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