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Chapter 13: Pregnancy and Breastfeeding


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Title: Chapter 13: Pregnancy and Breastfeeding

Chapter 13 Pregnancy and Breastfeeding
Planned Pregnancies Have The Best Outcome
  • Many practices can be harmful to the fetus
  • Minimize exposure even prior to conception
  • Nutrition is important
  • 50 of all pregnancies are unplanned

The First Trimester
  • First 13-14 weeks of pregnancy
  • Formation of a zygote
  • Rapid increase in cell number and size
  • Nutritional deficiency or toxicity can be harmful
  • Medication, drugs, radiation, trauma can also be
  • half of all pregnancies miscarry during the
    first trimester

Vulnerable Periods of Fetal Development
The Second Trimester
  • Begins to look more like an infant
  • Still can be affected by toxin exposure
  • Deposit of (2-4 lb.) of breast tissue and fat
    tissue for the mother
  • Nutritional deficiency at this time will affect
    mothers ability to breastfeed

The Last (3rd) Trimester
  • Rapid growth
  • Deposition of fat, calcium, and iron to the fetus
    during the last month
  • Baby may deplete moms store of iron if there is
    low intake

A Successful Pregnancy
  • Mothers physical and emotional health
  • 37 weeks gestation at the time of birth
  • Sufficient lung development
  • The longer the gestation, the less the health
  • Birth weight 5.5 pounds

Low-Birth-Weight Infants
  • Weighing less than 5.5 pounds at birth
  • Usually due to
  • preterm births (before 37 wks)
  • Small for gestational age
  • Are full term babies
  • Low birth weight

Energy Needs During Pregnancy
  • Balanced and adequate diet during the first
  • 300 extra kcal per day during the 2nd and 3rd
  • Seek nutrient dense foods
  • Adequate weight gain is the best predictor of

Recommended Weight Gain During Pregnancy
  • 2 - 4 lb. of weight gain during the 1st trimester
  • 0.75 - 1 lb. weekly weight gain during the 2nd
    and 3rd trimester
  • Total weight gain goal is 25-35 lb. for normal
    weight women
  • Underweight women should gain 28 - 40 lb.
  • Obese women should gain 15 - 25 lb.

Components of Weight Gained During Pregnancy
Physical Activity
  • Low impact and non-contact activities recommended
  • Non-active women should not begin an intense
    exercise program
  • High risk pregnancies may need to restrict
  • Consult physician about possible limitations

Protein and CHO Needs During Pregnancy
  • RDA for protein is increased by 10-15 gm/day
  • Many (non-pregnant) women already consume the
    recommended amount for protein
  • Minimum of 100 gm of CHO to prevent ketosis
  • Most women exceed the minimum needs of CHO

Additional Vitamin Needs
  • Vitamin D
  • Increased for fetal bones development
  • 20-30 min. of sun exposure several times a week
  • Found in fortified milk and prenatal supplement
  • Folate (600 ug/day)
  • Synthesis of DNA
  • Fetal and maternal growth
  • Increase red blood cell formation
  • Neural tube defect
  • Decrease absorption with contraceptive use
  • Other B-vitamins are increased

Additional Mineral Needs
  • Iron (30 mg/day during last 2 trimesters)
  • Increased hemoglobin
  • Iron stores for the fetus
  • Need to take iron supplement
  • Iodide (220 ug/day) to prevent goiter
  • Calcium
  • Adequate mineralization of fetal skeleton and
  • Low amounts in prenatal supplement
  • Zinc
  • Supports growth and development

Using the Food Guide Pyramid
  • 3 - 4 servings from the milk group
  • 3 servings from the meat and meat substitute
  • 3 servings from the vegetable group
  • 2 servings from the fruit group
  • 6 servings from the bread group
  • Will supply adequate vitamin D, folate, calcium,
    iron, and zinc

Should Pregnant Women Take Supplements?
  • High iron needs
  • High folate needs
  • Prenatal supplements are routinely prescribed
  • Easier to take supplement than change diets
  • Highly recommended for women with poor eating
  • Vitamin A should not exceed 3000 RAE/day

Vegetarian and Pregnant
  • Lacto-ovo or Lacto-vegetarian can usually meet
    nutritional needs
  • Vegan must plan diet carefully
  • Requires sufficient protein vitamins D, B-6,
    B-12 iron, calcium, and zinc
  • Prenatal supplements may be necessary

Does Nutrition Matter?
  • YES!
  • Supports fetal growth
  • Supports maternal changes to support pregnancy
    and lactation
  • Inadequate kcal can retard fetal growth
  • Higher risk for maternal and fetal death in
    famine areas
  • The poorer the nutritional status of the mother,
    the poorer the outcome
  • Success of WIC

Other Factors on Pregnancy Outcome
  • Socioeconomic status
  • Closely spaced births (
  • Teenage pregnancy
  • Advanced maternal age
  • Early prenatal care
  • Lifestyle and use of drugs, tobacco
  • Crash diets/fasting and prenatal ketosis
  • Body weight and weight gain

What About Caffeine ?
  • Decreases iron absorption
  • May reduce blood flow through the placenta
  • Risk of spontaneous abortion with heavy caffeine
    use in the 1st trimester
  • Risk of low-birth-weight infant
  • Limit caffeine intake (

What About Aspartame?
  • Harmful for mothers with phenylketonuria (PKU)
  • Will disrupt fetal brain development
  • Does not seem harmful for women who do not have

Listeria monocytogenes
  • From unpasteurized milk, soft cheeses make from
    raw milk, raw cabbage
  • Cause flu-like symptoms
  • Occur 7 - 30 days after exposure
  • May attribute to spontaneous abortion
  • Recommend pasteurized milk and thoroughly cooked
    meats, fish, and poultry.

Importance of Prenatal Care
  • Medical assessment
  • Monitoring
  • Educate about an adequate diet
  • Learn what to avoid
  • Proper health habits
  • Women, Infants, and Children (WIC) supplemental
    food program

The Discomforts of Pregnancy
  • Heartburn
  • Hormone relaxes muscles in the uterus and
  • Stomach acid more likely to slip up the esophagus
  • Avoid lying down after eating
  • Avoid spicy foods
  • Check with physician regarding use of antacids

The Discomforts of Pregnancy
  • Constipation
  • Relaxation of the intestinal muscle
  • Fetus competes with the GI for space
  • Regular exercise
  • Fluid and fiber
  • Reevaluate iron dose
  • Hemorrhoids
  • Straining during elimination
  • A result of constipation

The Discomforts of Pregnancy
  • Edema
  • Placenta hormone causes body tissue to retain
  • Increase in blood volume
  • Some swelling is normal
  • Salt restriction and/or diuretics not needed
  • Only a problem if accompanied by hypertension and
    protein in the urine

The Discomforts
  • Morning sickness
  • 50 of all women will experience in the 1st
  • May be related to heighten sense of smell
  • Can occur anytime throughout the day
  • Avoid nauseating foods or smell of food
  • Eat small, frequent bland meals
  • Consider changing brand of prenatal supplement

  • Physiological anemia
  • Mothers blood volume increase 150 of normal
  • Amount of red blood cell only increase 20 - 30
  • A lower ratio of red blood cell leading to anemia
  • Occurs as a normal response to pregnancy
  • May need medical attention if iron store is

  • Gestational diabetes
  • Hormones synthesized by the placenta decrease the
    action of insulin
  • Usually begins 20 - 28 weeks gestation and are
    routinely screened
  • Diabetic diet may be recommended
  • Insulin may be recommended
  • Usually disappears after birth but is linked to
    diabetes later in life for mom
  • If untreated, can produce a large baby

  • Pregnancy-induced hypertension
  • High-risk disorder
  • Preeclampsia (mild form)
  • Eclampsia (severe form)
  • Elevated blood pressure, protein in the urine
  • Edema, change in blood clotting
  • Nervous system disorder, leading to convulsions
  • Liver and kidney damage leading to death

  • Recommended for the first 4-6 months of life the
    American Dietetic Association and the American
    Academy of Pediatrics
  • Only 55 of all mothers nurse in the hospital
  • Number of moms still breast feeding decreases as
    infant gets older

How Do You Know If The Infant Had Enough?
  • Infant has 6 wet diapers a day
  • Shows normal weight gain
  • Passes 1 stool per day
  • Softening of the breast tissue
  • May take 2-3 weeks to establish a breastfeeding
  • Try not to introduce the bottle until
    breastfeeding is well established

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

Mature Milk
  • Composition changed, is thin, watery, slightly
  • Easy to digest proteins and protein binds to iron
    reducing bacteria growth
  • High linoleic acid and cholesterol content for
    brain development
  • Long chain omega-3 fatty acids (DHA) for
    synthesis of brain tissues, CNS, eyes
  • DHA not available in formula yet

Milk Composition
  • Foremilk
  • Resembles skim milk
  • 17 fat, 74 CHO, 9 protein
  • Makes up 60 of volume
  • Hindmilk
  • Resembles cream
  • 66 fat, 28 CHO, 6 protein
  • Makes up the last 5 of the volume
  • Released 10-20 minutes into the feeding

Fluid Needs
  • Human milk provides adequate hydration
  • Hot climate, diarrhea, vomiting may necessitate
    additional fluids
  • Too much water may lead
  • Lead to brain disorders
  • Low blood sodium

Nutritional Needs For Lactation
  • Most substances ingested are secreted into
    mothers milk
  • Milk production requires additional 800 kcal/day
  • RDA for energy is an additional 500 kcal/day
  • The 300 kcal difference will contribute to slow
    gradual weight loss for mom
  • Increase in vitamins A, E, C, riboflavin, copper,
    chromium, iodide, magnanese, selenium, and zinc

Food Plan
  • Balanced and a variety of foods
  • 1800 kcals/day
  • Moderate fat
  • Fluids
  • Restriction of kcals will reduce milk supply
  • Alcohol and smoking reduces milk supply
  • Limit fish and intake of peanuts (allergens)

Benefits of Breastfeeding
  • Always ready, sterile, and meets nutritional
    needs for first 4-6 month
  • Provides antibodies
  • Contributes to maturation of the GI
  • Reduces risk of food allergies
  • Establishes eating in moderation
  • Contributes to proper development of jaws, teeth
    for better speech
  • Decreases ear infections
  • Bonding with mom

Benefits of Breastfeeding
  • Quicker return of the uterus to its pre-pregnancy
  • Decreases risk of ovarian and premenopausal
    breast cancer
  • Cheaper (than buying formulas)
  • Bonding with child
  • Increased energy need for mom

  • Lack of information and role models
  • Burden on mom
  • Need to return to the work force
  • Embarrassment and modesty
  • Medial conditions
  • Infant with PKU
  • Mothers on medications
  • Mothers with TB, AIDS, HIV, hepatitis

Fetal Alcohol Syndrome
  • Large amounts of alcohol during pregnancy
  • Excess alcohol reaches the embryo/fetus
  • Embryo and fetus cannot metabolize alcohol
  • Poor fetal and infant growth
  • Physical deformities
  • Mental retardation
  • Irritable and hyperactive

Fetal Alcohol Effects
  • Usually no telltale facial abnormalities
  • Parents may not suspect the effects of alcohol
  • Hyperactivity
  • Attention deficit disorder
  • Poor judgment
  • Delayed learning

Effects of Alcohol
  • Unclear of how it causes its effects
  • Abstinence is important, especially during the
    first trimester
  • Binge drinking can arrest and alter cell divisions