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Chapter 15 – Life Cycle Nutrition: Pregnancy and Lactation
Learning Objectives
After completing Chapter 15, the student will be able to:
15.2 Describe fetal development from conception to birth and explain how maternal malnutrition can affect
15.3 Explain how both underweight and overweight can interfere with a healthy pregnancy and how weight gain
15.4 Summarize the nutrient needs of women during pregnancy.
15.5 Identify factors predicting low-risk and high-risk pregnancies and describe ways to manage them.
a. Describe the programs available to women with high-risk pregnancies.
15.6 Summarize the nutrient needs of women during lactation.
a. Discuss the habits that are incompatible with lactation.
15.7 Explain how drinking alcohol endangers the fetus and how women can prevent fetal alcohol syndrome.
Assignments and Other Instructional Materials
The following ready-to-use assignments are available in this chapter of the instructor’s manual:
• Case Study 15-1: Weight Status and Pregnancy
• New! Case Study 15-2: Safe Food Choices during Pregnancy
Lecture Presentation Outline
3
Key to instructor resource annotations (shown to the right of or below outline topics):
TRA = Transparency acetates: 13e = 13th edition, 12e = 12th edition, 11e = 11th edition, 10e = 10th edition
Website = Available for download from book companion website: HN = student handout
IM = Included in this instructor’s manual: CS = case study, WS = worksheet, CA = classroom activity
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Introductory/whole chapter resources: PL figure JPEGs; Test Bank; IM WS 15-3, CA 15-1, 15-2
I. Nutrition Prior to Pregnancy
A. Achieve and maintain a healthy body weight
II. Growth and Development during Pregnancy
A. Placental Development (Figure 15-1) – Define and explain the following: 10e TRA 152
1. Uterus
B. Fetal Growth and Development (Figure 15-2) – Define and explain the following: 10e TRA 153
1. The sperm fertilizes the ovum
2. The Zygote
a. Blastocyst
b. Implantation
C. Critical Periods (Figures 15-3 & 15-4) 10e TRA 154, 155
1. The critical period for neural tube development is 17-30 days gestation
2. Neural Tube Defects 13e TRA 16
a. Anencephaly
2. Folate Supplementation
a. Reduces risk of neural tube defects
3. Chronic Diseases
4. Fetal Programming
a. Nutrients play key roles in activating or silencing genes
b. More research is needed
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III. Maternal Weight IM CS 15-1
A. Weight Prior to Conception
1. Underweight
a. Tend to have lower-birthweight babies
b. Higher rates of preterm infants and infant deaths
2. Overweight and Obesity
a. Tend to be born post term
B. Weight Gain during Pregnancy (Figure 15-6) 10e TRA 156
1. Recommended Weight Gains
a. Underweight woman, 18.5 BMI: 28-40 pounds
2. Weight-Gain Patterns IM WS 15-1
3. Components of Weight Gain (Figure 15-7)
4. Weight Loss after Pregnancy
a. Some fluid losses
IV. Nutrition during Pregnancy 13e TRA 17
A. Energy and Nutrient Needs during Pregnancy (Figures 15-9 & 15-10) Website HN 15-1
1. Energy
2. Carbohydrate
3. Protein
4. Essential Fatty Acids – Essential fatty acids should be consumed
5. Nutrients for Blood Production and Cell Growth
a. Folate at 600 g/day
6. Nutrients for Bone Development
a. Vitamin D
b. Calcium
C. Common Nutrition-Related Concerns of Pregnancy
1. Nausea and Vomiting
a. Morning (anytime) sickness
b. Ranges from mild queasiness to debilitating nausea and vomiting
c. Hormonal changes
d. Alleviation strategies
2. Constipation and Hemorrhoids
3. Heartburn
4. Food Cravings and Aversions
5. Nonfood Cravings
a. Pica
b. Often associated with iron deficiency
V. High-Risk Pregnancies
A. The Infant’s Birthweight
1. Low birthweight (LBW)
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
2. Women develop amenorrhea
b. Loss of sexual interest during starvation
C. Food Assistance Programs
1. WIC (formerly Supplemental Nutrition Program for Women, Infants, and Children)
2. Nutrition education
3. Food vouchers for nutritious foods only
D. Maternal Health
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b. Risks
2. Gestational Diabetes
a. Routine screening with glucose tolerance test
3. Chronic Hypertension
a. Heart attack and stroke
b. Low-birthweight infant
c. Separation of placenta from wall of uterus resulting in a stillbirth
3. Maternal death
E. The Mother’s Age
1. Pregnancy in Adolescents
a. Complications include iron-deficiency anemia and prolonged labor
b. Higher rates of stillbirths, preterm births, and low-birthweight infants
c. Major public health problem and costly
d. Encourage higher weight gains
e. WIC program
2. Pregnancy in Older Women
a. Hypertension and diabetes
b. High rate of birth defects – Down syndrome
F. Practices Incompatible with Pregnancy
1. Alcohol
a. Lead
b. Mercury
7. Foodborne Illness IM CS 15–2, WS 15-2
VI. Nutrition during Lactation 13e TRA 17
A. Lactation: A Physiological Process
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C. Breastfeeding: A Learned Behavior IM CA 15-3
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 – 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
b. May protect against cancer
F. Practices Incompatible with Lactation
1. Alcohol
VII. Highlight: Fetal Alcohol Syndrome (FAS)
A. Symptoms 10e TRA 158
1. Prenatal and postnatal growth retardation
2. Impairment of brain and central nervous system
3. Abnormalities of face and skull (Figure H15-1)
4. Birth defects
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4. Recommendation is to stop drinking
D. When Is the Damage Done?
1. First two months are critical periods and a woman may not know she is pregnant
Case Studies
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Case Study 15-1: Weight Status and Pregnancy
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 her weight status and
information in Table 15-1, how much weight is Sadie recommended to gain during her pregnancy?
2. Using the charts in Figure 15-6, evaluate Sadie’s weight gain at this point in her pregnancy. How does it
compare to what is recommended?
3. What medical complications of pregnancy are associated with being overweight or obese? Describe risks for the
mother and the infant.
4. What would you tell Sadie about the benefits of water exercises during pregnancy? What precautions would you
give her about other water-related activities during pregnancy? Explain.
5. What are some strategies presented in this chapter that would help alleviate Sadie’s constipation as well as
improve her nutritional status during this pregnancy?
6. Based on information on Table 15-3, which conditions contribute to her having a high-risk pregnancy? Explain
how these conditions may affect the outcome of her pregnancy.
Answer Key
1. BMI = 27.4. Sadie is overweight. She should gain between 15 and 25 pounds during this pregnancy.
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Case Study 15-2: Safe Food Choices during Pregnancy
Stephanie F. is a 30-year-old professional woman in her first trimester of pregnancy. She and her husband entertain
guests frequently and enjoy wine and specialty cheeses on these occasions. They buy fresh produce, eggs, milk, and
cheese from a local farmer’s market each week and limit their intake of packaged foods. She has no food aversions
and eats a variety of foods. Stephanie wants to make sure her diet is nutritious and safe for pregnancy. She decides
to evaluate her typical daily intake:
Breakfast:
Coffee with cream and sugar (2-3 cups)
Orange juice (1 cup)
Bagel with lox and cream cheese
Lunch:
Fresh vegetable salad with canned tuna or deli turkey
Cheese with fruit and crackers
Iced tea with sugar and lemon
Dinner:
Beef, pork, poultry, or fish
Pasta or rice
Fresh cooked vegetables
Red or white wine (1 glass)
Snacks:
Cookies and milk
Fresh fruit
1. What is the safest and wisest decision for Stephanie to make about drinking alcohol during pregnancy? Give
reasons for your answer.
2. During her pregnancy, what special considerations for food safety should Stephanie keep in mind when buying
fresh produce, juice, and dairy foods at her local farmer’s market? Explain.
3. What changes could Stephanie make to her usual breakfast in order to meet the current dietary
recommendations for pregnancy presented in this chapter? Explain your answer.
4. Due to their high content of mercury, what types of fish should Stephanie completely avoid during her
pregnancy?
5. Stephanie decides to eliminate fish from her diet except lunch on weekdays. Plan five lunches that will safely
provide the weekly amount of seafood recommended for a healthy pregnancy. Include portion sizes and fish
types that are good sources of omega-3 fatty acids and low in mercury.
6. What precautions regarding meat, poultry, seafood, and eggs should Stephanie be aware of during her
pregnancy? Why is it important for her to follow this advice?
Answer Key
1. Stephanie should refrain from drinking any alcohol during pregnancy. Reasons for abstinence from alcohol
during pregnancy may include: alcohol consumption during pregnancy has severe consequences; the effects of
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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-worthy topics such as breastfeeding versus
formula feeding, alcohol intake during pregnancy, and others make excellent topics for expanded class discussions.
Classroom Activity 15-1: Role Playing
Key concept: Nutrition issues throughout the life cycle Class size: Medium or small
Instructions: Have students write a play/skit that portrays people discussing nutrition issues with medical
professionals. Roles in the play could include: a student, physician, nutritionist, parent, child, and/or professor. Each
character asks questions, makes statements based on myths and/or describes a questionable eating pattern.
Volunteers may read the play out loud.
Classroom Activity 15-2: Debates
5
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.
Classroom Activity 15-3: Identify Attitudes towards Breastfeeding
Key concept: Attitudes and values about breastfeeding Class size: Any
Instructions: Prior to the discussion about lactation, instruct students to think about the breastfeeding process. Ask
the women to write on a sheet of paper “yes” or “no” to indicate if they intend to breastfeed. Ask the men to write if
they expect their wives/children’s mothers to breastfeed. Ask all students if they were breastfed. Instruct them to list
potential barriers to breastfeeding and ways they could overcome those barriers. You may want to have students pair
up and share their responses with their partner. Next you could initiate a class discussion. A lively discussion could
ensue, especially with increased numbers of women obtaining breast implants.
Study Card 15 Answer Key
1. The placenta is an organ that develops inside the uterus early in pregnancy, as an interweaving of fetal and
maternal blood vessels embedded in the uterine wall. The maternal blood transfers oxygen and nutrients to the
7. Low-birthweight infants are more likely to experience complications during delivery than normal–weight
babies. They also have a statistically greater chance of having physical and mental birth defects, becoming ill,
8. Simply being young and physically immature increases the risks of pregnancy complications. The rates of
stillbirths, preterm births, and low-birthweight infants is high for teenagers. Many of these infants suffer
physical problems, require intensive care, and die within the first year. The care of teen mothers and their
9. Alcohol must be avoided, because consumption during pregnancy can cause irreversible mental and physical
retardation of the fetus—fetal alcohol syndrome (FAS). Medicinal drugs and other compounds can also cause
complications during pregnancy, problems in labor, and serious birth defects, so pregnant women should not
Critical Thinking Questions
6
1. Clinical evidence has demonstrated an association between folic acid deficiency and the occurrence of neural
tube defects. What methods can be utilized in health promotion to make sure that women of childbearing age
have adequate folic acid levels prior to pregnancy?
2. Compare the relative impact of pregnancy for the underweight and the obese individual in terms of health
concerns.
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3. Why are the nutrient needs of a lactating mother greater than her needs during her pregnancy?
4. Discuss dietary practices that pregnant women should follow so as to avoid adverse health outcomes.
5. Recommendations for the amount of weight gain to support pregnancy have changed over time.
Recommendations are now individualized. What concerns are warranted by higher-than-recommended weight
gains occurring periodically throughout the course of pregnancy? Of what consequence is excessive total weight
gain over the course of pregnancy?
6. What dietary changes are necessary for a pregnant woman who has PKU?
Answer Key
1. Through the process of fortification, folic acid has been added to certain foods in the American diet. Women of
childbearing age should be encouraged to maintain adequate folic acid intake either in the form of fortified food
2. Pregnancy is a stressful period of growth for both the mother and the fetus. Maternal weight at the beginning of
pregnancy can affect pregnancy outcomes. The underweight pregnant female is more at risk to have a low–birth
weight and/or pre-term baby, either of which will increase the risk for perinatal mortality. In addition, the
3. Pregnancy is a hypermetabolic process, which dramatically increases the BMR. As the pregnancy progresses,
additional calories are required so as to allow for growth and development of the fetus and maternal stores.
4. Pregnant women should be advised to be cautious during the course of their pregnancy with regard to certain
food items such as seafood (mercury contamination) and raw foods (listerosis and/or Salmonella exposure).
5. The first factor that must be addressed is the individual’s weight prior to pregnancy. Based on this information,
recommendations are made that will incorporate weight gain per week, which is then differentiated by the
trimester of pregnancy. As the pregnancy progresses, the amount of weight gain per week will increase. If an
individual periodically exhibits increased gains of weight during the pregnancy, one may consider whether the
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IM Worksheet Answer Key
Worksheet 15-1: Maternal Weight Gain Calculations
1. BMI = 26.6 = overweight: 15-25 lbs recommendation
Worksheet 15-2: Food Safety for Pregnancy (Internet Exercise)
Worksheet 15-3: Chapter 15 Crossword Puzzle
1. A: underweight;
3. quantity
6. No
9. fertility
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Worksheet 15-1: Maternal Weight Gain Calculations
For the following pregnant women listed below indicate whether they are within, below, or above the recommended
weight gain pattern. (Calculate BMI, then determine recommended prenatal weight gain based on prepregnancy
weight, using Table 15-1 and Figure 15-6 in the text.)
1. 22 year old, prepregnancy weight 155 lbs, 5’4”, 38 weeks gestation, weighing 200 lbs BMI = ________
3. 22 year old, prepregnancy weight 125 lbs, 5’6”, 12 weeks gestation, weighing 140 lbs BMI = ________
5. 30 year old, prepregnancy weight 138 lbs, 5’1”, 36 weeks gestation, weighing 158 lbs BMI = ________
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Worksheet 15-2: Food Safety for Pregnancy (Internet Exercise)
Read this guide in order to answer questions 1-8. Do not close the window until you have finished
answering the questions.
1. It is safe to eat feta cheese during pregnancy as long as it is made from unpasteurized milk products.
a. True
b. False
2. You can eat hot dogs when pregnant, provided they are hot and not lukewarm in temperature.
3. When pregnant, you can eat fruits and vegetables immediately once you purchase them from the
4. It is advised that pregnant woman should be cautious when eating any raw fish product such as
5. Listeria is a virus that is found in seafood products.
a. True
b. False
6. Toxoplasma is a bacterium found in cold refrigerators.
7. It is advisable to avoid eating mung bean sprouts when pregnant.
8. What are the three main dangers for pregnant women that are found in food?
a. Mercury
b. Listeria
c. Toxoplasma
d. Sushi
e. Queso blanco
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Worksheet 15-3: Chapter 15 Crossword Puzzle
1
2
3
4
5
6
7
8
9
10
11
Across:
Down:
1. Women who are _____ during pregnancy have a
higher risk of having a preterm delivery.
6. _____ amount of alcohol is safe to ingest during
pregnancy.
9. Being under- or overweight can impact _____ in
both men and women.
1. _____ may be a reason for heart defects in babies
born to overweight women.
3. Inadequate nutritional intake reduces the _____ of
the milk rather than the quality.
8. The increased DRI for kcalories starts in the _____
trimester.