Pregnancy & Breastfeeding

Energy Needs During Pregnancy

1st trimester. Balanced and adequate diet. 2nd and 3rd Trimester. 350-450 extra kcal per day. Choose nutrient-dense foods. Adequate weight gain. The best predictor of outcome

Recommended Weight Gain During Pregnancy

2 - 4 lb. weight gain during 1st trimester. 0.75 - 1 lb. weekly weight gain during 2nd and 3rd trimester. Total weight gain goal 25 - 35 lb. for normal weight women - 28 - 40 lb. for low weight (BMI < 19.8) - 15 - 25 for high weight (BMI 26-29) - 15 - 25 lb. for obese (BMI > 29)

Ability to Breastfeed

Almost all women are physically capable. Irrespective of breast tissue size. Barriers to breastfeeding: Lack of support. Lack of appropriate information. Inexperienced mothers. Requires patience

Environmental Contaminants in Breast Milk

Avoid freshwater fish from polluted water. Carefully wash and peel fruits and vegetables. Remove fat from meats

Overall Food Plan

Balanced variety of foods. Moderate fat intake. Adequate fluids. Reduction of milk supply caused by restricting kcal. Ingestion of alcohol, Smoking. Limit high mercury fish and intake of peanuts (allergens)

Food Plan for Lactating Moms

Calcium-rich sources: 2-3 servings. Meat, meat substitute group: 2 servings. Vegetable group: 4 servings. Fruit group: 3 servings. Bread, cereal, rice, pasta group: 9 servings

What About Caffeine?

Decreases iron absorption May reduce blood flow through the placenta. Caffeine withdrawal symptoms in newborn. Risk of spontaneous abortion. Heavy caffeine use in the 1st trimester. Risk of low-birth-weight infant Limit caffeine intake (< 3 cups coffee/day)

The Second Trimester

Fetus begins to look more like an infant. Still susceptible to toxin exposure. Preparation for lactation. Increase of 2-4 lb. in breast tissue. Deposit of fat tissue. Nutritional deficiency at this time affects mother's ability to breastfeed

The First Trimester

First 13-14 weeks of pregnancy. Rapid increase in cell number and size. Nutritional deficiency or toxicity. Can be harmful to embryo. Medication, radiation, trauma. Can be harmful to embryo. ~ Half (1 in 2) of all pregnancies miscarry during the first trimester

Breastfeeding

First 6 months of life breastfeed solely. Solid foods and breast milk until 1 year. Recommended by American Dietetic Association and American Academy of Pediatrics. The World Health Organization. Breastfeed for at least 2 years. 70% of all mothers breastfeed in the hospital. Number decreases as infants get older

Milk Composition

Fore milk (first 10-20 minutes of every feeding). Resembles skim milk - ~17% fat, ~74% CHO, ~9% protein. Hind milk is released 10-20 minutes into the feeding and resembles cream - ~66% fat, ~28% CHO, ~6% protein

Listeria monocytogenes

Found in unpasteurized milk, soft cheeses make from raw milk, raw cabbage. Causes flu-like symptoms. 7 to 30 days after exposure. May contribute to spontaneous abortion. Recommend pasteurized milk, thoroughly cooked meats, fish, and poultry

Fluid Needs

Human milk provides adequate hydration for baby. Additional fluids needed (only if) hot climate, diarrhea, vomiting. Too much water leads to brain disorders and causes low blood sodium

Well-nourished Breastfed Infant How can you tell?

Infant has 6 + wet diapers a day. Shows normal weight gain. Passes 1+ stool per day. Softening of breast tissue May take 2-3 weeks to establish breastfeeding routine Introduce bottle-feeding only after breastfeeding is well established, and only if needed!

Fetal Alcohol Syndrome

Large amounts of alcohol during pregnancy. Excess alcohol reaches the embryo/fetus. Embryo/fetus cannot metabolize alcohol. Poor fetal and infant growth. Physical deformities. Mental retardation Irritability and hyperactivity

Low Birth Weight Infants

Less than 5.5 pounds at birth. Usually due to preterm births. Increased medical costs. Small for gestational age. Full-term babies. Low birth weight. More likely to have medical complications

Physical Activity

Low impact and non-contact activities. 30+ minutes on most days. Promotes easier delivery. Non-active women. Should not begin an intense exercise program. High risk pregnancies. May need to restrict activities. Consult physician about possible limitations

Planned Pregnancies Have the Best Outcome

Many practices can be harmful to the fetus. Minimize exposure even prior to conception. Nutrition is important. ~50% of all pregnancies are unplanned.

Environmental Contaminants

Mercury. Avoid swordfish, shark, king mackerel and tile fish. < 6 ounces of tuna per week

Barriers to Breastfeeding

Misinformation. Need to return to work force. Embarrassment and modesty. Medical conditions include, infant with galactosemia, Infant with PKU, Mothers on medications, Mothers with TB, AIDS, HIV+, undergoing chemotherapy

Lactation Nutritional Needs

Most substances ingested are secreted into mother's milk. Milk production requires ~800 kcal/day. Energy RDA is additional 400-500 kcal/day. kcal difference will contribute to mother's gradual weight loss. Increased need for vitamins A, E, C, riboflavin, copper, chromium, iodide, magnanese, selenium, and zinc. Follow the diet plan for pregnancy

A Successful Pregnancy

Mother's physical and emotional health. Infant: >37 weeks gestation. Birth weight > 5.5 pounds. Sufficient lung development. The longer the gestation, the less the health risk.

Success in Pregnancy

Prenatal care. Maternal age. Closely spaced and multiple births. Smoking, medication and drug abuse. Food safety. Nutritional status

Protein and Carbohydrate Needs During Pregnancy

RDA for protein. Additional 25 gm/day. Many (non-pregnant) women already consume recommended amount of protein. RDA for carbohydrate. Prevent ketosis. 175 gm/day. Most women exceed this amount

The Third Trimester

Rapid growth. 2X length - 2X-3X weight. Transfer of fat, calcium, and iron to fetus during the last month. Iron. Fetus may deplete mother's store of iron if intake is low

How Human Milk is Produced

Simulates hypothalamus (brain). Suckling by infant Initiates the release of hormones prolactin and oxytocin by the pituitary gland (brain). Prolactin stimulates milk production. Oxytocin causes release of milk from storage (breast). Let-down reflex. Milk supply for the infant inhibited by nervous tension, lack of confidence, fatigue

Colostrum

Thick, yellow fluid produced during late pregnancy and few days after birth. Contains antibodies, immune-system cells and Lactobacillus bifidus factor. Provides protection to infant against. infections. Facilitates the passage of 1st stool (meconium).

Mature Milk

Thin, watery, slightly bluish composition. Easily digested proteins. Protein binds to iron, reducing bacteria growth. High linoleic acid and cholesterol content. Needed for brain development. Long chain omega-3 fatty acids (DHA). Synthesis of brain tissues, central nervous system, eyes

Does Nutrition Matter?

Yes! Supports fetal growth. Supports maternal changes. To support pregnancy and lactation. Inadequate calories. Can retard fetal growth. Higher risk for maternal and fetal death in famine areas. The poorer the nutritional status of the mother, the poorer the outcome. Women, Infant, and Children (WIC)