copyright © 2010 wolters kluwer health | lippincott williams & wilkins healthy eating for...

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Healthy Eating for Healthy Babies

Chapter 11

Healthy Eating for Healthy Babies

Chapter 11


Healthy Eating for Healthy BabiesHealthy Eating for Healthy Babies

• An optimal diet before and during pregnancy can improve the chance of a healthy newborn baby, a healthy mom, and a healthy future for both

• Recent studies suggest that nutritional deficiencies during the first trimester increase the risk of certain chronic diseases later in the infant’s life

• An optimal diet provides enough, but not too many, calories and nutrients to optimize maternal and fetal health


Prepregnancy NutritionPrepregnancy Nutrition

• Basic principles of healthy eating are appropriate before, during, and after pregnancy

• Many experts recommend that synthetic folic acid be consumed prior to pregnancy to prevent neural tube defects

• Other preconception care recommendations include controlling obesity


Prepregnancy Nutrition (cont’d)Prepregnancy Nutrition (cont’d)• Folic acid supplementation

– It has been well established that daily supplements of folic acid taken prior to pregnancy decrease the risk of neural tube defects by as much as two thirds

– Recommended: 400 micrograms of synthetic folic acid every day

– Synthetic folic acid in supplements and fortified foods is recommended


Prepregnancy Nutrition (cont’d)Prepregnancy Nutrition (cont’d)

• Obesity control

– The CDC recommends that overweight women try to get within 15 pounds of their ideal weight prior to conception

– Prepregnancy BMI is the strongest predictor of excess gestational weight gain and future obesity

– Once a woman becomes pregnant, weight reduction should never be undertaken


QuestionQuestion

• Is the following statement true or false?

Recent studies suggest that nutritional deficiencies during the second trimester increase the risk of chronic diseases later in the infant’s life.


AnswerAnswer

False.

Rationale: Recent studies suggest that nutritional deficiencies during the first trimester increase the risk of certain chronic diseases later in the infant’s life (Fowles, 2006).


Nutrition and Lifestyle During Pregnancy Nutrition and Lifestyle During Pregnancy

• Key recommendations

– Increase synthetic folic acid intake to 600 micrograms/ day

– Eat a variety of nutrient-dense food and beverages among the basic food groups

– Limit the intake of saturated fat, trans fats, cholesterol, added sugars, salt, and alcohol

– Meet recommended intakes for nutrients within calorie needs

– Eat a balanced plan, such as an individualized MyPyramid food plan


Nutrition and Lifestyle During Pregnancy (cont’d)


• Key recommendations (cont’d)

– Women of childbearing age who may become pregnant:

o Consume adequate synthetic folic acid daily (from fortified foods or supplements) in addition to food forms of folate from a varied diet

o Eat foods high in heme-iron and/or consume iron-rich plant foods or iron-fortified foods with an enhancer of iron absorption, such as vitamin-C–rich foods

o Alcoholic beverages should not be consumed

• Most nutrient requirements increase during pregnancy but can be met with an adequate and varied diet





– Pregnant women:

o Ensure appropriate weight gain as specified by a health care provider

o In absence of medical or obstetric complications, incorporate 30 minutes or more of moderate-intensity physical activity on most, if not all, days of the week; avoid activities with a high risk of falling or abdominal trauma




• Key recommendations (cont’d)– Pregnant women (cont’d):

o Alcoholic beverages should not be consumed o Do not eat or drink unpasteurized milk or any products

made from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, raw or undercooked fish or shellfish, unpasteurized juices, and raw sprouts

o Eat only certain deli meats and frankfurters that have been reheated to steaming hot





– Breastfeeding women:

o Moderate weight reduction is safe and does not compromise weight gain of the nursing infant

o Be aware that neither acute nor regular exercise adversely affects the mother’s ability to successfully breastfeed




• Amount of weight fain

– Based on prepregnancy BMI

– Recommended weight gain

o 25 to 35 pounds in women of normal weight

o 28 to 40 pounds for underweight women

o 15 to 25 pounds for overweight women

o At least 15 pounds for women who are obese at the time of conception




• Amount of weight gain (cont’d)

– There is concern that the guidelines encourage too much weight gain during pregnancy and may result in heavy birth weights and an increased risk of overweight in the offspring

– Guidelines currently being revised





– Overweight women are more likely to gain more than the recommended amount

o Increases risk to mother for:

Gestational diabetes, cesarean deliveries, complications during delivery, and postpartum weight retention

o Increases risk to fetus for:

Hypoglycemia, large-for-gestational age, a low Apgar score, seizures, and childhood obesity





– Underweight women are more likely to gain less than recommended amount

o Increases risk of a low–birth-weight (LBW) infant

LBW infants have a high incidence of postnatal complications and mortality

Increased risk for coronary heart disease, type 2 diabetes, and hyperlipidemia later in life




• Weight gain pattern

– Women who begin pregnancy at a healthy weight

o 2- to 4-pound weight gain in first trimester

o 3- to 4-pound gain/month thereafter

– Underweight women

o Gain 1 pound/week in the second and third trimesters

– Overweight women

o Gain about 0.66 pounds/week




• Calorie requirements

– Calorie requirements do not increase until the second trimester of pregnancy

– During the second trimester, normal-weight women need approximately 340 extra calories/day

– Third-trimester normal-weight women need approximately 450 extra calories/day

– Most pregnant women need a total of 2,200 to 2,900 calories/day




• Vitamin and mineral supplements

– Most nutrients are needed in greater amounts during pregnancy

– Exceptions

o Folic Acid

o Iron


QuestionQuestion• Mrs. M, a 30-year-old, presents at the labor and

delivery suite in active labor. Her prenatal history reveals that Mrs. M was underweight at conception and has not gained the recommended amount of weight during her pregnancy. What is her infant at risk for later in life?

a. Iron deficiency anemia

b. Type 1 diabetes mellitus

c. Hyperlipidemia

d. Hypocholesterolemia


AnswerAnswer

c. Hyperlipidemia

Rationale: In contrast, underweight women are more likely to gain less than the recommended amount of weight, which increases the risk of a low–birth-weight (LBW) infant. LBW infants have a high incidence of postnatal complications and mortality and are at increased risk for coronary heart disease, type 2 diabetes, and hyperlipidemia later in life (Hanson, et al., 2004).




• Vitamin and mineral supplements (cont’d)

– Iron

o Dietary reference intake for iron increases by 50% during pregnancy

o Infants born to women who have iron deficiency anemia are at: Increased risk of low birth weight and possibly

preterm delivery and perinatal mortality

o Recommended that pregnant women take an iron supplement of 27 mg of iron daily

o Anemic women may need 60 mg of iron daily





– Iron (cont’d)

o Pica A craving for nonfood items such as laundry

starch, clay, or ice Can be a strongly rooted social tradition More prevalent among African Americans and

rural residents Iron deficiency may be a consequence





– Other supplements

o A multivitamin and mineral supplement is recommended for pregnant women who (ADA, 2008):

Have iron-deficiency anemia

Consume a poor quality diet

Do not consume enough foods from animal sources




• A multivitamin and mineral supplement is recommended for pregnant women who (cont’d):

– Smoke or abuse alcohol or drugs

– Are carrying 2 or more fetuses

– Have HIV, especially if access to antiretroviral treatment is limited

• Specific supplements may be needed based on individual circumstances




• Alcohol– Alcohol use during pregnancy can cause:

o Physical and neurodevelopmental problemso Fetal alcohol syndrome

• Avoiding foodborne illness– Foodborne risks are more dangerous for pregnant

women than for most other adults– May lead to miscarriage, stillbirth, premature

delivery, or neonatal infection – Pregnant women are 20 times more likely to get

listeriosis




• Avoiding foodborne illness (cont’d)

– To reduce the risk of listeriosis, pregnant women should not consume

o Unpasteurized milk or products made with unpasteurized milk

o Raw or undercooked meat, poultry, eggs, fish, or shellfish

o Refrigerated pâtés or meat spreads

o Certain soft cheeses such as feta, Brie, bleu, and Camembert

o Leftover foods and ready-to-eat foods, including hot dogs and deli meats, unless heated until steaming hot




• Avoiding foodborne illness (cont’d)– Toxoplasma gondii (parasite)

o Eating raw meat is the cause o To prevent transmission to fetus:

Cook meat thoroughly Peel or wash fresh fruits and vegetables before

eating Avoid cross contamination in the kitchen by

cleaning surfaces and utensils exposed to raw food

Avoid changing cat litter (cats pass an environmentally resistant form of the organism in their feces)




• Caffeine

– A high caffeine intake is associated with:

o Spontaneous miscarriage

o Low birth weight

• Nonnutritive sweeteners

– Has been studied extensively

– All deemed to be safe during pregnancy when consumed at levels within the U.S. Food and Drug Administration (FDA) acceptable daily intake (ADI) guidelines




• Herbal supplements

– Generally recommended that they not be used during pregnancy and lactation

– Little animal or human testing has been done to determine if herbs can cause birth defects or potentially harm mothers and infants




• Fish

– FDA has issued advisories regarding fish and shellfish consumption during pregnancy

– Nearly all fish contain trace amounts of mercury; it accumulates in humans primarily by eating fish

– Mercury poisoning in a fetus can result in learning delays in walking or talking to more severe problems such as cerebral palsy, seizures, and mental retardation




• Fish (cont’d)

– To reduce the risk of methylmercury poisoning, it is recommended that pregnant women, lactating women, and women who may become pregnant:

o Not eat shark, swordfish, king mackerel, and tilefish

o Limit total intake of seafood to 12 oz./week

o Limit albacore (“white”) tuna to 6 oz./week

o Check with the local health department or Environmental Protection Agency to determine which fish from local waters are safe to eat




• Physical activity

– Healthy pregnant women who do not have medical or obstetric complications are urged to follow the advice for all healthy adults:

o Get at least 30 minutes of moderate exercise on most days of the week

o Pay attention to fall risk and avoiding supine positions during the second and third trimesters

– These measures may help prevent and/or manage gestational diabetes and fetal macrosomia




• Maternal health

– Common complaints associated with pregnancy, such as nausea, heartburn, and constipation, may be prevented or alleviated by nutritional interventions

– More serious health conditions in the mother, whether preexisting or gestational, can greatly impact the course of pregnancy and infant health




• Maternal health (cont’d)

– Diabetes mellitus

o Preexisting diabetes increases the risk of congenital malformations

o Gestational diabetes Appears in the latter half (after 24 weeks) of

pregnancy Increases the risk of macrosomia Can make delivery difficult, increasing the risk

of infant shoulder dislocation and need for cesarean birth





– Diabetes mellitus

o Gestational diabetes (cont’d)

Mother is at high risk for type 2 diabetes later in life

Child at increased risk for hypertension and high BMI in childhood

o Diabetes mellitus requires nutrition management

o Women with preexisting diabetes should achieve glycemic control prior to conception





– Gestational hypertension

o Disease develops in 5% to 8% of pregnancies

o Defined as a systolic blood pressure of ≥140 or a diastolic reading of ≥90 with onset after 20 weeks’ gestation

o Approximately one quarter of the gestational hypertension cases progress to preeclampsia




•Maternal health (cont’d)– Gestational hypertension (cont’d)

o Edema of the hands and face, weight gain ≥5 pounds/week, visual disturbances, severe headaches, dizziness, and pain in the upper right abdominal quadrant may occur

o Preeclampsia can progress to eclampsia

o Risk factors for eclampsia History of chronic hypertension or preeclampsia

in a prior pregnancy, primiparity, multiple pregnancy, maternal age of <20 or ≥35 years, African-American race, and maternal obesity





– Maternal PKU

o Very high blood levels of phenylalanine are devastating to the fetus

o Causes mental retardation and many infants also develop microcephaly, heart defects, and low birth weight

o Most infants do not inherit PKU

o Prevention includes a rigid low-phenylalanine diet for at least 3 months before conception and throughout the duration of the pregnancy




• Nutrition care: assessment and counseling

– First prenatal visit should identify clients who present with a high-risk pregnancy

o Monitoring continues throughout pregnancy to identify high-risk criteria

o All women should receive prenatal nutrition advice that includes guidelines for healthy eating and diet strategies for preventing or treating common problems, as appropriate


QuestionQuestion

• When does gestational diabetes usually occur during a pregnancy?

a. After 16 weeks

b. After 20 weeks

c. After 24 weeks

d. After 30 weeks


AnswerAnswer

c. After 24 weeks

Rationale: Gestational diabetes, which appears in the latter half (after 24 weeks) of pregnancy, increases the risk of macrosomia and can make delivery difficult, increasing the risk of infant shoulder dislocation and cesarean birth.


Nutrition for Lactation Nutrition for Lactation • World Health Organization recommends:

– Infants be exclusively breastfed for the first 6 months of life

– Introduction of complementary foods thereafter

– Breastfeeding continues for the first 2 years of life (WHO, 2003)

• In the U.S., both the American Academy of Pediatrics and the American Dietetic Association recommend:

– Infants be exclusively breastfed for the first 6 months of life

– Breastfeeding continue with complementary foods until 1 year of age


Nutrition for Lactation (cont’d) Nutrition for Lactation (cont’d)

• Promoting breastfeeding

– Almost all women have the potential to successfully breastfeed

– It is a learned behavior, not a physiologic response

– It can be positively impacted by counseling

– Preparation for breastfeeding should begin prenatally


Nutrition for Lactation (cont’d) Nutrition for Lactation (cont’d) • Promoting breastfeeding (cont’d)

– Contraindications

o Galactosemia in the infant

o Illegal drug use in the mother

o Active tuberculosis

o HIV/AIDS (in some countries, the risk of infant mortality from not breastfeeding may outweigh the risk of acquiring HIV through breast milk)

o Use of certain drugs, such as radioactive isotopes, antimetabolites, cancer chemotherapy agents, lithium, and ergotamine



• Maternal diet

– Nutritional needs during lactation are based on:

o Nutritional content of breast milk

o Energy “cost” of producing milk


Food Guide Pyramid for Pregnancy and LactationFood Guide Pyramid for Pregnancy and Lactation

Food Group # Daily Servings

• Bread, cereal, rice, and pasta 7-11

• Vegetable 4-5

• Fruit 3–4

• Milk 3-4

• Meat, poultry, fish, dry beans, 3 eggs, and nuts



• Calories

– Women use approximately 500 calories above their normal total daily calorie needs to produce breast milk

– Adequacy of calorie intake is determined by changes in a woman’s weight

– Most women need at least 1,800 calories/day to obtain adequate amounts of nutrients needed during lactation



• Fluid

– Another nutritional consideration during lactation is fluid intake

– It is suggested that breastfeeding mothers drink a glass of fluid every time the baby nurses and with all meals

– Fluids consumed in excess of thirst quenching do not increase milk volume



• Vitamins and minerals

– For many vitamins and minerals, requirements during lactation are higher than during pregnancy

– An inadequate maternal diet decreases the quantity of milk produced, not the quality

– Maternal supplements can correct inadequacies

o Their use may be prudent for the majority of lactating women in developing and industrialized nations



• Attaining healthy BMI

– Highest incidence of obesity in women is during the childbearing years

– Excess weight gain during pregnancy, insufficient weight loss at 6 months’ postpartum, and high prepregnancy BMI were predictive of BMI 15 years later

– 6 weeks’ postpartum over two thirds of women have not achieved their prepregnancy weight



• Suggestions for managing postpartum weight are to (Krummel, 2006):

– Assess readiness to change

– Assess lactation status, dietary intake, and activity levels

– Assess for stress or depressive symptoms, which complicate weight management

copyright © 2010 wolters kluwer health | lippincott williams & wilkins healthy eating for...

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