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A woman's nutritional status before and during pregnancy affects not only her own health but also the health and development of her baby.

If a woman is underweight before becoming pregnant or fails to gain sufficient weight during pregnancy,her chance of having a premature or low-birth-weight infant is increased. Overweight women, on the other hand,have a high risk of complications during pregnancy, such as high blood pressure(hypertension) andgestational diabetes, and of having a poorly developed infant or one with birth defects.

Weight loss during pregnancy is never recommended. Recommended weight gain during pregnancy is 11.5 to 16 kg (25 to 35 pounds) for a woman of normal weight—slightly more for an underweight woman and slightly less for an overweight woman.

At critical periods in the development of specific organs and tissues, there is increased vulnerability to nutrient deficiencies, nutrient excesses, or toxins. For example, excessvitamin Ataken early in pregnancy can causebrain malformations in the fetus.

One important medical advance of the late 20th century was the recognition that a generous intake offolic acid (also called folate or folacin)in early pregnancy reduces the risk of birth defects, specificallyneural tube defects such as spina bifidaandanencephaly (partial or complete absence of the brain), which involve spinal cord damage and varying degrees of paralysis, if not death.

For this reason, supplementation with 400 micrograms (0.4 milligram) of folic acid is recommended for all women who have a chance of becoming pregnant. Good food sources of folic acid include green leafy vegetables, citrus fruit and juice, beans and other legumes, whole grains, fortified breakfast cereals, and liver.

Overall nutritional requirements increase with pregnancy. In the second and third trimesters, pregnant women need additional food energy—about 300 kilocalories abovenonpregnant needs. Most additional nutrient needs can be met by selecting food wisely, but aniron supplement(30 milligrams per day) is usually recommended during the second and third trimesters, in addition to a folic acid supplement throughout pregnancy. Other key nutrients of particular concern areprotein, vitamin D, calcium, and zinc.

Heavy alcohol consumption or "binge drinking"during pregnancy can causefetal alcohol syndrome, a condition with irreversible mental and physical retardation. Even lighter social drinking during pregnancy may result in milder damage—growth retardation, behavioral or learning abnormalities, or motor impairments—sometimes described as fetal alcohol effects.

Until a completely safe level of intake can be determined, pregnant women are advised not to drink at all, especially during the first trimester.Caffeineconsumption is usually limited as a precautionary measure, and cigarettesmokingis not advised under any circumstances.Limiting intake of certain fish, such as swordfish and shark, which may be contaminated with methylmercury, is also recommended.

An extra 500 kilocalories of food per day is needed to meet the energy demands of lactation. Because pregnancy depletes maternal iron stores, iron supplementation during lactation may be advised. Breast-fed infants may be sensitive to theconstituents and flavoursof foods and beverages consumed by the mother. In general, lactating women are advised to consume little, if any, alcohol.

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