Nutrition in the Childbearing Years

Emma Derbyshire is Senior Lecturer and Researcher?in Human Nutrition at Manchester Metropolitan University.

Foreword xi Preface xvii Dedication xviii Acknowledgements xix Glossary xx 1 Nutrition and Fertility 1 1.1 Introduction 1 1.2 Nutrition and female fertility 2 1.3 Nutrition and male fertility 12 1.4 Conclusion 20 2 Preparing the Body for Pregnancy 25 2.1 Introduction 26 2.2 Nutrient stores 26 2.3 Body weight before pregnancy 28 2.4 The importance of a balanced diet 29 2.5 What are women eating? 29 2.6 A note on dietary recommendations 30 2.7 Compliance with current recommendations 31 2.8 A focus on alcohol 33 2.9 A focus on caffeine 33 2.10 A focus on calcium 34 2.11 A focus on folate 34 2.12 A focus on iron 36 2.13 Emerging interest in choline 38 2.14 Multivitamin and mineral supplements 38 2.15 Application in practice 39 2.16 Food safety 39 2.17 Vitamin A 41 2.18 Fish consumption 41 2.19 Peanut allergy 42 2.20 Food additives and ingredients 43 2.21 Organic food 43 2.22 Other concerns 43 2.23 Application in practice 44 2.24 Conclusion 44 3 Hormonal and Physiological Changes 50 3.1 Introduction 50 3.2 Before conception 51 3.3 After conception 52 3.4 Formation of the neural tube 55 3.5 Foetal growth 56 3.6 Key hormones 57 3.7 Key physiological changes 61 3.8 Conclusion 69 4 Nutrient Metabolism in Pregnancy 74 4.1 Introduction 74 4.2 Energy metabolism 75 4.3 Carbohydrate metabolism 78 4.4 Lipid metabolism 80 4.5 Protein metabolism 83 4.6 Calcium metabolism 84 4.7 Vitamin D metabolism 87 4.8 Iron metabolism 89 4.9 Folic acid versus folate 92 4.10 Conclusion 95 5 Macronutrients and Pregnancy 100 5.1 Introduction 100 5.2 Food cravings and aversions 101 5.3 Energy 102 5.4 Carbohydrate 104 5.5 Sugar 106 5.6 Protein 107 5.7 Fat 109 5.8 Fibre 111 5.9 Water 113 5.10 Dairy products 114 5.11 Salt 116 5.12 Application in practice 116 5.13 Food choices 117 5.14 Dietary assessment 118 5.15 Diet quality index 119 5.16 Biomarkers 119 5.17 Application in practice 120 5.18 Conclusion 120 6 Vitamins and Pregnancy 126 6.1 Introduction 126 6.2 Vitamin A 127 6.3 Thiamine (vitamin B1) 129 6.4 Riboflavin (vitamin B2) 130 6.5 Niacin (vitamin B3) 130 6.6 Pantothenic acid (B5) 130 6.7 Pyridoxine (B6) 130 6.8 Biotin 131 6.9 Cobalamin (B12) 132 6.10 Folate 133 6.11 Choline 137 6.12 Vitamin C 138 6.13 Vitamin D 140 6.14 Vitamin E 141 6.15 Vitamin K 142 6.16 Combined vitamin deficiencies 142 6.17 Supplements and pregnancy 143 6.18 Application in practice 143 6.19 Conclusion 144 7 Minerals and Pregnancy 149 7.1 Introduction 149 7.2 Macrominerals 150 7.3 Microminerals 153 7.4 Application in practice 162 7.5 Conclusion 162 8 Diet and Pregnancy Outcome 168 8.1 Introduction 168 8.2 What is a 'healthy' baby? 169 8.3 A note on Apgar scores 170 8.4 What is foetal growth restriction? 170 8.5 Poor pregnancy outcomes 170 8.6 Sensitive windows of pregnancy 171 8.7 Alcohol 172 8.8 Caffeine 174 8.9 Dietary mutagens 178 8.10 Pesticides 182 8.11 Hypospadias 182 8.12 Nutrigenomics 183 8.13 Foetal origins of adult disease 185 8.14 Supplements 187 8.15 Application in practice 190 8.16 Conclusion 190 9 Weight Gain in Pregnancy 195 9.1 Introduction 195 9.2 Body weight before pregnancy 196 9.3 Weight gain - how much and when? 198 9.4 Components of weight gain 199 9.5 Proportions of pregnancy weight gain 199 9.6 Measuring body composition in pregnancy 200 9.7 High pregnancy weight gain 203 9.8 Low pregnancy weight gain 207 9.9 Weight gain guidelines 209 9.10 Multiple foetuses 210 9.11 Weight retention 210 9.12 Weight loss interventions 211 9.13 What about physical activity? 211 9.14 A note on weight management 212 9.15 Application in practice 212 9.16 Conclusion 213 10 Special Cases 218 10.1 Introduction 218 10.2 Pregnant adolescents 219 10.3 Advanced maternal age 223 10.4 Multifoetal pregnancies 224 10.5 Maternal obesity 227 10.6 Diabetic mothers 228 10.7 Phenylketonuria (PKU) in pregnancy 230 10.8 Vegetarian mothers 231 10.9 Alternative dietary practices 232 10.10 Nutrition and culture 234 10.11 Conclusion 235 11 Physiological and Hormonal Changes after Birth 241 11.1 Introduction 241 11.2 When is 'postpartum'? 242 11.3 Changes after birth 242 11.4 Lactogenesis 247 11.5 A note on colostrum 251 11.6 What is transitional milk? 251 11.7 Nutritional composition of milk 251 11.8 Milk synthesis - use it or lose it 252 11.9 Milk volume 253 11.10 Breastfeeding as contraception 254 11.11 Breast cancer risk 254 11.12 Body weight after birth 254 11.13 Breastfeeding and body weight 255 11.14 Body composition changes 256 11.15 Exercise and breastfeeding 256 11.16 Weight loss interventions 257 11.17 Conclusion 257 12 Nutrition after Birth 262 12.1 Introduction 262 12.2 Is breast best? 263 12.3 What's in breast milk? 264 12.4 Breastfeeding - for how long? 264 12.5 Who is breastfeeding? 266 12.6 Infant feeding survey 267 12.7 Why do women stop breastfeeding? 267 12.8 Feeding and infant growth 269 12.9 Dietary requirements after birth 269 12.10 Vegetarian and vegan mothers 276 12.11 Feeding multiples 276 12.12 Allergy risk 276 12.13 Postnatal depression 277 12.14 Supplement use after birth 279 12.15 Healthy eating from an early age 280 12.16 Application in practice 280 12.17 Conclusion 281 APPENDICES. Appendix 1 International definitions of indices used to form dietary recommendations 289 Appendix 2 Recommended nutrient intakes for women of childbearing age (19-50 years) 290 Appendix 3 Recommended nutrient intakes for pregnancy 292 Appendix 4 Recommended nutrient intakes for breastfeeding mothers 293 Appendix 5 Recommended nutrient intakes for pregnant and lactating adolescents (14-18 years) 294 Appendix 6 Suggested nutritional recommendations for twin pregnancies 295 Appendix 7 Tolerable upper intake levels (ULs) for vitamins and minerals 296 Appendix 8 Institute of Medicine pregnancy weight gain guidelines 297 Appendix 9 Examples of common food safety concerns 298 References 301 CASE STUDIES Planning a pregnancy 305 Older mother 307 Multifetal pregnancy 308 Teenage mother 310 Vegetarian mother 311 Breastfeeding mother 313 Overweight mother 314 Index 315