Chapter 8 Nutrition

Caffein

-very young infants cannot eliminate this toxin easily from the body -baby may experience fussiness or excessive wakefulness

Anorexia is the deliberate restriction of calories, to the point of starvation

Women who are bulimic overfeed (binge) and then force themselves to vomit. ask the mother about her eating habits and any history of an eating disorder.

Vit D in food

- Fatty fish such as salmon, tuna, and mackerel are among the best sources. - Beef liver, cheese, and egg yolks provide small amounts. - Mushrooms provide some vitamin D. In some mushrooms that are newly available in stores, the vitamin D content is being boosted by exposing these mushrooms to ultraviolet light. -Almost all of the U.S. milk supply is fortified with 400 IU of vitamin D per quart. But foods made from milk, like cheese and ice cream, are usually not fortified. -Vitamin D is added to many breakfast cereals and to some brands of orange juice, yogurt, margarine, and soy beverages; check the labels. -The body makes vitamin D when skin is directly exposed to the sun

It is important for the health of both mother and baby that a woman embrace good nutrition during pregnancy, and that she continue healthful habits throughout lactation.

- Suggestions that mention specific foods are easier for people to accept and adapt to their eating practices -translate the instruction, "You need 60 grams of protein each day," into a food practice with specific food selections that provide protein. -Thus, you might say, "You can keep a couple of containers of yogurt on hand for mornings when you don't feel like making breakfast." -suggest that they use vegetable and olive oils instead-avoid animal fats and trans-fats

Dieting While Breastfeeding

- Well-nourished women who reduce their caloric intake modestly can achieve gradual weight reduction and continued appropriate infant growth -healthy women can safely lose approximately 1.1 pounds (0.45-0.5 kg) per week. At this rate of weight loss, they should not experience any adverse effect on milk production, fat content in their milk, or infant growth -caloric intake should not go below 1800 kilocalories (kcal) per day -liquid diets and diet medications should be avoided -combination of exercise and diet to achieve weight loss is preferable

Simple carbohydrates;

- include sugar, jams, honey, chocolate, and other sweets. -can cause a sudden rise in blood sugar level -After only a short time, the blood sugar level drops rapidly, which can create a craving for more food -Stimulate a craving for more food -large amounts of simple carbohydrates may cause fatigue, dizziness, nervousness, or headache

Carbohydrates: -which the body breaks down into simple sugars.

- main source of energy for all body functions and activity; they also help to regulate protein and fat metabolism -body converts excess carbohydrates in the diet into fat and stores it. Carbs can be: simple or complex

vegetarian diet

- vegetarian diet that includes animal products such as milk and eggs can easily supply the pregnant or lactating woman with the nutrients needed to support her body functions and provide for the healthy growth of her baby. -a balanced vegetarian diet may be more healthful than a meat-based diet. Vegetarians consume more volume and fiber with fewer calories and fats, thereby aiding digestion and decreasing the likelihood of accumulating excess weight. -The key to successful management of a vegetarian diet is to plan combinations of foods that provide the essential amino acids -Without the proper balance of amino acids, the body is unable to synthesize the proteins essential for building tissues. -Mother can be deficient in protein and minerals. -This imbalance may result in inadequate growth of the fetus and breastfed infant and inadequate nourishment of the mother -understanding of nutrition, careful meal planning, and selective food shopping are essential for a woman on a vegetarian diet. -Ex: combinations of bread or crackers with nut spreads or tofu (soybean curd) spreads are healthy snack foods -If the mother doesn't consume dairy product she can meet her calcium needs by adding large quantities of green leafy vegetables, broccoli, almonds, molasses, tofu, and fortified soymilk -Iron requirements can be the most difficult to meet. -Foods containing vitamin C—citrus fruit or juice and fresh vegetables eaten at the same meal with legumes and whole grains—help the body absorb the iron from these foods -drinking coffee or tea, including herbal tea, with the meal will decrease the amount of iron absorbed

What to eat?

-A healthy diet low in carbohydrates is compatible with breastfeeding -eat fruits and vegetables and a limited amount of whole grains -to lose weight eliminate high carb food: sugar, flour, breads, cakes, pasta, junk foods, desserts, potatoes, and rice

Unsaturated fats

-A healthy diet should contain a greater amount of unsaturated fats -Unsaturated fatty acids come from vegetables, nuts, and seeds. Fish is a good source of omega fatty acids,

To preserve nutrients

-Cooking food for as short a time and in as little liquid as possible—as with stir-frying and pressure cooking—helps preserve nutrients. -Steaming is preferable to boiling, because the nutrients are not lost in the water needed for boiling -Raw food is even more desirable, as cooking destroys some vitamins -Ex:Raw spinach contains more B vitamins than cooked spinach -Sometimes cooking is important some foods, such as meat, may contain harmful bacteria, which cooking can destroy.

Physical activity postpartum

-Exercising four to six times per week, beginning 6 to 8 weeks postpartum, is safe for most women -Breastfeeding appears to contribute to a mother's postpartum weight loss -between 3 and 6 months postpartum, there was a significantly greater weight reduction when breastfeeding

Fats

-Fats, the most concentrated source of energy in the diet -act as carriers for the fat-soluble vitamins A, D, E, and K -prolong the process of digestion by slowing down the stomach's emptying, which in turn creates a longer-lasting sensation of fullness after a meal

Complete protein food

-Foods that contain all 22 of the essential amino acids Ex: meats and dairy products

Teach mothers

-Fresh, unprocessed foods are the most nutritious and most desirable choices. -food served directly after purchasing or picking is the most flavorful and nutritious -Encourage mothers to select foods that are grown without, or with a minimum amount, of pesticides and heavy metals such as lead and mercury—substances that are stored in their fatty tissue and later enter into their milk. -limiting their intake of freshwater fish and animal fats and by washing all fruits and vegetables thoroughly. -Removing the skin of fresh fruits and vegetables robs them of much of their nutrients and fiber. -Read food labels that provide nutritional information that assists shoppers in healthy food selection, -Food labels also identify additives such as sugar, salt, preservatives, flavoring, and coloring -Package labels offer information on the percentage of the recommended daily allowances of nutrients the food provides as well -Be aware that chemical additives that color the food, enhance flavor, or preserve freshness may alter the nutritional quality -handling and preserving techniques can alter food quality Ex: mushrooms may be bleached, and other vegetables may be treated with fungicides to retard mold growth - Some foods, such as peppers, cucumbers, and tomatoes, are waxed to preserve their freshness during long transport and storage times. Other foods, such as some oranges, are colored to enhance their visual appeal. -Washing with water and mild dish detergent can reduce pesticide residues in fruits and many vegetables

-Dietary iron exists in two forms.

-Heme iron comes from meat, poultry, and fish and is easily absorbed. -Non-heme iron comes from vegetables, iron-enriched cereals, and whole grains -Iron absorption from non-heme food sources can be reduced with the consumption of tea and coffee; phylates in legumes and bran; and oxalates in spinach, beet greens, chard, rhubarb, and sweet potato. -Excess calcium, both in food and supplements, can reduce iron absorption as well. -iron supplements gastrointestinal effects such as heartburn, nausea,constipation, and diarrhea -Supplements may be better tolerated when taken at bedtime and should be consumed with water or juice, and not with milk, tea, or coffee -During lactation, iron levels in the mother's milk remain steady and are unrelated to maternal iron status

Nausea during Pregnancy

-If a woman experiences morning sickness and nausea, she can eat a cracker or a protein such as a piece of turkey or a cube of cheese before getting out of bed. -Following this "stomach settler" with a high-protein breakfast and continued access to simple and healthy foods throughout the day will help her avoid an empty stomach and the return of the nausea -avoid nausea include opening a window or turning on a fan to remove food odors. -eat small, frequent meals, avoid fatty foods, and drink plenty of liquids -avoid highly spiced and very rich foods.

Pregnant women can be encouraged to begin working on good eating habits by learning the relationship of nutrition to the way they feel.

-Issues may include doing the best thing for the baby, having a healthy pregnancy, maintaining a safe weight during pregnancy, and losing pregnancy weight more easily after delivery

Nutrition During Lactation

-Mothers do not need to consume special foods to maintain high-quality milk production -normal healthy diet recommended for an average adult generally suffices to meet most needs - A very young mother, a woman who is carrying or nursing two or more babies, or a pregnant woman who is nursing another child may need to increase her food intake

Avoiding Feelings of Hunger and Fatigue

-Refined sugar is absorbed directly and quickly, causing the blood sugar to rise and fall rapidly, and resulting in hunger soon afterward. -The body converts complex carbohydrates such as potatoes and grains into sugar. a- These nutrients enter the bloodstream more slowly than when sugar is consumed alone, however, leading to a slower rise and more gradual fall in blood sugar. -Proteins and fats are digested even more slowly than carbohydrates a-blood sugar rises slowly and steadily, remains sustained for a longer period, and falls slowly - Caffeine and tobacco tend to suppress the appetite, whereas marijuana and alcohol stimulate appetite and promote indiscriminate snacking -over-the-counter and prescription medications can affect appetite as well, either suppressing or stimulating it

Allergens

-Some evidence suggests that a fetus can be sensitized to allergens in utero and a breastfed infant sensitized through breastfeeding. -A baby born to parents with a history of allergies has a greater possibility of developing the same allergies -Maternal avoidance of potentially allergenic foods such as cow's milk, eggs, and fish during late pregnancy and lactation has been associated with a lower incidence of allergy in children -most foods are considered to be acceptable in the mother's diet unless they cause allergic reactions in the parents

Vit D

-Source : - diet -the body can manufacture vitamin D under the influence of sunlight -Women at highest risk for this problem are those who do not consume milk or fortified margarine, who regularly avoid sunlight or spend little time outdoors, and who wear clothes that cover most of their skin -Women with dark skin coloring are at an even greater risk - short walk outdoor benefits mother and baby terms of their vitamin D level

-body constantly builds and repairs tissues -At times of stress, such as during surgery, hemorrhage, or prolonged illness, it is necessary to consume extra protein to meet the body's increased requirements for this function

-Women aged 19 to 70 consume 46 grams of protein per day, increasing to 71 grams during pregnancy and lactation

Young children and nursing women

-also should avoid consuming those species of fish (shark, swordfish, king mackerel, or tilefish), which tend to live longer and have higher mercury concentrations in their tissues than other fish. -it is permissible to eat as much as 12 ounces per week of shrimp, canned light tuna, salmon, pollock, and catfish -The FDA warns against eating more than 6 ounces of white albacore tuna, which contains more mercury than light tuna. -Good nutrition need not become a barrier to breastfeeding - You can teach them that the human body is very flexible and can make good milk out of many combinations of foods

Vitamins

-are organic substances - vitamins convert fats and carbohydrates into energy and help to form bone and tissue -breastfeeding women are advised to continue taking their prenatal vitamins throughout lactation -Encourage women to consult their caregiver before taking supplemental vitamins and minerals during pregnancy or lactation -supplements should not replace the proper intake of foods rich in vitamins and minerals

Water-Soluble Vitamins

-body cannot store water-soluble vitamins (the B vitamins and vitamin C) -maternal intake of water soluble vitamins can affect the amounts found in milk for most of these vitamins

To reduce energy intake

-can substitute skim milk for whole milk, -unsweetened yogurt for other dessert-type foods, -low-calorie fluids for higher-calories options -lean meat, fewer eggs, and less cheese will all help to reduce fat intake

During Pregnancy

-do not consume raw egg, should be cooked until white and yellow part are solid -Raw foods should be stored separately from cooked foods, and hands and utensils should be washed between preparing these foods -pregnant women should drink only milk that is pasteurized and discard food not used prior to its expiration date -wear gloves when gardening or changing cat litter for further protection -All family members should wash their hands after using the toilet or changing diapers and before eating. -Pregnant women and women considering pregnancy should not eat shark, swordfish, king mackerel, or tilefish. -contain enough mercury (a toxin) to harm a fetus's nervous system

Teach mothers how to eat healthy

-eat whole-wheat bread rather than white bread, bake with whole-wheat flour mixed half and half with unbleached flour, use whole-grain cereals and crackers, and select brown or wild rice rather than polished, instant, or converted rice -many vitamins are water soluble, it is preferable to cook vegetables in a minimal amount of water, tightly covered, and until just tender. -Cooking them in their skins will further help to preserve nutrients -Water saved from cooking vegetables can form the basis of soups and gravies -good practice to serve something raw at every meal, such as carrots, celery, peppers, cauliflower, broccoli, spinach salad, cabbage, cucumbers, grapefruit sections, apple slices, or fresh pineapple. -Purchasing fruits canned in juice rather than in heavy syrup helps reduce sugar intake -use 100% juices are superior to fruit drinks or other beverages that are high in sugar -use Homemade popsicles consisting of fruit juice

Preconception Nutrition

-encourage them to eat a healthy, varied diet and to aim for the recommended weight range. Either a very low weight or a very high weight could decrease a woman's ability to conceive -a healthy weight and a moderate alcohol intake by the male partner can assist in conception and development of a healthy baby. -maternal alcohol intake can have serious effects on the baby, so women who are planning a pregnancy are encouraged to reduce or cease their consumption of alcohol. -check iron levels before pregnancy -folic acid supplement is frequently recommended both prior to conception and during the first 3 months of pregnancy to reduce the risk of neural tube defects in the developing fetus

Vitamins continue

-excess amounts of some vitamins, such as vitamin A, can be harmful. -High doses of vitamin B6 (600 mg/day) have been reported in older studies to cause lactation suppression

With constipation

-exercise, drinking plenty of fluids, and consuming a sufficient amount of fiber in the form of fresh fruits and vegetables, whole grains, nuts, seeds, and bran

Calcium

-gives bones their rigidity and teeth their hardness. -This mineral also has a role in blood clotting and in controlling the action of the heart, muscles, and nerves. -Consumption of vitamin D along with calcium promotes optimal absorption and use of calcium - breastfeeding appears to increase the mother's bone mineral density, thereby helping to prevent osteoporosis -Pregnant women and mothers need adequate calcium intake, particularly women younger than the age of 25 who are still experiencing an increase in their bone content -recommended 800-1200 mg per day. Calcium carbonate is the safest supplement

Sources of protein: include meats, eggs, nuts, grains, legumes, and dairy products such as milk and cheese

-incomplete protein food makes a complete protein complement when it is combined with other incomplete protein foods that fill in the missing pieces - Ex: Peanut butter and bread, pasta and cheese, breakfast cereal and milk, and beans and rice

Protein

-is the major source of building materials for all of the body's internal organs, as well as for muscles,blood, skin, hair, and nails -important to the formation of hormones that - (control sexual development and the production of milk during lactation) -is also a source of heat and energy for the body -building blocks ( 22 amino acid) -body can synthesize 14 of these amino acids whereas the diet must supply the remaining 8

Incomplete protein food

-lacking or having extremely low amounts of any of the essential amino acids are.... - most vegetable or plant proteins, such as beans and grains

Inadequate nutrition due to improper diet can restrict healthy fetal growth by reducing the number or size of fetal cells, including brain cells.

-maternal malnutrition due to critically low nourishment can contribute to fetal death -arbitrary dietary restrictions while breastfeeding may increase the risk of early weaning -.Referral is appropriate for women with a body mass index (BMI) of less than 19.8 (very underweight) or more than 26 (overweight), teens , people with diabetes, , bariatric surgery, or metabolic disorders.

Minerals

-minerals contribute to a person's overall mental and physical well being -maintaining physiological processes, strengthening skeletal structures, and preserving the vigor of the heart, brain, muscles, and nervous system. - minerals play important roles in the production of hormones and help maintain the delicate water balance essential to the proper functioning of mental and physical processes -A varied and mixed diet of animal and vegetable origin that meets the recommended energy and protein needs will typically furnish adequate minerals -Three minerals—calcium, iron, and salt—are especially important during pregnancy and lactation

Nutrition During Pregnancy

-needs an increased amount of most nutrients during pregnancy -Fetal growth may affect later adult health -example: intrauterine growth retardation (IUGR) is associated with increased risk to the infant of coronary heart disease, stroke, diabetes, and high blood pressure in adult life - Large size at birth, known as macrosomia, is associated with increased risk of diabetes and cardiovascular disease in later life and an increased risk of some cancers. -Maternal insulin-dependent diabetes or gestational diabetes increases the risk for macrosomia and other infant health problems

Nutrient

-promote body function -Each nutrient has a specific function

Based on the findings, study researchers are recommending that pregnant women take 4,000 international units (IU) of vitamin D every day -- at least 10 times the amount recommended by various health groups.

-reduced risk of complications, including gestational diabetes, preterm birth, and infection, new research suggests. -These women who took 4000 UI of vit D every day also had the lowest rate of pregnancy-related complications -They were also less likely to give birth prematurely. -infants with very low vitamin D levels are at increased risk for soft bones, or rickets -Fortified milk and fatty fish are common food sources of vitamin D -breast milk alone does not provide infants with an adequate intake of vitamin D

Group Instruction in Nutrition

-serve nutritious juice -Nutritious snacks might include natural fruit juices, fresh fruit, raw vegetables and dip, wholesome cookies and breads, cheese and crackers

A mother who does not eat breakfast...

-suggest a quick protein food such as peanut butter on toast and a glass of milk for breakfast. - Later you may offer an additional suggestion of replacing white bread with whole-grain bread. -Help her to change one step at a time, making sure she understands the purpose for each change. -suggest changes in diet gradually

Complex carbohydrates include starches such as cereals, rice, breads, crackers, pasta, vegetables, and fruits.

-they are key components of a healthy diet. -take longer to digest than simple carbohydrates and do not stimulate a craving for more food -contain important vitamins and minerals, also provide fiber ( vegetables, grains, fruits)

linoleic and alpha-linolenic,

-which are known as essential fatty acids (EFAs)—are converted into arachidonic acid (AA) and docosahexaenoic acid (DHA), respectively -AA and DHA are important for neural and visual development in the fetus. - Ex: of EFAs vegetable oils; margarines and salad dressings -AA is directly available from beef, pork, poultry, and eggs. -DHA is available from fatty fish such as mackerel, salmon, and sardines. - Encourage women to use a variety of types of oil in addition to animal sources of AA and DHA -Advice woman do not eat a very low fat diet during pregnancy and lactation

1. macronutrients (protein, fats, and carbohydrates)

2. micronutrients (vitamins and minerals).

Drinking a moderate amount (up to 2 to 3 cups a day) of coffee or other caffeinated beverages does not affect your baby. - See more at: http://www.choosemyplate.gov/moms-breastfeeding-nutritional-needs#sthash.o5MbZmQO.dpuf

A common suggestion is to drink a glass of water or other beverage every time you breastfeed. - See more at: http://www.choosemyplate.gov/moms-breastfeeding-nutritional-needs#sthash.o5MbZmQO.dpuf

Fat-Soluble Vitamins

A, D, E, and K are stored in the body's fatty tissues -Vitamin A contributes to the growth of the skeleton and promotes healthy mucous membranes and vision -Vitamin K is essential for blood clotting. Ex of Vit. K; green leafy vegetables - Vit K- infants' stores at birth are low, which can lead to a risk of hemorrhagic disease in newborns -Maternal supplementation during the final weeks of pregnancy may reduce the risk -Infants usually receive vitamin K routinely at birth

Iron

Additional iron is needed during pregnancy to support the growing fetus and placenta and to increase the mother's red cell mass -Low levels of iron can cause tiredness

Certain other groups may not get enough vitamin D: Breastfed infants, since human milk is a poor source of the nutrient. Breastfed infants should be given a supplement of 400 IU of vitamin D each day. Older adults, since their skin doesn't make vitamin D when exposed to sunlight as efficiently as when they were young, and their kidneys are less able to convert vitamin D to its active form. People with dark skin, because their skin has less ability to produce vitamin D from the sun. People with disorders such as Crohn's disease or celiac disease who don't handle fat properly, because vitamin D needs fat to be absorbed. Obese people, because their body fat binds to some vitamin D and prevents it from getting into the blood.

Cancer Some studies suggest that vitamin D may protect against colon cancer and perhaps even cancers of the prostate and breast

A number of factors decrease the amount of vitamin D a person will synthesize from sunlight. These factors include Living at high latitudes (closer to the polar regions), particularly during winter months Air quality conditions: high levels of air pollution Weather conditions: dense cloud covering The degree to which clothing covers the skin Use of sunscreen Skin pigmentation: darker skin types

Human milk typically contains a vitamin D concentration of 25 IU per liter or less. Therefore, a supplement of 400 IU per day of vitamin D is recommended for all breastfed infants.

Weight during lactation

Lactation uses energy from body stores and the mother's diet, with an average weight loss of 1-2 pounds per month for a mother with a healthy diet and normal physical activity. If the mother's intake exceeds her needs, or if she eats large amounts of sweet foods in place of more nutritious foods, she will likely gain weight during lactation

-poor maternal nutrition during pregnancy

Risk for: -chronic diseases later in life, such as obesity, hypertension, cardiovascular disease, and diabetes later in life

Fatty acids; which give fats their different flavors, textures, and melting points

Saturated Unsaturated

Saturated fatty acid

Saturated fatty acids come primarily from animal sources, such as meat, milk products, and eggs.

Vitamin D is found in supplements (and fortified foods) in two different forms: D2 (ergocalciferol) and D3 (cholecalciferol). Both increase vitamin D in the blood.

Vit D level in blood: levels below 30 nmol/L (12 ng/mL) are too low for bone or overall health, and levels above 125 nmol/L (50 ng/mL) are probably too high. Levels of 50 nmol/L or above (20 ng/mL or above) are sufficient for most people. -on-Hispanic blacks tend to have the lowest levels and non-Hispanic whites the highest

Vit D

Vitamin D is a nutrient found in some foods that is needed for health and to maintain strong bones. It does so by helping the body absorb calcium -People who get too little vitamin D may develop soft, thin, and brittle bones, a condition known as rickets in children and osteomalacia in adults. -Muscles need it to move, for example, nerves need it to carry messages between the brain and every body part, and the immune system needs vitamin D to fight off invading bacteria and viruses. -calcium, vitamin D also helps protect older adults from osteoporosis

You can continue to breastfeed and have an occasional alcoholic beverage if you are cautious and follow these guidelines:

Wait until your baby has a routine breastfeeding pattern, at least 3 months of age. Wait at least four hours after having a single alcoholic drink before breastfeeding. Or, express breast milk before having a drink and use it to feed your infant later. - See more at: http://www.choosemyplate.gov/moms-breastfeeding-nutritional-needs#sthash.o5MbZmQO.dpuf

water

Water is the most abundant—and by far the most important—nutrient in the body - Fruits and vegetables are especially good sources of chemically pure water -average adult female body contains 50-55 percent water (approximately 30 quarts) and loses about 2 quarts daily through perspiration and excretion -Having a beverage next to them when they nurse their baby will remind them to drink to satisfy their thirst. -woman needs approximately 6 to 8 cups of fluid per day during pregnancy and lactation, to ensure that her body has enough fluid to function and to avoid constipation - women who consume excessive amounts of fluid actually produce less milk and their babies gain less weight -Mothers can monitor the adequacy of fluid intake by observing their urine. Except for the first morning void, the mother's urine should be clear to light yellow. If her urine appears more concentrated, she can increase her fluid intake throughout the day.

Vitamin B12 Intake

available primarily from animal sources -vegetarian diets who avoid animal products may be deficient in this vitamin -signs that suggest a deficiency in an infant between 4 and 8 months of age—namely, anemia, growth failure, neurological delay,tremors, and excess skin pigmentation -supplementation during pregnancy and lactation is essential when the mother's diet limits or excludes sources of this vitamin

. These diets tend to be unbalanced

macrobiotic diet, raw foods diet, fruitarianism, or any other arbitrarily adopted pattern that may be harmful during pregnancy or lactation

snack ideas

include a bran muffin with cream cheese, cheese with crackers, yogurt dip with raw vegetables, fresh fruit, custard, popcorn, cottage cheese and fruit, and hard-boiled eggs.

Salt

woman's blood volume increases by more than 40 percent to meet the placenta needs the increased blood flow to work efficiently -pregnancy is one condition in which the body actually requires more salt so that it can function well -salt restriction during pregnancy is not beneficial and may even be harmful

• Fats create a longer feeling of fullness. • Folic acid helps prevent anemia in pregnancy and neural tube defects. • Vitamin B12 may help prevent neural tube defects and cardiac defects.

• A newborn's vitamin K levels are low and are typically supplemented. • Low levels of vitamin D in a pregnant woman result in low levels in the baby. • Pregnancy and lactation require increased calcium, iron, and water intake to ensure good health for both mother and child.

Nutrition in pregnancy and lactation: • Pregnancy and lactation are times when women are often especially receptive to nutrition education. • A mother's body stores and the food she eats provide energy and nutrients for her baby.

• Sugary foods may cause erratic blood sugar, fatigue, dizziness, nervousness, and headache. • Complex carbohydrates take longer to digest and prevent cravings for more food. • Protein is needed for formation of hormones and milk production during lactation.

Applying what you learned— • Strive for diet improvement, where the ideal diet consists of three well-balanced meals a day with snacks as needed. • Encourage pregnant women to eat small, frequent meals, avoid fatty foods, and drink plenty of liquids.

• Teach mothers about practical food choices rather than nutrients. • Teach mothers to base their meal planning on the food pyramid. • Teach mothers how to balance complete protein and incomplete protein foods.

• Teach mothers how to consume more unsaturated fats than saturated fats and to avoid trans-fats. • Teach mothers to respond to their thirst as a signal to consume necessary additional fluids.

• Teach mothers that consuming protein and complex carbohydrates at breakfast help prevent laterfatigue. • Teach mothers to read food labels for nutritional information.

-normal weight gain during pregnancy

• Underweight (BMI of less than 19.8): 28-40 pounds • Normal weight (BMI of 19.8-26.0): 25-35 pounds • Overweight (BMI of 26-29): 15-25 pounds • Obese (BMI of more than 29): Approximately 13 pounds

Making Healthy Food Choices • Make half your plate fruits and vegetables. Choose a variety, including dark-green and red and orange vegetables and beans and peas. • Make at least half your grains whole. Choose whole grains in place of refined grains. • Switch to skim or 1% milk. Choose fat-free or low-fat milk and milk products such as milk, yogurt, cheese, or fortified soy beverages.

• Vary your protein food choices. Choose seafood, lean meat and poultry, eggs, beans and peas, soy products, and unsalted nuts and seeds. • Use oils to replace solid fats where possible. • Make choices that are low in "empty calories." What are "empty calories"? They are calories from added sugars and solid fats in foods. Some foods with empty calories: • Candy • Desserts • Fried foods • Ice cream • Sugar-sweetened • Sweetened cereals • Biscuits • Hot dogs • Soft drinks/soda fruit drinks/tea

• Consuming excessive fluid can reduce milk production. • A normal, healthy diet will meet the mother's nutritional needs during lactation. • Lactation uses energy from body stores and from diet.

• Well-nourished, healthy women can safely lose about one pound (0.55 kg) per week after giving birth. • Food additives and processing alter nutritional quality favorably and unfavorably. • Vegetarian diets that include milk and eggs supply necessary nutrients.