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Chapter 15 – Life Cycle Nutrition: Pregnancy and Lactation
Learning Objectives
After completing Chapter 15, the student will be able to:
1. List the health habits a woman should develop prior to pregnancy.
2. Describe placental and fetal development and the importance of critical periods.
3. Explain the risk factors for the development of neural tube defects.
4. Describe the expected weight gain during pregnancy and components of the gained weight.
5. Describe exercise recommendations for pregnant women.
Assignments and Other Instructional Materials
The following ready-to–use assignments are available in this chapter of the instructor’s manual:
• New! Case study
• Worksheet 15-1: Maternal Weight Gain Calculations1
Other instructional materials in this chapter of the instructor’s manual include:
• Classroom activities
• Worksheet answer keys (as appropriate)
Lecture Presentation Outline3
“Of special interest to…” symbol key: = Hot Topic = Personal Health
= Health Care Professionals = Science Majors
Key to instructor resource annotations (shown to the right of or below outline topics):
PL = Available on Power Lecture DVD-ROM (ISBN 0538797592): V = video
TRA = Transparency acetates: 12e TRA = 12th edition, 11e TRA = 11th edition, 10e TRA = 10th edition
Website = Available for download from book companion website: HN = student handout
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I. Nutrition Prior to Pregnancy
There are several health habits that contribute to healthy pregnancies. A man’s and a woman’s fertility may be
affected by nutrition.
A. Achieve and maintain a healthy body weight.
B. Choose an adequate and balanced diet.
II. Growth and Development during Pregnancy
A new life begins at conception. The growth and development of the zygote, embryo, and fetus proceed on
their own schedule. There are critical periods that depend on nutrition to proceed smoothly. Folate is especially
important.
A. Placental Development 10e TRA 152
1. Takes place in the uterus, a muscular organ.
B. Fetal Growth and Development 10e TRA 153
1. The sperm fertilizes the ovum.
2. The Zygote
a. Fertilized ovum that becomes a blastocyst.
b. Implantation occurs in the uterus within two weeks.
C. Critical periods are finite periods of intense development and rapid cell division. 10e TRA 154, 155
1. The critical period for neural tube development is 17–30 days gestation.
2. Neural Tube Defects
a. Anencephaly affects brain development.
b. Spina bifida can lead to paralysis or meningitis.
c. Factors that increase occurrence of neural tube defects
1. Previous pregnancy with neural tube defects.
2. Folate Supplementation IM CI 15.4
a. Reduces risk of neural tube defects.
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d. Those who have previously given birth to a child with a neural tube defect may be prescribed a 4
III. Maternal Weight
A mother’s weight prior to conception and weight gain during pregnancy will influence an infant’s birthweight.
Higher birthweights present fewer risks for infants. Lower birthweights present more problems.
A. Weight Prior to Conception
1. Underweight
2. Overweight and Obesity
a. Tend to be born post term (42 weeks).
b. Tend to be greater than 9 pounds at birth (macrosomia).
B. Weight Gain during Pregnancy 10e TRA 156; IM CI 15.3
1. Recommended Weight Gains
a. Underweight woman 18.5 BMI: 28-40 pounds.
2. Weight-Gain Patterns IM WS 15–1, CI 15.1
a. 3 ½ pounds first trimester.
b. 1 pound per week thereafter.
3. Components of Weight Gain
a. Increase in breast size = 2 pounds.
b. Increase in mother’s fluid volume = 4 pounds.
4. Weight Loss after Pregnancy
a. Some fluid losses.
b. Some weight retention.
C. Exercise during Pregnancy
1. Adjust duration and intensity as needed.
2. Improves fitness, prevents gestational diabetes, facilitates labor, and reduces stress.
g. Adequate rest.
5. “Don’t” guidelines
a. No vigorous exercise.
b. Keep out of hot and humid weather.
c. No exercise when sick with fever.
IV. Nutrition during Pregnancy 10e TRA 157; IM CI 15.1
Energy and nutrient needs are high during pregnancy. A nutritious diet, regular physical exercise, rest, and
caring companions can help to prepare for all the physical and emotional changes. Iron and folate are nutrients
that need special attention. Proper rate of weight gain is also important. Nausea, constipation, and heartburn are
common problems.
A. Energy and Nutrient Needs during Pregnancy Website HN 15-1
1. Energy
2. Carbohydrate
3. Protein
a. Additional 25 grams/day.
b. Use food, not supplements.
4. Essential fatty acids, especially long-chain omega-3 and omega-6 fatty acids, should be consumed.
5. Nutrients for Blood Production and Cell Growth
a. Folate at 600 g/day.
6. Nutrients for Bone Development
7. Other nutrients are needed to support growth, development, and health of the mother and fetus.
8. Nutrient Supplements
a. Prenatal supplements prescribed by physicians.
b. May help to reduce risk for preterm delivery, low infant birthweights, and birth defects.
B. Vegetarian Diets during Pregnancy and Lactation
1. Adequate energy is important.
C. Common Nutrition-Related Concerns of Pregnancy
1. Nausea
a. Morning (anytime) sickness.
b. Ranges from mild queasiness to debilitating nausea and vomiting.
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c. Hormonal changes.
d. Alleviation strategies
1. Eat desired foods at desired times.
2. Constipation and Hemorrhoids
a. Altered muscle tone and cramping space for organs.
b. Straining during bowel movements.
c. Alleviation strategies
1. High-fiber foods.
3. Heartburn
a. Digestive muscles are relaxed and there is pressure on the mother’s stomach.
b. Stomach acid backs up into the lower esophagus.
c. Alleviation strategies
1. Relax and eat slowly.
4. Food Cravings and Aversions
a. Common.
5. Nonfood Cravings
a. Pica.
b. Often associated with iron-deficiency.
V. High-Risk Pregnancies IM CI 15.2
High-risk pregnancies threaten the life and health of both mother and infant. Proper nutrition and the
avoidance of alcohol, drugs, and smoking improve outcomes. Prenatal care includes the monitoring of weight
gain, gestational diabetes, and preeclampsia. Low-risk pregnancies are ones without risk factors.
A. The Infant’s Birthweight
1. Low birthweight (LBW) is 5 ½ pounds or less and associated with complications during delivery.
2. Preterm infants may be appropriate for gestational age (AGA); that is, they are small but the right
B. Malnutrition and Pregnancy
1. Malnutrition and Fertility
a. Severe malnutrition and food deprivation reduce fertility.
1. Men lose the ability to produce viable sperm.
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2. Women develop amenorrhea.
b. Loss of sexual interest during starvation.
2. Malnutrition and Early Pregnancy
3. Malnutrition and Fetal Development
a. Fetal growth retardation.
C. Food Assistance Programs IM CI 15.3
1. Supplemental Nutrition Program for Women, Infants and Children (WIC).
3. Food vouchers for nutritious foods only.
D. Maternal Health
1. Preexisting Diabetes
2. Gestational Diabetes
1. Age 25 or older.
2. BMI 25 or excessive weight gain.
c. Consequences
1. Complications during labor and delivery.
2. High-birthweight infant.
3. Preexisting Hypertension
a. Heart attack and stroke.
b. Low-birthweight infant.
c. Separation of placenta from wall of uterus resulting in a stillbirth.
4. Transient Hypertension of Pregnancy
5. Preeclampsia and Eclampsia; also called toxemia
a. Preeclampsia
1. High blood pressure.
2. Protein in the urine.
b. Eclampsia
1. Severe stage of preeclampsia.
2. Seizures and coma.
3. Maternal death.
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E. The Mother’s Age
1. Pregnancy in Adolescents
a. Complications include iron-deficiency anemia and prolonged labor.
2. Pregnancy in Older Women
a. Hypertension and diabetes.
b. High rate of birth defects – Down syndrome.
F. Practices Incompatible with Pregnancy PL V “Pregnancy & Alcohol”
1. Teratogenic factors can result in abnormal fetal development or birth defects.
2. Consuming alcohol during pregnancy can cause fetal alcohol syndrome.
3. Medicinal drugs may result in complications and problems with labor and serious birth defects.
4. Herbal supplements on the advice of physician only.
5. Illicit drugs easily cross the placenta and cause complications.
6. Smoking and Chewing Tobacco
a. Fetal growth retardation.
b. Low birthweight.
7. Environmental Contaminants IM CI 15.5
a. Lead can affect the nervous system of a fetus.
b. Fish with high levels of mercury should be avoided.
8. Foodborne Illness IM WS 15-3
a. Can leave a pregnant woman exhausted and dehydrated.
b. Pregnant women are 20 times more likely to get listeriosis.
VI. Nutrition during Lactation 10e TRA 157; IM CI 15.6
Breastfeeding offers many health benefits to both mother and infant. Nutrient and energy needs are higher.
Fluid needs are higher. Alcohol, other drugs, smoking, and contaminants may reduce milk production as well as
enter breast milk and impair infant growth and development.
A. Benefits of lactation
1. For infants
a. Appropriate composition and balance of nutrients with high bioavailability.
2. For mothers
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3. Other benefits
a. Cost savings.
B. Lactation: A Physiological Process
1. Mammary glands secrete milk.
2. Prolactin is the hormone responsible for milk production.
3. Oxytocin is the hormone responsible for the let-down reflex.
C. Breastfeeding: A Learned Behavior IM CA 15–4
1. Health care professionals offer information and encouragement.
2. The mother’s partner offers support.
3. Successful breastfeeding in maternity facilities
a. Breastfeeding policy.
b. Training for health care staff.
D. Maternal Energy and Nutrient Needs during Lactation
1. Energy Intake and Exercise
a. Additional 500 kcal per day for the first six months—330 kcal from food, rest from fat reserves.
b. For the second six months, an additional 400 kcal per day.
c. Intense physical activity may raise lactate levels of the milk.
2. Energy Nutrients
3. Vitamins and Minerals
4. Water as a protection from dehydration.
5. Nutrient Supplements
6. Food Assistance Programs
7. Particular Foods
a. Strong or spicy foods may flavor breast milk.
b. Food allergies.
c. Monitor problem foods.
E. Maternal Health
1. HIV Infections and AIDS – mother will transmit virus.
2. Diabetes – careful monitoring and counseling.
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F. Practices Incompatible with Lactation
1. Alcohol – infants drink less breast milk.
2. Medicinal Drugs – consult with physician.
VII. Highlight: Fetal Alcohol Syndrome (FAS) PL V “Pregnancy & Alcohol”; IM CI Highlight
Fetal alcohol syndrome can only be prevented; it cannot be cured. Thousands of infants are born with FAS
because their mothers drank too much alcohol during pregnancy. The range of abnormalities that may occur are
referred to as fetal alcohol spectrum disorders. It is recommended that women do not consume any alcohol
during pregnancy.
A. Symptoms 10e TRA 158
1. Prenatal and postnatal growth retardation.
3. Abnormalities of face and skull and birth defects, called alcohol-related birth defects (ARBD).
B. Drinking during Pregnancy
1. Malnutrition.
C. How Much Is Too Much?
1. Drinking alcohol in excess of liver’s capacity to detoxify.
D. When Is the Damage Done?
1. First two months are critical periods and a woman may not know she is pregnant.
Case Study4
Sadie is a 37-year-old teacher in her 20th week of pregnancy. She is 68 inches tall and weighs 195 pounds. Her pre–
pregnancy weight was 180 pounds. She gained 50 pounds with her first pregnancy two years ago. Her doctor has
recommended that she limit her weight gain this pregnancy. She likes to swim but has not been exercising regularly
since she found out she was pregnant. She has had morning sickness through much of this pregnancy and says that
she feels better when she eats starchy foods such as bread, potato chips, and pasta. She complains of recent problems
with constipation and is seeking ways to relieve this discomfort.
1. Calculate Sadie’s body mass index (BMI) based on her prepregnancy weight. Based on the information on
Table 15-1, what is the recommended range of weight gain for her pregnancy that would be most healthful?
2. Using Figure 15-7, evaluate Sadie’s weight gain at this point in her pregnancy compared to a normal range.
3. What medical complications of pregnancy are associated with being overweight or obese?
4. How would you reassure Sadie about the safety of water exercises during pregnancy? What precautions would
you give her about exercise?
5. What are some strategies that would help alleviate Sadie’s constipation as well as improve her nutritional status
during this pregnancy?
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6. Would you consider Sadie a “high–risk” pregnancy? On what factors do you base your decision?
Answer Key:
1. BMI = 27.4. Recommended weight gain range for pregnancy: 15 to 25 pounds.
Suggested Classroom Activities
Chapter 15 presents more than many instructors may want to cover on maternal and infant nutrition. Of course, you
may want to tailor reading assignments to meet your class needs. Debate topics such as breastfeeding versus formula
feeding, water fluoridation, and others make excellent topics for expanded class discussions.
Classroom Activity 15-3: Debates5
Key concept: Various: e.g. breast- vs. bottle feeding, etc. Class size: Small to medium
Instructions: Have students research and debate a controversial topic such as breastfeeding versus bottle feeding,
sugar in the diet, water fluoridation, or federal programs such as WIC. Greater interest in such topics is often
generated by debates than by straight lectures.
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Critical Thinking Questions6
These questions will also be posted to the book’s website so that students can complete them online and e-mail their
answers to you.
For this chapter, the following case scenario will be utilized for all five questions. Please refer back to the vignette
for each question.
Mya and her husband have had one prenatal check-up and the physician indicated that everything looked good but,
given her past history, he would like to see her every two weeks for two months until a satisfactory pregnancy
history is established. Mya found out about you and your fabulous work as an RD from the nutrition department at
the university and from her physician. At present Mya is very nauseous and really can’t eat anything without
vomiting. She would like to receive information on how to deal with this particular situation. She would also like to
know whether she should continue with the vegetarian diet, and is asking for advice on types of food groups to
include to gain weight in a healthy manner. She requires advice on how to eat to ensure a satisfactory lactation
experience for her and the baby after the birth.
1. Chapter 15 stresses the importance of diet and health of the mother for the growth of the fetus during the first
trimester of pregnancy. Given the information that you have about Mya, her diet, and her health, what are your
concerns and what are your suggestions to alleviate these concerns?
Answer: Mya has several issues that would be of concern to the RD given her past maternity history, age
during this pregnancy, and present nutrition issues. While Mya did have a miscarriage during the second
trimester in her earlier life, she was successful with another pregnancy. Her present height and weight are