The following pargraphs are part of a chapter that I've reviewed with Dr Katz for the last edition of the Enciclopedya of Primary Prevention. It was super interesting because I 've learnt many evidence based information about nutrition during Pregnancy and Early Childhood. The Chapater is meant for health professionals particularly, so I admit that it can be a little bit boring and relatively long. In the next few weeks I will try to generate some more easy-to -read posts based on this for all my friends who are facing motherhood.
"In general, pregnancy requires a calorie
increase over baseline of approximately 300 kcal/day, and lactation requires
500 kcal/day. Nutrients for which
the recommended daily allowance (RDA) is specifically raised in pregnancy
include: total protein, total energy, magnesium, iodine, zinc, selenium,
vitamin E, vitamin C, thiamin, niacin, iron, calcium, and folate. Lactation requires further increases in
protein, zinc, vitamin A, vitamin E, vitamin, C, and niacin. Requirements for iron and folate
actually decline These adaptations in the maternal diet are necessary to assure optimal
nutrition for the fetus/newborn.
Immediately postpartum for a period of
approximately 3-5 days, human mammary glands produce colostrum, a fluid rich in
sodium, chloride, and immune globulins that confer passive immunity to the
newborn. Colostrum is replaced by
milk, which is rich in lactose and protein, and comparatively low in sodium and
chloride. Milk volume consumed by
the neonate is 50 cc per day at birth, 500 cc by day 5, and 750 cc at 3
months. Milk production is
maintained by infant suckling. The
first four months of lactation consume, and convey to the infant, a comparable
amount of energy as the entire gestational period. Human milk is appropriate as the sole source of infant
nutrition for up to 6 months provided it is free of dangerous contaminants or
pathogens (e.g., the HIV virus).
There is uncertainty whether milk meets all of the infant's nutritional
needs beyond this point.
Breastfeeding, under most circumstances, is the preferred nutritional
source for neonates. A generous
intake of dietary calcium, and continued use of prenatal vitamins, is indicated
throughout the period of lactation.
Breast
milk and infant formulas differ substantially in a variety of nutrients. The
significance of all of the differences has yet to be established. The prevailing view is that breast milk
favors optimal brain development, and breast-feeding is associated with greater
intelligence, at least during childhood, although such observations are subject
to confounding. There is interest in the role
breast-feeding may play in preventing the development of atopy (allergy). Evidence is convincing that breast-feeding confers
protection against infections, although the mechanisms by which breast milk
influences infant immunity remain under study. Provided that a sanitary water supply
is available, the safety of formula is generally not of concern. Soy-based formulas are available for
infants intolerant of bovine milk protein. Properly nourished, the healthy infant should double in
weight by 4-5 months, and triple in weight by 12 months. Demand feeding is the preferred method
of assuring adequate energy intake......"
Strategies That Work
Optimal
development in utero is associated with several nutrients in particular. Supplementation with approximately 400 mg of folic acid per day
beginning prior to conception markedly reduces the risk of neural tube defects,
including anencephaly and spina bifida.
Evidence for this association has been extensively reviewed and is
considered definitive. Ingestion of more than 1 mg per day of
folate is generally not recommended.
However, in women with prior pregnancies leading to neural tube defects,
the ingestion of up to 4 mg per day of folate may confer additional benefit.
