 Hey everybody, Dr. O here. Welcome to chapter 15. So we're beginning these next three chapters as a little unit on life cycle nutrition. So I think it's the next three chapters, yeah. We're going to focus on pregnancy and lactation here and then infancy, childhood into adolescence in the next one. And then we'll look at nutrition for aging populations in chapter 17. So all right, so pregnancy and lactation obviously huge deals. I mean, think about how important I always tell students that the nine most important months of your life where the nine months you're in your mother's womb, and you can make an argument that the 10th most important month is the month before you were conceived because the nutritional status of your parents impacts everything from the health of the gametes to you know, you developing, I mean your mother is basically the environment that you develop in. So clearly nutritional status during pregnancy is going to play a big role in helping you reach your genetic limits or your genetic capabilities basically. And then we'll look at lactation and breast milk, I really like to talk about that topic. It's actually one of my favorite topics because we look at from an immunity standpoint the importance of breast milk and of course nutritional quality but the vitamins and minerals and things like that that you find in breast milk, they can be reproduced more with formula. But if you look at the immunity aspect of it and the fact that breast milk is loaded with material that's designed to enhance and build your baby's microbiome, certainly one of my favorite topics. But of course never any condemnation from me right, I think that breast milk is the best choice when possible but I also know it's not always possible. And I know even in our lives with Oliver that my wife is not able to breastfeed near as long or as much as we had hoped so sometimes it's completely out of your control. Alright let's go ahead and dive in. So the ice breaker, what is the relationship between what is consumed before and during pregnancy and the genetically defined limits of a newborn? Again that's a huge topic but I think it makes sense that you need to be as healthy as possible prior to becoming pregnant and then after getting pregnant and then of course even with males we'll look at how nutrition and health impact the quality of sperm. So if you have the highest quality sperm and the highest quality egg and then a great environment for that baby to grow up in then you will hopefully reach those genetic limits like I said get as healthy as you potentially can. Does this change as they grow? I mean I think that when you're young I mean nutrition is critically important right. For me you know as a 44 year old man I'm basically maintaining right. I'm trying to maintain my brain health. I'm trying to basically slow the decline of my brain health. You know I'm trying to stay as strong as possible and all these types of things but when you're young and you're growing and building it's even more critically important. When I look at I mean just anything right when I think about my son Oliver's brain you know he's seven almost eight now. His you know his brain is literally being built out of the building blocks that come from his food right. So I think that nutrition is important for every age but during development. So in your mother's womb and those first few years of your life it is the most critically important time and then even from a microbiome standpoint a microbiological standpoint right your adult microbiome is basically built by the age of three which means that things that happen in those first three years of your life from delivery onward can have an impact on your microbiome that will persist forever right. If I take antibiotics now as a 44 year old man it will have an impact on my microbiome but imagine eating antibiotics when you're two or three months old or one year old that can literally have an impact forever. So all these nutrition always matters but I think that it's even more important when you're building something right. It's a lot easier for us to maintain our house now that it's built but when it was being built the better quality ingredients and materials that you use to build this house will be what maintains it for hopefully decades to come just like our internal houses as well. Okay so many things we talk about there right. I mean that the healthier your bones are when you're young the more bone you can afford to lose as you age and the more muscle you have when you're young the more muscle you can afford to lose as you age right. You don't want these things to happen but I think you get the point. All right the learning objectives for this chapter list the ways men and women can prepare for a healthy pregnancy so it is not just women you look at you know many traditional cultures I mean pretty much all traditional cultures that I've ever studied had special pre-pregnancy nutrition rituals and routines for women but some of the cultures also had special pre-pregnancy nutrition for men and I think it makes sense. All right describe fetal development from conception to birth and explain how maternal malnutrition can affect critical periods so we'll talk about what critical periods are and then how malnutrition can have devastating impacts and impacts that are permanent. Explain how both being underweight or overweight can interfere with the healthy pregnancy and how weight gain and physical activity can support maternal health and infant growth so we'll look at like how much weight someone should gain during pregnancy and what the benefits are of that etc. Four summarize the nutrient needs of women during pregnancy so how does how do nutrient needs change identify factors predicting low risk and high risk pregnancies and describe ways to manage them and then summarize the nutrient needs of women during lactation so the needs during pregnancy and lactation are different and unique. Okay nutrition prior to pregnancy nutrition can affect fertility risk with being both overweight or underweight and I think that's the case for both men and women but obviously we're mainly talking about females here but you know the healthier a male is the healthier their sperm are right so if you if you're malnourished or and you're overweight and you're inflamed and all the and all these types of things then you're you're more likely to have a pretty large percentage of your sperm that are non-motile maybe not moving or they're non-functional right so and this is something that's a pretty serious issue your sperm count may also be lower so if a male is healthy and taking care of themselves and not malnourished not only will their sperm be healthier but there should be more of them and they should be more functional ones meaning that you're more likely to conceive. So with females though both the so if you're overweight you see that how that can impact sex hormone levels quite a bit and if you're underweight remember that your you know your your adipose tissue your body fat basically sends signals to your brain about how much stored energy you have using a hormone leptin well leptin can have a direct impact on the gonadotropins or or or a hormone called gonadotropin releasing hormone which will impact the the main gonadotropins which they're called that because they impact the gonads so the gonadotropins are follicle stimulating hormone and luteinizing hormone and they impact the production of your sex hormones and your sex cells your gametes so if you're underweight your brain is basically getting the signal that now's not a good time to conceive because if you don't have enough stored energy for you to survive then now is definitely not time to be building another human being and bringing them into this this world uh so this is why you see with people that get extremely lean uh maybe female bodybuilders or or athletes you know athletes involved in in sports like gymnastics you see that they get their body fat levels can get so low that they lose their menstrual cycle it's called amenorrhea and that's quite common when people get um overly lean so you do need you need a you need a certain amount of body weight and body fat to support a healthy pregnancy so being overweight makes you inflamed and impacts hormone levels and hormone signaling being underweight um impacts the production of sex hormones and the the odds that you will become pregnant if anything I guess if you if you asked me I would say that in you know in the month uh month or two prior to getting pregnant you know if you maybe gained a couple of pounds it might send um stronger signals to your body that um reproduction is a is is a go than if you were to lose a couple pounds so but obviously it depends on the weight you're at when you're when you're starting all right so preparation before pregnancy I mentioned this several times with some of the nutrients like if you can become pregnant you should already be eating like you are because as you'll see in a little bit here many of the critical periods um in in your baby's development are going to happen very early right think about uh basically the you know in the first um six, seven, eight weeks tops um after becoming pregnant that's when a child will develop neural tube defects well you often don't know you're pregnant I've had students that said they didn't even know they're pregnant for eight, nine, ten weeks so uh it's too late to start taking a folate supplement if if you've already passed these critical periods where the neural tube is developing so if you can become pregnant you should already be thinking about these types of things and we all know where babies come from so all right uh preparation before pregnancy achieve and maintain a healthy body weight so if you're overweight uh trying to get to a better better body weight uh through diet and exercise if you're underweight you know trying to add a little bit of weight make a lot of sense I think this is this is why you see that um you know people that make positive lifestyle changes like changing their diet and exercising they often do see an increase uh odds of of fertility choose an adequate and balanced diet and making sure you have all the nutrients you need for yourself as you know whether it's for the production of the gametes the sex cells or if it's for you know being healthy for because you're the environment and you're where the baby is going to um get their nutrients if you if you're the female uh be physically active that impacts hormone signaling and controls inflammation all positive things receive regular medical care you want to make sure you don't have hypertension or high blood sugar right or diabetes these kind of things uh polycystic ovarian syndrome which is the leading cause of infertility in the united states you want to get these things dealt with to make it more likely that you will become pregnant and to make it more likely that you have a you have a healthy pregnancy and a healthy baby manage chronic conditions again you have chronic inflammatory conditions or whatever underlying conditions you have if you help deal with them you will be healthier and avoid harmful influences things that could negatively impact a pregnancy one that you don't whether you know it's there or not at the you know like alcohol and drugs those kind of things we'll cover that at the end our reflection number one you can feel free to pause this and match these uh the metabolic the active organ that's the placenta so the placenta basically is a temporary organ that develops during pregnancy and that's that's going to be the main connection between mom and baby contains fetal blood vessels extending through the placenta that'd be the umbilical cord that's how the baby gets fed i like to think about you know i've heard that a baby called a perfect parasite before right it's basically uh you know it's it's an organism living inside of you that's half you genetically but not not all you so that's you know there are some concerns there with your immune system recognizing this thing any of this baby as foreign um but then babies are generally really good at getting the nutrients they need like for example um fetal hemoglobin has a higher affinity for oxygen than regular hemoglobin so babies are going to get the oxygen they need babies are going to get the nutrients they need so basically if mom is well nourished then everything's good but if mom is poorly nourished um the baby's going to extract whatever nutrients it needs generally you know the baby seems to take priority which which it should so a pregnancy can be very hard on mom right and that's where you have issues with um making sure you're properly nourished before you get pregnant during pregnancy uh and then after pregnancy right the next thing you know thing is if you have a baby when are you going to have the next baby you know and our ancestors um many cultures they have you know they had strategies in place to try to to try to space babies out to make sure that mom fully recovered um from from delivery you know growing one human before they started growing another one so and some studies have shown that if children are bone you know if a if a mother has three or four kids right in a row that you know the third and fourth kid are more likely to have some problems whether it's immune system problems or or different health problems then it could be that mom's nutrient stores have just been tapped out all right um embedded in the uterine wall that's the placenta fluid field structure that houses the developing fetus that's the amniotic sac with full of amniotic fluid the exchange is oxygen nutrients and waste that's the placenta the mirror that organ that connects mother and baby growth so just back to what we're talking about just making you know getting as healthy as possible you know prior to making the sperm and egg that are used uh um for fertilization will not only increase your chances of having a baby but will give them the healthiest start possible and that's what I said before when I said the 10th most important month of your life was the month before you know your your mother and father conceived you growth and development during pregnancy now all right so the placental placental and fetal growth and development so the placenta develops right in the uterus uh the amniotic sac is what houses the fetus and it's full of the amniotic fluid and the umbilical cord contains the blood the fetal blood vessels that connect mom and baby that's how the baby remember the baby isn't breathing right the baby you know the baby isn't um eating right so it's getting all of its nutrients all of its oxygen from mother and and delivering all the waste products back to mom and through mom fetal growth and development we start with uh the uh the ovum or the oocyte or the egg and sperm so those those are the gametes they both have one set of chromosomes or 23 chromosomes and then a fertilized egg would be would be called a zygote so once that sperm and egg come together a zygote is a single cell that divides to become what's called a blastocyst so for about a half an hour you were you know give or take you were a fertilized egg and then you were two cells and four cells and eight cells and and all these cells had the ability to become an entire you right entire human being but then as these rounds and rounds of cell divisions continued cells started to travel down paths this is what you learn in embryology classes they traveled down paths where they decided what kind of cell they were going to be like oh i'm going to become part of the liver i'm going to become part of the brain that's what happens uh so but at that but when you have that single cell that fertilized egg that zygote that cell has all the instructions to make any part of you so pretty cool all right and then we have that cluster of cells implantation is when it implants in the uterus and and where it's going to stay uh and develop into a baby and then we have the embryo uh into a fetus so you start as that single cell uh the the embryo becomes a fetus that eight weeks the stages of embryonic and fetal development so we can look at these here uh a zygote is a newly fertilized egg or ovum and is about the size of the period at the end of this sentence less than one week after fertilization cells have rapidly divided to become a blastocyst ready for implantation which you see up in that picture uh so fertilization usually takes place in the uterine tube or the fallopian tube and then as this cluster of cells starts to divide it's traveling towards the uterus where it should implant so after implantation the placenta develops and begins to provide nourishment for the developing embryo this is an embryo that's five weeks old after fertilization is about half an inch long uh a little a little peanut there a fetus after so here we see after 11 weeks of development is just over an inch long notice the umbilical cord and blood vessels connecting the fetus with the placenta so that's that lifeline between mom and baby a newborn infant after nine months of development measures close to 20 inches in length from eight weeks to term this infant grew 20 times longer and 50 times heavier so uh so thinking of healthy you know baby just born uh a healthy weight for a baby is generally going to be in the six and a half to eight pound range obviously some kids are smaller some are larger but that's kind of what you what the ideal that you'd like to see I know Oliver he was not quite six pounds so he was he was no no he was he was almost seven pounds actually sorry I was not quite six pounds so I've made up for it since then but uh I was not quite six pounds when I was born okay uh the placenta and its associated structures so again you just see the placenta is this connection um it's where the it's where the umbilical cord arises and heads into the amniotic uh sac and that's that lifeline between mom and baby so all the oxygen and nutrients the baby needs is coming um from you know from mom to baby and then all the carbon dioxide and waste products is coming back so pretty cool all right and then the yeah the placenta is it basically is a temporary endocrine organ it's a temporary organ that is that is delivered you know with the after birth after after delivery all right reflection you can feel free to pause and try to answer these implants in the uterine wall after one week that's called a blastocyst uh two to eight weeks after conception we have the embryo uh newly fertilized ovum is called a zygote and then from eight weeks on grows until birth that's the that's the fetus all right critical periods so these are very important and many of them are very early in the process because a critical period I'll read the I'll read the the definition they give here times of intense development and rapid cell division so cellular here's the key cellular activities can occur only during these times so if you miss a critical period or if you you don't have the nutrients needed during your critical period you can't undo that so you see here over on this right hand side uh the first half an adverse influence experienced early in pregnancy permanently impairs fetal development and a full recovery never occurs that's why it's called a critical period whereas here in the green bar you see an adverse influence experienced late in pregnancy temporarily impairs fetal development but a full recovery is possible not guaranteeing it but it is possible so that's why these critical periods are so important and this is why I always say that if you can become pregnant you need to act as if you are because look at the I mean you see the critical critical periods are so early on in the process that you will probably not even know you're pregnant and so if you're if you're missing you know key nutrients or you're consuming alcohol you're doing these kind of things they can they can leave a permanent impact on your baby okay excuse me take a drink here quick so damage during these critical periods has permanent consequences for the fetus's life and health a good example the best example critical period for neural tube development is between 17 and 30 days of gestation so you often will not know you're pregnant in between 17 and 30 days so if you didn't have enough folic acid or folate on board then there's no way to undo a neural tube defect if it has occurred all right here's here here's these these critical periods you're looking at week's of gestation notice that the first thing that develops is a central nervous system so being being malnourished or exposed to things like alcohol or drugs in those first few weeks is going to have the largest impact on the the central nervous system like your brain and spinal cord then you see the heart ears eyes legs and arm teeth palate and external genitalia so if you're and none all of these things are occurring in the first 12 weeks so these critical periods all of them have occurred in the first three months but look at how many of them have started have occurred or started to occur in the first four weeks which it's it's almost rare to know you're pregnant in the first four weeks so this is why I just continually say you know make make sure that you're I would say if you can become pregnant at least be taking a prenatal vitamin right and you know and just be focusing on being healthy but that's like that to me that's the least you should be doing just in case anything else about these you do see the central nervous system develops first that's why the neural tube develops right away at the beginning and there's a there's a book called the first thousand days that's good but I mean it's terrifying but it talks about malnutrition you know during pregnancy and how it pregnancy and in the first thousand days of life after birth how if you don't have the nutrients you need for brain development you don't have the calories and the fats and all the nutrients you need then you will that the brain will permanently be smaller and that will lead to permanent problems right so I give a presentation on on malnutrition and the developing brain and and it's really really sad you know the research I've done but these these things have generational impacts so if you're malnourished while your child's brain's developing they will never reach their potential right they think about all the untapped potential they will never be able to reach which then means that that's going to impact their ability to take care of their family and make money and these kind of things which means that that cycle will probably continue and this is especially true in the developing world we'll look at global nutrition later but if we can if we can get mothers right get males too but if you can get the females properly nourished prior to pregnancy and during pregnancy that means that you can set that child on a completely different trajectory so really really important all right development issues during pregnancy so we've talked about neural tube defects a few examples here and encephaly is when the brain is either missing or fails to develop spina bifida is an incomplete closure of the spinal cord or that the bony vertebrae behind it real really minor issue like something called spina bifida occulta where basically like the the back of the vertebrae might not fuse together completely so you see a little tiny crack there a little tiny gap that's nothing compared to having exposed spinal cord so there's there's different levels of of neural tube defects but some are much worse than others I would say that you know in my career and looking at x-rays and stuff somewhere in the ballpark of 10 percent of people had this real minor spina bifida stuff but you know not the the really really disastrous development of problems unknown causes but the main the main concern is getting folate on board right making sure that that mom is is properly nourished but especially with folate because folate and b12 are so critically important for cell division and and development and differentiation so this is why pregnant women need 800 micrograms a day of folate compared to 400 you know green leafy vegetables lots of good food sources take a prenatal vitamin like if you're already taking a multivitamin anyways and you may possibly become pregnant then I would I'd recommend switching to a prenatal vitamin just my recommendation not medical advice you'll notice I say that a lot all right um this is also why folate's been added to our food supply so if you look at your good food sources of folate you're going to see enriched grain products so when you go to the store and you buy bread or really anything that has grains in it for decades now that those grains have been fortified where they've added folate to it to make sure that the average Americans folate intake is high enough folate does more than prevent neural tube defects but this is a huge deal right prior to these fortification programs several thousand maybe three thousand or so um children a year were born in the united states with with neural tube defects and that number has dropped drastically so all right um the developmental origins of disease there's a lot to unpack here but we'll just cover a few examples mother's nutrition may change gene expression in the fetus and this can influence diseases of adulthood I mean absolutely this is the entire field of study called epigenetics so epigenetics epigenetics says that okay you can't change your genetic code you can't change the a's and c's and g's and t's that you're made out of but you can influence your genes right you can you can turn gene expression on or turn it off you can speed up gene expression or slow it down so mom's nutrition absolutely has an impact on how the genes operate in their developing baby and here's why we always talk about well simply put anyways we always talk about uh nature versus nurture right and how important your environment is so you know that your environment is really important for your health well the your environment for nine months of your life was inside your mother's womb so if mom was properly nourished then you were getting that then signals were being sent to your body that you're entering a world where there's plenty of nutrition right if mom is malnourished then you're getting signals as well getting signals that there's famine and food's hard to come by so you can see how so you see here malnutrition can increase the risk of type 2 diabetes well that that could be because this baby's been getting signals for months that food's hard to come by so when you find food you should eat it right this baby's being hardwired for famine even though it's not a real famine right mom's malnourished because she's not getting enough nutrients because she's maybe eating a nutrient poor diet but she's probably getting plenty of calories so food's food is plentiful usually but if mom's malnourished and the baby's getting signals that when you should when you find food you should eat it when you find food you should eat all of it um when you eat food you should store as much of it as fat as possible and these all lead to this environment where a malnourished mom is more likely to have a a kid that has type 2 diabetes that is obese uh they're more like you know their children are more likely to die before the age of 63 you know things like that so I think that that that one actually makes a lot of sense you see another example here inadequate growth during placental and gestational development can affect blood pressure so that's another example but another one that's really good and again not good news but let me go back a point so chronic diseases adverse influences at critical times during fetal development can impact the baby into adulthood we've said that so another really good example would be stress right some of these epigenetic studies were done on women that were in concentration camps during world war two while they were pregnant sorry why is getting itchy nose so um they were under extreme stress they were malnourished too but they were under extreme stress and they found that basically the stress that mom had left an imprint on the baby so these these babies of mothers that were in concentration camps while they were pregnant were more like were hardwired for stress more likely to be stressed out more likely to have anxiety more likely to have schizophrenia these kind of things so early research in this area of epigenetics has shown that one of the reasons that mom's nutrition matters so much is mom is the environment mom is the nurture right is the environment that this baby is growing up in for the for those nine months and every day the baby is getting signals about what to expect in the world after delivery so another reason to make sure that you're taking really good care of yourself like when my wife was pregnant i mean i i couldn't carry the baby right so but i but i told her that my you know my job was to do whatever i needed to do to make sure that she was as nourished as possible you know keeping your blood sugar stable because big swings in blood sugar appear to be one of the things that lead to this increased risk of diabetes so my job was to try to make sure that my wife was really properly nourished and so so that my son was being taken care of and then i told her i said let me let me handle the stress let me worry about the money and this and that like let me take the stress on me so i'm not putting it on you and the baby right she kind of joke too because she said oh don't worry i can keep my blood sugar stable i'll just keep it high all the time right that was that was kind of our little joke but so you know as the father that's what i tried to do right i tried to help um help oliver's environment as much as i could by taking care of my wife you know that's what i felt like my my job was all right maternal weight so weight gain should be game weight what's what is the weight game how much weight should you gain all all things that depend on where you start so weight your weight prior to conception influences infant birth weight for sure if you're underweight which generally you know could be seen as signs of malnutrition in some cases higher rates of preterm births so babies that are born too early and too small overweight and obesity a higher rates of medical complications you see a couple clear examples gestational hypertension so during pregnancy blood high blood pressure and gestational diabetes is a you know a temporary transient form of diabetes that develops during pregnancy both are bad both have a very negative impact on the baby and both have a negative impact on mom so uh so you don't want to be underweight prior to conception but if you're overweight and especially if you're obese there there's a lot of there's a lot more risk here uh more likely to have somacrosomia so children know above the 90th percentile and an increased risk of cesarean delivery because the baby's too large to exit the birth canal and that from a might we in microbiology would talk about this a lot but that that could have an impact on the baby too because if a baby's born vaginally then then they're seated with mom's vaginal microbiome if they have to be born bsc section they are colonized by you know the quote unquote wrong microbes so this so not only would uh you know being obese or overweight during pregnancy um have an impact on the baby's health directly but it also has an impact on the ecosystem that develops inside the baby too with the microbiome so all important stuff um what about that yeah so so having diabetes gestational diabetes they definitely lead to larger children and that's and that's where you see that increased risk of c-section or cesarean delivery all right weight gain during pregnancy so you see the the question here is how much weight should be gained during pregnancy um the answer is depends on where uh where you started right so um so weight gain during pregnancy does impact fetal growth and maternal health but it does depend on sufficient maternal weight gain so so you do want to gain weight even even a even someone that's obese um will be gaining weight and it's not it's not all fat as you'll see a lot of it's fluid and of course it's the baby itself um the weight gain during pregnancy does correlate closely with infant birth weight so it's a predictor of health and development so not only do you want to be the right body weight when you start um you want to make sure that you you gain an appropriate amount of weight during pregnancy uh you should definitely not be trying to lose weight for example and you and there's never a reason to need to gain more weight than you need you see here looking at um um you know even let's see someone with a healthy weight having twins they're they're never recommending gaining more than 54 pounds all right uh so recommended weight gains depends on the number of fetuses and your beginning weight so let's go through this if you're underweight with the bmi or body mass index below 18.5 um for a single birth uh you would need you recommended weight gain is 28 to 40 pounds if you started a healthy weight bmi of 18.5 to 24.9 that number goes to 25 to 35 pounds if you're overweight notice that you need to gain less weight you don't need you know because part of the weight gain maybe seven pounds of it or so is going to be fat well if you already have excess body fat you don't need to gain those pounds you still need to gain the weight of the baby and the fluids and all that but you don't need to gain that that extra fat weight um so overweight you see 15 to 25 pounds and then obese with the bmi above 30 you see 11 to 20 pounds and then with twins you'd obviously want to gain more weight because there's two babies in there okay so what is the weight gain that occurs during pregnancy so here we see if we see a 30 pound weight gain you see two pounds come from an increase in breast size because the glandular tissue is developing uh it from the mammary glands for lactation and the development and the production of breast milk for increase in mother's fluid volume so you know if you've been pregnant or know someone that has you know they start to they can start to swell up swollen ankles these kind of things uh one and a half pounds the placenta four pounds an increase in blood supply to the placenta I mean all body tissues need blood so eating about a pound of fat might have seven miles of blood vessels in or something like that so you see an increase in blood supply so more blood vessels more blood two of the pounds are amniotic fluid uh seven and a half give or take is the baby at birth excuse me and then two pounds increase in size of the uterus and supporting muscles the uterus gets I mean can grow up to 500 times its normal size and then um seven pounds is mother's necessary fat stores so again if you're already overweight or obese that seven pounds would would not really be needed all right let's look at go ahead and pause this and then you can answer these questions and we'll go and check them together uh so as far as weight gain here you see during the first trimester you only a typical weight uh recommended weight gain is only three and a half pounds let me go back a picture you see you haven't seen a couple you haven't seen a lot of changes as far as needing to gain weight the mammary glands haven't been developing the uterus is still small etc etc so during the first trimester only three and a half that should be pounds not uh semicolon bs so during the second and third trimester you aim for about a pound a week um increase in mother's fluid volume four pounds the placenta one and a half and then seven pounds for those needed fat stores weight loss after pregnancy so there the return to pre-pregnancy weight depends on whether mother stayed within weight gain recommendations so if uh if you if mom gained that 30 pounds she's more likely to return to her pre-pregnancy weight if she gained 40 or 50 pounds way less likely to uh most women tend to retain a couple of pounds with each pregnancy uh if you want to uh one of the best things you can do to uh besides not gaining too much weight to begin with but one of the things that you can do to increase your chances of returning to a pre-pregnancy weight by maybe even a couple hundred percent is uh breastfeeding is lactation so that yet as you'll see uh lactation costs about 500 calories a day so you you basically can put yourself in a 500 calorie a day deficit just by producing producing ample amounts of breast milk all right um additional weight retention increase increases the risk for diabetes hypertension and chronic diseases just like any weight gain right if you if you gain five to ten pounds every pregnancy well then you you now weigh more and that puts you at higher risk categories for chronic diseases like diabetes and like high blood pressure or hypertension all right dos and don'ts of exercise during pregnancy i kind of i like this i thought this was a pretty good list right the the main key is um it when people have concerns about exercising during pregnancy uh the main concerns that i've heard anyways would be uh core temperature climbing too high right um anything that would be kind of robbing the baby of blood supply and then the fact that especially in the third trimester of pregnancy uh you get you know there's there's a hormone called relaxin and and ligaments and soft tissue or ligaments and connective tissues start to loosen up a little bit to prepare for delivery so increased risk of injuring mom during that time but the you know obviously the key concerns would be would be the baby at least early on so do uh let's look at the dos first begin to exercise gradually you just you don't want to shock your body at this point um exercise regularly most if not all days of the week like the recommendations we covered chapter or two ago uh do warm up with five to ten minutes of light activity you'll see most of these are just smart things everybody should do uh do 30 minutes or more of moderate physical activity per day we talked about that do cool down with five to ten minutes of slow activity and gentle stretching all great do drink water before during and after exercise we've covered that on two separate chapters now as far as hydration do eat enough to support the needs of pregnancy plus exercise so if you're going to be burning 500 calories a day more with exercise let's that's a big number but let's say you are um you can't let that rob the calories that your baby needs so whatever whatever your needs would be uh let's say you need 2000 calories a day uh during pregnancy if you're going to be exercising and burning 500 more calories a day then you need to be eating 2500 calories a day you are not trying to lose weight uh during during pregnancy all right and do rest adequately okay the don'ts don't exercise vigorously after long periods of inactivity just don't want to don't want to hurt yourself don't uh don't exercise in hot humid weather concerns about dehydration uh especially when you're pregnant don't exercise when sick with the fever your core temperature is already elevated uh don't exercise while lying on your back after the first trimester of pregnancy or stand motionless for prolonged periods just you know looking at the health of the baby don't exercise if you experience any pain discomfort or fatigue I guess that depends on what you mean by those things right because uh I feel pain and discomfort and fatigue every time exercise but uh I don't know uh don't participate in activities that may harm the abdomen or involve jerky bouncy movements no brainer and no scuba diving because of the pressure changes and those types of things all right nutrition during pregnancy energy and nutrient needs during pregnancy so there are dramatic changes especially during rapid periods of development of the baby I mean you're growing the human being right think about that think about how the nutritional needs and the caloric needs in growing a human I mean that's that's pretty amazing all right dramatic changes guidelines for your healthy pregnancy good nutrition healthy rate of weight game we just covered those uh physical activity just covered that prenatal supplements and we'll look at what what that means you know prenatal vitamins are basically the same as regular multivitamins they just generally have more iron and more folic acid or folate avoid harmful substances obviously like we'll talk about alcohol and and fetal alcohol syndrome secondhand smoke can increase the risk of sids you know these kind of things um energy and nutrient needs are highest during pregnancy and lactation you'll see that nutrient needs are actually higher or energy needs sorry are higher during lactation than pregnancy so these are uh so your your energy expenditure is going to be higher during pregnancy and lactation than any other time in your life because you're you're growing another human being and then you're literally producing milk all right so to meet your needs make careful selections and you know nutrient dense foods making sure you're getting enough calories but not too much the body maximizes absorption and minimizes losses so that's you know I mean it's like the like I told you the baby is is really designed to harvest whatever it needs the mom is designed during these critical periods to to give the baby whatever it needs so that's um that's all good all right um this should not be there I read this PowerPoint and I was like I don't even know what's talking about this is so lactate this is a metabolism thing I don't know whoever put the power point together um don't worry about this right lactate is uh yeah just to discuss they must have been thinking lactate like lactation so that this is not uh we are not talking about the byproduct of anaerobic glycolysis here so typo discussion question why do the needs for carbohydrates and calories change during pregnancy what roles do essential fatty acids and proteins play during pregnancy so you need more of all of those um so carbohydrates spare protein needed for growth so that's the same with everyone carbs spare proteins because if you don't eat carbs your body has to make carbs it makes carbs through a process called gluconeogenesis uh which uses proteins usually so you need enough carbs to make sure you have all the protein you need for you and for growing more of you because of the pregnancy and then also growing a human being so ideally um you're looking for 175 grams per day or more remember that the rda for carbohydrates is normally 130 so it's jumped up to 175 during pregnancy and then an additional 25 grams per day of protein is needed so whatever your excuse me whatever your protein intake was you take you know whether i generally recommend for physically active people 1.6 to 2.2 grams per kilogram of body weight of protein well whatever protein is the healthy amount for you to be consuming you add 25 grams a day during pregnancy so your calorie needs increase uh 340 calories per day during the second trimester and five uh 450 calories per day in the third trimester you don't actually see an increase in calorie needs in the first trimester you're not the baby's still like this so uh first trimester calorie needs are the same second trimester 340 more calories a day third trimester 450 calories a day uh omega 3 and omega 6 fatty acids are needed for brain growth structure and function i mean you're building another human being so you need more protein to build that human you need the energy to build that human from carbs and then you need the essential fatty acids because you're building the brain right especially the omega 3 fats and i would say especially dha or decosa hexanoic acid uh the other omega 3 fat that we find in fish oils is called epa but dha critically important for brain health all right so here we see uh won't go through all these because you see a lot of similarities but comparison of nutrient recommendations for non-pregnant pregnant and lactating females so you see a 24 year old woman is the green bar a typical one non-pregnant uh what is that tan would be pregnant and purple would be lactating so you notice that um for some of the nutrients the needs don't change during pregnancy uh most of them though the needs do increase a little bit uh you'll see that folate has has really jumped up compared to a non-pregnant woman iron needs go way up and you even see a note here the increased need for iron in pregnancy cannot be met by diet or by existing stores therefore iron supplements are recommended i told you that you know those are the two two big things you see in a prenatal vitamin is more folate and more iron to meet those needs but you see iodine needs go up we talked about that remember how important iodine is for the brain uh if if mom is malnourished and doesn't have enough iodine in her body uh during pregnancy that can lead to cretinism you see your zinc needs do jump up quite a bit uh very important for development um same thing with b6 so so almost every nutrient you do see an increased need but then look at that purple bar for lactation so the needs get even higher right i told you that lactation you know you need you need more calories and more nutrients uh because you're producing breast milk i always talk about you are what you eat um but the leftover of what you eat becomes the food that you feed the baby and that's why nutrient needs uh stay stay quite elevated uh during lactation now if you're actually if you're still taking your prenatal vitamin and you're um and you're consuming 500 more calories a day of nutrient dense foods not soda or something then you should be getting all the nutrients you need but you see big increases that needs for vitamin a b6 vitamin c uh zinc over here manganese iodine chromium all over the place right so make sure you are eating plenty of nutrient dense foods and getting plenty of calories uh when you're pregnant and lactating all right nutrients for blood production and cell growth these are going to be especially important because you're you're think about the you know the the new cells that you're building which is which is your baby uh so fetal cells are laid down at a tremendous rate i mean you start as a single cell and you end up as a entire human being after nine months uh maternal red blood cell mass expands we talked about that the pounds of extra blood that are needed uh so the needs for uh the the nutrients that increase cell growth and dna replication are really important and that's these nutrients here folate we've talked about b12 also talked about how it's it plays a big role in cell division and differentiation iron and zinc so all those are four critically important nutrients to get more of while you're pregnant and lactating nutrients for bone development i mean you're building a skeleton inside of you so vitamin d because vitamin d is needed for calcium absorption and metabolism so vitamin d calcium absorption and retention increase which is good right that means that your body will extract more calcium from your food during pregnancy intake usually usually falls below recommendations so a prenatal vitamin should hopefully catch catch that issue as well uh short intervals we uh we talked about this before but short intervals between pregnancies can deplete nutrient reserves so just remember when you're done when you're done growing one human being you it's you see here the optimal interval is 18 to 23 months but many many of our ancestral cultures at least the ones i've studied um they generally had plans where uh you know for it would be about two years between babies uh and that to make sure mom could fully recover and be really be healthy enough to have on their child some cultures the mom and dad slept in different beds you know because we know where babies come from uh other you know and many cultures remember that that uh because of hormonal changes lactation and breastfeeding can function in some ways as a birth control not a full proof form of birth control at all and especially less so now than ever because the average human care like in america especially is carrying maybe 25 more pounds of weight and a lot of that is fat and that impacts hormone signaling too so i would never trust lactation as a primary form of birth control but it does decrease the chances that you're going to have another baby so spacing out children is very important and if not if you have two three kids in a right in a row just imagine you didn't have the same nutrient reserve uh to build that third baby as you did the first one but you know like my mom and her brother they were they were irish twins they which is what i what we call it anyways when uh they were born within a one year period so it happens all right um common nutrition related concerns of pregnancy so nausea and vomiting people you know morning sickness doesn't just occur in the morning right uh this could be because of hormone changes and lots of other things but occurs at any time not just in the morning and ranges from mild queasiness to debilitating nausea and vomiting i know you know my wife really struggled with this especially with oliver compared to the first two pregnancies uh you know she was just constantly using what was like ginger ginger lozenges and saltine crackers and just yeah she didn't feel very good in it you know primarily in the first trimester but even some into the second trimester so this can absolutely require hospitalization i've had students that need to be hospitalized for this if you have a lot of nausea and vomiting that can affect hydration right and and the health of the baby so i have seen that uh constipation and hemorrhoids that just comes from um well the slow GI tract but the hemorrhoids come from abdominal pressure so hemorrhoids are basically distended veins around the rectum and anus so that can those can become real serious and very painful though um heartburn that could be you know the increase of abdominal pressure same thing uh you know popping open the lower esophageal sphincter leading to heartburn uh hormonal things can do it too food cravings and diversions most most women when they're pregnant crave certain foods and have aversions to others and that can even change by pregnancy i know that you know with my wife's three pregnancies there were different cravings with all three of them uh non-food cravings this is also something that's quite common pica is the you know craving non-food substances that usually things like clay and dirt and that has been associated with mineral deficiencies especially iron deficiency it's almost like your body's craving these minerals and that is a place where you can find them okay high-risk pregnancies so what is a high-risk pregnancy um so the infant's birth weight it would be would be one so a low birth weight babies that five and a half pounds or less we said earlier that six and a half to eight pounds is ideal uh if a baby has a low birth weight there are increased risk of complications relationship with socioeconomic status i mean you know usually you know of poverty uh increased risk of um mom being malnourished you've got maybe maybe cigarette smoking or other things that can impact this as well other drug use so there are lots of things i mean some kids are just born small but there are lots of things that can increase the likelihood that a child has a low birth weight and then uh so gestational age so that would be you know preterm babies and babies that are small for their gestational age so that would be the these low birth weight babies um what are some what are some so that obviously that's that's the real big concern is making sure the baby reaches the appropriate weight before delivery let's go ahead and look at some of these um the factors that impact high-risk pregnancy i like to see like maternal diabetes and stuff like that we're all really important ones so maternal we've talked about several before already so maternal weight prior prior to pregnancy if if mom has an is either underweight or overweight or obese as classified by the BMI all of those um increase the risk uh during pregnancy insufficient or excessive pregnancy weight gain we covered all that so either you're not gaining enough weight that pound a week during the second and third trimester or you're gaining too much weight both of those so starting too light or gaining too little weight starting too heavy gaining too much weight all increase the risk factor for during the pregnancy for uh or risks of a high risk pregnancy all right previous pregnancies see the number so many previous pregnancies three or more to mothers younger than the age of 20 or four or more to mothers age 20 or older why we talked about before you're dipping into your nutrient reserves um interval short or long intervals between pregnancies especially under 18 months but also over 59 months um outcomes so previous history of problems so if you've had high if you've had um problems before then of course you'd be at a higher risk for having problems again sadly uh multiple births like twins or triplets uh birth weight so either a low or high a birth weight infant we talked about we talked about that before maternal health so high blood pressure puts you at an increased risk of developing gestational hypertension which can be very serious things like preeclampsia as well uh diabetes if you have if mom has diabetes then the the development of gestational diabetes is much more likely and this is why um I think all women are screened their blood sugar should be screened between weeks 24 and 28 but if you have a high risk pregnancy then they would screen your blood sugar um earlier and more often uh chronic diseases that can impact pregnancy diabetes heart respiratory and kidney disease certain genetic disorders people on special diets or medications all these things can put you at high risk during pregnancy maternal nutrition so nutritional deficiencies or toxicities and eating disorders or disorder eating patterns all those increase the risk of the pregnancy social economic status poverty lack of family support low level of education limited food availability all things would increase risk of malnutrition poor diet etc lifestyle habits smoking alcohol drug use and then age either um 15 years or younger or 35 years or older so being so being young comes with some risks and being old comes with some older sorry comes from risk as well we'll come back and talk about that a little bit more later uh malnutrition and pregnancy so malnutrition's effects on fertility we talked about that before if you're malnourished you're less likely to have a healthy viable sperm you're less likely to have a high enough sperm count to to actually um lead to pregnant conception um can if can a loss of sexual interest can lead lead libido so that's a loss of libido so if someone is malnourished really low body fat they often will have no interest in sex which which again makes sense if you're preparing for a body build you know a bodybuilding competition and you're five percent body body fat your body is thinking that you're starving to death so your libido goes away because if you're if you can't find food for yourself you should not be reproducing right that's why weight loss low body fat these things can lead to a loss of libido and loss of sexual interest uh the friends I have that are bodybuilders when they get in your competition prep they have no interest in sex and probably couldn't get an erection if they wanted to at least not as often as they'd want to so malnutrition impacts sperm impacts libido and then we talked about all the things it does in females as well uh early pregnancy so prevents the placenta from fully developing uh fully because you know with malnutrition and then fetal development you you need building blocks to build a human being and if you don't have them there can be a price to pay we've talked about neural tube defects and others bone health etc all right so how do we how do we prevent this malnutrition that can be associated with low socioeconomic status and poverty etc so we have food assistance programs like wick women infants and children nutrition education and nutritious foods given to vulnerable populations who qualify for help all all great stuff the cost-benefit analysis I mean I think it's great I mean I think that we've talked about before helping the next generation can have an impact forever right you can change the trajectory of a child's life so if a if a kid is get is given more nutritious food then they are more likely to improve their own status in life as they get older and that's all great remedial and preventative services incentives to encourage breastfeeding so I think all good news effects of particular foods may alter breast milk flavor and then can impact things like allergies so I just all stuff to keep in mind you know I recommend not having super spicy food and things like that when you're when you're lactating breast milk provides immunological protection so we can talk a little bit more about that but so the two main reasons that I that I love breast milk is that well for nutrition or nutrition and microbiological reasons for babies not me personally sorry might sound weird is that you know so breast milk has all five classes of antibodies meaning that you know IgG IgA IgM IgE and IgD so basically babies getting dosed with an immunotherapy every time they're being breastfed mom's exposed to the same environment as her child mom's immune system so the baby's immune system is underdeveloped mom's supposed to cut fill in the gaps and covered them because mom's exposed to the same thing mom's immune system recognizes the environment and makes antibodies and then doses the baby every time they're being breastfed so that's what it means when it says breast milk provides immunological protection but then on top of that breast milk human breast milk has over 200 HMOs which are human and milk oligosaccharides they're called prebiotics they're fibers that feed the microbiome in your gut so not only is your immune system benefiting from breast milk but so is your microbiome and breast milk is actually a probiotic food too so it has living organisms plus it has food for those organisms to help your microbiome develop so those are the two main reasons I mean you can you can get formula that has the vitamins and minerals and fatty acids you need but if you were to ask me what are the two reasons why breast milk is superior those would be the two big ones the immunity aspect and the development of the microbiome for sure all right women with HIV should not breastfeed that's because HIV can cross into breast milk it also can cross the placenta all right so infant formula you know if infant formula is available then if you have HIV you should definitely not be breastfeeding but you know it's is that or starve the baby then then you'd still want to breastfeed all right maternal health talked about a lot of these things already pre-existing diabetes puts you at high risk so that's why they would test your blood sugar earlier and more often hopefully they wouldn't wait until weeks 24 to 28 to screen your blood sugar because you're at much higher risk gestational diabetes which is diabetes that occurs during pregnancy and then should go away complications during labor and delivery due to the high birth weight so if you have gestational diabetes that baby's more likely to be very large chronic hypertension so already having high blood pressure is going to have an impact on on baby's health and mom's health then gestational hypertension can develop and can become a life-threatening condition called preeclampsia which has effects to the mom's circulatory system liver the kidneys are real important there and the brain and the brain preeclampsia can lead to eclampsia which can lead to seizures coma and death so no joke monitoring your blood sugar and your blood pressure during pregnancy super super important all right age of the mom so physically ideal childbearing age they say here is 20 to 25 so if you're under 20 especially we said earlier under 15 so adolescents risks of pregnancy complications higher rates of stillbirths preterm births low birth weight infants again that's whether that's because of the age of the mom or the bottom here need for economic social physical support these kind of things so they need to seek prenatal care so it's I don't know if it's a cause or an effect I don't know if it's just that adolescents are more likely to be malnourished or more likely to you know have lower social economics status I don't know but but the younger you are the higher risk of the of the pregnancy and then on the other end too so pregnancy in older women first births to those that are 35 and older higher maternal death rates so harder on the mom because of underlying chronic conditions like hypertension and diabetes infants also face potential problems allow that as genetic so down syndrome is much more common you'll see some numbers here in just a moment you can pause and try to answer these complications with later childbearing is often due to chronic conditions like diabetes and hypertension cesarean deliveries are twice as likely in women over the age of 35 1 in 50 this is a big deal 1 in 50 pregnancies in older women produces an infant with genetic abnormalities so you see here maternal death rates are higher in women over 35 risk of down syndrome goes is 1 in 100 for a 40 year old woman compared to 1 in 10 000 for a 20 year old woman it has to do with just the the health of the genetic material in someone that's 40 years old versus 20 all right practices just about done here practices that are incompatible with pregnancy alcohol consumption can lead to irreversible mental and physical retardation it's called fetal alcohol syndrome medicinal drugs that's why you always got to work with your doctor with drugs you know decide which drugs are classified but whether or not they're safe during pregnancy and then if you're if you're on a drug that puts your pregnancy at high risk you have to decide if it's worth getting pregnant getting off the drug etc etc work with your doctor on that kind of stuff herbal supplements seek positions advice just because again better safe than sorry when you're pregnant an herb that might be completely safe to take when you're not pregnant is questionable at best when pregnant so always work with your doctor on that elicit drug use obviously can lead to all sorts of problems other dangerous practices smoking and chewing tobacco harmful effects are magnified during pregnancy and we talked about secondhand smoke or smoking and increased risk uh or not the baby wouldn't smoke but um secondhand smoke for babies seems to increase the risk of SIDS sudden infant death syndrome environmental contaminants we call we talked about this in an earlier chapter things like um lead and mercury lead they both could have a permanent impact on the developing nervous nervous system so minimizing exposure to lead and mercury is a really great idea eating fish is really good but if you're pregnant you know making sure it's fish that are super low in mercury super low in toxins you have to be real smart about your seafood choices when you're pregnant and and for your children um foodborne illnesses so there are there are a group of infections called torch infections that can cross the placenta and then mom is also a bit immunocompromised or has a suppressed immune system during pregnancy which makes sense because a baby's growing inside of them that is only half them so it's a foreign invader there's a parasite living inside of your uterus and so the immune system is basically suppressed now this can actually if mom has autoimmune conditions they can actually get better during pregnancy because of this but um so you have so mom a pregnant woman is at increased risk of certain infections uh so a big one here you see an increased risk of listeriosis you can get that from like deli meats and fish so you're going to be very very careful about your food choices another one is you know pregnant women need to avoid kitty litter or cat poop because of uh toxoplasmosis infections so those are a couple things uh and then there's a whole list of these infections that can cross the placenta they're called torch infections okay um other risky behaviors vitamin and mineral mega doses so excessive vitamin a is a big one can cause fetal malformations and spontaneous abortion those kind of things so making sure you're not getting you know toxic levels of nutrients is just as important as not having deficiencies uh caffeine high intakes risk of miscarriage and fetal death low intakes appear safe so you and your doctor figure out what low versus high intake means i guess um restrictive dieting i don't think that um during pregnancy is really a time to be doing any sort of restrictive dieting but you see here's an example um low carb diets can deprive the fetal brain of needed glucose so i do you know i'm a big fan of low carb diets diets for lots of people for lots of reasons but when you're pregnant you need to focus on what's the the healthiest thing for the baby um sugar substitutes again just depend you know what um you have to work with your doctor on those kind of things what is safe and what's not safe all right nutrition so now we've had the baby nutrition during lactation to the benefits of breast breast milk i've talked about quite a bit already so nutritionally it can be really really good uh there are situations though where if mom's malnourished or mom has a real toxic burden in her body that might not be the you know it might not always be the right thing to do but generally speaking it's that you get the right nutrients and the right levels um if you are breastfeeding they generally recommend supplementing with vitamin d though but uh so nutrient the correct nutritional composition nutrients are bioavailable um yeah and then it's just of course some hormones basically prolactin is what's leading to the development of the mammary glands and production of breast milk and then the hormone oxytocin it should be milk production not mild production but oxytocin is what causes the ejection of milk and they will say mild there but they should both say say milk so so oxytocin and prolactin are the two key hormones there but i've mentioned earlier not just nutritional composition but um the immunity that comes from breast milk and then the development of the microbiome are two really big ones so what are some of the benefits of breastfeeding for infants provides the appropriate composition and balance of nutrients with high bioavailability so nutrients that are designed for the baby provides hormones that promote physiological development absolutely like oxytocin is a pair bonding molecule protects against a variety of infections and illnesses including diarrhea and ear infections which all great may protect against some chronic diseases later in life including diabetes obesity and asthma i think that has to do with the microbiome component more than anything protects against food allergies reduces the risk of SIDS and supports a healthy weight so all great things for mothers it contracts the uterus helping the uterus return to its closer to its normal size and decreasing infection risk delays the return of regular ovulation thus lengthening birth intervals we talk again we i mentioned all this before it's not a dependable method of contraception but it does generally help so i can space out the babies at least 18 months as recommended conserves iron stores by prolonging amenorrhea or the absence of the menstrual cycle may protect against breast and ovarian cancer and reduce the risk of type 2 diabetes hypertension and heart disease all interesting but i think that i think a lot of that is linked to the next point increase energy expenditure which may help bring about weight loss or helping you return to your propregnancy weight so pretty cool stuff there other cost and time savings from not needing medical treatments for childhood illnesses or leaving work to care for sick infants i mean yeah that could be a positive i mean it is a positive it's true but not always guaranteed right cost and time savings from not needing to purchase and prepare formula even after adjusting for added foods in the diet of a lactating mom because she has to consume 500 more calories but it can still be a cost in time setting again could be my son oliver he never latched so my wife would basically spend 30 minutes pumping and then 30 minutes feeding him and then it was about time to start over again so i would not say that there was a cost or a time savings for for us in our situation environmental savings to society from not needing to manufacture package and ship formula and dispose of the packaging sadly right now there are formula shortages so this is even more true than ever and the convenience of not having to shop for and prepare formula so you see here at the bottom and that i don't know where the number comes from but an estimated savings of 12 to 1500 dollars in the first year maternal energy and nutrient needs during lactation we talked about nutrient needs before almost 500 calories extra a day exercise is compatible with breastfeeding but you have to make up for the exercise calories energy needs recommendations increases for carbs and fiber nutrient inadequacies reduce the quantity not the quality of breast milk so generally again babies can get what they need so mom's going to pour whatever nutrients she has available into breast milk but the quantity of breast milk will go down if mom is malnourished total water intake that's 3.8 liters per day that's about 13 cups 13 cups of water per day i think is what's recommended during lactation minimum number of calories that i've ever seen is 1800 when lactating but of course scale that to whatever your needs are all right nursing offers immunological protection we talked about that because all all different types of antibodies are given to the baby and then breast milk is also a probiotic and a prebiotic food HIV infection in AIDS can be transmitted through breast milk so keep that in mind diabetes requires careful monitoring because if mom's blood sugar is all over the place that can have a negative impact postpartum amenorrhea is prolonged but women are not protected from pregnancy so i think i think our ancestors would have been more protected but the fact that we carry so much extra body fat around a typical person anyways kind of negates some of that but it is so it's kind of like a decent form of birth control but not not extremely effective breast health increase breath health breast health decrease breast cancer risk we talked about that and then the links with postpartum depression nursing helping with that all right what practices are incompatible with lactation alcohol because it crosses into breast milk infants eat less when mothers consume alcohol you shouldn't be consuming alcohol medicinal drugs work with your doctor on those kind of things all sorts of illicit drugs put put mom and baby at risk smoking we've talked about environmental contaminants like lead and mercury we've talked about caffeine we've talked about so i think we've hit all that these are all things that should be avoided for the health of during pregnancy and during lactation okay we did it great you know a great chapter i think obviously an important important period of life because it sets you up for the rest of your life now the lesson is over you should have learned to list the ways men and women can prepare for a healthy pregnancy we've done that describe fetal development from conception to birth and explain how maternal malnutrition can affect critical periods we covered those explain how both underweight and overweight can interfere with the healthy pregnancy and how weight gain and physical activity can support maternal health and infant growth that was what we spent most of our time talking about summarize the nutrient needs of women during pregnancy i showed you that chart identify factors predicting low risk and high risk pregnancies and describe ways to manage them talked about all that age diabetes hypertension etc summarize the nutrient needs of women during lactation so we did it all right good chapter uh now now we'll look at taking care of the infant moving on in our next section uh on the nutrition across the lifespan so i hope this helps have a wonderful day be blessed