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  3. Maternal-Fetal Nutrition During Pregnancy and Lactation
Maternal-Fetal Nutrition During Pregnancy and Lactation
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Book description

Improving clinicians' understanding of effects nutrition can have on maternal health and fetal and neonatal development can have considerable impact on achieving a healthy pregnancy and reducing childhood morbidity. This book defines the nutritional requirements with regard to each stage of fetal development and growth, placing scientific developments into a clinical context. Clinicians and scientists discuss: how the fetus grows and what macro- and micronutrients it requires; what happens when there is nutrient deficiency and when placental development is abnormal; aspects of infant feeding, both with breast milk and formula milk. Specific problems encountered in pregnancy that pose a nutritional challenge are also considered, including pregnancy in teenagers, multiple pregnancies and pregnancy in those who are vegetarians or vegans. All doctors, health-care workers or scientists who either care for women, their newborn and growing infants, or who are involved in research in these areas, will find this to be essential reading.

Reviews

'… excellent, essential and exciting …'

Source: Journal of Obstetrics and Gyanaecology

'… this is a book that is of much use for all those involved with breasteeding advice, such as doctors, midwives and breastfeeding counsellors.'

Source: Acta Obstetricia et Gynecologica

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Contents

Contents
  • Chapter 7 - Macronutrients for lactation and infant growth
    pp 63-71
  • View abstract

    Summary

    This chapter describes the maternal adaptation to pregnancy and the role of the placenta in nutrient transfer to the fetus. During pregnancy, an adaptation of maternal metabolism functions to ensure normal fetal growth throughout gestation and neonatal growth during lactation. The maternal metabolic reprogramming is believed to be directed by placental hormones. Maternal nutrition around the time of conception may have important effects on gestational length, fetal growth trajectory, and postnatal growth and health. Insulin-like growth factor 1 (IGF-1) is the primary fetal growth-stimulating factor in response to altered nutrient supply during late gestation and is under the control of fetal insulin. Insulin and leptin are maternal metabolic indicators that may be involved in fetal intrauterine growth adaptation and long-term health. Fetal blood sampling and the use of stable isotopes in human pregnancy have allowed for description of maternal and fetal nutrient concentrations.
  • Chapter 9 - Comparison between preterm and term infants
    pp 82-91
  • View abstract

    Summary

    Placental nutrient transfer capacity increases over gestation by increased placental growth, primarily of membrane surface area, allowing for the increase in nutrient supply required for the growing fetus. Glucose is the primary energy substrate for the mammalian fetus and placenta. The fetus metabolizes glucose in several ways, including oxidation for energy requirements and as a carbon source for production of various macromolecules, such as glycogen, glycolytic products, proteins, and fatty acids. Total nitrogen concentration measurements have been used to estimate the rate of protein accretion in tissues, because most of the total nitrogen is represented by amino acid nitrogen uptake. The net uptake of amino acids by umbilical circulation through the placenta represents the dietary supply of amino acids for fetal growth and protein metabolism. The transport of fatty acids and other lipid substances across the placenta and the deposition of lipids in fetal adipose tissue are primarily late-gestation phenomena.
  • Chapter 10 - Influences of timing and duration of formula feeding on infant growth
    pp 92-105
  • View abstract

    Summary

    Minerals known to be of major importance during pregnancy include calcium, copper, iodine, iron, magnesium, selenium, and zinc. Deficiencies in these minerals have been associated with complications of pregnancy, childbirth, or fetal development. This chapter considers each, by briefly discussing their physiological roles, and discussing how the symptoms of deficiency overlap. It also discusses the consequences of deficiencies using both animal and human models and considers how these might be best treated, if indeed they can. Mineral deficiencies have varied effects because of the wide range of roles they play. In pregnancy, the effects can be seen in both the mother and her fetus. The mother can suffer from pregnancy induced hypertension, anemia, preeclampsia, labor complications, and death. To meet the increased demand for the essential minerals during pregnancy and lactation, maternal physiology undergoes several alterations.
  • Chapter 11 - Maternal and offspring benefits of breast-feeding
    pp 106-118
  • View abstract

    Summary

    Individualized fetal growth curves can be used to assess the appropriateness of fetal growth given the nonpathological characteristics or predict size at birth given all growth-determining characteristics of the pregnancy. Fetal growth may be affected by the mother's nutrition throughout her life. In developed countries, adequate micronutrition before conception and avoidance of teratogens in early pregnancy are the nutritional factors most relevant to optimal fetal growth. Under famine or near-famine conditions, fetal growth appears increasingly restrained by a lack of maternal energy supply as pregnancy progresses. In the developed world, the major causes of fetal growth pathology are maternal vascular disease, particularly preeclampsia, maternal infections, particularly of the genitourinary tract, chromosomal and genetic anomalies, and, increasingly, syndrome X, the metabolic anomaly that includes diabetes and insulin resistance. There is some evidence that these may respond to micronutritional therapy.
  • Chapter 12 - Teenage pregnancies
    pp 119-128
  • View abstract

    Summary

    Poor fetal growth in the developing world is largely attributed to widespread maternal undernutrition. The majority of low birth weight (LBW) in developing countries is due to intrauterine growth restriction (IUGR), the causes of which are complex and multiple, depending primarily on the mother, placenta, fetus, and combinations of all three. The recent hypothesis on fetal origins of adult diseases suggests that fetal undernutrition at critical periods of development in utero and during infancy leads to permanent changes in body structure and metabolism. Cultural beliefs, practices, and food taboos play a role to some extent in determining maternal intakes in some of the populations in developing countries. In most populations, maternal diets are inadequate in both macronutrients and micronutrients. Minerals such as iron, zinc, and calcium are known to have an important role in fetal growth. Reappraisal of maternal interventions is essential to explore future possibilities through systematic research.
  • Chapter 13 - Vegetarians and vegans during pregnancy and lactation
    pp 129-137
  • View abstract

    Summary

    Preeclampsia carries implications in adult life, with offspring of affected preterm pregnancies demonstrating poor growth in childhood and an increased risk of hypertension, heart disease, and diabetes. This chapter discusses the role of maternal nutrition in the prevention and development of preeclampsia. Restriction of activity and prolonged resting has traditionally been advocated for the prevention and treatment of many of the ailments of pregnancy, including the prevention and treatment of hypertension. The evidence linking the promotion of regular exercise and a reduction in the risk of hypertension in the nonpregnant person is well established. Achieving an ideal body mass index (BMI) relationship between a person's height and weight by weight loss before conception may be the most prudent advice in many patients. The chapter highlights the significant lack of quality studies from which to draw conclusions regarding the role of nutrition in the prevention or treatment of preeclampsia.
  • Chapter 14 - Hyperemesis in pregnancy
    pp 138-146
  • View abstract

    Summary

    Lactogenesis begins during pregnancy and secretory material accumulates in the acini from the third month of gestation. Milk production is stable during the first months of lactation, but there is a wide range of milk intake among healthy breast-fed term infants, averaging 750 to 800 ml per day but ranging from 450 to 1200 ml/day because of infant demands. Human milk fat content is the main source of energy and its most variable constituent. Fat content is low in colostrum and increases from 2% to 5% in mature milk. Dietary fats are the main source of infants' energy, provide essential fatty acids, and facilitate the absorption of fat-soluble vitamins. Immunological and anti-infectious proprieties of human milk are of major importance compared with formulas. Environmental factors, including early infant nutrition, may influence their development. Potential energy mobilization during lactation depends on weight gain during gestation and nutritional status of the mother.
  • Chapter 16 - Mineral and vitamin supplementation before, during, and after conception
    pp 155-166
  • View abstract

    Summary

    This chapter considers nutritional requirements of the neonate during the period between birth and weaning. Requirements comprise whatever is necessary to maintain normal healthy body functions, daily energy expenditure above maintenance, and growth. Exclusive breast-feeding to 6 months meets all of the protein requirements of the healthy baby. Milk fat provides more than half of the neonate's dietary energy; and individual fatty acids play an important role in neonate's growth and development. Lactose is the principal carbohydrate in breast milk and makes a significant contribution to energy supply. Through provision of glucose, it is essential for brain and nervous tissue function. Fluid requirements are stated to increase from approximately 100ml/kg/day at birth to approximately 150ml/kg/day at 6 months. Calcium levels in breast milk are less than one third of cow's milk levels, and formula is intermediate, but the absorption of calcium from breast milk is higher than that from formula.
  • Chapter 17 - Determinants of egg and embryo quality: long-term effects of maternal diet and assisted reproduction
    pp 167-179
  • View abstract

    Summary

    Early nutrition affects both the short-term and longer-term health and development of preterm infants. This chapter discusses the important differences in nutrient requirements in preterm infants compared with those in infants born at term. It provides the practicalities of meeting these requirements during the early postpartum period and following discharge. Despite greater appreciation of the importance of adequate nutrition for outcome in preterm infants and the existence of specific nutritional recommendations, it is widely recognized that these infants often exhibit suboptimal growth, which may persist for some time after hospital discharge and which may have adverse consequences for cognitive outcome. The use of breast milk is associated with a reduction in the incidence of necrotizing enterocolitis (NEC) and systemic infection and is associated with improved cognitive outcome, lower blood pressure, and more favorable plasma lipid profile during childhood and adolescence.
  • Chapter 18 - Nutrition, environment, and epigenetics
    pp 180-195
  • View abstract

    Summary

    This chapter presents a brief history of formula feeding to provide a historical perspective into the evolution of modern infant formulas. It discusses the types and composition of modern infant formulas available, and the regulation of infant formula composition and marketing. The chapter discusses the growth of formula-fed versus breast-fed infants, and the appropriate introduction of complementary foods for both breast-fed and formula-fed infants. The most commonly used infant formulas are standard cow's milk-based formulas. Infant formula is regulated as a food intended solely for infants. It simulates human milk or is suitable as a complete or partial substitute for human milk. Current recommendations for infants with a strong family history of food allergy are that they should be breast-fed for as long as possible and should not receive complementary foods until 6 months of age. The parents' approach to child feeding is central to the child's early feeding experience.

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