THE PHASES OF THE FIRST 1000 DAYS OF LIFE

Fetus growth every trimester

1-12 months old: Growth of crucial organs (eyes, heart, digestive systems, lungs)

13-27 months: Fetus gains weight, organ begins to operate

28-40 months: Fetus grows weight rapidly, organs mature

THE KEY CHALLENGES OF NUTRITION DURING PREGNANCY

Nutritional status of a woman before becoming pregnant:

Determines early embryo and placenta development

The body weight of the mother at conception:
Being underweight or overweight mother puts a pregnancy at risk, and adversely affects later disease risk for the child

Nutritional requirements:
Are increased in pregnancy, particularly for some vitamins and minerals

Total food intake:
Mothers do not need to “Eat for two” but “Think for two”. Quality is the key.

NUTRITIONAL REQUIREMENTS DURING PREGNANCY

Women should have folic acid supplements before pregnancy and during the first trimester, to prevent neural tube defects such as spina bifida.

Plenty of women of reproductive age have bad Vitamin D status, which is why
Vitamin D is recommended in many countries

The requirements for zinc, omega 3 fatty acid (DHA) rises.

Experts recommend that pregnant mothers have enough intake of omega 3 fatty acid (DHA)

Differences between the needs of pregnant women& normal women

Normal Women Needs = 1900 KKal

Nutritional Need Increase For Breast-feeding Women +330 s/d +400 KKal

Protein needs of normal women = 50 g

Protein needs of pregnant women = Increased +20 g

Fat nutrition needs of normal women = 75 g

Fat nutrition needs of pregnant women = Increased +11 g

Carbohydrate needs of normal women = 309 g

Carbohydrate needs of pregnant women = Increased +44 - 55 g

Fiber nutrition needs of normal women = 32 g

Fiber nutrition needs of pregnant women = Increased +5 - 6 g

Water needs of normal women = 2300 g

Water needs of pregnant women = Increased +650 - 800 g

Folic Acid needs of normal women = 200 ug

Folic Acid needs of Pregnant woman = Increased +100 ug

Calcium needs of normal women = 800 mg

Calcium needs of pregnant women = Increased +150 mg

Example of a Balanced Menu Guide

Food Groups	Trimester 1	Trimester 2 & 3	1 equal portion	Important to Note
Food Groups	Combination of Food Menu and Daily Menu
Fruit	2 portions	2 portions	1 glass of fruit juice and half bowl of cut fruit	Eat all kinds of fruit
Vegetables	2.5 portions	3 portions	1 glass of vegetable juice 2 bowl of vegetables	Increase intake of dark green and orange vegetables
Energy Source	6 portions	8 portions	1 slice of bread 1,5 scoop of rice	Increase intake of complex energy source such as rice, biscuit, bread potato, cassava
Protein	5.5 portions	6.5 portions	1 chicken, fish, 1 egg, 2 tempe slices, tofu	Choose parts with less fat
Milk & processed food	1-3 portions	1-3 portions	1 glass of milk 1 cup of yogurt 1 slice of cheese	Pick low or non-fat ones

Breast milk is the best food for babies. Breast milk should be given exclusively during the first 6 months of baby's life and it is recommended for two-year-old children, with the appropriate complementary feeding. Infant formulas can be provided upon a recommendation of the medical personnel, only when the mother was unable to breastfeed.

Breastfeeding decreases the risk of:

Breast & ovarian cancer type II Diabetes
Cardiovascular disease *

Breastfeeding plays a central role in mobilising fat stores accumulated during pregnancy thus helping a mother return to her pre-pregnancy weight.

Breastfeeding “reset" maternal metabolism, thereby reducing maternal risk for metabolic disease.**

*Ballard, 2013, **Stuebe, 2009

Short Term Benefits
Protection against gastrointestinal and respiratory infection and allergy.*

Longer Term Benefits
1. Associated with lower incidences of obesity, diabetes
2. Lower levels of cholesterol and blood pressure
3. Higher performance in intelligence tests **
(not all studies have demonstrated these benefits conclusively it depends on sample size, timings of end point measurement)

*ESPGHAN, 2009, **Kelishadi et al, 2014

Breastfeeding has benefits for mother & child.

The close contact between the mother and child stimulates the mother to make antibodies and to secrete these in her breast milk.

Two key reasons to start complementary feeding :

1	Breastfeeding alone is insufficient to meet the increased nutritional requirements in the rapidly developing child.
2	It is important that a child is introduced to solid food with new tastes and textures to develop healthy eating habits.

It is important to introduce appropriate complementary (or weaning) foods to children by 6 months of age.

Texture progression is important in the first year of life
Textures develop oral motor capabilities, reduce risk of feeding problems and optimise the acceptance of healthy foods.

Young Children have Specific Nutritional Requirement

They need up to 7 times more nutrients than an adult ( per kg body weight ). Therefore, with every spoon, a child has to eat significantly more nutrients than an adult.

Children in aged 1-2 years require nutrients ( per kg body weight ) higher than require of adults person.

Example young children need 5.5 times as much iron per kg as adults.

Dietary protein is essential for the supply of nitrogen and amino acids to synthesise body protein for muscles, organs and as the foundation of tissues, but too much protein may be a risk for the development of obesity.

Vitamin D (& calcium) are essential to bone health, key for children as they have a high rate of skeletal growth.

Iron, in the form of haemoglobin, delivers oxygen to the growing organs. Iron is also required for brain development , i.e. the formation of myelin and neuronal growth. Iron deficiency in early life is linked with developmental and behavioural problems.*

Iodine is a component of the thyroid hormones regulating metabolic activity and growth.

Zinc is essential for the structure or action of many enzymes that have a metabolic function, e.g. in cartilage growth.

Vitamin A is needed for growth, immune function and vision.

THE PHASES OF THE FIRST 1000 DAYS OF LIFE

PREGNANCY PHASE

THE KEY CHALLENGES OF NUTRITION DURING PREGNANCY

NUTRITIONAL REQUIREMENTS DURING PREGNANCY

Differences between the needs of pregnant women& normal women

Example of a Balanced Menu Guide

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Our Support for the First 1000 Days of Life