Chapter 10 Healthy Support Tissue
Pregnancy: The Impact of Nutrition
on the Future
Nutrition Prior to Pregnancy
 Achieve and maintain a healthy body weight
 Choose an adequate and balanced diet
 Be physically active
 Receive regular medical care
 Avoid harmful influences
PREPREGNANCY WEIGHT
 Underweight
An underweight woman has a high risk of having a low-birth
weight infant, especially if she is unable to gain sufficient
weight during pregnancy. Compared with normal-weight
infants, low-birth weight infants are more likely to contract
diseases and nearly 40 times more likely to die in the first
month of life. Impaired growth and development during
pregnancy may have long-term health effects as well.
 Overweight and Obesity
Obese women are also urged to strive for healthy weights
before pregnancy. The infant of an obese mother may be
larger than normal and may be large even if born
prematurely. The large early infant may not be recognized
as premature and thus may not receive the special medical
care required. In addition, both overweight and obese
women have a greater risk of giving birth to infants with
heart defects and other abnormalities.
A major reason that the mother’s pre pregnancy nutrition is
so crucial is that it determines whether her uterus will be able
to support the growth of a healthy placenta during the first
month of gestation.
THE EVENTS OF PREGNANCY
The newly fertilized ovum is called a zygote. It begins as
a single cell and rapidly divides to become a blastocyst.
During the first week, the blastocyst floats down into the
uterus where it will embed itself in the inner uterine wall—a
process known as implantation.
A Note about Critical Periods
NUTRIENT NEEDS DURING PREGNANCY
 Carbohydrate, Protein, and Fat
Energy needs vary with the progression of pregnancy. In the
first trimester, the pregnant woman needs no additional
energy, but as pregnancy progresses, her energy needs rise.
She requires an additional 340 kcalories daily during the
second trimester and an extra 450 kcalories each day during
the third trimester.
 Of Special Interest: Folate and Vitamin B12
folate plays an important role in preventing neural tube
defects. To review, the early weeks of pregnancy are a
critical period for the formation and closure of the neural
tube that will later develop to form the brain and spinal cord.
By the time a woman suspects she is pregnant, usually
around the sixth week of pregnancy, the embryo’s neural
tube normally has closed. A neural tube defect (NTD) occurs
when the tube fails to close properly.
In a more common NTD, the spinal cord and backbone do
not develop normally— and the result is spina bifida.
 Vitamin D and Calcium for Bones
Vitamin D plays a vital role in calcium absorption and
utilization. Consequently, severe maternal vitamin D
deficiency interferes with normal calcium metabolism,
which, in rare cases, may cause rickets in the infant.
Intestinal absorption of calcium doubles early in pregnancy,
when the mother’s bones store the mineral. Later, as the
fetal bones begin to calcify, there is a dramatic shift of
calcium across the placenta.
 Fluoride
Mineralization of the fetus’s teeth begins in the fifth month
after conception. For this and for bone development,
fluoride may be needed. Fluoride crosses the placenta, and
whether the placenta can defend against excess intakes is
questionable.
 Iron
The body conserves iron especially well during pregnancy:
menstruation ceases, and absorption of iron increases up to
threefold due to a rise in the blood’s iron absorbing and iron-
carrying protein transferring. Still, iron needs are so high that
stores dwindle during pregnancy.
 Zinc
Zinc is required for DNA and RNA synthesis and thus for
protein synthesis. (+) Typical zinc intakes for pregnant
women are lower than recommendations, but, fortunately,
zinc absorption increases when zinc intakes are low
Nutrient Supplements
Physicians often recommend daily multivitamin-mineral
supplements for pregnant women. These prenatal
supplements typically provide more folate, iron, and
calcium than regular supplements. Prenatal supplements
are especially beneficial for women who do not eat
adequately and for those in high-risk groups: women
carrying twins or triplets, cigarette smokers, and alcohol and
drug abusers.
What are the considerations?
FOOD ASSISTANCE PROGRAMS
Special Supplemental Nutrition Program for Women, Infants,
and Children (WIC) provides vouchers redeemable for
nutritious foods, nutrition education, and referrals to health
and social services to low-income pregnant and lactating
women and their children
WEIGHT GAIN
Women must gain weight during pregnancy—fetal and
maternal well-being depend on it. Ideally, a woman will
have begun her pregnancy at a healthy weight, but even
more importantly, she will gain within the recommended
weight range based on her prepregnancy body mass index
(BMI).
WEIGHT LOSS AFTER PREGNANCY
The pregnant woman loses some weight at delivery. In the
following weeks, she loses more as her blood volume returns
to normal and she gets rid of accumulated fluids. The typical
woman does not, however, return to her prepregnancy
weight. In general, the more weight a woman gains beyond
the needs of pregnancy, the more she retains— mostly as
body fat.
PHYSICAL ACTIVITY whose prepregnancy blood pressure is unknown, diagnosis
of chronic hypertension is based on the presence of
By remaining active throughout pregnancy, a woman can
sustained hypertension before 20 weeks of gestation.
develop the strength she needs to carry the extra weight
and maintain habits that will help her lose it after the birth. Gestational hypertension develops after the 20th week of
gestation. In women with gestational hypertension, blood
COMMON NUTRITION-RELATED CONCERNS OF PREGNANCY
pressure usually returns to normal during the first few weeks
 Food Cravings and Aversions after childbirth.
 Morning Sickness
 Preeclampsia
 Heartburn
 Constipation Preeclampsia affects almost all of the woman’s organs—the
circulatory system, liver, kidneys, and brain. If it progresses,
PROBLEMS IN PREGNANCY
she may experience seizures; when this occurs, the
 Preexisting Diabetes condition is called eclampsia.

Pregnancy presents special challenges for the PRACTICES TO AVOID

management of diabetes.46 Insulin-induced hypoglycemia
 Cigarette Smoking
has a more rapid onset during pregnancy and is a danger
 Medicinal Drugs and Herbal Supplements
to the mother, especially in those with type 1 diabetes.
 Drugs of Abuse
Women with type 2 diabetes oft en start pregnancy with
 Environmental Contaminants
insulin resistance and obesity, making optimal glycemic
 ADOLESCENT PREGNANCY
control difficult. The risks of diabetes during pregnancy
 Breastfeeding
depend on how well it is managed before, during, and after.
NUTRITION DURING LACTATION
 Gestational Diabetes
ENERGY
Some women are prone to developing a pregnancy related
form of diabetes, gestational diabetes. A nursing woman produces about 25 ounces of milk a day.

Gestational diabetes can lead to fetal or infant sickness or 500 kcalories per day above her regular needs.
death. When it is identified early and managed properly,
WEIGHT LOSS
however, the most serious risks fall dramatically.
Many women actively try to lose the extra weight and body
 Hypertension
fat they accumulated during pregnancy.
Chronic hypertension can be a preexisting condition that
A gradual weight loss (1 pound per week) is safe and does
develops before a woman becomes pregnant. In women
not reduce milk output.
CONTRAINDICATIONS TO BREASTFEEDING Energy Nutrients

 Alcohol for infants, breast milk is nature’s most nearly perfect food
 Caffeine
Vitamins and Minerals
 Cigarette Smoke
 Medications and Illicit Drugs the vitamin content of the breast milk of a well-nourished
 Maternal Illness mother is ample.
 Nutrition of the Infant
Supplements for Infants
NUTRIENT NEEDS DURING INFANCY
Pediatricians may prescribe supplements containing vitamin
Nutrients to Support Growth D, iron, and fluoride (after six months of age)
An infant’s birth weight doubles by about five months of age Immunological Protection
and triples by the age of one year, typically reaching 20 to
25 pounds. Breast milk offers immunological protection. Not only is
breast milk sterile, but it actively fights disease and protects
An infant’s length increases about 10 inches from birth to infants from illnesses.
one year. By the end of the first year, the growth rate slows
considerably. During the first two or three days after delivery, the breasts
produce colostrum, a premilk substance containing mostly
The infant’s length changes more slowly than weight serum with antibodies and white blood cells.
Water Bifidus Factors, which favor the growth of the
“friendly” bacterium Lactobacillus bifidus in the
The younger a child is, the more of the child’s body weight
infant’s digestive tract
is water.
Lactoferrin, keeps bacteria from getting the iron they
Breast milk or infant formula normally provides enough water
need to grow, helps absorb iron into the
to replace fluid losses in a healthy infant.
infant’s bloodstream, and kills some
BREAST MILK bacteria directly.

Frequency and Duration of Breastfeeding Lactadherin, in breast milk binds to, and inhibits
replication of, the virus that causes
During the first few weeks, approximately 8 to 12 feedings a
most infant diarrhea.
day, on demand, as soon as the infant shows early signs of
hunger such as increased alertness, activity, or suckling
motions, promote optimal milk production and infant
growth.
INFANT FORMULA
Infant Formula Composition Manufacturers can prepare
formulas from cow’s milk in such a way that they do not
differ significantly from human milk in nutrient content.
Notice the higher protein concentration of cow’s milk,
which stresses the infant’s kidneys.
Infant Formula Standards
FDA mandates quality control procedures to ensure that
these standards are met.
All standard formulas are therefore nutritionally similar. Small
differences in nutrient content are sometimes confusing but
usually unimportant.
Special Formulas
Special formulas have been designed to meet the dietary
needs of infants with specific conditions such as prematurity
or inherited diseases.
Some infants who are allergic to cow’s milk protein may also
be allergic to soy protein. For these infants, special formulas
based on hydrolyzed protein are available.
Risks of Formula Feeding
Formulas contain no protective antibodies for infants, but, in
general, vaccinations, purified water, and clean
environments in developed countries help protect infants
from infections.
Over dilution of formula can cause malnutrition and growth
failure. Contaminated formula oft en causes infections
leading to diarrhea, dehydration, and malabsorption.
Nursing Bottle Tooth Decay
Dentists advise against putting an infant to bed with a bottle.
Salivary flow, which normally cleanses the mouth, diminishes
as the infant falls asleep.
To prevent nursing bottle tooth decay, no child should be
put to bed with a bottle as a pacifier.
INTRODUCING FIRST FOODS
When to Introduce Solid Food
The main purpose of introducing solid foods is to provide
needed nutrients that are no longer supplied adequately by
breast milk or formula alone.
 Foods to Provide Iron and Vitamin C
Rapid growth demands iron. At about four to six months, the
infant begins to need more iron than body stores plus breast
milk or iron-fortified formula can provide.
The best sources of vitamin C are fruits and vegetables. It has
been suggested that infants who are introduced to fruits
before vegetables may develop a preference for sweets
and find the vegetables less palatable, but there is no
evidence to support offering these foods in a particular
order.
 Physical Readiness for Solid Foods
The ability to swallow solid food develops at around four to
six months, and food offered by spoon helps to develop
swallowing ability.
 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 three to five days before introducing the next new
food.

 Choice of Infant Foods

Infant foods should be selected to provide variety, balance,

and moderation. Commercial baby foods offer a wide
variety of palatable, nutritious foods in a safe and
convenient form. Homemade infant foods can be as
nutritious as commercially prepared ones, as long as the
cook minimizes nutrient losses during preparation.

 Foods to Omit

Sweets of any kind (including baby food “desserts”) have no

place in an infant’s diet.

Canned vegetables are also inappropriate for infants; they

oft en contain too much sodium.

Honey and corn syrup should never be fed to infants

because of the risk of botulism.

 Foods at One Year

Whole milk is the best food to supply most of the nutrients the
infant needs at one year of age; 2 to 3 cups a day meet
those needs sufficiently.

More milk than this displaces iron-rich foods and can lead to
the iron deficiency anemia known as milk anemia