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Healthy Eating for
Healthy Babies
Chapter 11
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Healthy 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
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Prepregnancy 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
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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
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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
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Question
• 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.
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Answer
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).
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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
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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 ironrich 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• Key recommendations (cont’d)
– 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 moderateintensity physical activity on most, if not all, days
of the week; avoid activities with a high risk of
falling or abdominal trauma
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• Key recommendations (cont’d)
– 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• Amount of weight gain (cont’d)
– 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• Amount of weight gain (cont’d)
– 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• Vitamin and mineral supplements
– Most nutrients are needed in greater amounts
during pregnancy
– Exceptions
o Folic Acid
o Iron
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Question
• 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
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Answer
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).
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• Vitamin and mineral supplements (cont’d)
– 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• Vitamin and mineral supplements (cont’d)
– 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• Alcohol
– Alcohol use during pregnancy can cause:
o Physical and neurodevelopmental problems
o 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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)
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• Maternal health (cont’d)
– 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• Maternal health (cont’d)
– 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• Maternal health (cont’d)
– 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
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Nutrition and Lifestyle During Pregnancy
(cont’d)
• 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
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Question
• 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
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Answer
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.
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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
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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
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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
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Nutrition for Lactation (cont’d)
• Maternal diet
– Nutritional needs during lactation are based
on:
o Nutritional content of breast milk
o Energy “cost” of producing milk
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Food Guide Pyramid for
Pregnancy and Lactation
Food Group
Servings
# Daily
• Bread, cereal, rice, and pasta
7-11
• Vegetable
4-5
• Fruit
3–4
• Milk
3-4
• Meat, poultry, fish, dry beans,
eggs, and nuts
3
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Nutrition for Lactation (cont’d)
• 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
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Nutrition for Lactation (cont’d)
• 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
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Nutrition for Lactation (cont’d)
• 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
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Kluwer Health | Lippincott Williams & Wilkins
Nutrition for Lactation (cont’d)
• 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
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Nutrition for Lactation (cont’d)
• 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
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