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


– 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”


•  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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•  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


•  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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•  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


•  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


•  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


•  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


•  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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•  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.


•  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


•  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%)


•  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


•  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

BIOL103 Ch 11 Maternal and Infant Nutrition for Students · – Fetal(stage:Weeks!9Q!delivery •...

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