Module 12: Nutrition Through the Life Stages - Pregnancy through Infancy

Learning Outcomes for Module 12 Part 1

  • 14.1 Explain the importance of lifestyle factors, including diet, and how they affect the likelihood of conception.

  • 14.2–14.4 Identify key nutrient needs and potential complications in the first, second, and third trimesters of pregnancy.

  • 14.5 List special concerns of younger and older mothers-to-be.

  • 14.6 Describe the benefits of breast-feeding.

  • 14.7 Identify key nutrient needs and lifestyle factors for breast-feeding women.

  • 14.8 Explain why formula can be a good alternative to breast milk.

  • 14.9 Discuss the nutritional needs of infants.

  • 14.10 Explain when and how solid foods may be introduced to infants.

What Nutrients and Behaviors Are Important for People of Childbearing Age?

  • Male Factors:

    • A male's diet and lifestyle affect the health of his sperm:

    • Smoking, alcohol, and drug abuse may decrease sperm production and function.

    • Essential nutrients:

      • Zinc and folate contribute to healthy sperm production.

      • Antioxidants (e.g., vitamins C and E, carotenoids) protect sperm from free-radical damage.

    • Recommendation: Consume a well-balanced diet rich in fruits, vegetables, whole grains, and healthy protein foods.

  • Female Factors:

    • Females need to adopt a healthy lifestyle before conception by:

    • Achieving a healthy weight.

    • Getting adequate folic acid to support new cells and ensure baby's growth and development.

    • Moderating fish and caffeine intake:

      • Methylmercury is present in some fish (e.g., shark, swordfish, tilefish, king mackerel).

      • Limit caffeine consumption to less than 200 milligrams/day; more than 500 milligrams may delay conception.

    • Avoiding cigarettes and other toxic substances.

Caffeine Content in Common Beverages

  • Table 14.1: A Jolt of Caffeine

    • Coffee (8 oz, brewed drip): 85 mg

    • Energy drinks (8 oz): 80 mg

    • Espresso (1 oz): 40 mg

    • Brewed tea (8 oz): 40 mg

    • Iced tea (8 oz): 25 mg

    • Soft drinks (8 oz): 24 mg

    • Hot cocoa (8 oz): 6 mg

    • Milk chocolate (1 oz): 6 mg

    • Chocolate milk (8 oz): 5 mg

    • Decaffeinated coffee (8 oz): 3 mg
      (Caffeine levels differ by brand)

Nutrition and Behaviors During the First Trimester

  • Development Stages:

    • Full-term pregnancy lasts approximately 40 weeks, divided into three trimesters.

    • The first trimester begins at conception, where the fertilized egg develops into a fetus.

    • The placenta, attached via the umbilical cord, nourishes the developing fetus.

  • Common Symptoms:

    • "Morning Sickness"

    • A common misconception is that morning sickness occurs only in the morning;

    • Causes are often unknown, but fluctuating hormone levels may play a role.

    • Women may develop aversions to certain foods or cravings, including Pica (craving for non-food substances like cornstarch, clay, dirt).

  • Weight Gain Recommendations:

    • Healthy women should aim to gain 25 to 35 pounds during the entire pregnancy:

    • Women carrying twins should gain between 37 to 54 pounds.

    • Typical first trimester weight gain is 1 to 4.5 pounds.

    • Excess weight gain can lead to challenges in weight loss post-delivery and increase the risk of obesity in the offspring.

  • Table 14.2: Recommended Weight Gain During Pregnancy

    • BMI < 18.5 (Underweight): Suggested weight gain is 28–40 pounds.

    • Weekly rate: 1 pound (1.0–1.3 lbs).

    • BMI 18.5–24.9 (Normal weight): Suggested weight gain is 25–35 pounds.

    • Weekly rate: 1 pound (0.8–1.0 lbs).

    • BMI 25.0–29.9 (Overweight): Suggested weight gain is 15–25 pounds.

    • Weekly rate: 0.6 pounds (0.5–0.7 lbs).

    • BMI ≥ 30.0 (Obese): Suggested weight gain is 11–20 pounds.

    • Weekly rate: 0.5 pounds (0.4–0.6 lbs).

  • Essential Nutrients:

    • Increased requirement for certain nutrients during the first trimester:

    • Folate/Folic acid: 400 micrograms/day before conception; 600 micrograms/day after.

    • Iron: Supplementation needed for red blood cell production, anemia prevention, and fetal development.

    • Zinc and Copper: Essential for baby's cell growth.

    • Calcium and Vitamin D: Important for preserving maternal bone mass.

  • Nutrients of Concern for Special Diets:

    • Nutrients needing special attention, particularly for vegans and vegetarians:

    • Omega-3 fat DHA (from seafood) for brain and retina development.

    • Choline for healthy cell division, especially in brain development.

    • Vitamin B12 (from animal foods) for nerve cells and red blood cell production.

    • Be cautious with preformed Vitamin A, which can be toxic; limit supplements to no more than 3000 IU/day.

  • Risk of Foodborne Illness:

    • Pregnancy increases risks for foodborne illnesses, such as those caused by Listeria monocytogenes. Avoid:

    • Raw or undercooked meats, seafood, and poultry.

    • Unpasteurized milk, cheese, or juices.

    • Raw sprouts.

  • Substances to Avoid:

    • Pregnant women should avoid nicotine, alcohol, and illicit drugs due to risks including:

    • Sudden Infant Death Syndrome (SIDS), Fetal Alcohol Spectrum Disorders (FASDs), and birth defects.

    • Limit caffeine intake to 300 milligrams or less.

  • Critical Periods:

    • Critical periods are developmental stages during the first trimester when cells and tissues grow and differentiate rapidly.

    • Nutritional deficiencies and toxin exposure during these critical periods may lead to birth defects or miscarriage, making the first trimester extremely important for maternal nutrition.

Nutrition and Behaviors During the Second Trimester

  • Increased Caloric Needs:

    • Pregnant women should consume an additional 340 calories/day in the second trimester (relative to pre-pregnancy needs).

    • Average weight gain should be about 1 pound per week.

    • Increased carbohydrate needs: additional 40 grams/day required.

    • Protein requirements also increase by 25 grams/day.

  • Importance of Exercise:

    • Regular exercise is crucial, with recommendations suggesting at least 150 minutes of moderate-intensity aerobic activity per week.

    • Benefits include:

    • Improved weight management within targeted ranges.

    • Decreased physical discomfort, such as aches and pains.

    • Reduced risk of constipation, gestational diabetes, stress, and improved energy levels.

  • Safe vs. Unsafe Exercises:

    • Safe Activities::

    • Includes walking, stationary cycling, low-impact aerobics, swimming, and dancing.

    • Unsafe Activities: Avoid contact sports and high-impact activities like hockey, basketball, or gymnastics.

  • Potential Complications:

    • Gestational Diabetes: Develops during pregnancy; contributing factors include:

    • Genetic predispositions, age, weight, and other health issues.

    • Risks include macrosomia (large baby - over 8 pounds, 13 ounces) and possible baby complications (jaundice, breathing issues).

  • Pregnancy-induced Hypertension:

    • Includes conditions such as:

    • Gestational Hypertension: High blood pressure developing mid-pregnancy.

    • Preeclampsia: Characterized by hypertension and protein in urine; untreated can escalate to eclampsia, causing seizures and potential mortality.

Nutrition and Behaviors During the Third Trimester

  • Additional Caloric Requirements:

    • Healthy women should consume an additional 450 calories/day and gain approximately 1 pound per week.

    • As the growing baby places pressure on the stomach and intestines, hormonal changes may lead to:

    • Heartburn and constipation

    • Recommendations include eating small, frequent meals and avoiding spicy foods to alleviate heartburn, while increasing fiber-rich foods may help prevent constipation.

Special Concerns for Younger and Older Mothers-to-Be

  • Teenage Mothers:

    • Typically face challenges due to ongoing growth and development, which may lead to:

    • Nutrient deficiencies (iron, folic acid, calcium, calories).

    • Higher risks of complications such as pregnancy-induced hypertension and delivering preterm or low birth weight babies.

  • Older Mothers (35+):

    • Increased likelihood of developing gestational diabetes and hypertension.

    • Recommendations include achieving a healthy weight prior to conception and avoiding harmful substances, along with consuming a balanced diet and adequate folic acid.

Benefits of Breast-Feeding

  • Lactation: Refers to breast milk production post-childbirth, influenced by hormones, particularly prolactin (milk production) and oxytocin (milk release).

  • Physical, Emotional, Financial Benefits for Mothers:

    • Assists in postpartum recovery and reduces risks of chronic diseases.

    • Cost Efficiency: Breast-feeding costs approximately $300 annually, while formula can be around $2,000 annually.

    • Promotes bonding with the infant, providing emotional rewards.

Milk Composition in Breast-Feeding

  • Fore Milk vs. Hind Milk:

    • Fore Milk: Resembles skim milk (approx. 17% fat, 74% carbohydrates, 9% protein).

    • Hind Milk: Resembles cream (approx. 66% fat, 28% carbohydrates, 6% protein).

    • Released 10-20 minutes into feeding.

  • Nutritional Composition:

    • Changes over time with the infant growth needs:

    • Colostrum: First fluid produced post-birth containing antibodies, protein, minerals, and vitamin A, essential in early infancy.

    • Breast milk offers unique nutritional profiles: high in lactose, fat, and certain B vitamins; low in protein but present in a more digestible form.

Health Benefits of Breast-Feeding

  • Protects against infections (diarrhea, meningitis, ear infections).

  • Lowers risks for allergies and chronic diseases and may boost brain development in infants (DHA and AA contributing).

Dietary and Lifestyle Habits for Breast-Feeding Mothers

  • Fluid Requirements: Approximately 13 cups of fluids per day.

  • Caloric Needs: Extra 500 calories/day in the first six months, 400 calories in the second six months.

  • A balanced diet similar to pregnancy is advised, advising to avoid alcohol and drugs, limit caffeine, and adhere to FDA guidelines on fish consumption.

Infant Formula as an Alternative to Breast Milk

  • Situations for Formula Use:

    • Certain health conditions (e.g., HIV, AIDS, cancers) or medications can prevent breast-feeding.

    • Infants with galactosemia must not be breast-fed, leading to the necessity of formula.

  • Nutritional Similarities: Formula composition aims to closely replicate breast milk:

    • Table 14.4 outlines nutritional content such as:

    • Protein per 100 ml: Breast Milk - 1.1g; Formula - 1.8g.

    • Fat: Breast Milk - 4g; Formula - 4.8g.

    • Carbohydrates: Breast Milk - 7g; Formula - 7.3g.

    • Iron absorption discrepancies indicate breast milk is preferable but formula is regulated and enhanced for adequate nutrition.

Nutritional Needs of Infants

  • Growth Expectations: Infants typically double birth weight by six months and triple it by twelve months.

  • Monitoring Growth: Failure to thrive indicates inadequate nutrition and can affect developmental milestones. Growth charts help assess progress.

  • High Nutritional Needs:

    • Infants require 82 calories/kg body weight around 6 months of age. Needs for carbohydrates and proteins should increase with age.

    • Important vitamins/minerals: Vitamin K injections, Vitamin D drops, iron-rich foods (fortified cereals); introduced beginning at 6 months watch for deficiencies especially for breastfed infants.

  • Introducing Solid Foods: Generally starts at six months following developmental readiness; gradual introduction of textures:

    • First solid foods should be puréed (meat, cereals, vegetables, fruit).

    • Avoid choking hazards like hot dog rounds and honey due to botulism risk.

Food Allergies

  • Definitions:

    • A food allergy is an abnormal response by the immune system triggered by a food. Two stages: sensitization and allergic reaction (with possible life-threatening anaphylaxis).

    • Common allergens include: eggs, milk, peanuts, tree nuts, and wheat; specific lifelong allergies may develop.

  • Food Intolerance: Differentiated from allergies; reactions do not involve the immune response (e.g., lactose intolerance).

Summary of Nutritional Guidelines for Parents and Infants

  • Focus on achieving an adequate diet and health standards for infants and pregnant mothers while monitoring any special dietary needs and guidelines.