This document discusses nutrition considerations during pregnancy, lactation, and infant development. It provides general recommendations for a healthy pregnancy including achieving a healthy pre-pregnancy weight and receiving regular medical care. Key nutrients like folate, iron, iodine, and omega-3 fatty acids are emphasized. Breastfeeding is outlined as the recommended method of infant feeding for at least the first year. Nutritional needs gradually change as the infant develops from newborn to one year old.

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