Questions about infant feeding and pregnancy?

What you eat during pregnancy and your child's early nutrition is vitally important. Here Lisa Lathleiff, a registered dietician gives some advice on the most common questions around nutrition.

1. Why is it important for a pregnant woman or a women of child bearing age to eat healthy?

The first two years of a child’s life (conception until around 24 months) are the most critical time in their life.

During pregnancy the DNA of the child can still be affected by lack of nutrients.  A big factor that can also be influenced during this critical period is the IQ of the child.  The reason why this is so important, is because these negative changes can influence at least the next three generations, which may result in all next generations to have lower IQ’s which can be further affected if those generations are not well nourished.   

The risk for low birth weight infants also increase, among other factors, if the mother is underweight or malnourished.  These infants (and all malnourished infants) have a high risk for developing chronic diseases, such as diabetes, hypertension, and certain cancers etc., in later life.  Its crucial for children and pregnant women to be protected in this regard. 

2. Which foods are important during pregnancy and which should be avoided?

During pregnancy, the body needs extra nutrients and energy to support the growing foetus.  Its important to eat a variety of foods in order to obtain all these necessary vitamins and minerals.   

Focus on the different food groups:  whole wheat and fortified starchy foods, such as brown rice, Low GI bread, high fibre cereals; Beans, peas, lentils and soya foods; Fish, chicken, lean meats and low fat dairy products (yoghurt/milk/maas); Fruit and Vegetables (5 – 7 servings per day); and 1.5 to 2 Litres of fresh, clean water everyday. 

Specific nutrients which are needed in larger quantities during pregnancy include:

• Folic acid rich foods:  Spinach, liver, dry beans and fortified products.
• Iron rich foods:  Liver, kidney, spinach, red meat, dried beans and fortified products.
• Vitamin C rich foods:  These foods also increase iron absorption – Strawberries, Oranges, kiwi fruit, guavas, pineapples, mangoes, tomatoes and raw cabbage.
• Calcium rich foods:  Milk, maas, yoghurt, cheese, broccoli and tofu (soya bean curd).
• Vitamin A rich foods:  Most brightly coloured fruits and vegetables, liver, egg yolk, fish and green leafy vegetables.

 Foods to avoid include: Unpastuerised dairy products, including some cheeses; raw or undercooked meat, fish or eggs; Food or drinks high in Caffeine (limit coffee and tea – Rooibos is safe).

Its not safe to smoke or to use alcohol and addictive drugs during pregnancy.  These practises can have detrimental effects on a growing foetus.

Use only medications prescribed by a doctor, and always mention to any health care worker that you are pregnant. 

3. I would rather formula feed my baby, why is it so important to breastfeed?

First of all, breastfeeding is the normal, natural feeding method intended for babies.  There are a lot of emotional aspects to breastfeeding for mother and baby.  The first thing a baby looks for after birth is the mothers eyes and after that they look for the breast via the instinctive rooting reflex. 

This is a crucial time for bonding between mother and baby, which in turn starts the process of milk production and ejection due to hormones which are released by these emotions and early suckling.   

Colostrum is the first milk which is immediately available after  birth and is already produced during the last trimester of pregnancy.  It is very important for baby to receive this ‘first milk’ because it contains anti-bodies that is similar to an immunisation, it lines and prepares the gut for mature milk and also has a laxative effect which helps to remove the first black stool (meconium) in order to help prevent neonatal jaundice.   

From days 2 – 4 the mature milk will start flowing if the mother has breastfed the baby on demand, every few hours, including night feeds.  This milk contains foremilk for quenching baby’s thirst and hindmilk for satisfying baby’s hunger.  

 The amount of nutrients in breast milk is 100% of what baby needs to grow and develop optimally for at least the first 6 months of life.  It also contains DHA in its natural form, which is a fatty acid necessary for brain development and this helps to increase the baby's IQ.   

Breastfeeding has benefits for mother as well, as it reduces her risks for osteoporosis and certain female cancers, and of course it can help with losing the unwanted weight gained during pregnancy.  

There is a definite place for formula, for example, when a mother cannot breastfeed due to medical reasons, or in the case of an orphaned baby, but the benefits of breast milk far outweigh those of formula. 

4. How do I know my baby is getting enough milk when I am breastfeeding?

With formula feeding it is easy to measure how much the baby drinks. If you feed your baby on demand (when the baby ‘asks’ for milk) and you give night feeds as well, you should have a good milk supply.   

The best indicator is to check your baby’s weight every week for the first month, every two weeks for the second month and only monthly there after.  If your baby lost some weight after birth, he/she should reach the birth weight again within the 1st month.  From there, a steady weight gain should be seen when plotting on a growth chart.   

Babies should drink between 6 and 8 times within 24 hours and at least 10 minutes on each breast, to ensure that they receive foremilk for thirst and hind milk, which is higher in fat and energy.  Another way to know that you have enough milk, is if you feel your breasts getting ‘full’ between feeds and feel less full after baby has breastfed.  Some women also feel a definite letdown reflex as the milk is ejected, this is a tingling sensation which usually happens in the first few minutes of a feed. 

5. Is it safe to breastfeed my baby when I am HIV positive?

Research has shown that there is a small risk of mother to child transmission of HIV through breast milk or during pregnancy and delivery - especially if the mother has a low CD4 count or a high viral load.  The risk during breastfeeding is increased by non-exclusive breastfeeding, re-infection with HIV during breastfeeding and opportunistic infections during lactation.  Protected sex, by means of a condom is therefore strongly advised during pregnancy and lactation.   

If the mother is on Anti-Retroviral Treatment (ART), the baby receives Nevirapine drops and the mother breastfeeds exclusively, the risk for transmission of HIV to the baby is minimal.  Exclusive breastfeeding means that the baby receives only breast milk and NO other foods or drinks, not even water or supplements, other than prescribed by a medical doctor. 

The reason for this is that the digestive system of the baby is very sensitive and giving foods or other drinks too early can cause small lesions in the digestive tract and the virus can enter the baby’s body in that way. 

Formula feeding is an option if the mother has full blown Aids and is too weak to breastfeed.  It remains a mothers choice to formula feed.  Do keep in mind that there is a much larger financial implication to formula feeding.  It is recommended that a pregnant woman, who is HIV positive, discuss this issue in detail with a health professional before making a choice on feeding. 

6. When is an appropriate time to start feeding my baby complementary foods?

Certain milestones need to be achieved by an infant and their digestive system needs to be ready for the addition of solid foods to their diet.  These milestones include sitting with support, showing an interest in food and trying to grab it, moving food to the back of the mouth and swallowing it, and also a stronger sucking and chewing pattern should begin.

Milk remains the main source of nutrients and should not be decreased at this time.  Usually these milestones are reached at around 6 months of age.  This is also the time when breast milk alone does not provide sufficient iron and iron-rich complementary foods are needed. 

Which foods do I start with when I introduce complementary foods and when do I stop giving milk feeds?

The following table gives ideas on how to include a new food every week: 

 Reference: Lisa Lathleiff,  Registered Dietician

(Health24, October 2012)

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