Pregnancy, Lactation, and Birth - 24 Months

How do we determine the nutrient/energy needs for those who are pregnant?

make used of a factorial model

• have a basal baseline (for non-pregnant, non-lactating woman)

• add other factors onto the baseline (amount deposited in fetus and related tissues, increased need for other tissues that expand during pregnancy such as blood volume, and different activity levels)

Are a woman’s needs the same through each trimester?

no

• first trimester: little change compared to non-pregnant and non-lactating women

• second trimester: needs increase

• third trimester: highest caloric needs

What are the different weeks associated with the first, second, and third trimesters?

• first: 1 - 13 weeks

• second: 14 - 27 weeks

• third: 28 - 40 weeks

How do we determine the energy needs during the different trimesters of pregnancy mathematically?

EER Equations made for each trimester (make sure age is in years, height in cm, and weight in kg, gestation in weeks, and takes into consideration physical activity levels)

• for those in the first trimester, you can use the non-pregnant EER prediction equations

What is energy deposition? Why is it only taken into consideration when talking about the EER for the 2nd and 3rd trimester but not the first?

the extra calories needed for fetal growth and maternal tissue accumulation

• different levels based on pre-pregnancy BMI

• energy deposition in the first trimester is so little that it is negligible

What is the healthy range of total weight gain for those who are pregnant (take into consideration their pre-pregnancy weight category)?

What are three Institute of Medicine (IOM) recommendations for pregnant women/those expecting to get pregnant ?

1. encourage women to reach normal body weight before pregnancy

2. promote prenatal weight gain within recommended ranges

3. women to return to normal weight by one year after delivery

What is the issue with being overweight while pregnant?

being overweight/obese can impact the child and maternal health adversely

• we see that the rates of those who are overweight and obese increasing in terms of those giving birth

How do we determine the energy needs during lactation?

factorial model

• basal needs for non-pregnant non lactating women

• add onto the amount secreted in milk (assuming that milk output is 0.7 L/d at 0-6 months and 0.6 L/d at 7-12 months)

  • needs vary by stage of lactation

• adjustments for amount available from other body tissues

• girls < 19 separated from 19+ bc they have different metabolic needs, those < 19 are still growing themselves

What is the relationship between inches and cm? lbs and kg?

• 1 inch = 2.54 cm

• 1 kg = 2.2 lbs

What months are exclusively breastfeeding? What does this entail? What is partial breastfeeding?

• exclusive = 0 - 6 months

  • breastfeeding every three hours

• partial = 7 -12 months

What takes more metabolic energy, being pregnant or producing milk?

producing milk

What are the calorie changes that need to happen during lactation?

• EER for first 6 months was calculated by adding 500 cal/day to pre-pregnancy needs - 170 cal/day to account for weight loss in the first 6 months postpartum

In general, why do women who are pregnant/lactating have a higher HEI score?

more conscious about being healthy

• still lowkey low ~ 60, but still better than the average ~50

What are the 8 nutrients of concern for pregnant and lactating women? Which one apply to the general public? Which ones are specific for pregnancy and lactation?

general public too

• calcium

• vitamin D

• potassium

• dietary fiber

• iron

specific for pregnancy and lactation

• iron

• folate/folic acid

• iodine

• choline

What changes occur for iron needs for those who are pregnant vs pre-pregnancy?

increases

• pregnant: 27 mg

• pre-pregnancy: 19 mg

How do iron requirements change during lactation before menstruation returns?

decreases

• pre-pregnancy: 19 mg

• lactation: 9 - 10 mg

How many women who are pregnant are affected by iron deficiency?

1/10

Wha are good sources of iron?

red meat and fortified cereals

How many women who are pregnant in their third trimester are affected by iron deficiency?

¼

• more prevalent bc this is when most blood volume is developed within the baby

What is the RDA for folate during pregnancy and lactation?

• pregnancy: 600 mcg DFE

• lactation: 500 mcg DFE

  • typical: 400 mcg DFE

Why is folate important during pregnancy?

to prevent neural tube defects

• 1 month prior to conception

  • food sources and supplementation are both recommended

• 2-3 months of pregnancy

What are good sources of folate?

• mushroom

• dark leafy greens

• legumes

Why is iodine important during pregnancy and lactation?

important for neurocognitive development of the fetus

• many prenatal supplements do no contain iodine

What foods have iodine (4)?

• dairy products

• eggs

• seafood

• iodized table salt

What is the AI of iodine during pregnancy and lactation?

• pregnancy: 220 mcg

• lactation: 290 mcg

Why is choline important during pregnancy and lactation?

supports growth and development of child’s brain and spinal cord

• many prenatal supplements do not contain choline

What is the AI of choline during pregnancy and lactation?

• pregnancy: 450 mg

• lactation: 550 mg

What foods have choline?

many dairy and protein foods

• eggs

• meats

• some seafood

• beans

• peas

• lentils

What is the recommended alcohol consumption for those who are pregnant/lactating?

• pregnant: none

• lactation: 1 drink/day is not known to be harmful to the infant

What is the recommended caffeine consumption for those who are pregnant/lactating?

pregnancy: low < 200 mg/day

lactation: ~ 300 mg/day OR 2-3 cups

What amount of exercise is recommended for women during pregnancy/lactation/postpartum?

at least 150 minutes/week of moderate intensity aerobic activity

• helps to reduce risk of excessive weight gain and gestational diabetes

According to the 2025 DGAs, what are the top three nutrient priorities during pregnancy?

1. iron

2. folate

3. iodine

According to the 2025 DGAs, what should breastfeeding women consume?

a wide variety of nutrient-dense foods, including vitamin B12 rich protein sources (meats, poultry, eggs, and dairy), omega-3-rich seafood, folate rich legumes, and vitamin A rich vegetables

What are the age ranges for infants? toddlers?

• infant: 0 - 1 year

• toddler: 1 - 3 years

According to the 2025 DGA, what supplement should be provided to infants soon after birth?

vitamin D

What is recommended the first 6 months of life? What if no human milk is available?

• 0 - 6 months: exclusive breastfeeding with human milk

  • contains immunoglobulins that are beneficials for babies

• if no human milk = switch to iron fortified infant formula

  • continue as long as mutually desired

Why is it recommended that the first 6 months of life are exclusively breastfeeding (5)?

1. promotes bonding between baby and parent

2. protective against gastrointestinal infections

3. prolongs duration of lactational amenorrhea (temporary infertility)

4. accelerates maternal weight loss

5. may enhance motor, cognitive, and social-emotional development of child

What percent of infants were ever fed human milk?

84%

What percent of infants were exclusively fed human milk through 6 months?

35%

What percent of kids continue to be fed any human milk at 12 months?

35%

What has contributed to low breastfeeding of kids?

no federally mandated paid maternal leave

When should infants be introduced to nutrient dense complimentary foods, and potentially allergenic foods?

at about 6 months

• need to be nutrient dense bc its a time of rapid growth and they have small stomachs

• should still complement human milk or infant formula

• not recommended to introduce before 4 months

What nutrients should be fed to infants? Especially for those who are fed human milk?

iron and zinc

What is the main source of nutrition for infants up to 12 months of age?

breast milk/formula

According the DGA how should parents encourage healthy eating?

offering new foods multiple times (8 - 10 exposures) and modeling healthy eating behaviors

What food groups do 12- 23 month year olds have trouble meeting the requirement for?

• vegetables

• fruits

• grains

• dairy

• protein foods

vegetables

What are the four benefits of introducing complementary foods?

1. adequate nutrition

2. exposure to flavors, textures, and different types of foods

3. age and developmentally appropriate foods to prevent choking

4. introduction of potentially allergenic foods

Which of the following is not a nutrient of concern for breastfed infants?

• folic acid

• iron

• vitamin D

• zinc

folic acid

• the rest are low in breastmilk

• folic acid primarily an issue during pregnancy

What is the role of iron for infants and toddlers?

supports neurologic development and immune function

Why do breastfed babies need iron?

human milk contains low iron

• born with body stores of iron adequate for first 6 months

• 77% of infants fed human milk have inadequate iron intake

What is the role of zinc for infants and toddlers?

supports growth and immune function

What are food sources of zinc (3)?

1. meats

2. beans

3. zinc fortified iron cereals

Why do breastfed babies need zinc?

zinc content in human milk declines after 6 months

• 54% of infants fed human milk have inadequate zinc intake

What are the top allergenic foods (8)?

1. peanuts

2. egg

3. cow milk products

4. tree nuts

5. wheat

6. crustacean shellfish

7. fish

8. soy

What are some foods to avoid for infants and toddlers (4)?

1. sugar

2. sodium

3. honey (has botulism)

4. unpasteurized foods and beverages

What are five signs that a child is ready to begin eating solid foods?

1. can control head and neck

2. sitting up alone or without support

3. bringing objects to the mouth

4. trying to grasp small objects (toys or foods)

5. swallowing food rather than pushing it back out

What are some signs that a child is hungry or full?

What are some benefits of baby led weaning?

they themselves can become familiar with different textures and flavors

• learns self regulation, grows independence, and improves their manual dexterity