Nutrition: Chapter 14

Pregnancy and Lactation

Nutritional facts about pregnancy

- Underweight and overweight males and females have LOWER fertility rates
- Unsaturated fats, fewer animal proteins, and more complex carbohydrates INCREASE fertility in women
- Men who eat the antioxidant vitamins and more phytochemical make MORE sperm
- Poor nutrition at ANY stage can affect the baby's future health
- Most women do NOT return to their pre-pregnancy weight
- Underweight women tend to have lower birth weight children and babies with more health problems
- Overweight women tend to have large babies and complications within themselves
- Low socioeconomic levels result in more stress, more teen pregnancy, more smoking, alcohol, and drugs and limited medical care

What does early malnutrition affect?

Early malnutrition affects the PLACENTA which causes smaller babies, birth defects, and poorly developed reproductive system in the baby

Embryonic development after conception

- After conception, the baby implants in the uterus and then the PLACENTA forms
- As the baby develops an AMNIOTIC sac surrounds it which is a membrane filled with FLUID
- Also the UMBILICAL cord forms to connect the baby to the placenta, arteries and veins travel through it from the baby to the placenta

*IMPORTANT
Embryo during first two months

The embryo DOUBLES about every 24 hours the first two months and has complete CNS, beating heart, digestive system, fingers, and toes

Embryo 3 months and on

The organs mature and certain parts are more damageable at certain times

Placenta

Organ where mothers blood flows next to baby's blood vessels so nutrients and gases can exchange

*IMPORTANT
Energy requirements during pregnancy

- 300 calories more are needed for the second trimester
- 450 calories more for the third trimester

Protein requirements during pregnancy

10g more protein is required

Vitamins required during pregnancy

- Slightly more B vitamins but especially FOLATE for growth of new cells
- Slightly more iron, zinc, and iodine

anencephaly and spina bifida

- 300,000-400,000 babies per year worldwide have either anencephaly or spina bifida
- Some are caused by genetics, some because mom is diabetic, or on anti-seizure meds or very obese
- Folate supplements help but best one month before getting pregnant to three months of pregnancy

Minerals required during pregnancy

Extra iron, zinc, and iodine are needed for metabolism, blood formation, DNA and RNA

What extra vitamins and minerals do vegans need when pregnant?

Calcium, vitamin D, and B12

*IMPORTANT
Recommended weight gain during pregnancy

- 15-25 pounds if overweight before pregnancy
- 25-35 pounds if normal weight before pregnancy
- 30-40 pounds if underweight before pregnancy

Problems associated with pregnancy (recommendations in parenthesis)

- CRAVINGS are caused by hormonal changes which change the sensitivity to tastes and smells (eat whatever is within reason)
- NAUSEA is caused by increased estrogen (eat bland foods)
- CONSTIPATION caused by increased hormones (eat more fiber)
- HEMORRHOIDS and VARICOSE VEINS are caused by the weight of the baby pressing down on the return flow of blood and lymph (exercise)

*IMPORTANT
What is the most important indicator of a baby's future health?

birth weight

What is the optimal birth weight?

7.5 lbs

\____ of infant deaths are due to low birth weight

⅔

Women Infants & Children (WIC)

Food assistance program that offers nutrition education and food certificates for pregnant women, newborns, and young children

diabetes

- Increases chance for abortion unless it is under control
- If not under control, infants are often born being very large and can have mental and physical defects and respiratory distress

hypertension

- Low birth weight
- Placenta abruptio

Placenta abruptio

PREMATURE separation of placenta that causes heart attack and stroke in mother

gestational diabetes

- Hormones from placenta disrupt mother's blood glucose levels (raise blood sugar)
- Can result in abortion, heart damage, and limb deformities in babies
- Controlled by diet and exercise and insulin if needed

pre-eclampsia

- Swelling and high blood pressure due to increased fluid and blood supply
- Results in convulsions and kidney failure
- Unknown cause, possibly genetic predisposition
- Other symptoms include PROTEINURIA, abdominal pain, headaches, vomiting, blurry vision, and sudden weight gain

Eclampsia

Develop seizures and coma

adolescent pregnancy

- Most teenage girls rarely meet RDAs without being pregnant
- Pregnancy usually causes decreased adult health
- Usually Fe deficient
- Have longer labor
- High blood pressure (50% higher in teen pregnancy)
- Low birth weights
- Stillbirths are more common
- Larger weight gain is recommended

*IMPORTANT
teratogens

- Substances that cause birth defects
- Ex. alcohol

Alcohol incompatibility with pregnancy

- Concentrates in the baby 10x that of the mother
- Causes mental retardation and physical defects
- Nearly all drugs pass through the placenta and affect the baby with either defects or addiction

Aspirin incompatibility with pregnancy

- Causes iron deficiency
- Decreases fetal circulation
- Causes uterine contractions

Tobacco incompatibility with pregnancy

- Causes low birth weight
- Reduces fetal circulation and breathing
- Increases the chance for sudden infant death syndrome (SIDS)
- Decrease intelligence
- Cause birth defects

SIDS (sudden infant death syndrome)

Sudden, unexpected death of an infant less than 1 year of age that has no identifiable cause

Various practices incompatible with pregnancy

- Vitamin and mineral megadoses are toxic to the baby
- Caffeine lowers babies weight
- If mother is pregnant and tries to lose weight by going on diet during pregnancy, it damages baby's brain
- Food borne illnesses can cause fetal death (ex. listeria)
- Pregnant women should not use artificial sweeteners because it seems to adversely affect the baby

lactation

Breastfeeding

How many calories per day does lactation need?

- Requires extra 500-650 calories per day depending on mother's weight
- If women gain the correct amount of weight, they will use some of the fat deposited in their body during pregnancy to make milk

What affects milk quality?

- Maintained at the expense of the mother
- Drinking more water will not produce more milk, but too little water will reduce milk volume
- Alcohol, caffeine, and some other drugs can enter breast milk as well as environmental contaminants such as DVT, lead, and PCDs
- Smoking cigarettes reduces milk volume and causes infants to sleep less
- Caffeine decreases iron in the baby and makes the baby irritable and sleepless
- Food allergies in the child do not depend on what the mother eats
- Breastfeeding does decrease food allergies in children
- Most illnesses do not pass through breast milk, except AIDs
- Children can get illnesses from bottles being held close and dripping from the mouth into their ears
- Strong flavors in the mothers food can change the taste of the mothers milk

breast milk

- Contains fat-digesting enzymes along with the fat
- Protein content is lower than cow's milk
- Contains lactoferrin which helps iron absorption
- High in vitamin C, but low in vitamin D (baby needs sun exposure)
- Contains zinc-binding proteins and abundance of antibodies against a variety of diseases (why infants normally do not get chickenpox during the beginning of life)
- Contains bifidus factors which promote growth of lactobacillus
- Contains lactose and oligosaccharides that bind to bad bacteria
- Sterile
- Contains lactadherin which binds to intestinal viruses
- Decreases future obesity
- Increases intelligence
- Cow's milk and goat milk are not nutritious enough for babies

recommendations of breast milk

- Recommended for 6-12 months
- 10-15 minutes of feeding from each breast, 8-12 times per day

What is the protein in breast milk?

Alpha lactalbumin

colostrum

- Watery secretion of protein, antibodies, vitamins, and minerals
- Released from mothers breast the first few days after birth
- Fills the baby with disease protection and nutrients
- Low in carbohydrate and fat so the baby often loses weight the first day or two when breastfed

infant formulas

- Should be fortified with IRON
- Do not contain antibodies
- Increases chance of tooth and ear infections due to bottle being left in mouth

Nutritional considerations of preterm infants

- Preterm infants are born with fewer nutrient stores and immature nutrient absorption
- Breast milk adapts and increases its nutrients stored
- All formulas should be designed for pre-term or supplemented

Fetal alcohol syndrome (FAS)

- Results in mental dehydration and physical defects to the baby
- Due to the mother drinking alcohol or consumption by the father in the month before conception
- 4 million children per year are born with alcohol-related defects
- Most damage is done in the first two months when the mother is not even sure she is pregnant

Half of deaths in children under 4 are caused by \__________________

malnutrition