Pre-Pregnancy Nutrition Guide

Pre-Pregnancy Nutrition

• Optimal pre-pregnancy nutrition improves chances of a healthy baby, mother, and future for both.
• Adequate, not excessive, calories and nutrients are crucial for normal fetal development.
• Inadequate intake can hinder fetal potential.
• Excessive weight gain is linked to maternal and fetal complications.

Key Recommendations for Women Capable of Becoming Pregnant

• Iron: Prioritize heme iron (animal sources). Enhance absorption with vitamin C-rich foods.
• Folic Acid: Consume 400 mcg synthetic folic acid daily, plus natural folate from foods.
• Weight Management: Maintain a healthy pre-pregnancy weight to minimize risks.
• Alcohol Avoidance: Completely avoid alcohol, especially early in pregnancy.

Key Nutrients Required Before Pregnancy

• Folic Acid (Vitamin B9): Prevents neural tube defects (anencephaly, spina bifida) by supporting fetal brain and spinal cord development.
  • Sources: Synthetic (multivitamins, fortified foods) and natural (leafy greens, citrus fruits, legumes).
  • Medical Note: Neural tube defects often develop in the first month of pregnancy.
• Iron: Supports increased blood volume and oxygen supply, reducing iron deficiency anemia.
  • Sources: Heme iron (meat, poultry, fish) and non-heme iron (plant-based, enhanced with vitamin C).
• Calcium: Supports bone health for both mother and baby.
  • Sources: Dairy products, fortified plant-based milk, leafy greens.
• Omega-3 Fatty Acids: Crucial for fetal brain and eye development.
  • Recommended Intake: 8-12 oz of various seafood weekly.
  • Limit: Limit albacore tuna to 6 oz weekly due to mercury.
• Iodine: Prevents fetal hypothyroidism and supports cognitive development.
  • Sources: Iodized salt, seafood, dairy products.

Weight Considerations Before Pregnancy

• Obesity During Pregnancy: Increases risks for:
  • Maternal: Gestational diabetes, hypertension, preeclampsia, birth defects, cesarean delivery, postpartum anemia, long-term obesity.
  • Fetal: Higher birth weight (macrosomia), perinatal death risk.
• BMI Counseling Recommendations:
  • Overweight (BMI 25-29.9): Moderate weight loss recommended if multiple risks are present.
  • Obesity (BMI ≥ 30): Substantial weight loss advised.
  • Underweight (BMI ≤ 18.5): Evaluate potential eating disorders or body image issues.

Nutrition and Lifestyle During Pregnancy

• High-Risk Pregnancy Definition: Pregnancy more likely to result in low birth weight (LBW) infants, delivery complications, or long-term developmental issues.
• Assessment During the First Prenatal Visit: Identify potential high-risk factors.
• Monitoring During Pregnancy: Regular monitoring reduces complications.
• Weight Gain During Pregnancy:
  • Normal BMI: 25-35 lbs total weight gain.
  • Excessive: Risks for gestational diabetes, hypertension, preeclampsia, postpartum weight retention, fetal hypoglycemia, macrosomia, low Apgar scores, and long-term obesity.
  • Inadequate: Risks for low birth weight (LBW) infants, increased postnatal complications like cardiovascular diseases, type 2 diabetes, and childhood obesity.
• Calorie Needs:
  • 1st trimester: No additional calories.
  • 2nd trimester: Increase by 340 calories.
  • 3rd trimester: Increase by 452 calories.
  • Total: 2,200-2,900 calories/day (varies based on BMI and activity).
• Nutrient Requirements: Iron needs increase (50%) due to blood volume, Vitamin B12 also increased (10%). Folic acid crucial for neural tube defects.
• Substances to Avoid:
  • Alcohol: Causes fetal cell damage, potential fetal alcohol syndrome (FAS) - facial abnormalities, intellectual disabilities, developmental delays.
  • Caffeine: High intake linked to low birth weight. Safe limit: 300 mg/day or less.
  • Herbal Supplements: Potential teratogenic effects due to unregulated ingredients.
  • Fish and Seafood: Mercury contamination in some fish can harm fetal brain and nervous system.
    • Safe: Low mercury fish (shrimp, salmon). Limit albacore tuna to 6 oz per week. Avoid high-mercury fish.
  • Foodborne Illnesses (Listeriosis, Toxoplasmosis, Pica): Avoid unpasteurized dairy, raw/undercooked foods, high-risk foods.

Nutrition for Lactation and Breastfeeding

• Breastfeeding Recommendations: WHO and AAP/ADA recommend exclusive breastfeeding for the first six months, continuing with complementary foods to two years or beyond.
• Benefits of Breastfeeding (Infant): Lower risks of various issues (otitis media, respiratory infections, asthma, eczema, gastroenteritis, obesity, T1/T2 diabetes, celiac disease, leukemia, SIDS).
• Benefits of Breastfeeding (Maternal): Faster postpartum recovery, reduced risk of postpartum depression, breast and ovarian cancer, type 2 diabetes.
• Barriers to Breastfeeding: Hospital practices (lack of rooming-in or lactation counseling), lack of knowledge/education, cultural/social attitudes.
• Factors that Impair Lactation (Letdown, Lactation Establishment, Decreased Demand).
• Calorie Requirements During Breastfeeding: 500 extra calories daily for milk production.
• Fluid and Nutrient Intake: Water when needed. Enhanced nutrient requirements for lactating mothers.
• Substances to Avoid (Breastfeeding): Alcohol passes into breast milk, reduces milk production. Caffeine intake is generally safe in moderation.

Nutrition for Infants (0-1 Year)

• Growth: Fastest physical growth period in human lifespan. Birth weight doubles by 4-6 months and triples by 1 year. Length increases significantly.
• Nutritional Needs: More calories per kg of body weight. Recommendations based on breastfed infants.
• Breast Milk Composition:
  • Protein (whey, easy digestion).
  • Fat (easily digested).
  • Enzymes (like amylase, aids digestion).
  • Minerals (balanced for infants).
  • Vitamins (provided, varies by mother's diet).
  • Immune factors (antibodies, Bifidus factor).

Infant Formulas

• Infant Formulas: Substitutes or supplements for breast milk when breastfeeding is not possible or discontinued before 12 months.
• Types: Standard, Preterm, Enriched, Soy, Lactose-Free, Hypoallergenic/Nonallergenic, Antireflux, Metabolic Disorder.

Infant Feeding and Obesity

• Risk Factors for Obesity: Early feeding patterns (overfeeding), parental practices (ignoring cues).

• Obesity Prevention Strategies: Breastfeeding (slower weight gain, improved appetite).

• Introducing Complementary Foods

• When to Introduce: Around 6 months, when developmentally ready.

• Developmental Readiness Signs: Sitting with support, good neck/head control, disappearance of tongue-thrust reflex, interest in food.

• Recommended First Foods: Iron-fortified infant cereal, pureed meats, pureed vegetables/fruits.

• Introducing New Foods: One food at a time, with 5-7 day intervals; watch for allergic reactions. Keep portions small; allow self-regulation and offer only nutrient-rich foods . Foods to Avoid Early-On: Common allergens (dairy, eggs, etc.). Honey, excessive fruit juice

Nutrition for Toddlers and Preschoolers (1-5 Years)

• Establishing healthy dietary habits. Emphasize parental role in guiding what and when children eat while child self-regulates portion intake.
• Calorie and Nutrient Requirements:
  • Toddlers: ≈ 1,000 calories per day.
  • Dietary Guidelines: Emphasize whole grains, fruits, vegetables, low-fat dairy, lean protein.
    • Limit solid fats, added sugars, and sodium. Portion sizes (1 tablespoon per age year); adjust to resemble adult portions by 4-6.

Nutrition for School-Age Children (6-12 Years)

• Growth Rate: Slower than infancy, with 2-3 inches in height and 5 lbs weight gain annually.
• Nutritional Needs: Increased calories relative to age, activity level, and growth spurts; decreased calorie needs per kilogram of body weight.
• Dietary Guidelines: Follow MyPlate guidelines (whole grains, fruits, vegetables, low-fat dairy, lean proteins).
• Nutritional Concerns: Excessive sugar/sodium, inadequate nutrient intake (calcium, potassium, Vitamin D, fiber).

Nutrition for Adolescents (12-18 Years)

• Growth Spurts: Girls 10-11, peak 12. Boys 12-13, peak 14.
• Weight Gain Differences: Girls tend to gain body fat; boys muscle mass.
• Bone Growth: Critical growth phase. High calcium and Vitamin D requirements.
• Calorie Needs: More calories for moderate activity; varies based on gender & activity level.
• Key Nutrients: Calcium (1,300 mg/day), Vitamin D (600 IU/day), iron, protein, and fiber.
• Nutritional Concerns: Deficiencies in key nutrients, high intake of calories from processed/high-calorie foods. Eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder), body image issues.

Overweight and Obesity in Children and Adolescents

• Causes: Calorie imbalance (overeating, lack of physical activity)
• Health Consequences: Physical (insulin resistance, high cholesterol), psychological (social stigma, depression, low self-esteem).
• Prevention Strategies: Healthy eating, physical activity, parental support, school-based programs.