Chapter 16

There is substantial evidence that individuals who suffered calorie restrictions during fetal life develop the capacity to use calories in a ____ manner. That is, throughout their lives they need ____ calories to maintain their bodies and support physical activity. Although this thrifty calorie usage promotes survival when the food supply is restricted, it elevates the risk of _____ when food is abundant.

- "thrifty" - fewer - obesity and type 2 diabetes

Underweight women should gain about __ to __ lb (0.45 to 0.6 kg) per week. Overweight women should gain about ___ to ___ lb (0.23 to 0.32 kg), and obese women should gain ___ to __ lb (0.18 to 0.27 kg) each week.

- 1, 1.3 - .5, .7 - .4, .6

During the 1st trimester, most women should gain about ___ to ___ lb (0.5 to 2 kg), most of which is accounted for by the enlarging ______. After that, a woman who starts at a normal weight should gain about __ to _ lb (0.35 to 0.45 kg) a week at a slow, steady rate.

- 1.1, 4.4 - breasts and uterus - .8, 1

- A healthy full-term newborn usually weighs about ___ lb. - Low-birth-weight babies are much more likely to die during the first ____ weeks of life than a heavier infant. -Those who survive are more likely to be ______ than heavier babies.

- 7.5 - 4 - ill and handicapped

During pregnancy, another type of diabetes, gestational diabetes, develops in approximately _% of women. Hormones synthesized by the placenta decrease the efficiency of ____ and lead to a mild increase in blood glucose. An excessive rise in blood glucose can lead to gestational diabetes, often beginning in weeks __ to __.

- 9 - insulin - 20, 28

_______—thin, yellowish, "immature" milk—may appear anytime from late pregnancy to several days postpartum. This early milk is richer in ______ than later milk, but it has less _____ (lactose) and slightly fewer calories. It also contains ____ and immune system cells, some of which pass unaltered through the infant's immature GI tract into the bloodstream and provide the infant with a defense against some diseases during the 1st few months of life when the immune system is very immature.

- Colostrum - protein, minerals, and vitamin A - carbohydrate - antibodies

Folate and vitamin B-12 are critical for the synthesis of _____. For instance, red blood cell formation, which requires ____, increases during pregnancy.

- DNA and fetal and maternal cells - folate

Insufficient evidence exists to conclude that vitamin _ and ____ supplements are effective in reducing the risk of preeclampsia. Restricting sodium does ____ reduce preeclampsia risk, although moderate ____ throughout pregnancy may reduce the risk.

- E, fish oil - not - exercise

_______ provide nutrition education for those with limited resources. Program participants learn about good nutrition, meal planning, and techniques for stretching food dollars. _____ also provides foods for those with limited financial resources. _____ provides nutritious foods specifically to low-income pregnant, postpartum, and breastfeeding women, as well as infants and children up to age 5 who are at nutritional risk.

- EFNEP and SNAP - SNAP - WIC

____ deficiencies in the very early stages of pregnancy also can cause neural tube defects. The neural tube is tissue that develops into the _____. It starts as a shallow groove running down the back of the embryo that, at __ days of gestation, folds in on itself to create a tube. If it fails to close at the ___, the brain does not develop fully and death occurs soon after birth.

- Folate - brain and spinal cord - 28 - top

One component of colostrum, the ______ factor, encourages the growth of Lactobacillus bifidus bacteria, which limits the growth of potentially toxic bacteria in the infant's large intestine. In addition, colostrum contains a potent ____, which helps the infant excrete the fecal matter that collected in the intestinal tract during fetal life.

- Lactobacillus bifidus - laxative

______ affect the fetus when the pregnant woman smokes or is exposed to secondhand cigarette or cigar smoke. Smoking restricts blood flow, reducing the amount of oxygen and nutrients, especially ____, that reaches the fetus, which in turn impairs growth. Smokers have an increased risk of spontaneous abortion and _____ problems. Smokers' babies are more likely to be premature, experience prenatal growth retardation, and die soon after birth than are nonsmokers' babies. They also have an increased risk of birth ____ and sudden infant death.

- Nicotine and carbon monoxide - zinc - placenta - defects

This combination of supplemental foods, nutrition education, and health-care referrals has helped improve the nutrition-related health conditions of ___ participants. In addition, participation in WIC is linked to ____ birth weights, ____ infant deaths, and ____ medical costs after birth.

- WIC - higher - fewer - lower

Breast surgery may affect a woman's ability to produce milk and/or secrete it. Many women who have had breast implants are ___ to breastfeed. Women who have had breast ____ surgery may not be able to breastfeed if the milk-producing glands have been removed or their connection to the lactiferous ducts has been disrupted.

- able - reduction

Women with poorly controlled type 1 or type 2 diabetes are at great risk of a poor pregnancy outcome. If blood glucose levels are elevated, the embryo or fetus is likely to have major birth defects that lead to spontaneous ______, infant ____, or serious infant _____. To prevent these consequences, women with diabetes need to work closely with their health-care providers to bring their diabetes under control before pregnancy and keep their blood glucose at normal levels throughout pregnancy.

- abortion - death - illness

Within minutes of its consumption, alcohol is present in the _____, where the alcohol's intensity is magnified by the small size of the embryo or fetus. In addition, the effects of the alcohol are prolonged because the developing offspring is unable to _____ the alcohol. It must wait for maternal blood to slowly carry the alcohol away.

- amniotic fluid - metabolize

Human immunodeficiency virus (HIV) can be transmitted to the baby via human milk; however, transmission of HIV to infants is greatly reduced when HIV-exposed infants or HIV-infected mothers receive _____ (ARV) interventions. The U.S. Centers for Disease Control and Prevention advises ____ breastfeeding by women with HIV or taking ARVs.

- antiretroviral - against

Iron supplements can decrease ____ and cause _____; taking them between meals or just before going to bed can minimize these problems. ____ should not be consumed with an iron supplement because these beverages contain substances that interfere with iron absorption. Eating foods rich in ____ along with iron supplements or foods that contain heme iron helps boost iron absorption.

- appetite - nausea and constipation - Coffee or tea - vitamin C

Once lactation is established, the let-down reflex becomes ______. It can be triggered just by thinking about her infant or hearing a baby cry. It generally takes ____ weeks to fully establish a feeding routine in which both the infant and the mother feel comfortable, the milk supply meets infant demand, and initial nipple soreness disappears. Establishing the breastfeeding routine requires patience, but the rewards are great.

- automatic - 2,3

Breastfeeding offers nutritional, immunological, and psychological benefits to the infant. Breastfeeding mothers, too, may gain health benefits, including a lower risk of ____ and premenopausal ____ cancer, bone remineralization to levels exceeding those before lactation, weight loss, quicker return of the uterus to its prepregnancy state, and less postpartum _____

- ovarian, breast - bleeding

For example, iron, zinc, selenium, and vitamins A, B-6, C, and D can exert ____ effects when taken in large doses. Supplemental preformed vitamin A is especially important to keep under control; it should not exceed ____ μg RAE/day (15,000 IU per day) because higher levels are linked with _____ birth defects, mainly during the 1st trimester.

- toxic - 3000 - teratogenic

The colostrum gradually changes in the early days after delivery to become ______. - Transitional milk contains more______, and calories than colostrum. Within a week or so, transitional milk is replaced by ______. - Mature human milk is thin and almost _____ in appearance and often has a slightly bluish tinge. It provides about __ calories per ounce and, with the possible exceptions of _____, supplies all the nutrients the growing baby needs

- transitional milk - fat, lactose, water-soluble vitamins - mature milk - watery - 20 - vitamin D and iron

That is, the more an infant suckles, the more milk that is produced. This is what makes it possible for a woman to adequately breastfeed even _____. To wean a child, it is best to gradually stop breastfeeding, usually by eliminating _ daily feeding each week. Abruptly stopping causes the breast to become painfully engorged with milk for several ___

- twins and triplets - 1 - days

The ______ is the pipeline that connects the placenta to the fetus. Fetal blood travels from the fetal heart to the placenta by way of _ umbilical arteries and returns (nutrient enriched and waste free) to the fetus by means of _ umbilical vein.

- umbilical cord - 2 - 1

Many teens enter pregnancy _____ and gain too little weight during pregnancy. In addition, many teens do not receive adequate ____ care. For all these reasons, babies born to teens are at greater risk of premature birth, prenatal growth ______, and _____ soon after birth. Teens also have more ____ and spontaneous abortions than older women

- underweight - prenatal - retardation - death - stillbirths

A zygote nourishes itself by absorbing secretions from glands in the _____ and digesting some of the _____. As a zygote develops into an embryo, the _____ begins to form inside the mother's uterus. - The placenta is a spongy, pancake-shaped, temporary organ that taps into the mother's ________.

- uterus - uterine lining - placenta - blood supply

____ is the main component of human milk, like other milk. Inadequate water intake can alter milk composition, decrease the amount of milk produced, and lead to maternal dehydration. To keep herself well hydrated, a breastfeeding woman should drink to satisfy her thirst. Most need an extra __ ounces of fluid daily, in addition to the __ ounces recommended for nonpregnant women. Some women, especially those breastfeeding more than _ baby, need to consume even greater quantities.

- water - 32 - 72 - 1

Thus, to help women of low socioeconomic status procure the foods and nutrition education they need, the U.S. Department of Agriculture funds the ______ (EFNEP), the Supplemental Nutrition Assistance Program (SNAP), and the Women, Infants, and Children (WIC) program.

Expanded Food and Nutrition Education Program (EFNEP)

An infant's birth weight is closely related not only to length of _____ but also to the woman's prepregnancy ____ and the amount of weight she ____ during pregnancy

gestation - weight - gains

An infant's chances of survival depend greatly on both

gestation length and birth weight

Zinc intake by both pregnant and nonpregnant women often is ___ than the RDA; however, deficiencies are uncommon. Severe zinc deficiency may cause birth defects, fetal growth ____, premature birth, and _____. Pregnant women may experience prolonged labor, bleeding, infections, and serious complications, such as pregnancy-induced hypertension and preeclampsia

less - retardation - spontaneous abortion

For instance, babies born to obese women are at increased risk of having birth defects, such as neural tube defects and _______, being _____ or dying in the 1st few weeks after birth, having high birth weights, and being obese in childhood. Many obese pregnant women experience high blood pressure, gestational diabetes, and ____ (also called surgical) deliveries. Obese women can reduce these risks by losing weight before becoming pregnant.

oral clefts - stillborn - Cesarean

Infants who are born small also have a greater risk of developing

heart disease, high blood cholesterol levels, diabetes, and high blood pressure and experiencing impaired immune function

The cause of cravings and aversions remains a mystery; they may be related to _____ changes in the mother or family traditions. There is no evidence that cravings and aversions are the result of nutrient deficiencies.

hormonal

pregnant women should avoid foods frequently found to be contaminated with______, such as raw sprouts, unpasteurized milk and juices, and raw or undercooked meat, fish, shellfish, and eggs.

pathogens

For example, breastfeeding may be detrimental to infants with the inborn error of metabolism ______ . The high concentration of phenylalanine and galactose in human milk may overwhelm the impaired ability of these infants to metabolize these nutrients, leading to serious ______ even death.

phenylketonuria or galactosemia - illness

Over the course of gestation, a single cell zygote will divide millions of times, creating trillions of cells. Although every nutrient plays an important role in manufacturing these new cells, the roles of ______ are especially noteworthy during pregnancy.

protein, essential fatty acids, zinc, folate, vitamin B-12, and iron

Infants born prematurely have difficulty______, which greatly affects their nutrient and calorie needs. Premature infants also are at risk of _____ because nutrient stores do not accumulate appreciably until the last _ to _ weeks of gestation.

regulating body temperature - nutrient deficiencies - 4,6

Infants breastfed by adolescent mothers may grow more ____ than infants of older mothers. Teens can successfully breastfeed their offspring, but they need to work with their health-care providers to ensure that their own as well as their infant's nutrient needs are adequately met.

slowly

In contrast, a preterm infant is almost always low birth weight but may not be ________.

small for gestational age

One approach to a diet plan that supports a successful pregnancy outcome is based on MyPlate. For an active adult woman in the 1st trimester, about_____ kcal are recommended. - Dairy group: - protein group: - vegetables group: - fruit group: - grains group:

2200 - 3 cups - 6 ounce (iron,zinc) - 3 cups (1 vitamin c, 1 cup folate) - 2 cups - 7 ounce

High-risk women should be screened for gestational diabetes as soon as possible, with repeated screenings if earlier tests were negative. Average-risk women are usually screened for gestational diabetes between __ and __ weeks of pregnancy.

24, 28

More than __ of all women in the U.S. of childbearing age consume alcohol. Alcohol intake can impair the ability to become pregnant. During pregnancy, alcohol may displace nutrient dense foods in the mother's diet. Alcohol also slows nutrient and oxygen delivery to the embryo or fetus, _____ growth and development. Although the most severe damage occurs during the ____ stage, a time with many critical periods, consuming alcohol at any time during pregnancy can cause damage to the embryo or fetus that lasts a _____.

- 1/2 - retarding - embryo - lifetime

Folic acid, the synthetic form of folate used in supplements and fortified foods, can prevent ____ or more of all neural tube defects. Folic acid is absorbed almost ____ as well as the folate that naturally occurs in foods.

- 1/2 - twice

Prior to 1998, when the FDA began requiring folate fortification of grains and cereals, only __% of women met the folate RDA. Almost 1 in every 1000 babies born in the U.S. had a neural tube defect. Since folate fortification began, the number of babies born with neural tube defects has declined by __%.

- 10 - 26

Young women continue maturing physically for about 5 years after the onset of menstruation (menarche). Because the average age for menarche is 13 years in the U.S., most women younger than __ years are not as physically ready to be pregnant as they will be later. In addition, the teen years are a period of high nutrient needs, and teens' nutrient intakes frequently are _____ recommended amounts.

- 18 - below

During the earliest days of life, sucking is strongest in the ____ or so after birth; thus, this is the best time to begin feeding. In the days right after delivery, the baby should suckle often (at least every ____ hours for ____ minutes on each breast) to promote the establishment of lactation. After a few weeks, nursing sessions can become less frequent. As long as the mother breastfeeds her baby regularly, milk production will continue and can theoretically go on for _____

- 1st hour - 2,3 - 15,20 - years

calorie needs can be met by eating the same number of servings from each food group as recommended for a pregnant woman in the last _ trimesters. The average breastfeeding woman uses about ___ calories per day during the 1st 6 months of lactation to produce ___ ml (3 cups) of milk daily. Approximately ___ calories should come from her diet, with the remainder supplied by the fat stored during pregnancy.

- 2 - 800 - 750 - 400, 500

During the fetal stage, length increases __ times or more to an average of 20 to 22 inches (51-56 cm). Weight skyrockets, increasing about ____ times, to an average weight of 7 to 8 pounds (3.2-3.6 kg).

- 20 - 3500

During pregnancy, the number of maternal red blood cells increases __ to __%, but the liquid portion of the blood (plasma) expands __%. Thus, there is a lower ratio of red blood cells to total blood volume. This hemodilution, known as ______ anemia, is a common, expected condition during pregnancy and does not pose a danger to the health of the mother or the fetus.

- 20, 30 - 50 - physiological

Nevertheless, many experts agree that it is sensible to limit caffeine intake during pregnancy to around ___ mg daily, which is about _ cups of coffee or _ cups of caffeinated soft drinks

- 200 - 2 - 3

Between __ and ___ weeks, body proportions shift to be similar to those of newborn infants, although the fetus is still quite slim and has loose, baggy skin. Body fat rises from less than _% at 20 weeks to __% by 38 weeks. The stored ______ smoothes and tightens the skin and, most importantly, insulates the body.

- 21, 30 - 1, 16 - subcutaneous fat

lactating women who want to drink alcohol (beer, wine, or liquor) are advised to limit their intake and wait ____ hours before nursing again. The amount of alcohol in breast milk peaks about ____ minutes after the mother ingests it, then declines.

- 3 to 4 - 30 to 60

Many experts recommend that pregnant women take a low-dose iron supplement (__ mg/daily). However, because iron can interfere with _____ absorption and utilization, women taking iron supplements also may need a zinc and copper supplement

- 30 - zinc and copper

Even though a full-term fetus stores about_____ mg of calcium, the recommended intake of this mineral does ___ rise during pregnancy. That's because, early in pregnancy, the mother's body adjusts to ____ calcium much more efficiently. The calcium is stockpiled in her bones, to be drawn on during late pregnancy and _____

- 30,000 - not - absorb - lactation

Many preterm (born before ____ weeks) infants have numerous medical problems, including those that complicate nutritional care, such as _________ and low birth weight (LBW) (weighing less than ___ pounds, or 2500 grams).

- 37 - poor sucking and swallowing abilities - 5.5

Early term: full term: late term: post term:

- 37-38 weeks - 39-40 weeks - 41- 41 weeks and 6 days - after 42 weeks

Weight gain recommendations for normal-BMI women carrying twins are __ to __ lb (17 to 20.5 kg). Overweight and obese women carrying twins should aim for a weight gain of __ to __ pounds (14 to 23 kg) and __ to __ pounds (11 to 19 kg), respectively.

- 37-45 - 31-50 - 25- 42

a favorable pregnancy outcome as a full-term gestation period _____ weeks that results in a live, healthy infant weighing more than ____ pounds (2.5 kg)

- 39 or 40 - 5.5

Of every 1000 babies born in the U.S. each year, as many as _ have fetal alcohol spectrum disorders (FASD). Children born to women who drank alcohol during pregnancy may have _____ malformations, growth retardation, and central nervous system defects, including profound ____ retardation and a small ____ size. These children are among the smallest in height, weight, and head circumference for their age. Prenatal exposure to alcohol also may cause somewhat lesser effects, such as lifelong _____ difficulties, short attention spans, poor coordination, and _____.

- 5 - facial - mental - brain - learning - hyperactivity

After _ months of breastfeeding, all these extra calories likely will need to come from the woman's diet if she has returned to her _____ weight. Inadequate calorie intakes will cause her body weight to continue to drop and, if BMI is substantially below ___, she may become unable to produce enough milk for her growing child.

- 6 - prepregnancy - 18.5

Embryonic stage endoderm: mesoderm: ectoderm:

- digestive system, liver, and pancreas - skeleton, muscles, heart, and blood vessels - skin, nervous system, and sensory organs

The let-down reflex is easily inhibited by nervous tension, a lack of confidence, and fatigue. If the let-down reflex does not occur, the baby will be able to obtain only the small amount of milk that trickles out of the lobules ______. This will lead to a hungry, fussy baby, which likely will increase the mother's stressful, tense feelings—a vicious cycle. - Careful monitoring during the ___ week of lactation by a physician or lactation consultant also helps ensure that breastfeeding and infant weight gain are proceeding normally.

- between feedings - 1st

In addition, drugs may reduce ______ to the fetus, which deprives it of oxygen and nutrients. A prescription drug that deserves special attention is _____ (isotretenoin), a form of vitamin A commonly used to treat severe acne. Babies born to mothers who take high doses of vitamin A, whether it is from isotretenoin or supplements, may experience severe birth defects, including nervous system abnormalities and _____ deformities.

- blood flow - Accutane® - facial and cardiovascular

Food additives, such as phenylalanine (a component of the noncaloric sweetener aspartame in NutraSweet® and Equal®), may be a cause for concern for some pregnant women. High amounts of phenylalanine in maternal blood disrupt fetal _____ development if the mother has the genetic disease ______. If the mother does ___ have this condition, it is unlikely that the baby will be affected by moderate aspartame use

- brain - phenylketonuria - not

Essential fatty acids are required for normal fetal growth and development, particularly of the - Sufficient intakes, especially of the omega-3 fat docosahexaenoic acid (DHA), may improve gestation duration and infant birth

- brain and eyes - weight, length, head circumference

Many lactating women consume _____ in less than recommended amounts. Adequate calcium intake is especially important because women who breastfeed their babies for 6 months or more lose significant amounts of ____ from their bones. Fortunately, with adequate calcium intake, bone density begins to return to normal within a few ____ after the baby is weaned. Adequate _____ intakes are particularly important.

- calcium, magnesium, zinc, folate, and vitamin B-6 - calcium - months - water and calorie

Medical advances have made it possible for women with several serious chronic diseases, such as diabetes, multiple sclerosis, lupus, phenylketonuria, and cystic fibrosis, to safely breastfeed their infants. Chronic diseases that are incompatible with breastfeeding are ____ being treated with chemotherapy medications and psychiatric conditions treated with ____.

- cancer - lithium

Ketosis can result from restricting ____ intake or fasting and is not desirable for the growing fetus. Ketone bodies are thought to be poorly used by the fetal ___ and may slow its development. Pregnant women can develop significant amounts of ketones after only __ hours of fasting, so eating regular meals and avoiding fasting for more than __ hours is important.

- carbohydrate - brain - 20 - 12

A minor disease, such as a ____, is not a reason to stop breastfeeding. The baby is likely to catch the disease, anyway, because he or she was exposed before the mother's symptoms were apparent. Also, the ____ factors in human milk may provide some protection for the breastfed baby against the minor disease. However, serious infectious diseases, such as tuberculosis and hepatitis C, can be life threatening, so it may be safer for women with such diseases to feed their babies_____.

- cold - immune - infant formula

Gestation begins at _______, when a sperm unites with an egg (ovum). About ___ hours after conception, the zygote, as the fertilized egg is called, begins the lifelong process of cell division. This cluster of cells drifts down the fallopian tube to the woman's uterus; within a _____ after conception, it has nestled deeply into the uterine lining and firmly attached itself there. - The next stage begins _____ after conception; the zygote is now called an embryo

- conception - 30 - week - 2 weeks

That is, there is a finite window of opportunity, called a ______, for cells to develop into a particular tissue or organ. As you can see, most critical periods occur during the ___ trimester. - For instance, critical ___ development occurs during the 3rd to 6th weeks. Critical ___ development happens during the 6th to 8th weeks of gestation.

- critical period - 1st - heart - tooth

Maternal exposure to the parasite that causes toxoplasmosis can lead to infant _______. This parasite is found in cat feces, bird feces, and the ____. Raw meat can be contaminated with this parasite. To avoid toxoplasmosis, pregnant women should avoid litter boxes, kittens, and birds; carefully ___ all produce to remove any soil; and thoroughly _____ all meat.

- death or brain damage - soil - wash - cook

Certain foods and compounds in foods (e.g., cabbage, chocolate) may cause some infants to become upset or not want to eat. Some foods can impart flavors to milk that may affect an infant's ____ to eat. For instance, when milk smells of garlic, babies spend more time _____. When it smells of alcohol, they suckle ___. If a woman notices a connection between her diet and the baby's fussiness or unwillingness to eat, she should ___ the offending food. - It's a good idea to experiment to see if eating the food causes feeding problems again because the irritability or unwillingness may ___ be related to the mother's diet at all.

- desire - suckling - less - avoid - not

Women at increased risk of gestational diabetes have a family history of _______, had gestational diabetes in a prior pregnancy, previously delivered an infant ____ for gestational age, have excess ____ in their urine (glycosuria), have _____ syndrome, or are from a high-risk group (e.g., Hispanic, Asian, Black, Native American).

- diabetes, are obese - large - sugar - polycystic ovarian

Women who gain less than recommended amounts have an increased risk of giving birth to a baby that is premature, is small for gestational age, and/or ___ soon after birth. In contrast, women who gain excessively higher amounts than the recommendations typically give birth to very large babies and experience an increase in complications at delivery, infant mortality, and weight _____ postpartum.

- dies - retention

The "ingredients" (nutrients) are drawn from the mother's ____, with deficits of some nutrients being made up by the mother's ____. These 2 sources of nutrients keep the composition and volume of the milk at fairly constant levels. If the mother's diet is poor for a prolonged period and she has depleted nutrient stores, the quantity of milk may _____. Maternal malnutrition must be extremely severe before the quality of milk produced ____.

- diet - stores - decline - drops

Caffeine is a stimulant and ______ found in coffee, tea, some soft drinks and energy drinks, and chocolate products. It also is a common additive in many ______, including headache and cold remedies. High caffeine intake (more than ____ mg daily) may hinder a woman's ability to become pregnant and increase the risk of having a spontaneous ______ or a ___-birth-weight infant.

- diuretic - medications - 500 - abortion - low

Metabolic adjustments that allow pregnant women to use some nutrients more _____ (e.g., protein), _____ some better (e.g., calcium, iron), and/or _____ less of others (e.g., zinc, riboflavin) also help meet the calorie and nutrient demands of pregnancy.

- efficiently - absorb - excrete

Obese women also may have difficulty becoming pregnant. Both the additional ____ produced by their extra fat stores and ____ resistance reduce fertility. Weight loss helps increase fertility in obese women.

- estrogen - insulin

If the medication will be taken for a short time, the woman can _____ her milk by hand or with a breast pump and discard it. The baby can be fed formula until the mother is finished taking the medication. All ____ drugs should be avoided during lactation. The most commonly used illegal drugs, marijuana and cocaine, depress milk production and pass easily into breast milk. Marijuana in human milk ____ infant development, and cocaine in milk causes babies to vomit and have _____, breathing difficulties, and convulsions.

- express - illegal - slows - tremors

As in pregnancy, a serving of a fortified ready-to-eat breakfast cereal or a multivitamin and mineral supplement can help meet ___ nutrient needs. Like pregnant women, breastfeeding mothers should consume sufficient amounts of omega-_ fatty acids because they are secreted into breast milk and are important for the development of the infant's ____. Fish and supplements can provide these fatty acids. Fish intake recommendations during pregnancy also apply during breastfeeding

- extra - 3 - nervous system

many women, pregnant or not, ____ to consume the RDA for calcium, which puts them at increased risk of osteoporosis later in life. Too little vitamin D may cause mothers to develop the vitamin D deficiency disease osteomalacia and their fetuses to develop ____, grow poorly, and inadequately ______ bones and teeth.

- fail - rickets - calcify

low-birth weight babies also are at risk of developing more body ____ and less lean body mass in childhood, which increases their risk of _____ in adulthood. - long-term consequences of prenatal growth retardation are much more profound than previously imagined—sometimes fetal health is harmed to the extent that its own future ______ also will be affected

- fat - chronic disease - offspring

Although the greatest risk is in the 1st trimester, a detrimental prenatal environment during the ____ also can adversely affect development; however, the damage often has less catastrophic consequences. Maternal ______ or exposure to _____ during the fetal stage can cause low nutrient stores, retarded growth, abnormal organ function, mental abnormalities, and/or a shorter than normal gestation period. Nutrient deficits during fetal life often can be partly ____ by adequate nutrition after birth.

- fetal stage - nutrient deficiencies - toxins - reversed

Those who eat zinc poor diets and have a high _____ intake (which impairs zinc absorption) need to pay particular attention to zinc intake.

- fiber or iron

A sudden change in weight (up or down) may signal health problems for the mother. For instance, a sudden, erratic gain may be caused by _____. This may indicate that the mother has pregnancy-induced _____, a potentially life-threatening condition.

- fluid retention - hypertension

Some are sold over the counter, whereas others are dispensed by prescription because of their high synthetic _____ content (1000 μg), which could pose problems for others, such as older people. Prenatal supplements also are high in ____

- folic acid - iron

A few measures a woman can take to counteract some known contaminants are to avoid _____ from polluted waters, to carefully ____ and peel fruits and vegetables, and to remove the _____ of meat because pesticides concentrate in fat. In addition, a woman should not try to lose weight rapidly while nursing (no more than _____ lb/week) because contaminants stored in her fat tissue might then enter her bloodstream and affect her milk.

- freshwater fish - wash - fatty parts - ¾ to 1

The placenta also synthesizes fatty acids, cholesterol, and the fetus's main fuel—______. In addition, the placenta produces hormones that help direct maternal _____ to the fetus, control fetal ______, promote the changes in the mother's body that support pregnancy, and may cause maternal ______

- glycogen - nutrients - metabolism - nausea

Although low birth weight is most commonly associated with being born preterm, infants who suffer ______ during prenatal development (also called intrauterine growth retardation) weigh less than expected for their gestational age—these infants are ______.

- growth retardation - small for gestational age

During pregnancy, caffeine can affect fetal _____ rate and ______ and decrease ______ through the placenta. In addition, the fetus is unable to _____ caffeine. Caffeine also may decrease the absorption of certain nutrients, such as _______. Heavy caffeine use during pregnancy may lead to caffeine ____ symptoms in the newborn.

- heart, breathing - blood flow - detoxify - calcium, iron, and zinc - withdrawal

Additional calories also are needed to fuel the extra metabolic workload pregnancy puts on a woman's _______, and other organs. Few, if any, of these extra calories are needed during the ____ trimester of pregnancy, when the developing offspring gains little weight. During the 2nd trimester, a daily increase of about ___ calories is recommended. And in the 3rd trimester, a daily increase of approximately ___ calories is recommended

- heart, lungs - 1st - 350 - 450

Vegans, pregnant teens, women at risk of pregnancy-induced ______, and those who do not consume dairy products are at risk of consuming insufficient calcium. Those who do not consume milk, which is fortified with vitamin D, or have limited exposure to sunlight also risk getting too little vitamin D. These women should choose foods fortified with calcium and vitamin D and discuss using a _____ with their health-care providers. A vitamin D supplement is particularly important during the winter in ______

- hypertension - supplement - northern latitudes

It is normal to see an elevation in blood pressure during pregnancy; however, pregnancy-induced _____ causes it to rise abnormally high. Pregnancy-induced hypertension impairs the delivery of _____ and nutrients to the fetus; thus, the fetus may experience retarded growth and _____ birth. Pregnancy-induced hypertension can escalate into potentially deadly conditions called _____ (formerly called toxemia).

- hypertension -oxygen - premature - preeclampsia and eclampsia

In addition, untreated chronic diseases, such as _____, increase the risk of fetal damage. Without prenatal care, a woman is _ times more likely to deliver a low-birth-weight baby. Although the ideal time to start prenatal care is _____ conception, about __% of women in the U.S. receive no prenatal care throughout the 1st trimester—a critical time to positively influence pregnancy outcome.

- hypertension or diabetes - 3 - before - 20

Once developed, the mammary glands are fairly______ until early in pregnancy. At that time, hormones secreted by the _____ cause the milk-producing glands to mature and the lactiferous ducts to branch more.

- inactive - placenta

The widespread increase in availability of lactation consultants over the past several years has helped _____ access to accurate information, role models, and social support. In almost every community, a group called La Leche League offers classes in breastfeeding and advises women who have difficulties with it.

- increase

Alcohol, drugs, herbal and botanical products, and smoking are lifestyle choices that _____ the risk of a poor pregnancy outcome. A woman should avoid substances that can harm the developing offspring, especially during the ___ trimester. This caution holds true, as well, for the time when a woman is ____ to become pregnant.

- increase - 1st - trying

underweight women who ____ their energy intake are more likely to give birth to healthier babies and experience fewer _____ than those who do not increase energy intake. Women who are physically active during pregnancy may need to increase their intake by more than ___ to ___ calories because greater body weight requires more energy for activity.

- increase - infant deaths - 350, 450

Individuals infected with human immunodeficiency virus (HIV) or who have acquired immune deficiency syndrome (AIDS) have _____ needs for energy and some vitamins and minerals. Supplements of some nutrients, such as ______, may adversely affect those who are HIV positive. Thus, careful dietary planning is needed by women with HIV or AIDS.

- increased - vitamin A, zinc, and iron

The oversupply of glucose from maternal circulation signals the fetus to increase _____ production, which causes fetal tissues to readily use ____ for growth. Another threat is that the infant may have ___ blood glucose at birth because of the tendency to produce extra insulin, which began during gestation. Other concerns are the potential for _____ delivery and increased risk of birth trauma and malformations.

- insulin - glucose - low - preterm

For many pregnant women, the only supplement needed is ____ during the last 2 trimesters. A multivitamin and mineral supplement is recommended for women who have a history of frequent ____; are teenagers or vegans; have a low income; are underweight; smoke or abuse alcohol or illegal drugs; are carrying multiple fetuses; and/or are eating a diet restricted in variety. - For instance, vegans may need a vitamin ___ supplement.

- iron - dieting - B-12

In addition, weight loss diets should never be attempted during pregnancy, regardless of prepregnancy weight or weight gain during pregnancy, because of the rise in ____ that can occur. Including at least ___ g of carbohydrate in the diet every day helps prevent ketosis.

- ketones 175

Some nonfood substances, such as mothballs, toilet bowl freshener blocks, and chalk, may contain dangerously high levels of toxins, such as ____. Clay can block the intestines and may contain ______ that impair mineral absorption. Laundry starch is high in calories (1800 calories per pound) but lacks all other nutrients, except carbohydrate, and can lead to ______

- lead - parasites and pathogens - malnutrition and obesity

common food contaminants that pose dangers to the pregnant woman and her fetus include _________. - ____ can leach into food from lead crystal glasses, some dishes, and the solder used to seal copper water pipes. - Fish are the food source most likely to be contaminated with _____, and other pollutants that were dumped into waterways and accumulated in the fish living there

- lead, mercury, polychlorinated biphenyls (PCBs), and pesticides - lead - mercury, PCBs

Infants born to women who exercise tend to be _____ and more _____ mature than babies born to nonexercisers. Women with high risk pregnancies, such as those experiencing premature labor contractions, may need to _____ their physical activity.

- leaner - neurologically - restrict

In comparison with nonsmokers, women who smoke or breathe secondhand smoke produce ____ milk, and their babies gain less ____. Mothers who use cigarettes, electronic cigarettes, or nicotine patches also secrete _____ in their milk, which can cause vomiting, slow breathing, increased blood pressure, and ____ in the infant.

- less - weight - nicotine - apathy

An important brain-breast connection—commonly called the______—is necessary for breastfeeding . The pituitary gland releases the hormone _____, which causes the musclelike cells in the breast tissues to contract and release (let down) the milk from the _____. The milk then travels through the ducts to the ____ area. - During the 1st few weeks after delivery, this reflex must be triggered by the infant _____ the mother's breasts.

- let-down reflex - oxytocin - lobules - nipple - suckling

Exposure to the bacterium that causes the foodborne illness _______ (Listeria monocytogenes) is especially dangerous during pregnancy; it can cause spontaneous _____, _______ delivery, stillbirth, and _______ in the newborn. Contaminated soft cheeses, such as Mexican-style cheese, feta, Brie, Camembert, and blue-veined cheeses (e.g., Roquefort), are often the cause of listeriosis. Thus, pregnant women are advised to avoid these cheeses. In addition, they are advised to cook leftovers and processed meats (e.g., hot dogs, deli meats) until _______.

- listeriosis - abortion - premature - infections - steaming hot

The primary regulator of energy (calorie) use in the body is _____ hormone. To ensure adequate production of thyroid hormone, pregnant women need to consume sufficient amounts of _____. Using iodized salt can easily meet the need for this mineral.

- thyroid - iodine

Women who begin pregnancy underweight are more likely to have infants who are ___ birth weight and ____ than are women at a normal weight. These differences may be because underweight women tend to have lighter placentas and lower nutrient stores, especially ___, than heavier women, which can affect fetal growth negatively. An underweight woman can improve her nutrient stores and pregnancy outcome by gaining weight before pregnancy or gaining extra weight during pregnancy.

- low - premature - iron

A ______ intensity exercise program can offer physical and psychological benefits to a woman experiencing a normal, healthy pregnancy. Benefits include improved ______ function, an easier and less complicated_____, and an improved attitude and mental state. Exercise also can help prevent or treat _______.

- low or moderate - cardiovascular - labor - gestational diabetes

Exercise and a diet that distributes ______ carbohydrates throughout the day are important for keeping gestational diabetes under control. Some women also may need ____ therapy. Untreated gestational diabetes can severely deplete fetal ____ stores. In addition, uncontrolled diabetes can cause the fetus to grow quite ____

- low-glycemic-load - insulin - iron - large

Contributing to the smaller birth size is the fact that smokers are likely to have a ____ prepregnancy weight and to gain less weight during pregnancy. Plus, many smokers' diets are less nutritious than those of nonsmokers. Nicotine alone, delivered by cigarettes, electronic cigarettes, or patches or exposure to electronic cigarette aerosol, has multiple health consequences, such as fetal ____and development abnormalities.

- lower - brain

Iron needs rise significantly during pregnancy, mainly because of the increasing number of _____ and accumulating _____ stores. The increased demand for iron puts many pregnant women at a greater risk of iron deficiency ____ than individuals in any other stage of the life cycle.

- maternal red blood cells - fetal iron - anemia

Low-birth-weight infants are more likely than normal-weight infants to have ________ complications, including problems with _____ control, ______ regulation, growth, and development in the early weeks after birth.

- medical and nutritional - blood glucose - temperature

Less visible changes include the growth and development of the _____ (lobules) and the network of ducts that connect the glands to the nipple. Malnutrition during adolescence can impair breast development and limit a woman's future ability to provide adequate nourishment for a growing baby.

- milk-producing/storage cells

if a woman begins to gain too much weight during her pregnancy, she should not try to lose weight. Instead, she should _____ her intake of foods that provide unnecessary calories. Even if a woman gains 35 lb in the first 7 months of pregnancy, she must still gain more during the last 2 months to have an optimal outcome. However, she should ____ the increase in weight to parallel the weekly recommended rise in prenatal weight gain

- minimize - slow

In the 2nd trimester, weight gain is divided between ______. In the 3rd trimester, weight gain is almost all ____ tissue. Low weight gain in either of the last 2 trimesters increases the chances of prenatal growth _____. Low weight gain in the last trimester raises the risk of _____ birth.

- mother and fetus - fetal - retardation - premature

The placenta's size and ability to support optimal fetal growth depend on the _______. Poorly nourished women tend to have smaller placentas with ____ blood vessels and smaller cells than those of well-nourished mothers. If the placenta is smaller than normal, the area of contact between the mother and fetus is reduced, which decreases the placenta's capacity to deliver _____ and remove _____. Small placentas may hinder optimal fetal growth and development.

- mother's nutritional status - fewer - nutrients - wastes

In the case of macronutrients and water, excess amounts usually have __ effect on milk composition or volume, although the proportions of different ____ in the milk vary with maternal intake. If vitamin and mineral intakes exceed the recommendations, increased levels of these nutrients may appear in the milk.

- no - fatty acids -

The abnormally high blood glucose levels caused by gestational diabetes often return to _____ after giving birth; however, the mother's risk of developing diabetes later in life rises, especially if she is _____. Infants born to mothers with gestational diabetes also may have higher risks of developing ____ and type _ diabetes as they grow to adulthood.

- normal - obese - obesity, 2

the placenta contains both maternal and fetal blood vessels. Although these vessels are ___ directly connected, they are so close together that nutrients and oxygen pass easily from the mother to the fetus, and fetal wastes are shuttled from the fetus to the mother for excretion. To accomplish these tasks, the placenta uses all the absorption mechanisms employed by the _____

- not - GI tract

Lactating women, like pregnant women, are advised ___ to smoke. However, those who are smokers are ____ to breastfeed because the benefits of breast milk outweigh the risk of nicotine exposure

- not - advised

Common drugs that can cause problems during pregnancy include aspirin (especially when used heavily), hormone ointments, nose drops, cold medications, rectal suppositories, weight control pills, medications prescribed for previous illnesses, marijuana, and cocaine. They may deplete ______, alter nutrient absorption, and decrease the ______.

- nutrient stores - desire to eat

Women who were ____ prior to pregnancy often have greater difficulty initiating and continuing breastfeeding and producing sufficient milk. Obstacles these women may face include difficulty getting the infant to ___ on adequately to their breasts and positioning the infant appropriately for breastfeeding. Obese women may have a low milk supply because they release less _____ and are more likely to have had Cesarean deliveries, which delay the first suckling. These women may need to supplement human milk with ____ until they develop a sufficient milk supply.

- obese - latch - prolactin - infant formula

However, in regions of the world where infectious disease and malnutrition are the primary causes of infant death, the risk of not breastfeeding may _____ the risk of possible transmission of HIV infection. Widespread lack of ____ (e.g., lack of clean water and soap) may make it more dangerous to feed the baby infant formula because formula prepared with polluted water and placed in a dirty bottle frequently causes ____—the number 1 killer of infants in developing countries

- outweigh - basic sanitation - diarrhea

In pregnancy, iron deficiency anemia means that less than optimal amounts of _____ may reach the fetus. Iron deficiency anemia can cause low birth weight, premature birth, and infant death, and it may result in low iron stores in the infant. In addition, pregnant women with this condition may experience______, labor and delivery complications, and an increased risk of ____

- oxygen - preeclampsia - death

Some evidence indicates that inadequate nutrient intakes may contribute to the development of _____. For instance, adequate _____ status may reduce the risk of preeclampsia. In women with ___ calcium intakes, ____ doses of calcium supplements may reduce the risk of preeclampsia.

- preeclampsia - antioxidant - low - large

Prepregnancy weight and nutrient stores affect not only pregnancy outcome but also the woman's ability to become _____. Many underweight women experience _______, which may reduce their ability to _____. The chances of ovulating and becoming pregnant improve when body fat increases to a healthy level.

- pregnant - amenorrhea - ovulate

The manufacture and secretion of _____, the principal hormone that promotes milk production, are stimulated by the birth of the baby and by suckling. When the baby suckles at the breast, nerve signals stimulate the _____ gland in the brain, causing it to release prolactin. The prolactin travels in the blood to the milk-producing glands in the breast and stimulates them to synthesize milk. If suckling stops (or never occurred after delivery), prolactin is ___ released and milk secretion usually stops in a few days. The breasts gradually return to their prepregnancy state

- prolactin - pituitary - not

Preeclampsia is high blood pressure accompanied by _____ in the urine, headaches, _____ vision, changes in ____, ______ system disorders, and ____ throughout the body. It can progress to eclampsia, which causes maternal ________. Blood pressure may climb so high that the kidneys and liver are damaged, and both the mother and her fetus may die. In fact, _____ is the leading cause of maternal and newborn death in the U.S.

- protein -blurred - blood clotting - nervous - edema - convulsions and coma - eclampsia

- Ovarian hormones stimulate the development of the milk-producing cells (lobules) and ducts. - Placental hormones stimulate lobules to mature and ducts to grow and branch. - Pituitary hormones cause the breasts to begin producing milk (the hormone prolactin) and releasing milk (the hormone oxytocin). Suckling stimulates the pituitary to continue releasing prolactin. If the nipple is not suckled regularly, milk production ceases.

- puberty - during pregnancy - following childbirth

Preparation for lactation begins when a young girl enters _____. Hormones, particularly _____, secreted during puberty stimulate the growth and development of the mammary glands. The most obvious change in the breasts is their size, which is due to the deposition of ____

- puberty - estrogen - fat

The lactating woman's Dietary Reference Intakes (DRIs) are based on the ___ of milk produced by the average mother, its ____ content, and the _____ of her nutrient stores used to produce milk. The RDA value for iron is ____ than that of both a pregnant and a nonpregnant woman because human milk contains only a small amount of iron and because women who exclusively breastfeed their infants often do not resume menstruating for _ months or so, thereby conserving iron. However, when a lactating woman begins menstruating again, her iron RDA returns to that of nonpregnant women.

- quantity - nutrient - amounts - lower - 6

Alternately, if a woman has not gained the desired weight by a given point in pregnancy, she should not try to gain the needed weight _____. Instead, she should ____ gain a little more weight than the typical pattern to meet the goal by the end of the pregnancy.

- rapidly - slowly

When folate intake is insufficient, fewer ______ are synthesized, causing folate-related _____. Insufficient folate intake also may cause premature birth, low birth weight, fetal growth retardation, spontaneous abortion, poor placenta development, and other pregnancy complications.

- red blood cells - anemia

Alcohol, especially beer or wine, was recommended for centuries as a way for new mothers to relax and allow babies to nurse longer. However, research shows that consuming alcohol actually ____ milk output and causes babies to drink less and have _____ sleep patterns. And infants are not as efficient as adults at breaking down alcohol, so the effects linger longer. The safest route for mothers and babies is to ____ alcohol altogether

- reduces - disrupted - avoid

Pregnancy-induced hypertension ____ itself when the pregnancy ends. However, because the problem often begins well before the normal end of gestation, treatment may be necessary to prevent the worsening of the disorder. ______ are the most effective treatment methods, although their effectiveness varies. Magnesium likely relaxes ____ and, so, leads to a fall in blood pressure. Several other treatments, such as various antiseizure and antihypertensive medications, are under study.

- resolves - Bed rest and magnesium sulfate - blood vessels

Compounds in the food the mother eats can be ____ into her milk. Environmental contaminants, such as _______, can appear in human milk. The risks of these substances are largely unknown. However, the benefits of human milk are well established and the effects of environmental contaminants on the breastfed infant have been seen mostly when the mother herself was _____ from the effects of the contaminants.

- secreted - pollutants and pesticides - suffering

Nutrient deficiencies or excesses, certain pathogens, trauma, radiation, tobacco smoke, and toxins (e.g., drugs and alcohol) during a critical period can interfere with normal development, causing effects ranging from

- severe physical or mental abnormalities to spontaneous abortion

On the other hand, obesity, inactivity, high-fat diets, and low nutrient intakes affect a man's ability to produce enough viable ____. When the number of sperm is low and/or the sperm's ability to propel itself is reduced, fertilization is unlikely to occur. _______ affect the quality of sperm; when these nutrients are in short supply or fat intake is high, men may experience fertility problems.

- sperm - Zinc, folate, and vitamin C

The spine is incompletely formed when the tube does not seal at the bottom, causing ______. Depending on the severity of spina bifida, children may be _____ or have curvature of the spine, ______ hips, or other physical handicaps. There is some evidence that poor folate status also may play a role in the development of _____ defects, other birth defects, and autism

- spina bifida - paralyzed - dislocated - heart - autism

experts recommend that all women who have the potential to become pregnant take folate supplements or eat folate-fortified foods in addition to eating a folate rich diet. This recommendation extends to all these women because a significant proportion of pregnancies are unplanned and neural tube defects occur in the 1st few ____ of pregnancy—before many realize they are pregnant. Women who have previously delivered an infant with a neural tube defect may need to consume ____ folate than the RDA.

- weeks - more

Preeclampsia seems to be related to abnormal implantation of the _____, which reduces the function of the ____. Certain substances produced by the poorly performing placenta also appear to be involved in the development of preeclampsia. Preeclampsia and eclampsia are most common among women who have a high ___, are pregnant for the __ time or have multiple-birth pregnancies, are older than __ years, are African-American, or had hypertension before pregnancy

- zygote - placenta - BMI - 1st - 35

Apgar Score. This score indicates the quality of an infant's heart rate, respiration, muscle tone, reflexes, and color at _ minute and _ minutes after birth.

-1, 5

Early spontaneous abortions, also called miscarriages, usually result from a genetic defect or fatal error in fetal development. About ___ or more of all pregnancies end in this way, often so early that a woman does not realize she was pregnant. An additional __ to __% are lost before the full-term gestation period ends

-1/2 - 15, 20

Two soft drinks or a chocolate candy bar supplies nearly the number of extra calories daily a woman needs in the last 2 trimesters—and provides almost no nutrients. On the other hand, 2 glasses of fat-free milk, a small spinach salad, and a bowl of strawberries will meet ____ the calcium and vitamin A and ____ the folate and will exceed the vitamin C needs for 1 day, all for less than 350 calories.

-2/3 - 1/4

when the embryonic stage ends after week __, the embryo is quite complex, yet it is no larger than a ___ (approximately 3/8 inch, or 8 mm, long). The major organs are in place and some, such as the ________, have begun to function.

-8 - pea - heart and liver

From week __ until birth, the developing offspring is known as a fetus. The fetal stage is when the most rapid growth occurs. In fact, about __% of all fetal growth occurs in the last ___ weeks of gestation.

-9 - 90 - 20

consuming as little as _ ounce of alcohol per day has resulted in mental and physical defects

1

Numerous previous pregnancies and/or closely spaced pregnancies (less than _ year apart) may deplete a woman's nutrient stores, which increases the risk that a subsequent pregnancy will result in a ___ birth, low-birth-weight infant, or small for ______ age infant. Carrying more than _ fetus also increases nutrient needs and makes it difficult to consume sufficient calories and nutrients to support optimal growth of the fetuses.

1 - preterm - gestational - 1

Caffeine may make infants fussy and unable to sleep. Lactating women can prevent these adverse effects by avoiding caffeine-containing foods or medications or limiting intake to ____ cups of coffee, tea, or cola daily.

1 to 2

Mothers can use a breast pump to express milk into a sterile bottle and then store it in a refrigerator or freezer. A schedule of expressing milk and using supplemental formula feedings is most successful if begun after ___ months of exclusive breastfeeding.

1 to 2

Overweight women appear to be able to rely on stored fat to meet their entire daily calorie need for lactation without adversely affecting the growth of their infants. However, severe calorie restrictions and weight loss greater than_____ pounds per month likely will reduce the total amount of milk produced.

1 to 4

Substances related to lifestyle choices (e.g., alcohol, drugs, herbal and botanical products, nicotine) also are secreted into breast milk. The amount secreted is usually small (____% of the mother's dose) but may be a potent and harmful dose for a baby.

1,2

At birth, a healthy placenta weighs about ___ lb (0.7 kg) and is about _ to _ inches in diameter and _ inch thick. It has about __ square meters of contact between maternal and fetal circulation.

1.5 - 6,8 - 1 - 13

The recommendations for prenatal weight gain have steadily increased in the last 60 years from 15 to 16 pounds in the 1950s to __ to __ pounds, now recommended for women of normal prepregnancy weight. Studies have shown repeatedly that gaining the amount of weight currently recommended by the National Academy of Science's Institute of Medicine improves the chances of optimal health for both mother and fetus if gestation lasts at least __ weeks

25, 35 - 38

In the 2nd and 3rd trimesters, the plan recommends slight increases in almost every food group. Specifically, the plan should include about ____ kcal, divided like this: - Dairy group: - protein group: - vegetables group: - fruit group: - grains group:

2600 - 3 cups - 6.5 ounce - 3.5 cups - 2 cup - 8 ounce

To help meet iron demands, maternal iron absorption increases up to _ times and this mineral is conserved because menstruation stops during pregnancy. Even with these adaptations and a carefully planned diet, it is very ____ to meet the need for iron.

3 - difficult

Protein intake recommendations for pregnant women are more than __% above those for nonpregnant women. Even with this substantial increase, insufficient intakes of protein are ______ in the U.S. and Canada because this nutrient is so plentiful that women, pregnant or not, consume amounts exceeding the RDA. Protein supplements are neither needed nor _____ during pregnancy.

50 - uncommon - recommended

In just 9 months or so, a mother's body provides all the calories and nutrients needed to produce an infant ____ times larger than the fertilized egg.

5000

A breastfeeding mother can tell whether her baby is getting enough milk if the baby has _ or more wet diapers each day and shows normal growth.

6

Women who experienced gestational diabetes should have a blood glucose screening _ weeks after giving birth and then annually. Those with elevated blood glucose levels should receive appropriate treatment to preserve their health

6

Pregnant women also should include about ____ teaspoons of vegetable oil that is rich in essential fatty acids.

6 to 7

During pregnancy, folic acid intake should increase to ___ μg daily.

600

WIC participants receive milk, cheese, eggs, fruits, vegetables, juices, iron-fortified cereal, whole grains, soy beverages, tofu, beans, peanut butter, and other nutritious foods that supply nutrients often lacking in their diets, such as vitamins ________.

A and C, folate, iron, potassium, calcium, and protein.

Although single food items that a mother eats have very little bearing on her milk's nutritional quality or the amount she manufactures, many cultures believe that certain foods, such as _____, boost the amount of milk produced.

garlic, oatmeal, or ginger

before exceeding the Upper Level of folate, women should consult a health-care provider because large doses of folate can make it difficult to diagnose a vitamin ____ deficiency.

b-12

Herbal and botanical products can exert potent, ____ effects on both the mother and the fetus. Until the safety of these products can be verified, experts recommend that pregnant women use all herbal and botanical products—including herbal tea—with caution and under the guidance of a health-care professional

druglike

women who experienced pregnancy-induced hypertension, preeclampsia, and/or eclampsia in a previous pregnancy or who have a ______ of these conditions are at increased risk of developing these conditions.

family history

To minimize pregnant women's exposure to ____, the FDA and Environmental Protection Agency (EPA) advise pregnant women to avoid swordfish, shark, king mackerel, and tilefish and keep their intake of other fish and shellfish to 12 ounces (no more than 6 ounces from albacore tuna) per week.

mercury

Many herbal and botanical products contain druglike compounds, which may appear in ____. All herbal and botanical products should be used cautiously during lactation.

milk

Insufficient intake of choline and/or vitamin B-12 also may contribute to the development of ______. Women who eat animal products usually consume sufficient amounts of vitamin B-12; however, vegans need a vitamin B-12 _______.

neural tube defects - supplement

supplements are not high in calcium (200 mg per pill). If iron and calcium supplements are used, they should ____ be taken together to avoid possible competition for absorption.

not

On the other hand, for a vegan, careful diet planning before and during pregnancy is crucial to ensure sufficient intakes of protein, - The basic vegan diet should be modified to include more _____ to supply the necessary extra amounts of some of these nutrients.

vitamin D (or sufficient sun exposure), vitamin B-6, iron, calcium, zinc, and especially vitamin B-12 - grains, beans, nuts, and seeds

The fetus needs large quantities of ________ for normal bone and tooth development.

vitamin D, calcium, phosphorus, magnesium, and fluoride

It is only when a mother's diet is poor for several _____ that maternal nutrient stores may become depleted and her milk supply negatively affected.

weeks or months

Certain medications, cigarette smoking, alcohol abuse, and strenuous exercise may prevent the placenta from transferring adequate _____ to the fetus.

zinc