Getting Back Into Shape After The Pregnancy

Pregnancy Diet Plan

Pregnancy Diet Plan

The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.

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Pregnancy Without Pounds

This proven program will get you through your pregnancy in better shape than most other women in as little as 27 minutes a day and with minimal effort. It contains all the information that I believe will Help you to look and feel like I did barefoot and beautiful! Inside you will learn Exactly how to avoid unwanted pounds, overcome your food cravings, care for your skin, dress to kill and look like one Hot Mama. Ive also put together Fifty simple, yet extremely effective pregnancy-friendly exercises and stretches to keep you and your body looking and feeling Great (includes 3 different fitness programs depending on Your fitness level)!

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Nutrition After Pregnancy

If you are a new mother who worries that you'll never lose the weight gained during pregnancy, be patient and remember that life has seasons. The first year after pregnancy may not be the season to be as lean or as athletic as desired. Pregnancy lasts for 9 months, and many women need an additional 9 to 12 months to return to their prepregnancy physiques (see figure 12.1). Don't try to crash diet now. If you fear that you'll end up overweight for the rest of your life, take note of a survey of new moms. The women, who were all runners, reported that most returned to running five weeks after delivery and were at their prepregnancy weights in five months (Lutter and Cushman 1982). Yes, there can be a lean life after pregnancy, as verified by the many mothers you see around you who are lean. For now, love yourself from the inside out, enjoy your baby, be proud of your accomplishment, and be gentle on yourself.

Body weight changes after pregnancy

Weight increases suggest that pregnancy may not have a significant influence on body weight for a sizable percentage of women. However, approximately 20 of the women studied experienced a 5 kg or greater weight increase after pregnancy 44, 46-48 . In the NMIHS, almost 16 of women were more than 6.4 kg heavier by 10-18 months postpartum. Therefore, use of the mean value to assess body weight increases after pregnancy fails to adequately reflect the population at risk 44 .

Sarah C Couch and Richard J Deckelbaum

Summary Obesity in pregnancy is associated with numerous maternal and neonatal complications including difficulty conceiving, increased risk of miscarriage, fetal anomalies and mortality, higher rates of gestational hypertension, gestational diabetes and preeclampsia, and an increased risk of cesarean section and delivery related complications. Nevertheless, more women are entering pregnancy with excessive weight and are gaining weight above the Institute of Medicine (IOM) recommendations during pregnancy. Weight loss is not recommended during pregnancy however, overweight and obese women should be advised to aim for a moderate weight loss prior to conception and during the postpartum period. Strategies for achieving moderate progestational and postpartum weight loss include a low-calorie, low-fat diet and at least 45 min of daily physical activity. Benefits to mother and child are achieved with even a moderate weight loss. Importantly, health care professionals should counsel women...

Classification of diabetes

Type 1 diabetes requires exogenous insulin for survival and is diagnosed primarily in persons less than 30 years of age. Type 2 diabetes, which accounts for almost 90 of diabetes cases, was previously known as adult-onset or non-insulin dependent diabetes. Insulin resistance rather than insulin deficiency and obesity are associated with type 2 diabetes. GDM is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The definition applies if medication or MNT is used in treatment or the condition persists after pregnancy. It does not exclude the possibility that the diabetes may have existed prior to pregnancy.

Lifecycle approach to nutrition

This analysis of the food patterns recommended for nonpregnant women of reproductive age in the United States shows that the same general food patterns can be followed throughout pregnancy, and that the recommended intake of all but two nutrients (iron and vitamin E) will be met. The only change necessary in the second or third trimester is to increase total energy intake by about 200 or400 kcal to cover the additional energy needed for tissue energy deposition and the metabolic costs of pregnancy. Thus, the food pattern for nonpregnant women only needs minor adjustments for pregnancy. This continuity makes it easier to provide guidance to women planning pregnancies. Furthermore, the general food pattern for pregnant women is appropriate for all family members as well as the mother after pregnancy. This means that dietary counseling provided to pregnant women is a great opportunity to promote good nutrition for everyone in the household. Pregnant women generally tend to have a...

Babys Bottle Feeding Routine

Newborns eat frequently in the first months after birth perhaps every two hours Since their stomachs are small, just 2 ounces, or as many as 4 ounces of infant formula, may be enough for the early feedings. See How Much Formula on page 386for guidelines during the first twelve months.

What Contributes to Weight Gain During Pregnancy

As a female gains weight during pregnancy, usually about 7 to 8 pounds is attributable to the weight of the infant at birth. The rest of the weight is distributed throughout the mother in various tissues developed during pregnancy. These tissue include the placenta, amniotic fluid, increased breast tissue, expanded blood volume, and fat storage and muscle. These all help support the mother and fetus during pregnancy and after birth. Even the mother's bones will become a little denser during pregnancy.

Peri and Postnatal Studies

Spirulina was given until Day 21 postpartum. After birth, the numbers of live, dead and externally abnormal newborns were counted. Postimplantation loss was calculated and bodyweight and viability were recorded. At approximately 10 weeks of age, the reproductive performance was assessed by mating males and females. Fetuses in the F2 generation were examined for survival, bodyweight and external, visceral and skeletal anomalies. Uteri were examined for implantations and resorptions and

Effects of postpartum depression on motherinfant interaction

Postpartum depressed mothers displayed significantly lower contingent responsiveness and higher negative contingent responsiveness to their infants 34 . Recently Paulson et al. 35 found that mothers depressed at 9 months after birth were 1.5 times more likely to engage in less positive enrichment activity with their child such as reading, singing songs, and telling stories. Forman et al. 36 reported that at 6 months postpar-tum depressed mothers were less responsive to the infants, experienced higher levels of parenting stress, and perceived their infants more negatively than nondepressed mothers. Since a mother constitutes the infant's primary social environment during the first months of life, the effects of postpartum depression on the rapidly developing baby is of great concern and merits closer scrutiny and study.

Activation of the local Bcell system

Peyer's patches are the best studied MALT structures and start to develop in fetal life (Cornes, 1965 Husband and Gleeson, 1990), with discrete T- and B-cell areas being apparent as early as 19 weeks of gestation (Spencer and MacDonald, 1990). The primary lymphoid follicles seem to be generated around follicular dendritic cells (FDCs). However, lymphoid hyperplasia, with secondary follicles containing germinal centres (signifying B-cell activation), does not occur until shortly after birth (Bridges et al., 1959 Spencer et al., 1986a Gebbers and Laissue, 1990) this reflects the dependency of MALT on exogenous environmental stimulation. Furthermore, animal studies have shown an absence of secondary follicles in Peyer's patches of germ-free mice (Parrott, 1976). The germinal-centre B-cells express small amounts of membrane IgA, along with less IgM or IgG (Butcher et al., 1982). Such isotype skewing reflects differentiation to precursors for IgA-producing cells. The drive for isotype...

Individual variations

Post-natal mucosal B-cell development shows large individual variations, even within the same population (Brandtzaeg et al., 1991). This disparity could partly reflect a genetically determined effect on the establishment of the mucosal barrier function. Thus, it has been proposed, on the basis of serum IgA levels, that a hereditary risk of atopy is related to a retarded post-natal development of the IgA system (Taylor et al., 1973 Soothill, 1976). This notion was later supported by a report showing significantly reduced IgA immunocyte numbers (with no compensatory IgM enhancement) in the jejunal mucosa of atopic children (Sloper et al., 1981). Also, an inverse relationship was found between the serum IgE level and the jejunal IgA cell population in children with food-induced atopic eczema (Perkkio, 1980). It was subsequently reported that infants born to atopic parents showed a significantly higher prevalence of salivary IgA deficiency than age-matched control infants (van Asperen et...

Energy Protein and

In the second half of pregnancy, protein needs almost double - the average woman requiring 40-50 g day before pregnancy now requires 70-90 g day.4 The choice of dietary fat is important. A pregnant woman's diet should be rich in the omega-3 fatty acids, eicosapenta-noic acid (EPA), and docosahexanoic acid (DHA). These fatty acids are important components of the developing baby's central nervous system and eyes. Because most of the cells in the central nervous system are formed during pregnancy and the first year after birth, ample intakes of EPA and DHA are vital during this period.5 Although adults are able to synthesize some EPA and DHA from li-nolenic acid (see pp.89), the fetus cannot because the necessary metabolic pathways have not fully developed. These fatty acids need to be supplied to the fetus by the mother.

Cardiovascular Disease

Besides the acute danger faced when eating meals high in MSG another less obvious danger exists. Recent studies have found that animals exposed to MSG soon after birth show markedly elevated levels of triglycerides and the very low-density lipoproteins (VLDL) that persist throughout life.245 The values were higher in males than females, ft is now accepted that elevated serum oxidized lipids are associated with an increased risk of heart attack and stroke.

The Role of DHA in Neurotransmission

In a study of 865 Japanese women Miyake and colleagues 75 investigated risk of postpartum depression related to dietary fatty acid intake. Again, the EPDS was used to evaluate postpartum depression and diet history questionnaires were self-administered to measure dietary fatty acid intake. There were no significant relationships between dietary fish consumption or n-3 fatty acid intake and postpartum depression. Likewise, Browne et al. 76 investigated maternal fish consumption and plasma DHA status after birth in relation to postpartum depression diagnosed using the Composite International Diagnostic Interview. There were no associations between maternal fish consumption during pregnancy or maternal DHA status following delivery and depressive symptoms in the postpartum period.

Striking species differences

Immediately after birth, the mucosae are bombarded by a large variety of microorganisms, as well as by protein antigens from the environment, the latter particularly in formula-fed infants. The mucosal surface to be protected is enormous, probably more than 100 times that of the skin. In fact, the various mucosae are favoured as portals of entry by the majority of infectious agents, allergens and carcinogens. In most mucosal tissues, the epithelial barrier is monolayered and therefore quite vulnerable, so the defence of this large surface area is a formidable task. Nevertheless, most babies growing up under

Factors influencing initiation and duration of breastfeeding

In today's society, many women are pursuing their education or are in the work force. It is not uncommon for a new mother to return to school or employment soon after birth or a maternity leave of 3 to 6 months. Some mothers discontinue or never attempt nursing their babies under these circumstances, believing that they will be unable to maintain a milk supply, or that breastfeeding will take too much of their time or cause discomfort when they are away from the baby. After lactation is well established, an occasional bottle of breast milk substitute should not necessarily have a detrimental effect on the continuation of nursing (Riordan and Auerbach, 1993). Many mothers have successfully maintained breastfeeding after returning to work or school with support in the workplace and appropriate child care arrangements (CICH, 1996). Factors which may increase the duration of breastfeeding include the use of breast pumps to express milk, flexible work schedules and...

Potential contraindications to breastfeeding

The role of breastfeeding in the horizontal transmission of HIV has been uncertain because of the difficulty in differentiating congenital from early postnatal infection. Transmission of HIV through breast milk was initially recognized in situations where the mother acquired the infection shortly after birth (Goldfarb, 1993). The chances of the virus being spread to the infant depended on the mother's degree of infection. A woman who is viraemic during the acute phase of the primary infection is more likely to shed viruses into her milk than if she were HIV antibody positive with an established infection (Dunn et al., 1992). The estimated risk of transmission through breast milk by a woman of high viral burden is 29 (95 C.I. 16 -42 ) by a woman who is already HIV antibody positive during the pregnancy, 14 (95 C.I. 7 -22 ) (Newell and Peckham, 1994).

Behavioral and Neurological Effects of Mercury Exposure During Childhood

The developing brain is more vulnerable than the mature brain to a multitude of toxic insults, including exposure to heavy metals such as arsenic, lead, cadmium, and mercury. Remember, the brain undergoes its most rapid growth during the third trimester of intrauterine development and this continues until two years after birth. By four years of age the brain has reached only 80 percent of its full growth. Many complex processes occur during this critical period trillions of synaptic junctions are interconnecting, neural pathways are probing their way to their final destinations, and the brain is progressively coating its neural fibers with a protective carapace of fatty myelin.

Calorie recommendations and weight gain during pregnancy

Weight gain during pregnancy after bariatric surgery is variable, as with any pregnancy. There are no published guidelines for pregnancy weight gain in bariatric patients. Therefore, the guidelines set forth by the Institute of Medicine should be used (Table 6.2) 28 . The postoperative BMI should be used to determine the appropriate weight category.

Improving Compliance to IOM Recommendations

In 2000, Abrams et al. 72 conducted a systematic review of available observational data published between 1990 and 1997 on weight gain and maternal and fetal outcomes. Not surprising, this review showed that pregnancy weight gain within the IOM recommended range was associated with the best outcome for both mothers and infants. However, this review also found that most women were noncompliant with these guidelines many women were gaining excessive amounts of weight. Researchers speculated many reasons for these findings, including environmental temptations, inactivity, and prepregnancy restrictive dieting. They also reported that many women were not given appropriate targets for weight gain. The Women and Infants Starting Healthy study also found that from pregnant women studied in the San Francisco Bay area (excluding women with preterm birth, multiple gestation, or maternal diabetes), 50 of obese women were given advice by their physician to overgain, 35 of underweight women were...

Postpartum weight retention

The most consistent and strongest determinant of weight loss during lactation is pregnancy weight gain 11, 12 . Other factors that have been shown to influence postpartum weight loss, albeit inconsistently, include prepregnancy weight, age, parity, race, smoking, exercise, return to work outside the home, and lactation. While the impact is modest, the portfolio of evidence suggests that breastfeeding results in a faster rate of postpartum weight loss than formula feeding 13 . The average difference in weight loss by 12 months postpartum between lactating and nonlactating women is about 0.6-2.0 kg (1.3-4.4 lb) 13 .

Nutritional status of the mother

The nutritional status of an HIV-infected woman prior to and during pregnancy influences both her own health and the health of her unborn child 8 . The nutritional challenges for the HIV-infected pregnant woman are threefold. First, during pregnancy, just as in the uninfected woman, maternal metabolism is altered by hormones in preference of the developing infant, and nutrients are directed to the placenta, the mammary gland, and the infant 9, 10 . Additionally, HIV infection can prompt micronutrient deficiencies and lean body mass depletion because of decreased nutrient intake, malabsorption, and increased utilization and excretion of nutrients resulting in undernutrition 11 . Finally, HIV infection affects nutritional status through an increase in resting energy expenditure (REE) 12-14 . For women who are malnourished, an energy-protein supplement during pregnancy may improve pregnancy outcomes by improving maternal weight gain and reducing the risk of perinatal mortality 15, 16 ....

Recommendations for weight gain during pregnancy

Guidelines for weight gain during pregnancy aim to promote adequate, but not excessive, weight gain for optimal fetal development. Weight gain is highly correlated with infant birth weight making optimal weight gain during pregnancy important to fetal outcomes 1 . For a thorough discussion of optimal weight gain for pregnancy, the reader is referred to Chap. 2, Optimal Weight Gain, in Part 1 of this book. In brief, the Institute of Medicine (IOM) developed guidelines for maternal weight gain based on aggregate data examining fetal outcomes and associated maternal conditions 1 . These guidelines, adapted by both the American College of Obstetrics and Gynecology (ACOG) and the American Dietetic Association (ADA), use maternal body mass index (BMI, kg m2) prior to conception (Tables 13.1, 13.2) as a starting point for recommended weight gain during pregnancy 1-4 . Although these guidelines are available to women during pregnancy, educational programs regarding how to follow these...

Multiple Micronutrient Supplementation

The evidence for benefits of multiple micronutrient supplementation in pregnancy from randomized trials has been equivocal to date. In a trial in semirural Mexico, Ramakrishnan et al. randomized pregnant women to receive daily iron supplementation (60 mg) either alone or in combination with multiple micronutrients these supplements contained several vitamins and minerals (vitamins A, B-complex, C, D, E, and folic acid iron, zinc, and magnesium) at doses of one to 1.5 times the Recommended Dietary Allowance (RDA) levels. Multiple micronutrients did not confer any additional benefit on maternal weight gain during pregnancy 18 , maternal hematological status 19 , or infant birth weight or length 20 , compared with iron-only supplementation.

Nutrition intervention

The primary objective for AN is to gradually increase energy intake to support a positive energy balance to allow repletion of the mother while meeting fetal energy demands. An intake of 130 of estimated energy needs is initially recommended. Reaching this goal should be attained through incremental increases of 100-200 kcal per day approximately twice per week. In the first trimester, additional kilocalories are not needed to support fetal growth and development however, maternal weight gain of one to two pounds per week may be expected due to repletion of maternal energy stores. During the second and third trimesters, energy intake should increase beyond maternal repletion needs to supply requirements of the fetus (see Table 9.2). Frequent recalculation of estimated energy needs is necessary to adjust for changes in body composition, basal metabolic rate, and energy expenditure, including physical activity.

Benefits of breastfeeding to infants in Canada

For infants with a family history of atopy, maternal avoidance of specific foods (e.g. milk and dairy products, eggs, peanuts) during pregnancy and lactation has not been proven to be more effective in reducing the incidence and severity of atopy throughout the first year of life than exclusive breastfeeding without maternal food restriction (Falth-Magnusson, 1994 Zeiger et al., 1989). Risk of reduction in third trimester maternal weight gain and lower infant birth weight in the women avoiding potentially allergenic food during pregnancy illustrate the need for close nutritional monitoring. Until the efficacy of a restricted diet during pregnancy and lactation is known, routine restriction of diets of mothers of infants at risk for allergy is not recommended.

Gestational weight gain recommendations

In 1995, the World Health Organization (WHO) Collaborative Study on Maternal Anthropometry and Pregnancy Outcomes 4 reviewed information on 110,000 births from 20 different countries to define desirable maternal weight gain. The range of gestational weight gain associated with birth weights greater than 3 kg was 22-31 lb (10-14 kg). Comparing the WHO weight ranges with the IOM's recommended weight ranges for women with low and normal prepregnancy BMI, the WHO's ranges are slightly lower than the IOM's ranges (10-14 kg versus 12.5-18 kg low BMI and 11.5-16 kg normal BMI ).

Pathophysiology of functional constipation

Hirschsprung's disease is suspected after a delayed production of meconium beyond 48 h after birth, and continuing defecation problems usually with distended abdomen and poor appetite, failure to gain weight and vomiting. Also, the history would often document episodes of acute, severe enterocolitis with explosive diarrhea. Clinically, the diagnosis is made by insertion of a catheter through the anus in the distended part, after which decompression follows (see Chapter 17).

The influence of maternal nutrition on fetal nutrient supply

Maternal Nutrient Metabolism

The associations between maternal prepregnancy weight, pregnancy weight gain and birth weight are well known. Birth weight increases with increasing maternal prepregnancy size,6 and has also been associated with maternal weight gain in pregnancy, particularly with increases in maternal fat mass.7 Similarly, poor maternal weight gain in all trimesters of pregnancy has been associated with lower birth weight,8-10 although there is some disagreement about which period of pregnancy is most crucial. Customized growth charts have been developed which take into account maternal height, weight, parity and ethnic group,11 which may assist in the detection of babies that are not growing appropriately.12,13 However, these factors account for, at best, 15 of the variability in fetal growth,14 with the best predictor of birth weight being the mother's own growth in utero. This is true in both developed and developing nations.14,15

Daniel M Herron and Amy Fleishman

Summary The dramatic increase in the incidence of obesity has resulted in an overwhelming increase in the number of bariatric, or weight loss, operations performed in the United States. These operations induce long-term weight loss through a combination of volume restriction and malabsorption. As a result, bariatric surgery patients may suffer from nutritional deficiencies over the long term and need to be followed extremely closely before, during, and after pregnancy. Bariatric patients are given regimens of nutritional supplementation that are specific for their operation. This chapter describes the different types of bariatric surgery and the nutritional disturbances associated with each one. Additionally, the standard recommendations for supplementation and follow up are reviewed. Alterations to these regimens during pregnancy are discussed. Pregnancy outcomes after bariatric surgery are reviewed.

Weight gain recommendations and consequences of noncompliance

Evidence is mounting that significant numbers of women, particularly overweight and obese women, are not adhering to IOM guidelines. In an investigation of over 120,000 women enrolled in Women, Infants, and Children (WIC) clinics over a 6-year period, Schieve et al. 55 found that the percentage of women reporting a pregnancy weight gain greater than the IOM recommendations increased significantly from 41.5 to 43.7 . In 2005, Jain et al. 56 examined data from the New Jersey Pregnancy Risk Assessment Monitoring System (n 7,661) and found that nearly 64 of overweight women and 78 of obese women were noncompliant with IOM recommendations (e.g., overgained). women who gained at the recommended level 60 . In a longer-term study, Rooney et al. 61 followed 540 women for 8 years after childbirth and found that women who gained more than the IOM recommended weight during pregnancy retained 2 kg above their prepregnancy weight more at 8 years postpartum compared with those who complied with...

Nutrient needs of the pregnant adolescent

Important assessment data that need to be collected and evaluated to comprehensively develop educational approaches for pregnant adolescents can be categorized as follows (1) determining the quality, quantity, and rate of weight gain in pregnancy (2) evaluating current dietary intake to determine the adequacy of nutrient and energy intake during pregnancy and (3) assessing dietary issues that may affect intake, e.g., food allergies or vegetarianism 13 . Data derived from these assessments can provide a focus for discussions with all adolescents throughout pregnancy. Adolescents, especially those younger than 15 years of age, are at high risk for inappropriate maternal weight gain, anemia, and more serious complications such as lung and renal disease. Maternal weight gain is reportedly more influential than age of mother on fetal birth weight 11, 14 . Given that fetal birth weight < 3,000 g is related to increased infant morbidity and mortality, optimizing maternal weight gain should...

Disorders of the enteric nervous system

In the Krishnamurthy group37 there were 19 children with a deficiency of argyrophilic neurons. When argyrophilic neurons were present, they were small and had few processes. It was suggested that these patients suffered from a defect in differentiation and maturation of neurons from primitive neuroblasts. As these processes continue after birth, this would explain why some infants during the first year of life may have apparent abnormalities of the myenteric plexus which are not the case.38 to a systemic disease. Secondary visceral neuropathies may occur at any age, before or after birth, but most often occur in adults compared to children.

Macronutrients Energy

The additional energy requirements of pregnancy are small relative to the needs for many other nutrients. While an extra 340-450 kcal could be consumed by simply adding a glass of 2 milk and a small sandwich, this would not meet increased nutrient needs for pregnancy. The fact that the relative increase for many other nutrients is more dramatic than for energy indicates the importance of emphasizing nutrient-dense foods during pregnancy. Following the dictum of eating for two may result in excessive maternal weight gain. Further, for obese women, sedentary women, and women whose activity levels decline during pregnancy (e.g., bed rest) the recommendations of 340-450 kcal day may be too high. On the other hand, underweight women, young adolescent mothers who are still growing (< 14 years), and women carrying multiple fetuses may need 500 kcal day or more 7 .

Clinical presentation

The majority of children with CIP present either at birth or in the neonatal period.1 In all series approximately half the infants have symptoms at birth or within the first few days of life. In those who present at birth, the labor and delivery are frequently difficult, owing to an already distended abdomen. After birth there is abdominal distension, failure to pass meconium and bilious vomiting. The abdominal distension is due to swallowed air, which distends and dilates the small bowel, but is not passed further through the gut. Contrast studies may show the presence of a microcolon or a short small intestine or, in approximately 34 , a malrotation. In some there may be a specific clinical syndrome of a congenitally short small intestine, pyloric stenosis and a mal-rotation.6,7 In addition to gastrointestinal symptoms, there may also be failure to pass urine, mega-cystis and hydroureter or hydronephrosis. Incomplete bladder emptying often results in recurrent urinary tract...

Essential Fatty Acid Requirements

Although adequate dietary intake of n-3 EFA appears to be critical for central nervous system development, the optimum requirements for n-3 EFA for infants are not known. Human milk provides both C18 3n-3 and C22 6n-3 that are often absent from most infant formulas on the market. Formula-fed infants thus depend on endogenous synthesis of long-chain PUFA. Infant formulas provide nutrition that results in growth rates equal or superior to those of breast milk-fed infants. There is a suggestion, however, that long-chain n-3 PUFA may not be synthesized from their parent EFA at optimal rates for brain development during the first few weeks after birth, particularly in preterm infants. Clandinin et al. ( 137) have indicated that the infant's requirement for neural accumulation of long-chain PUFA can be met by intake of long-chain PUFA alone, without endogenous synthesis. Using the FA composition of red blood cell PL as an index of cerebral membrane composition, infants fed human milk had a...

Fluoride and the Brain

Behavioral effects were different when animals were exposed to fluoride either soon after birth or as adults. The subjects in this case became sluggish, like human couch potatoes. Specific behavioral impacts depended on the timing of fluoride exposure during brain development. There was also a direct correlation between the level of fluoride accumulated in the brain (hippocampus) and behavioral effects in adult females, but not adult males.

Now about Nutrients

Your calcium needs don't change when you're breast-feeding. Still, make sure you consume enough. If you come up short, your body may draw from calcium in your bones so the calcium content in breast milk remains adequate. Calcium losses in your bones may put you at greater risk for osteoporosis later in life. Periodontal problems also may crop up after pregnancy and nursing, perhaps related to calcium drain. Enjoy the equivalent of 3 cups of milk daily. And eat leafy-green vegetables, and fish with edible bones they're both good calcium sources. See Osteoporosis Reduce the Risks in chapter 22.

Postpartum

Women with GDM are at increased risk for developing type 2 diabetes after pregnancy and should be screened 6-12 weeks postpartum 3, 58 . The American Diabetes Association recommends a 75-g, 2-h oral glucose tolerance test to identify women with possible undiagnosed diabetes before conception, impaired glucose tolerance, or risk for

Fetal Growth

Many LBW infants do not catch up after birth even with adequate nutrition after birth, most will be shorter than average for the rest of their lives, and many show long-term impairments in intellect and mental development. In addition, LBW infants tend to have more chronic health problems in later life. Thus, poor nutrition in utero may have profound effects that cannot be reversed after birth. A multivitamin mineral supplement taken during pregnancy may decrease risk of delivering a LBW infant.3

Clinical features

In the current era, diaphragmatic hernia is often diagnosed during prenatal ultrasound scanning. The advantage of prenatal diagnosis is that delivery can be planned to take place in a unit with appropriate pediatric surgical and intensive care facilities. For those infants who avoid prenatal diagnosis, for whatever reason, the clinical features depend on the volume of abdominal contents within the thoracic cavity and the degree of lung hypoplasia. In the most severe cases, there will be severe respiratory distress and cyanosis from shortly after birth. At the other end of the spectrum are infants who have minimal if any respiratory symptoms or signs and in whom intestinal loops are noted to be in the abdomen on chest X-ray (Figure 2.7).

What Is Colostrum

Colostrum is a yellowish, viscous solution that contains more than nutrients it also contains immune factors. These immune factors include antibodies and other factors that can help boost an infant's developing immune capabilities. Since the infant's digestive tract is unused during pregnancy, it is relatively immature at birth and will take the first few months after birth to develop. Many of the immune factors present in colostrum pass through the infant's immature digestive tract wall intact and enter the blood. The immune factors in colostrum are believed to contribute to the fewer lung and intestinal infections observed in breastfed infants than formula-fed infants. Further, factors in breast milk seem to promote the formation of a healthy colon bacteria population, since an infant's digestive tract is also born sterile (without bacteria).

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Bitter tastes are generally disliked. This dislike can be seen soon after birth in the facial expressions of newborn infants (811). Although a dislike for bitter seems to be innate, it is also modifiable by experience. For example, Moskowitz et al. (12) reported on a population of Indian laborers who showed a high preference for sour and bitter tastes. The unusual level of liking was attributed to familiarity with such flavors in their cuisine. Bitterness can also come to be appreciated in the context of many foods and beverages including chocolate, coffee and beer.

Vitamins

Vitamin K is important during the newborn period for normal blood clotting. However, the infant requirement for vitamin K cannot be met by usual levels in breast milk. Poor vitamin K status can lead to hemorrhagic disease of the newborn. Therefore, to prevent bleeding problems and provide adequate body stores, newborns often receive a single dose of 0.5-1 mg of vitamin K soon after birth.

Obesity

While most will attribute the problem to children's couch-potato lifestyles or diets high in sugar and other forms of carbohydrate and fat, other research has been conducted that sheds further light on the theory of MSG-induced obesity. One study discovered that animals fed MSG soon after birth preferred foods that were high in carbohydrates and low in nutritional value.236 They also ate less, but ate rapidly. In other words, they were eating like teenagers.

Developing Children

Unlike other organs, the brain undergoes it greatest growth and organization during the last trimester of pregnancy and during the first two years after birth, even though it is the first system to begin development. This process of brain organization and development continues throughout the teen years. Other studies have described similar findings on brain development and function. In one study mice exposed to MSG soon after birth demonstrated significant difficulties in adapting to stress and to new environments,229 similar to behaviors seen in autistic children. A more recent study found that mice exposed to MSG have greater difficulty performing a non-spatial water-escape task. Examinations of the brains of animals exposed to MSG have shown injury to the hippocampus of the brain, an area vital for learning and memory, as well as emotional development.

Screening

Women should be screened for postpartum depression periodically during the first year after delivery. The standard practice of screening just one time during the early postpartum period (i.e., at 6 weeks postpartum) may not detect postpartum depression that develops later. Because a woman is adjusting well during the early postpartum period does not mean she will not develop postpartum depression sometime later during the first 12 months after birth. Without repeated screenings, a mother may fall through the cracks in the health care system. Prior to screening women for postpartum depression, health care providers need to dispel the idealized myths of motherhood and provide a trusting environment in which women can feel free to discuss any negative feelings or thoughts they may be experiencing.

Etiology

Present a dilated cecum, underdeveloped lymphatic tissue and reduced levels of immunoglobulins in the serum. The intestinal wall of these animals is thinner, and lymphoplas-mocytic infiltration is not observed in the lamina propria as in animals raised in normal environments, which present digestive tube colonization.1,5 In the human being, during gestation, the intestine of the fetus is sterile. Shortly after birth, the intestine of the newborn is rapidly colonized by bacteria from the vaginal canal of the mother and from the environment. However, the bacterial flora also depends on the type of milk used in the diet. In infants who receive breast milk, Lactobacillus bifidus predominates and represents from 95 to 99 of the bacteria in the intestinal lumen. When an unweaned infant is fed with milk-based formulas, in addition to the bifidobacteria, bacteroids and anaerobes also appear.5,7

Requirements

NTDs are major malformations in which there is a failure of the developing neural tube to close properly during the fourth week of embryonic life. Incomplete closure of the spinal cord results in spina bifida while incomplete closure of the cranium results in anencephaly (McNulty, 1997). The latter condition means the babies will either die in utero or shortly after birth.

Type Diabetes

IRS-deficient mice rapidly develop diabetes and die within 3-7 days after birth, thus demonstrating the essential role of IRS in the control of glucose metabolism (179,180). Deficiency of the insulin receptor substrate 1 protein (IRS-1) in mice results in postnatal growth retardation with only mild insulin resistance and no diabetes, whereas deletion of IRS-2 causes impaired insulin signaling and P-cell function, resulting in progressive deterioration of glucose metabolism (181,182) . On the other hand, IRS-3 and IRS-4 knockout mice show respectively either mild glucose intolerance or have no phenotype, therefore suggesting that they are unlikely to play a major role in glucose homeostasis (183,184).

Meat and Poultry

Most types of meat are warm to hot in thermal nature and are excellent for supplementing qi and yang. Meat should be eaten primarily during the cold seasons. Meat intensifies body energy and provides the body with a degree of aggressiveness. It is very suitable for quickly replenishing energy deficits (following heavy physical exertion, after childbirth, during recovery). Excess consumption of meat pollutes the body with toxins and promotes phlegm disorders.

Weight gain

Weight gain goals during pregnancy for HIV-infected women are the same as those for uninfected women. This weight gain is representative of two entities, the products of conception (fetus, placenta, amniotic fluid) and maternal tissues (expansion of blood and extracellular fluid, uterus, mammary glands, and adipose tissue) 10 . Weight gain goals should be based on the woman's prepregnancy weight and height 21 . It is recommended that a woman with a normal prepregnancy weight for height, or a body mass index (BMI) of 19.8-26 kg m2 gain approximately 3.5 lb (1.6 kg) in the first trimester and then approximately 1 lb ( 0.5 kg) per week during the second and third trimesters, for a total pregnancy weight gain goal of 25-35 lb (11-16 kg). Women who are underweight for height (BMI < 19.8 kg m2) prepregnancy should aim to gain approximately 5 lb in the first trimester and a little more than a pound per week in the second and third trimesters, for a total weight gain of 28-40 lb. Women who...

Optimal Weight Gain

Summary Optimal birth weight and outcome are influenced by maternal weight gain. Low gestational weight gain is associated with poor fetal growth and risk of preterm delivery. Excessive weight gain affects infant growth, body fatness in childhood, and the potential for postpartum weight retention and future obesity. Guidelines from the Institute of Medicine recommend that a woman with a normal body mass index (BMI) of 19.8 to 26 should gain 11.5-16 kg (25 to 35 lb). Women with a lower-than-normal BMI should gain slightly more, and those with a BMI greater than 26 should gain 5.911.5 kg (13 to 25 lb). Ideally, weight gain recommendations should be individualized to promote the best outcomes while reducing risk for excessive postpartum weight retention and reducing the risk of later chronic disease for the child and adult.

Weight

The first aspect of nutrition to be examined relates to weight. Much attention has been directed toward this aspect of nutrition because weight is measured easily and can be followed over time. Measurement of weight has been examined by prepregnancy maternal weight, maternal weight at different times during the pregnancy, weight gain based on body mass index (BMI), and neonatal birth weight 5-8 . Maternal weight gain and patterns of this weight gain have been shown to be important predictors of a good perinatal outcome defined in various ways, but usually by birth weights greater than 2,500 g 5-8 . Luke et al. 11 examined the maternal weight gain stratified by BMI as it relates to the optimal fetal growth and weight in twins. In this historical cohort study of 2,324 twin pregnancies, optimal rates of fetal growth and birth weights were associated with varying rates of maternal weight gain, depending on the pregravid BMI and the period of gestation. These data were obtained over a...

Energy Intake

Vegetarians may be similar in weight to the general populace or weigh somewhat less.16 This is particularly true of vegans, who may weigh as much as 10-20 less than omnivores or LOVs.2,17 This may, in part, be due to dietary factors such as the higher intake of plant foods, which contain much more fiber and are usually less energy dense than animal food products, as well as the somewhat lower fat intake. Thus, some vegetarians may enter pregnancy at a lower weight for height and may need more careful monitoring of weight status. Birth weight among macrobiotic infants was positively associated with maternal weight gain in pregnancy, as it was in the recent study of LOVs.5,18

Group Programs

Programs, including Medicaid and WIC. Bowan and Palley tracked 40 adolescent participants for a year and reported improved mean maternal weight gain and birth weights over the background statistics for the area they served. These authors postulated that the individual contact with social workers, who provided flexible services to participants, helped to reduce program-related anxiety. Other reported positive outcomes of the program included an increase in the number of participants who received regular prenatal care, and a reported 100 participation rate in WIC services for their study population 35 .

Energy

Activity level, age, height, and weight prior to pregnancy are all factors that are considered when determining an individual's energy requirements. Although energy requirements vary from woman to woman, most women's energy needs range from approximately 2,500 to 2,700 kcal daily 4 . Caloric requirements during the second and third trimesters of pregnancy are estimated to be 300 kcal day (500 kcal day for adolescents < 14 years of age) above caloric requirements prior to pregnancy. The prepregnancy energy requirements used as a basis for this caloric estimation during pregnancy should account for age, activity level, and prepregnancy weight 4 . The Dietary Reference Intakes (DRIs) for pregnancy take into account increasing needs in support of fetal growth and appropriate maternal weight gain 5-7 . Butte and King 8 estimated energy costs of pregnancy using respiratory calorimetry throughout pregnancy and found that the daily cost of pregnancy increased by trimester. Weight gain...

Iron and Folate

Multivitamin supplementation during pregnancy for the HIV-infected woman has many benefits. Supplementation with a multivitamin (including B-complex, vitamin C, and vitamin E) but not vitamin A alone effectively reduces adverse pregnancy outcomes, such as fetal loss, low birth weight, and prematurity, while also improving maternal weight gain during pregnancy 19, 50 . In addition, micronutrient supplementation has been shown to improve body weight and body cell mass 61 , specifically during the last trimester of pregnancy 19, 62 , while reducing incidence of opportunistic infections 63 and hospitalizations 64 . Multivitamin supplementation has been shown to significantly decrease the risk of maternal weight loss and also improve hemoglobin concentrations 62 . Fawzi et al. reported that multivitamins had a significant beneficial effect on T-cell subset counts. There were increases seen in both CD4 and CD8 cells, which are the main cellular indicators of immunity in HIV infection 65 ....

Amniotic Fluid

That these flavor changes in amniotic fluid are perceived by fetuses and bias their preferences after birth was later demonstrated in a study conducted in Northern Ireland 39 . The response to the odor of garlic was assessed in two groups of infants one group had mothers who consumed garlic-containing foods on a regular basis during the last month of pregnancy, whereas the other group did not. Between 15 and 24 h after birth, newborns were given a two-choice test between a cotton swab that contained garlic and an unadulterated cotton swab. The infants whose mothers consumed garlic before their birth oriented their head slightly more toward the cotton swab that smelled like garlic, whereas the infants whose mothers avoided garlic expressed their aversion for the garlic odor by orienting their heads more to the unadulterated swab than to the garlic swab.

Breastfeeding Trends

Despite the many benefits of breastfeeding, only 64 percent of mothers in the United States initiate breastfeeding, with 29 percent still breastfeeding six months after birth. The U.S. goals for 2000 were to increase to 75 percent the proportion of women who initiate breastfeeding, and to increase to 50 percent the proportion of women who breastfeed for five to six months. In the United States, ethnic minorities are less likely to breastfeed than their white counterparts.

Conclusion

In summary, multifetal pregnancy offers many challenges for both physician and patient. Maternal, fetal, and neonatal complications are more common and make mothers with multifetal pregnancies a high-risk pregnancy group. These patients usually receive their clinical care from well-trained obstetricians or maternal-fetal medicine specialists, and yet, the clinicians do not commonly request nutrition consultation. Certainly, consults are not as common as when pregnancies are complicated by diabetes or hypertension. A reasonable approach would be to obtain a nutritional assessment every trimester. There are good data to support a recommendation for an increase in caloric intake and dietary management, based on BMI. Maternal weight gain, however followed clinically, is only one part of the algorithm for good nutritional care, as other variables are also crucial. Additional supplements with micronutrients and fish oil seem to be supported by the literature. Neonatal birth weight, as a...

Types of Diabetes

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. This definition applies regardless of whether insulin or diet modification is used for treatment, and whether or not the condition persists after pregnancy. GDM affects up to 14 percent of the pregnant population approximately 135,000 women per year in United States. GDM complicates about 4 percent of all pregnancies in the U.S. Women at greatest risk for developing GDM are obese, older than twenty-five years of age, have a previous history of abnormal glucose control, have first-degree relatives with diabetes, or are members of ethnic groups with a high prevalence of diabetes. Infants of a woman with GDM are at a higher risk of developing obesity, impaired glucose tolerance, or diabetes at an early age. After a pregnancy with GDM, the mother has an increased risk of developing type 2 diabetes.