Pediatric Nutrition in Practice

132 Malek  Makrides

infant. To avoid a deficiency, some animal-de-
rived foods or vitamin B 12 -fortified foods should
be consumed or a vitamin B 12 supplement taken.
An adequate intake of iron, zinc, calcium and
prot e i n s hou ld a l s o b e e n su re d. Ve ge t a r i a n s ou rc-
es of protein include dairy foods, legumes, cere-
als and grains as well as nuts and seeds. Vegetar-
ian sources of iron, zinc and calcium are shown
in table 3.

Mercury in Fish

Fish is an important part of a healthy diet. It pro-
vides long-chain omega–3 fatty acids and is a
good source of protein and minerals including io-
dine. Mercury is a neurotoxin which occurs natu-
rally in the environment and accumulates in fish.
The consumption of fish during pregnancy and
lactation should be guided by national, govern-
ment-endorsed recommendations, which gener-
ally advise eating 2–3 meals per week of fish/shell-
fish with low mercury levels and avoiding or lim-
iting the consumption of fish high in mercury
(predatory deep-sea fish) [9, 10]. Canned fish
generally has lower levels of mercury, as smaller
species and younger fish are used for canning.

Herbal Teas and Herbal Supplements

There is insufficient evidence to support the con-
sumption of herbal teas or herbal supplements
during pregnancy or lactation. Most herbal prep-
arations have not been tested to establish their ef-
ficacy and safety, and some may be dangerous to
the developing fetus or infant.

Listeriosis

Listeriosis is a rare but serious infection caused
by eating food contaminated with the bacterium
Listeria monocytogenes. The transmission of lis-

teria to the fetus can cause miscarriage, prema-

ture labour or stillbirth. The risk of listeriosis can

be reduced by avoiding high-risk foods and tak-

ing simple food hygiene and food safety steps.

Foods to avoid include chilled, ready-to-eat foods

such as cold cooked chicken, cold processed

meats, pre-prepared or pre-packed cold salads,

raw seafood, soft-serve ice cream, unpasteurised

dairy products, pâté as well as soft and semi-soft

cheese.

Caffeine (Coffee, Tea and Caffeine Soft

Drinks)

Some caffeine is transferred to the fetus via the

placenta and to the infant via breast milk. A daily

intake of 200–300 mg caffeine, equivalent to 2–3

cups of coffee, is considered to have no adverse

effect. Energy drinks are not recommended as

they can contain high levels of caffeine.

Alcohol

Alcohol is transferred to the fetus via the placenta

and to the infant via breast milk. There is no safe

limit for alcohol intake, and it is recommended

that alcohol consumption be avoided during

pregnancy. During lactation, the alcohol content

of breast milk reflects maternal blood alcohol

levels. As a general rule, it takes an average-sized

woman 2 h for blood alcohol levels to return to

zero after consuming 10 g of alcohol (1 standard

drink). Therefore, women who plan to consume

alcohol should breastfeed or express breast milk

before drinking.

Conclusions

• Nutrition in pregnancy can exert important
  short- and long-term effects on the mother
  and baby

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 127–133

DOI: 10.1159/000367872