1. Pregnancy,
Lactation &
Infant Nutrition
XNB151 Food and
Nutrition
ArnolfiniWedding - Jan van Eyck, 1434

2.  Both a man and woman’s nutrition can affect fertility
& possibly genetic contributions to children
 Woman’s nutrition most direct influence
 General recommendations to prepare for a healthy
pregnancy are:
 Achieve & maintain a healthy body weight
 Choose and adequate and balanced diet
 Be physically active
 Receive regular medical care
 Manage chronic conditions
 Avoid harmful influences
(Reference: Recommendations to improve preconception
health and health care – United States, Morbidity &
MortalityWeekly Report 55 (2006) : 552-561.

3. Progesterone
 relaxes smooth muscle
which helps with uterus
expansion
 ↓ GIT activity  ↑
absorption
 favours maternal fat
deposition
Oestrogen
 ↑ fluid retention to
maintain blood volume
 regulates thyroid
hormone production &
BMR
Placenta SecretesTwo Main Hormones

4. Components of body weight gain in normal pregnancy (Wahlqvist 3rd ed, p 385)

6. If your pre-pregnancy BMI was: You should gain
Less than 18.5 kg/m²
18.5 to 24.9 kg/m²
25 to 29.9 kg/m²
Above 30 kg/m²
12½ to 18kg
11½ to 16kg
7 to 11½ kg
5 to 9kg
Should be used as a general guide
Value of weight gain recommendations has been disputed
Important to consider the many individual and multiple factors that
can influence outcomes
Institute of Medicine, 2009

7. 3 stages
 The zygote
 divides into numerous small cells
 embeds itself into uterine wall after ~2 weeks
 no increased requirements for energy or protein in well
nourished women
 The embryo
 lasts ~6 weeks
 rudiments of all principal organs & membranes develop
 <5g & ~ 3cm long
 energy requirements not increased but nutrient intake very
important

8.  The foetus
 lasts ~7 months
 gets to 2.8-3.5kg
i.e. growth = ~200g
per week!
 energy & protein
requirements
increased
 nutrient intake
very important

9.  Critical periods – rapid cell division during
pregnancy, which if affected, can result in
irreversible effects
 Thought that maternal nutrition prior to &
during pregnancy can affect short & long
term health outcomes e.g. CVD, diabetes
 Critical period for neural tube defects is 17 to
30 days gestation
 minimised by folate supplementation

10. http://php.med.unsw.edu.au/embryology/index.php?title
=File:Humancritical_periods_of_development.jpg
Dark Orange = major abnormality
Light Orange = minor abnormality

11.  Current recommendations
 2nd trimester ~1.4MJ extra per day
 3rd trimester ~1.9MJ extra per day
 More if underweight & less if overweight at
conception
 Monitor weight gain and appetite

12. Nutrient Female 19-50yrs Pregnancy
Protein 46g 60g
Fats (essential
FAs)
8g (n-6)
0.8g (n-3)
90mg (LC n-3)
10g (n-6)
1g (n-3)
115mg (LC n-3)
Fibre 25g 28g
Folate 400µg FE 600µg FE
Calcium 1000mg 1000mg
Iron 18mg 27mg
Zinc 8mg 11mg
Iodine 150µg 220µg
Vitamin A 700µg RE 800µg RE
Vitamin D 5µg 5µg
Vitamin C 45mg 60mg

13.  Folate has a key role in cell division
 Direct link between folate deficiency & closure of the neural
tube in early pregnancy
 Critical in 28 days following conception
 →neural tube defects such as spina bifida
 folate supplementation of 400µg/d is encouraged for 1 mo
prior to conception & for 2 mo after + foods rich in folate
 folic acid is now added to wheat flour
for bread-making (except organic)
http://www.nlm.nih.gov/medlineplus/ency/im
agepages/19087.htm

14.  essential for ↑ in maternal red cell
mass & for the developing foetus &
placenta
 deficiency may lead to preterm
delivery, low birth weight CNS
development delay
 iron needs of foetus take precedence
over that of mother
 Vegetarians advised to have intake
80% higher than EAR & RDIs
 Many women have inadequate
status before pregnancy
 Important to optimise safety of
supplementation
Credit: JOHN BAVOSI/SCIENCE PHOTO
LIBRARY

15.  Essential for growth &
development, neuronal
function & development
 Inadequate intake in pregnancy can lead to:
 stillbirths
 miscarriages
 congenital abnormalities such as cretinism
 Deficiency is widespread in parts of Australia &
NZ
 table salt can be bought iodised
 iodised salt now used in bread making in Australia
& NZ

16.  Healthy, well-nourished women who
consume an adequate & varied diet need only
small adjustments to their diet during
pregnancy
 The poorer the mother’s pre-pregnancy
nutritional status the more important
nutrition is during pregnancy

19.  usually only for 1st trimester
 management via:
 small, frequent meals
 dry biscuit before getting out
of bed
 avoid large drinks
 staying away from strong
smelling foods, etc
 severe form is called
hyperemesis gravidarum

20.  cravings & aversions do
not seem to reflect
physiological needs
 but pica may reflect iron
deficiency
 pica is the compulsive
intake of non-nutritive
substance such as ice dirt,
soap, chalk etc
http://www.the-parenting-
magazine.com/tag/pregnancy-cravings/

21.  indigestion occurs later on due to relaxation
of GIT muscles & pressure of the growing
baby
 constipation is exacerbated by iron supp’s
 needs to be treated with increased fluid &
fibre

22.  No known safe amount
 2009 NHMRC Guidelines state that “not drinking
is the safest option”
 Heavy drinking known to ↑ risk of Foetal Alcohol
Syndrome:
 underdevelopment of the mid-face
 small body size
 mental retardation
 developmental delay
 behavioural disorders
www.pediatriceducation.org/.../

23.  crosses the placental barrier
 mother & foetus clear caffeine more slowly
 High levels of intake may lead to:
 delayed conception
 spontaneous miscarriage
 foetal growth restriction
 low birth weight
 Recommendations – limit to
 1 regular espresso style coffee, OR
 3 cups instant style coffeeOR
 4 cups tea OR
 4 cans diet/regular cola drink

24. Artificial Sweeteners
 most considered safe
 should not compromise energy/CHO intake
Nutrient supplements
 folic acid, iron & iodine important
 anything else not important if a well balanced
diet is consumed
 ExcessVitamin A in particular needs to be
avoided because of detrimental effects on the
foetus

25.  Guidelines are the same as Physical Activity
Guidelines for Australians: 30 min of moderate
intensity exercise on 5 or more days of the week
(i.e. brisk walking)
 Moderate exercise does not harm foetus & has
benefits for the mother, including:
 reduced fat gain - shorter labour
 lower risk of gestational diabetes - quicker delivery
 maintenance of aerobic fitness - fewer surgical
interventions
 High impact exercise or hard physical work can
affect foetal development & result in:
 low birth weight (LBW) babies
 Obstetric complications
Credit: IAN HOOTON/SCIENCE PHOTO LIBRARY

26.  Restricts the blood flow to the growing foetus
& limits O2 & nutrient delivery & water
removal
 May cause:
 birth complications
 foetal growth retardation (LBW)
 spontaneous abortion
 foetal death
 sudden infant death syndrome (SIDS)

27.  Contaminated foods can be debilitating &
dangerous during pregnancy mainly due to
dehydration
 Listeriosis (Listeria monocytogenes) can
cause:
 miscarriage
 stillbirth
 severe brain or other infections to the foetus

28.  To prevent listeriosis:
 safe handling & storage of food
 fresh, thoroughly cooked eaten
straight away, wash fresh fruit &
vegies
 avoid raw/uncooked/smoked
meat & seafood, deli meats,
leftovers, pre-prepared salads,
smorgasbords, soft serve ice-
cream, soft cheeses, raw eggs,
unwashed raw fruit & vegies

29. Mercury
 High levels found in large, long-lived fish
 Can cross the placenta & have severe negative
effects on the developing brain & nervous
system
 FSANZ recommends:
 1 serve (150g)/week of Orange Roughy (Sea Perch) or
catfish & NO other fish that week
 1 serve (150g)/fortnight of shark/flake or billfish
(swordfish/broadbill & marlin) & NO other fish that
fortnight
 2-3 serves of any other fish & seafood not listed above

30. Adolescent
 Teenage girls’ requirements are increased
without the extra needs of pregnancy
 More calcium, phosphorous & magnesium
required
Vegetarian
 vitamins B12 & D, calcium, zinc, omega-3
fatty acids, riboflavin & iron may be
problematic, esp. in vegans

31.  Begin pregnancy well nourished & physically fit
 Follow Dietary Guidelines & AGHE
recommendations for pregnancy
 Keep weight gain to less than 13kg
 Eat safe foods & prepare them safely
 Exercise regularly
 Minimise caffeine consumption
 No smoking or alcohol consumption

33. Breast of
lactating
female

34. PROLACTIN
Stimulates milk production
released in response to
suckling
OXYTOCIN
Causes the muscular tissue to
contract & pushes the milk
into the collecting ducts (‘let-
down’)
Pain, stress & anxiety can
interfere with secretion

35. http://www.youtube.com/watch?v=UgT5rUQ9EmQ&feature=related
Lactogenesis I
(2nd trimester to birth)
glands develop ability to secrete milk components
Lactogenesis II
(birth to ~60 hours after birth)
milk known as colustrum
increased blood flow to breast, milk ‘comes in’
Lactogenesis III
(by ~5 days after birth)
milk composition is stable

36. Energy
 2-2.1MJ/day extra
 = ~25% increase in intake
 Varies considerably between individuals
 Excessive restriction for weight loss not advised
Nutrients
 Nutrient content/MJ of the Aust diet > human milk for most nutrients
EXCEPT calcium & vitamin C
 Calcium RDIs not increased as body adapts – encourage to meet RDIs
 Vitamin C content of milk will fall if Mothers diet low in vitamin C
 Iron NRV falls to post-menopausal/pre-menstrual level as menstruation
ceases
 Vitamin D can be an issue in dark skin/low sun exposure infants

37. Nutrient Female 19-
50yrs
Pregnancy Lactation
Protein 46g 60g 67g
Fats
(essential FAs)
8g (n-6)
0.8g (n-3)
90mg (LC n-3)
10g (n-6)
1g (n-3)
115mg (LC n-3)
12g (n-6)
1.2g (n-3)
150mg (LC n-3)
Fibre 25g 28g 30
Folate 400µg FE 600µg FE 500µg FE
Calcium 1000mg 1000mg 1000mg
Iron 18mg 27mg 9mg*
Zinc 8mg 11mg 12mg
Iodine 150µg 220µg 220µg
Vitamin A 700µg RE 800µg RE 1100µg RE
Vitamin D 5µg 5µg 5µg
Vitamin C 45mg 60mg 85mg

38.  some foods may affect some infants
e.g. onions, garlic
 these should be avoided if necessary

40.  May be associated with:
 lactation performance
 earlier cessation of breastfeeding
 deficits in infant psychomotor development
 disrupted infant sleep-wake behavioural patterns
 alcohol consumption while breastfeeding is
not encouraged
 Avoid for first mo until Breastfeeding established
 No more than two std drinks per day
 Avoid immediately before breastfeeding

42.  Infant Nutrition = First year after birth
 Rapid growth
 Poor nutrition results in infant death or death before 5 y
 Inadequate nutrition causes:
 wasting
 stunting
 deficiency diseases
 global mortality & disease burden
 Over nutrition linked with
 Short-term outcomes
 Establishment of eating habits & consequent chronic disease
development

43. Governed in the 1st 12 months by:
 small body size
 small amount of food, frequently
 rapid growth rate
 needs influenced by tissue growth
 level of physiological maturity
 limits types of foods that can be given

44.  greater evaporation
 dehydration a major risk because of:
 high temperatures
 too concentrated formula
 vomiting
 diarrhoea
 breastfed infants don’t need extra water
 formula fed infants may in very hot weather
 Plain boiled
 Ensure does not replace feed

45.  dependent upon BMR, growth & activity
 3-4x greater amount per kg body weight than
adults
 decreases as growth slows but then increases
again as activity increases
• provided by fat & lactose in breast milk or formula for
1st 6mths
• then introduction of solids contributes energy from
other macronutrients

46.  In early infancy 60-75% of total protein for
growth; at one year about 15%
 Average 3g protein/day required in first year
 But requirement changes with age
 Recommendations based on breastmilk
intakes of healthy infants + allowances for
complimentary foods

47.  main CHO in human & cow’s milk is
lactose
 lactose facilitates calcium &
magnesium absorption
 lactose provides ~ 1/3 of energy
 primary lactose intolerance rare;
secondary usually due to repeated
attacks of gastroenteritis
 Human milk also has ~130
oligosaccharides – promote growth of
bacteria responsible for some diarrhoea
Credit: DRTIM EVANS/SCIENCE
PHOTO LIBRARY
Lactose Molecule

48.  Principal source of energy for
newborn
 40-50% energy from fat
 Important as:
 concentrated energy when capacity of intake
limited
 source fat soluble vitamins
 source essential fatty acids
 provides energy without increasing solute
load (protein) or loss of water from
hyperosmolar effects ( CHO)

49.  requirements are based on the amounts
estimated to be provided, on average, by
human milk from a well-nourished mother
 since not all babies are breast-fed some
allowances are made for formula fed babies
Credit: PAUL WHITEHILL/SCIENCE PHOTO LIBRARY

50.  exclusive breastfeeding for 6 months
 breastfeeding continued to at least 12
months after the introduction of solids at ~6
months
Credit: IAN BODDY/SCIENCE
PHOTO LIBRARY

51.  most mothers can learn to breastfeed
successfully but often need support &
assistance
 babies develop an innate reflex to turn their
head & open their mouth, suckle & swallow
 mothers need to practise appropriate
positioning & attachment of the baby to
allow effective suckling & minimise the risk of
nipple damage & breast problems such as
mastitis

52. World Health Organisation, 2009)

53. http://www.health.qld.gov.au/child-youth/factsheets/Brstfd_HowDoIStart.pdf

54.  changing composition of
various stages of lactation to
suit the needs of the infant
 changing composition within
a feed
 infant’s appetite &
consequent suckling regulate
amount produced
 presence of long chain PUFAs
Credit: MAURO FERMARIELLO/SCIENCE PHOTO
LIBRARY

55.  immunological
 lower infant mortality in developing countries
 fewer acute illnesses
 physiological
 jaw development in infant
 practical
 economic
Credit: MARK THOMAS/SCIENCE
PHOTO LIBRARY

56. Pattern
 infants should be fed on demand to promote the
best milk supply
 normally newborns will feed 10-12 times/day
Adequate intake
 baby is content after feeds
 feeding 8-10 times/day
 soaked nappy 6 or more times/day
 loose & mustard yellow stools
 following a recommended growth pattern

57.  Factors influencing
success
 environment &
support
 smoking
 motivation
 medicinal drugs
 illicit drugs
 Factors influencing
prevalence & duration
Reasons commonly given
by mothers for stopping
include:
 adequacy of milk supply
 nipple or breast
problems
 returning to work

58. Formula
 needs to be used in infants under 12 months
if not breastfed
 based on cow’s or goat’s milk or soy beverage
 For therapeutic nutrition:
 partially/substantially digested
 altered nutrient profile
 can also be anti-regurgitation (AR)
or hypoallergenic (HA) or extensively
hydrolysed Credit: BETTINA
SALOMON/SCIENCE
PHOTO LIBRARY

59. Issues with formula use
 inappropriate/incorrect mixing
 lack of immunological benefits
 contamination during preparation
 expense
 ? increased risk of chronic diseases later in life
– overweight, obesity, diabetes