biol103 ch 11 maternal and infant nutrition for students · – fetal(stage:weeks!9q!delivery •...
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Chapter 11 Life Cycle: Maternal and Infant Nutri4on
BIOL 103, Spring 2016
Nutri4on Before Concep4on
• Nutri4on status of mothers at concep4on can influence her pregnancy, delivery, and baby’s health.
• Preconcep4on Health Care and Guidance – Screening for risk – Health promo4on and educa4on – Interven4on as needed
Nutri4on Before Concep4on
– Weight • Maintain a healthy weight • Low or high weight increases risk for poor outcome – If low à preterm delivery – If too high à gesta4onal diabetes, preeclampsia, C-‐sec4on
• Not a good 4me to “diet”
Nutri4on Before Concep4on
• Vitamins – 400–800 micrograms synthe4c folic acid per day reduces risk of fetal neural tube defect
– Avoid high doses of vitamin A (re4nol) to avoid teratogenic effect
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Nutri4on Before Concep4on
• Substance use – Eliminate prior to pregnancy
– A woman who uses or abuses tobacco, alcohol, or illicit drugs during pregnancy is likely to have higher pregnancy-‐related complica4ons and more infant health problems.
Physiology of Pregnancy
• Stages of Human Fetal Growth – Blastogenic stage: Weeks 0-‐2
• Cells differen4ate into fetus and placenta – Embryonic stage: Weeks 2-‐8
• Development of organ systems • Cri$cal Period of Development
– Fetal stage: Weeks 9 -‐ delivery • Growth
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Physiology of Pregnancy
• Maternal Physiological Changes – Growth of maternal 4ssue
• Adipose, breast, and uterine 4ssues – Increase in maternal blood volume – Slower GI mo4lity
Maternal Weight Gain
• Recommenda4ons depend on BMI – Normal weight (BMI = 19.8–26 kg/m2)
• Gain 25 to 35 pounds – Higher recommended gain for underweight women, teens, and for pregnancies involving mul4ple fetuses
– Lower recommended gain for overweight and obese women
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Maternal Weight Gain Energy and Nutri4on During Pregnancy
• “Energy and nutrient needs both increase, but needs for calories increases by a smaller percentage than for most vitamins and minerals. As a result, food choices during
pregnancy must be nutrient-‐dense.”
Energy and Nutri4on During Pregnancy
• Energy – Needs increase to support fetus and placenta, as well as increased workload on mother’s heart and lungs
– Weight gain is the best indicator of adequate calorie intake.
• Nutrients to support pregnancy – Folic acid and Iron supplementa4on – Well-‐balanced diet
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Energy and Nutri4on During Pregnancy • Macronutrients
– Moderate-‐protein, low-‐fat, and high carbohydrate
– Protein • Extra needed for synthesis of new maternal, placental, and fetal 4ssues
• Addi4onal 25 gm/d over non-‐pregnancy needs
Energy and Nutri4on During Pregnancy • Macronutrients
– Fat • Fuel for mother and development of placenta • Stored fat supports breaseeeding
– Carbohydrates • Main source of extra calories • Complex carbohydrates • Fiber-‐rich
Energy and Nutri4on During Pregnancy
• Micronutrients – Increased needs for most vitamins and minerals • Support growth and development • Highest increase for iron and folate • Increased needs for vitamins A, B, and C
Food Choices for Pregnant Women
• Follow the USDA’s Daily Food Plan for Moms – Variety key to a well-‐balanced diet – Addi4onal servings of grain, vegetable, fruit, and low-‐fat milk
• Supplementa4on – Herbal supplements not recommended – Although mul4-‐vitamin supplements are common, generally if consuming a healthy diet, supplements are not needed other than for iron and folate.
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Food Choices for Pregnant Women
• Foods to Avoid – Alcohol – Certain types of fish high in mercury – Caffeine in quan44es higher than 300 mg per day
Substance Use and Pregnancy Outcome
• Tobacco – Increases risk for miscarriage, s4llbirth, preterm delivery, and low birth weight
• Alcohol – Increases risk for Fetal Alcohol Syndrome
• Physical and mental defects • Growth retarda4on
– No known safe threshold for alcohol use
Fetal Alcohol Syndrome
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Alcohol use and binge drinking among women of childbearing age 2011-‐2013
• 1/10 pregnant woman reported any alcohol use in the past 30 days
• 1/33 pregnant women reported binge drinking in the past 30 days
• Among women who reported binge drinking: 4.6 episodes/month
Substance Use and Pregnancy Outcome
• Drugs – Increase risks for low birth weight, preterm delivery, miscarriage, birth defects, and infant addic)on
– Maternal marijuana use can lead to physical abnormali4es similar to those caused by Fetal Alcohol Syndrome
Special Situa4ons During Pregnancy
• Gastrointes4nal Distress – Morning sickness
– Cons4pa4on – Heartburn
Special Situa4ons During Pregnancy
• Food Cravings and Aversions – Food cravings/aversions are rarely based on a nutrient deficiency or a physiological condi4on.
– Pica – consump4ons of nonfood items such as dirt, clay, laundry starch, ice, or burnt matches.
• Hypertension – Preeclampsia
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Special Situa4ons During Pregnancy
• Diabetes – May need to adjust diet and insulin as needed
• Gesta>onal diabetes: a condi4on that results in high blood glucose during pregnancy. – Hormones of pregnancy tend to counteract insulin • Ojen controlled through diet • May require insulin therapy
Special Situa4ons During Pregnancy
• HIV/AIDS – Medical treatment to reduce risk of transmission – Many times, women with HIV or AIDS are likely to
have multiple nutrition problems – Mul4ple nutri4on problems for mother
• Protein-‐energy malnutri4on • Vitamin and mineral deficiency • Inadequate weight gain
Special Situa4ons During Pregnancy
• Adolescence – Extra demands for growth and development – Risk for preeclampsia, anemia, premature birth, low-‐birth-‐weight babies, infant mortality, and sexual transmiked disease
– Pre-‐pregnancy ea4ng pakerns a concern – Weight gain toward upper limit recommended – Need for supplements
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Lacta4on
• Breaseeeding Trends – Healthy People 2020 goals
• To increase the propor4on of newborns who are ini4ally breaseed to almost 82%
• Current stats: – 77% of infants breaseed ini4ally – 49% of infants s4ll breaseed at 6 months
Physiology of Lacta4on
• Changes during Adolescence and Pregnancy – Increased breast 4ssue – Matura4on of structure: ducts, glands, secretory cells
• Ajer Delivery – Milk produc4on and secre4on • Colostrum: first milk
Breast milk
• Colostrum – ~5 days: Colostrum
• High in protein and immunoglobulins
• Beta-‐carotene – ~10 days: Mature milk
• Lower in protein, higher in fat and lactose
Physiology of Lacta4on
• Hormonal Controls – Prolac>n: s4mulates milk produc4on
– Oxytocin: s4mulates milk release • “Let-‐down” reflex
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Summary of Lacta4on Physiology
• Infant suckling à pituitary gland release prolac>n à milk 4ssue produc4on • Infant suckling à pituitary gland release oxytocin à release milk • Thus, giving water or infant formula to the baby reduces the 4me spent nursing at the breast à milk produc4on declines
Nutri4on for Breaseeeding Women
• Energy – Well-‐nourished pregnant women will lose weight slowly 1 ¾ lbs/month ajer ~6 months.
– Needs 330 kcal/day during first six months – Needs 400 kcal/day during second six months
• Proteins – RDA: 1.3 g per kg/day
Nutri4on for Breaseeeding Women
• Vitamins and Minerals – Needs higher or same as during pregnancy – Excep4ons:
• Vitamins D and K remain same • Iron and folate needs are lower than during pregnancy
• Water – AI for total water = 3.8 liters/day
Nutri4on for Breaseeeding Women
• Food Choices – USDA’s Daily Food Plan for Moms – ~2,200–2,800 Kcalories/day – Choose foods high in vitamins and minerals and low in added sugar and solid fats
• Supplementa4on – May be necessary for vegan women and women who do not drink milk or other for4fied products
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Benefits of Breaseeeding
• Benefits for infants – Op4mal nutri4on – Protects infant from infec4ons and illness including diarrhea, ear infec4ons, pneumonia, and asthma
– Reduce risks for chronic diseases: diabetes I/II, obesity, hypertension, heart disease
– Convenience – Strong bonding with mother
Benefits of Breaseeeding
• Benefits for Mother – Convenience – Enhanced recovery of uterus size – Help women return to pre-‐pregnancy weight faster
– Strong bonding with infant – Reduce risks for type II diabetes, ovarian and breast cancers
Contraindica4ons to Breaseeeding
• May be inappropriate due to infant or maternal disease or drug use – Breast enlargement or reduc4on surgery – Infec4ous or chronic disease (ex. HIV) – Prescrip4on and illegal drugs
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Resources for Pregnant and Lacta4ng Women and Their Children
• Promote health of pregnant and breaseeeding women and their children
• Special Supplemental Nutri4on Program for Women, Infants, and Children (WIC) – Service of USDA – Provides food assistance – Provides nutri4on educa4on – Provides referrals
Infancy
• Growth is the best marker of nutri4onal status – Evaluated using growth charts
• Weight gain – Double birth weight by 4 to 6 months – Triple birth weight by 12 months
• Length gain – Increase length by 50% by 12 months
• Head circumference
Energy and Nutrient Needs During Infancy
• Requirements based on composi4on of breast milk – Energy and Protein
• Highest needs of any life stage – Carbohydrate and fat
• Fat: major energy source • Carbohydrates as simple sugars
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Energy and Nutrient Needs During Infancy
• Water – Supplemental water feeding is not necessary for healthy infants who are exclusively breaseed (or receive properly mixed formulas). • This is true even in hot and humid weather. • Once solid foods are introduced, addi4onal water may be required.
Energy and Nutrient Needs During Infancy
• Key vitamins and minerals – Vitamin D: need adequate sunlight exposure – Vitamin K: produced by gut bacteria
• Single dose of vitamin K since gut is sterile at birth
– Vitamin B12: problem for a strict vegetarian mom • Folate metabolism and cell division
– Iron: if formula fed, need iron-fortified formula – Fluoride: at 6 months
Energy and Nutrient Needs During Infancy
• Newborn Breaseeeding – Ideal method of feeding – Feedings should occur every 2-‐3 hours with total of 8-‐12 feedings per day
– AAP recommends that NO supplements of formula or water be given to breaseed neonates unless medically indicated
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Breaseeeding Trends
• Healthy People 2020: increase propor4on of newborns who are ini4ally breaseed to ~82%.
• Currently: – 77% of infants are now breaseed ini4ally – 49% of infants are s4ll being breaseed at 6 months
• Top 3 Reasons mothers stop breaseeeding: – “My baby began to bite” (31.7%) – “My baby began to wean him/herself” (47.3%) – “Breastmilk does not sa4sfy my baby” (43.5%)
Energy and Nutrient Needs During Infancy
• Alterna4ve feeding: infant formula – Standard infant formula
• Cow’s milk base • “imperfect copy” of breastmilk
– Soy-‐based formula • Soy protein base • Switched to soy-‐based if formula-‐fed infants are having feeding problems (vomi4ng and diarrhea).
Energy and Nutrient Needs during Infancy – Special formula for formula-‐fed infants who are: • Allergic to milk/soy • Premature babies • Have rare defects in metabolic pathway
• Use medium-‐chain triglycerides as the fat source
Energy and Nutrient Needs During Infancy
• How much is enough? – Guidelines for feeding infant
• Measure amount of formula baby takes • Six or more wet diapers per day • Three or more stools per day
– Best indicators that baby has enough to eat: normal growth, regular elimina4on pakerns, and sa4sfied demeanor.
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Introduc4on of Solid Foods • Readiness for complimentary foods: ~6 months
– Physiological readiness • Diges4ve enzymes • Ability to maintain hydra4on
– Developmental readiness • Lack of extrusion reflex • Head and body control
• Feeding schedule – Start Healthy Feeding Guidelines
Feeding Problems During Infancy
• Colic – Crying and distress from abdominal distress
– No clear effec4ve treatment • Early childhood dental caries
– Associated with pusng baby to bed with a bokle
• Iron-‐deficiency anemia – For older infants who do not eat enough iron-‐rich foods
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Feeding Problems During Infancy
• Gastroesophageal reflux – Usually disappears within 12–18 months – ~3% of newborns, usually male
• Diarrhea – Requires increased fluids
• Failure to thrive (FTT) – Poor growth in absence of disease – Can be due to shortage or improper prepara4on of foods
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