Nutrition through the Life Span: Pregnancy & Infancy

Nutrition through the Life Span: Pregnancy

& InfancyDr Shatha Hammad

All people need the same nutrients, but the amounts

they need VARY depending on their stage of life.

Pregnancy: The Impact of Nutritionon the Future

To ensure an optimal pregnancy

• Before pregnancy

• Full nutrient stores are essential

• Habits to establish

• Achieve and maintain a healthy body weight

• How would unhealthy body weight affect pregnancy?

• Choose an adequate and balanced diet: Malnutrition reduces fertility and impairs the early development of an infant

• Be physically active

• Receive regular medical care

• Avoid harmful influences

Pregnancy: The Impact of Nutrition on the Future

Malnutrition during

critical periods !!!

Pregnancy: The Impact of Nutritionon the Future (cont’d.)

• Energy requirements

• Second trimester: extra 340 kcalories/day

• Third trimester: extra 450 kcalories/day

• Importance of nutrient-dense foods

• The increase in the need for nutrients is even greater than that for energy.

• Ample carbohydrates: 175+ grams/day

• no less than 135 grams/day

• is necessary to fuel the fetal brain and spare the protein needed for fetal growth


• Fiber: alleviates constipation

• Protein: to support the growth

• How much?

• Essential fatty acids

• Important for brain growth and development of the of fetus

• Special interest: folate and vitamin B12

• Needed in large amounts

• Why?

In anencephaly, the upper end of the neural tube fails to close.

Consequently, the brain is either missing or fails to develop.

Spina bifida is characterized by incomplete closure of the spinal

cord and its bony encasement

A critical period

How to be prevented?


• Vitamin D, calcium, phosphorus, magnesium, and fluoride

• Needed for developing fetal bones and teeth

• Calcium & vitamin D:

• Conserve mother’s bone mass while supplying fetal needs

• Regular exposure to sunlight and consumption of vitamin D–fortified milk are usually sufficient to provide the recommended amount of vitamin D

• 3 cups per day of milk products. Less preferred, but still acceptable, is a daily supplement of 600 milligrams of calcium.


• Iron recommendations

• How absorption is affected?

• How to ensure optimal intake, prior and during pregnancy?

• Fetus’ iron needs regulated by the placenta

• Given priority over those of mother

• Risks for entering the pregnancy with iron-deficiency anemia??

• Daily multivitamin-mineral supplements!

Nutrient Supplements

Weight gain during pregnancy

• Even a woman who has begun her pregnancy at a healthy weight, she needs to gain weight within the recommended weight range based on her prepregnancy BMI for optimal outcomes

• Weight loss during pregnancy is not recommended

Weight loss after pregnancy

• The typical woman does not, however, return to her prepregnancy weight

• Most women tend to retain a few pounds with each pregnancy

• Cumulative weight gain best avoided by:

• Healthy weight prior to first pregnancy

• Maintaining healthy weight between pregnancies

Weight gain may increase the risk of diseases later in life

Choose “low impact” activities

Enhance pregnancy outcomes and help in

achieving healthy body weight

Pregnancy: Common nutrition-related concerns

1. Food cravings and food aversions

• Do they reflect real physiological needs???

2. Pica

3. Morning sickness

• Arises from the hormonal changes of early pregnancy

• Medical advice is required if persists for ≥ 2 weeks

4. Heartburn

5. Constipation

• A high-fiber diet, physical activity, and plentiful fluids


• Problems in pregnancy

• Aided by healthcare and nutritional measures

• Preexisting diabetes

• Gestational diabetes

• Chronic or gestational hypertension

• Preeclampsia

Pregnancy:Practices to avoid

• Cigarette smoking

• Medicinal Drugs and Herbal Supplements

• Drugs of abuse

• Vitamin-Mineral Megadoses

• Restrictive Dieting

• Caffeine

• Caffeine crosses the placenta, and the fetus has only a limited ability to metabolize it.

Pregnancy:

Adolescent pregnancy

• Presents a special case of intense nutrient needs

• Mother and fetus are growing

• However, they are less likely to receive early prenatal care

• Mothers younger than 16 years of age

• Bear more infants who die within the first year than do women in any other age group

Breastfeeding

• Lactating women should:

• Eat nutrient-dense foods

• Not restricting weight gain excessively

• Ample fluid intake

• Optimal feeding pattern for infants

• Exclusive breastfeeding for six months and breastfeeding with complementary foods for at least 12 months

Breastfeeding (cont’d.)

• Energy

• 500 kcals/day are required to produce the necessary 25 ounces of milk a day

• Extra 330 kcal/day and 170 kcal from fat stores

• Severe energy restriction hinders milk production and can compromise the mother’s health.

• Gradual weight loss

• Vitamins and minerals

• How is milk production affected by nutritional deprivation?

• Water: about 13 cups/day, WHY?

• Foods with strong or spicy flavors (such as onions or garlic) may alter the flavor of breast milk

Nutrition of the Infant


• Infants and children

• Growth directly reflects nutritional well-being

• Full-term infant weighs: between 3 and 3.5 kg (healthy pregnancy)

• Five months: birthweight doubles

• One year: birthweight triples

• Infants: high basal metabolic rate

• Nutrients particularly important for infants

• Energy nutrients

• Vitamins and minerals critical to the growth

• such as vitamin A, vitamin D, and calcium

Nutrition of the Infant (cont’d.)

• As a percentage of body weight

• Infants need more than twice as much of most nutrients as an adult


• Age: six months

• Growth rate begins to slow, but physical activity increased

• Infants spontaneously reduce energy intakes

• Water:

• Breast milk or infant formula normally provides enough water to replace fluid losses in a healthy infant.

• What conditions may require an electrolyte solution for infants?

Breast milk

• Nutrient source for first six months (supplies ALL nutrients)

• More easily digested than formula

• Approximately 8 to 12 feedings per day

Breast milk (cont’d.)

• Energy-nutrients:

• Carbohydrate: lactose (main form)

• Easily digested

• Enhances calcium absorption

• What is the benefit of oligosaccharides in breast milk?

• Protein: mainly alpha-lactalbumin

• Lipids

• Main form of energy in infant’s diet

• Generous proportion of the essential fatty acids linoleic acid and linolenic acid as well as arachidonic acid and DHA, WHY??

Why protein is very low???


• What factors contribute to the likelihood of vitamin

D deficiency in infants?

• Ideal calcium content

• Generous amounts of vitamin C

• Iron & zinc amounts are low but highly absorbable


• Supplements

• After six months

• Vitamin D, iron, and fluoride

• Vitamin K

• Single dose at birth


• Immunological protection

• Breast milk contains no pathogens but isn’t sterile

• Antiviral agents, anti-inflammatory agents, antibacterial agents, and infection Inhibitors

• Provided by colostrum ?? and breast milk

• Maternal antibodies

• Oligosaccharides

• Bifidus factors ??


• Present in breast milk

• Lactoferrin (keeps bacteria from getting the iron they need to grow, helps absorb iron into the infant’s bloodstream, and kills some bacteria directly)

• Lactadherin (binds to & inhibits replication of, the virus that causes most infant diarrhea)

• Growth factor (stimulates the development and maintenance of the infant’s digestive tract and its protective factors)

• Lipase enzyme (digestion & also help protect the infant against infection)


• Other benefits:

• Offers protection against the development of allergies as well

• Some evidence suggests lower risk of diseases & weight gain later in life

• Intelligence (later in life) is suggested to be higher in breastfed infant (high DHA content)

Infant formula

• From cow’s milk

• do not differ significantly from human milk in nutrient content

• higher protein concentration of cow’s milk

• Fortified with iron

• Special formulas

• Soy protein (for milk protein allergy and lactose intolerance)

• Hydrolyzed protein (allergy to milk & soy protein)

• Contains no protective antibodies for infants


• Cow’s milk

• Cow’s milk is not appropriate during the first year

• May cause intestinal bleeding, which can lead to iron deficiency

• Cow’s milk is higher in calcium and lower in vitamin C → reduces iron absorption

• Once the infant is obtaining at least two-thirds of total daily food energy from a balanced mixture of cereals, vegetables, fruits, and other foods (after 12 months of age), cow’s milk is an acceptable and recommended accompanying beverage


• Purpose of introducing solid foods

• Provide needed nutrients

• No longer supplied adequately by breast milk or formula alone

• Factors governing addition of foods

• Infant’s nutrient needs

• Infant’s physical & metabolic readiness (able to digest)

• Need to detect and control allergic reactions


• Nutrients needed earliest are iron and then vitamin C

• Rapid growth demands iron

• Iron-fortified cereals

• Vegetables for vitamin C (introducing fruits first would develop a preference for sweets and makes the vegetables less palatable)

• Choice of infant foods

• Provide variety, balance, and moderation


• Foods to omit

• Sweets, canned vegetables, honey, and corn syrup

• Foods that might cause choking

• Allergy-Causing Foods:

• To prevent allergy and to facilitate its prompt identification should it occur, experts recommend introducing single-ingredient foods, one at a time, in small portions, and waiting 3-5 days before introducing the next new food


• During child’s first year

• Encourage healthy eating habits

• Introduce a variety of nutritious foods

• Do not force child to finish the bottle or baby food

• Avoid empty-kcalorie foods

• Do not use food as a reward or punishment

• Balance milk with iron-rich food, to prevent iron deficiency

• Provide a safe, loving, and secure environment

Nutrition through the Life Span: Pregnancy & Infancy

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