
  obesity, anti-seizure meds, mutation in
  folate-related enzymes
• - Folate supplementation 400 µg/d one month prior
  to conception and through 1st trimester
• - Public health recommendation to all women of
  childbearing age

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At 4 weeks, the neural tube has yet to close
(notice the gap at the top).
At 6 weeks, the neural tube (outlined by the
delicate red vertebral arteries) has successfully
closed.
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Spina Bifida

Spina Bifida
Normal Spine
Meninges
Vertebra
Spinal cord
Spinal fluid
Spina Bifida
Spine
Spine
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Growth and Development During Pregnancy

• Chronic diseases contd
• Adverse influences at critical times during fetal
  development
• Malnutrition folate deficiency
• Type 2 diabetes
• Maternal inadequate nutrition affects
  cardiovascular growth during placental
  gestational development ? infant hypertension,
  lipid metabolism, immune system ? adult health
• Fetal programming
• Mothers nutrition during pregnancy may change
  gene expression in fetus, influence disease
  susceptibility later in life

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Maternal Weight

• Birthweight is most reliable indicator of
  infants health
• Weight prior to conception
• Influences fetal growth
• Underweight
• Higher rates of preterm births and infant deaths
• Overweight obesity
• Higher risk of their own medical complications-
  hypertension, gestational DM, postpartum
  infections,
• Risks for infant- NTD from maternal poor glycemic
  control, heart defects and other abnormalities,
  infant wt gt9 lbs from diabetic mother- caesarean
  section

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Maternal Weight

• Weight gain during pregnancy- only 1/3 gain the
  right amount most gain more
• Fetal growth and maternal health
• Correlates closely with infant birthweight
• Predictor of health and development
• Recommended weight gains- see the chart
• Number of fetuses
• Beginning weight

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Recommended Weight Gains
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Maternal Weight

• Weight gain patterns
• 3.5 pounds in first trimester
• 1 pound per week thereafter
• Large weight gain over short time
• Preeclampsia
• Components of weight gain
• Placenta, uterus, blood, breasts, fluid volume,
  baby
• Maternal fat stores

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Weight gain (lb)
Stepped Art
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Maternal Weight

• Weight loss after pregnancy
• Return to prepregnancy weight
• Ideal but not typical
• Retain a couple of pounds fat with each pregnancy
• Seven or more pounds, BMI increased 1 unit risks
  diabetes and hypertension
• Chronic diseases later in life for mother and
  infant
• Losing the pregnancy weight indicates better
  success at maintaining middle age weight

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Exercise During Pregnancy

• Can continue moderate intensity exercise
  throughout pregnancy 30 min/session
• Do regularly and adjust duration and intensity as
  needed
• Low-impact activities like swimming, walking
• Benefits
• Less diabetes, easier labor
• Protect fetal development with Exercise Donts
• Stay out of saunas, hot humid weather.
• Keep hydrated Dont push yourself.
• No contact sports No exercise on your back
• Stop if painful No bouncy jerky exercise

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DO
DONT
Do begin to exercise gradually.
Dont exercise vigorously after long periods of
inactivity.
Do exercise regularly (most, if not all, days of
the week).
Dont exercise in hot, humid weather.
Do warm up with 5 to 10 minutes of light activity.
Dont exercise when sick with fever.
Dont exercise while lying on your back after
the first trimester of pregnancy or stand
motionless for prolonged periods.
Do 30 minutes or more of moderate physical
activity 20 to 60 minutes of more intense
activity on 3 to 5 days a week will provide
greater benefits.
Pregnant women can enjoy the benefits of exercise.
Dont exercise if you experience any pain,
discomfort, or fatigue.
Do cool down with 5 to 10 minutes of slow
activity and gentle stretching.
Do drink water before, after, and during exercise.
Dont participate in activities that may harm the
abdomen or involve jerky, bouncy movements.
Safe exercise during pregnancy
Do eat enough to support the needs of pregnancy
plus exercise.
Do rest adequately.
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Energy Nutrient Needs During Pregnancy

• Nutrient needs tend to be higher than any other
  time in life.
• To meet needs
• Make nutrient-dense selections
• Body maximizes absorption, minimizes losses
• Fe, folate, Ca especially important

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Energy Nutrient Needs During Pregnancy

• Energy
• Increase in basal metabolic rate
• 1st trimester- usual kcal, focus on getting ALL
  micronutrients
• 2nd trimester add 340 kcal/d
• 3rd trimester add 450 kcal/d
• Food energy
• Need 15 to 20 more energy than before pregnancy
• Nutrient-dense foods

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Energy Nutrient Needs During Pregnancy

• Carbohydrate
• Ample carbohydrate is necessary
• Protein
• RDA additional 25 grams per day
• Essential fatty acids
• Omega-3 and omega-6 fatty acids needed for
  developing brain material (make a smart baby now)

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Energy Nutrient Needs During Pregnancy

• Fetal blood production and cell growth (DNA)
• and maternal red blood cell mass
• Folate 600 µg/d
• Vitamin B12 2.6 µg/d
• Iron 27 mg/d
• Zinc 12 mg/d
• Benefits of prenatal supplements Drugstore
  prenatal OK
• Intentionally eat well. The pill can only do so
  much.

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Energy Nutrient Needs During Pregnancy

• Nutrients for bone development
• Protect your own bones from borrowing
• Vitamin D
• Deficiency interferes with calcium metabolism
• Calcium
• Absorption and retention increase
• Intake usually falls below recommendations
• Other nutrients
• Optimal interval between pregnancies

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Vegetarian Diets During Pregnancy Lactation

• Can support healthy pregnancy and lactation
• Must be planned and disciplined
• Should include dairy and eggs
• Variety of whole foods
• Additional supplementation- B12, Fe, Ca, D
• Focus on COMPLETE proteins (complementary)
• Vegan diets NO!! NO!! NO!! NO!!!
• Risks- too many to list, long-term and
  irreversible effects a real potential

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Common Nutrition-Related Concerns of Pregnancy

• Nausea
• Morning sickness to cant keep anything down
• Try a 50 mg B6 pill from weeks 6-14
• http//www.morningsicknesshelp.com/morning-sicknes
  s-cure.html
• Constipation and hemorrhoids
• Heartburn
• Food cravings and aversions
• Hormone-induced changes
• Nonfood cravings- pica

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High-Risk Pregnancies

• Infants birthweight
• Low birthweight (LBW)
• 5 ½ pounds or less
• Risk of complications
• Relationship with socioeconomic status
• Gestational age
• Preterm
• Small-for-gestational age

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High-Risk Pregnancies

• Malnutrition and pregnancy
• Fertility
• Early, unplanned pregnancy
• Poor placental development can affect fetuss
  future children
• Fetal development
• Consequences
• Retardation, birth defects, miscarriages,
  stillbirths, infant mortality 0-4 yrs.

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High-Risk Pregnancies

• Food Assistance Programs
• WIC
• Nutrition education and nutritious foods
• Vulnerable populations who qualify for help
• Cost-benefit
• Remedial and preventive services

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High-Risk Pregnancies

• Maternal health
• Preexisting diabetes
• Risks associated with unmanaged diabetes
• Gestational diabetes
• Common consequences
• Dietary recommendations

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High-Risk Pregnancies

• Maternal health
• Chronic hypertension
• Risks
• Gestational hypertension
• Preeclampsia
• Cause is unclear
• Risks for mother
• Risks for fetus
• Eclampsia

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High-Risk Pregnancies

• Maternal age
• Ideal childbearing age 20-25, up to 35 yrs OK
• Adolescents
• Risk of pregnancy complications
• Higher rates of stillbirths, preterm births, and
  LBW infants
• Weight gain recommendations
• Imperative need to seek prenatal care

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High-Risk Pregnancies

• Maternal age
• Women older than 35 yrs
• Complications often reflect chronic conditions
• Cesarean section rates increase
• Maternal death rates are higher
• Risks for fetus
• Downs syndrome 1/100 for 40 yr old vs. 1/10,000
  for 20 yr old

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High-Risk Behaviors

• Alcohol consumption
• Irreversible mental and physical retardation
• Fetal alcohol syndrome (FAS)
• Medicinal drugs
• No medication use without consulting physician
• Herbal supplements
• Seek physician advice

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High-Risk Behaviors

• Illicit drugs
• Many drugs easily cross the placenta
• Impair fetal growth and development
• Other risks to fetus, infant, and child
• Smoking and chewing tobacco
• Harmful effects magnified during pregnancy
• Risks for mother and infant
• SIDS

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High-Risk Behaviors

• Exposure to environmental contaminants
• Lead
• Mercury
• Foods to avoid-shark, swordfish, king mackerel,
  tilefish
• Supplements
• Foodborne illness
• No raw milk or dairy, undercooked eggs, meat or
  chicken, no sprouts
• Increased risk of listeriosis
• Risks associated with illness- meningitis,
  pneumonia, miscarriage

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High-Risk Behaviors

• Vitamin-mineral megadoses
• Excessive vitamin A (B6 for morning sickness OK)
• Fetal malformations
• Caffeine
• Miscarriage and fetal death
• Fetal growth
• Weight-loss dieting
• Sugar-substitutes

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Short List

• Good nutrition and health prior to pregnancy
• And prenatal care during pregnancy
• Gain a healthy amount of weight
• Eat a balanced diet, no risky foods
• Regular low-impact exercise
• Take prenatal vitamin and mineral supplement
• No smoking, drinking, drugs, herbs

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Lactation A Physiological Process

• Hormones promote growth and branching of duct
  system milk-producing cells
• Prolactin
• Milk production
• Oxytocin
• Cause mammary glands to eject milk into ducts
• Let-down reflex

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Breastfeeding A Learned Behavior

• Lactation is an automatic, physiological process
• Breastfeeding is a learned behavior
• Some decide not to breastfeed
• La Leche League International- THE experts
• Breastfeeding report (p. 28)
• Factors influencing breastfeeding and its success
• Father
• Adequate nutrition and rest

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Maternal Energy Nutrient Needs During Lactation

• Energy intake (1800 kcal/d total) and exercise
• Almost 500 extra kcal per day needed to produce
  25 oz milk
• Mother can eat 330 kcal extra and let body fat
  provide the rest. DGA Moderate weight loss is
  OK
• Exercise is compatible with breastfeeding
• Energy nutrients
• Recommendations increase for carbohydrates and
  fibers
• Water
• Prevent dehydration

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Maternal Energy Nutrient Needs During Lactation

• Vitamins and minerals
• Inadequacies reduce the quantity, not quality of
  breast milk
• Quality maintained at expense of maternal stores,
  though this varies by nutrient
• Prolonged inadequate intakes
• Impacts several nutrients- calcium, B6, B12, A, D
• Supplements
• Iron to replete anemia in pregancy
• Finish up the bottle of prenatal MVI

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Maternal Energy Nutrient Needs During Lactation

• Food assistance programs
• Free formula
• Participants are less likely to breastfeed
• WIC incentives to encourage breastfeeding
• higher priority, longer certification, more foods
  quantity, free breast pump
• Particular foods
• Strong flavors getting into the milk
• Infant w/family history of allergies needs to
  breastfeed

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Maternal Health

• HIV infection and AIDS
• HIV virus transmissable through breastmilk
• Developing countries Formula made with
  contaminated water causes 1.5 million infant
  deaths/yr
• Medications
• Diabetes type I
• Postpartum amenorrhea
• Does not protect from pregnancy
• Breast health
• Protective for breast cancer

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Practices Incompatible With Lactation

• Alcohol
• Easily enters breast milk
• Infants eat less when mother consumes alcohol
• Medical drugs
• Physician consultation
• Illicit drugs
• Risks

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Practices Incompatible With Lactation

• Smoking
• Reduces milk volume
• Sleep less
• Passive smoking and SIDS
• Environmental contaminants
• DDT, PCBs, and dioxin
• Caffeine
• Iron bioavailability

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Highlight 15

• Fetal Alcohol Syndrome

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Introduction

• Alcohol readily crosses the placenta
• Deprives fetus of nutrients and oxygen
• Fetal alcohol spectrum disorder
• Fetal alcohol syndrome (FAS)
• Cluster of physical, mental, and neurobehavioral
  symptoms
• Alcohol-related neurodevelopmental disorder
  (ARND)
• Alcohol-related birth defects (ARBD)

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Introduction

• Abstinence from alcohol during pregnancy is
  recommended
• Severe consequences
• FAS can only be prevented not treated
• Abstinence is recommended for those who may
  become pregnant

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Typical Facial FAS
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Drinking During Pregnancy

• Direct damage
• Intoxication
• Indirect damage
• Malnutrition
• Alcohol interferes with tissue development during
  critical periods
• Fetal blood alcohol concentration (BAC) increase
  until even with maternal BAC levels

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How Much Is Too Much?

• Even one drink a day may threaten neurological
  development and behaviors
• Total alcohol intake
• Average intakes
• Drinking patterns
• Frequency of consumption
• Quantity consumed
• Stage of fetal development

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When Is the Damage Done?

• First one to two months of pregnancy
• Critical periods and alcohol exposure
• Male alcohol ingestion
• May affect fertility and fetal development
• Association with low infant birthweight