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Nutri on Before Concep on
• Nutri on status of mothers at concep on can influence her Chapter 11 pregnancy, delivery, and baby’s Life Cycle: Maternal and Infant Nutri on health. • Preconcep on Health Care and Guidance BIOL 103, Spring 2016 – Screening for risk – Health promo on and educa on – Interven on as needed
Nutri on Before Concep on Nutri on Before Concep on • Vitamins – Weight – 400–800 micrograms • Maintain a healthy weight synthe c folic acid • Low or high weight increases risk for per day reduces risk poor outcome of fetal neural tube – If low à preterm delivery defect
– If too high à gesta onal diabetes, – Avoid high doses of preeclampsia, C-sec on vitamin A (re nol) to avoid teratogenic
•Not a good me to “diet” effect
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Nutri on Before Concep on Physiology of Pregnancy
• Substance use • Stages of Human Fetal Growth – Eliminate prior to – Blastogenic stage: Weeks 0-2 pregnancy • Cells differen ate into fetus and placenta – A woman who uses or – Embryonic stage: Weeks 2-8 abuses tobacco, alcohol, • Development of organ systems or illicit drugs during • Cri cal Period of Development pregnancy is likely to have – Fetal stage: Weeks 9 - delivery higher pregnancy-related complica ons and more • Growth infant health problems.
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Physiology of Pregnancy
• Maternal Physiological Changes – Growth of maternal ssue • Adipose, breast, and uterine ssues – Increase in maternal blood volume – Slower GI mo lity
Maternal Weight Gain
• Recommenda ons 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 mul ple fetuses – Lower recommended gain for overweight and obese women
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Energy and Nutri on During Maternal Weight Gain 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 Nutri on 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 supplementa on – Well-balanced diet
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Energy and Nutri on During Pregnancy Energy and Nutri on During Pregnancy • Macronutrients • Macronutrients – Moderate-protein, low-fat, and high – Fat carbohydrate • Fuel for mother and development of placenta – Protein
• Extra needed for synthesis of new maternal, •Stored fat supports breas eeding placental, and fetal ssues – Carbohydrates • Addi onal 25 gm/d over non-pregnancy needs • Main source of extra calories • Complex carbohydrates • Fiber-rich
Energy and Nutri on During Pregnancy Food Choices for Pregnant Women
• Micronutrients • Follow the USDA’s Daily Food Plan for Moms – Variety key to a well-balanced diet – Increased needs for most vitamins and minerals – Addi onal servings of grain, vegetable, fruit, and low-fat milk • Support growth and development • Supplementa on • Highest increase for iron and folate – Herbal supplements not recommended • Increased needs for vitamins A, B, and C – Although mul -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 quan es higher than 300 mg per day
Substance Use and Pregnancy Outcome Fetal Alcohol Syndrome • Tobacco – Increases risk for miscarriage, s llbirth, preterm delivery, and low birth weight • Alcohol – Increases risk for Fetal Alcohol Syndrome • Physical and mental defects • Growth retarda on – No known safe threshold for alcohol use
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Alcohol use and binge drinking among Substance Use and Pregnancy Outcome women of childbearing age 2011-2013 • Drugs • 1/10 pregnant woman – Increase risks for low birth weight, preterm reported any alcohol delivery, miscarriage, birth defects, and use in the past 30 days infant addic on • 1/33 pregnant women – Maternal marijuana use can lead to physical reported binge drinking abnormali es similar to those caused by in the past 30 days Fetal Alcohol Syndrome • Among women who reported binge drinking: 4.6 episodes/month
Special Situa ons During Pregnancy Special Situa ons During Pregnancy
• Gastrointes nal • Food Cravings and Aversions Distress – Food cravings/aversions are rarely based on a – Morning nutrient deficiency or a physiological condi on. sickness – Pica – consump ons of nonfood items such as dirt, – Cons pa on clay, laundry starch, ice, or burnt matches. – Heartburn • Hypertension – Preeclampsia
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Special Situa ons During Pregnancy
• Diabetes – May need to adjust diet and insulin as needed • Gesta onal diabetes: a condi on that results in high blood glucose during pregnancy. – Hormones of pregnancy tend to counteract insulin • O en controlled through diet • May require insulin therapy
Special Situa ons During Pregnancy Special Situa ons During Pregnancy
• HIV/AIDS • Adolescence – Medical treatment to reduce risk of transmission – Extra demands for growth and development – Many times, women with HIV or AIDS are likely to have multiple nutrition problems – Risk for preeclampsia, anemia, premature – Mul ple nutri on problems for mother birth, low-birth-weight babies, infant • Protein-energy malnutri on mortality, and sexual transmi ed disease • Vitamin and mineral deficiency – Pre-pregnancy ea ng pa erns a concern • Inadequate weight gain – Weight gain toward upper limit recommended – Need for supplements
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Lacta on Physiology of Lacta on
• Breas eeding Trends • Changes during Adolescence and Pregnancy – Healthy People 2020 goals – Increased breast ssue
•To increase the propor on of newborns – Matura on of structure: who are ini ally breas ed to almost 82% ducts, glands, secretory • Current stats: cells – 77% of infants breas ed ini ally • A er Delivery – 49% of infants s ll breas ed at 6 – Milk produc on and months secre on • Colostrum: first milk
Physiology of Lacta on Breast milk • Hormonal Controls • Colostrum – Prolac n: s mulates
– ~5 days: Colostrum milk produc on • High in protein and immunoglobulins – Oxytocin: s mulates • Beta-carotene milk release – ~10 days: Mature milk • “Let-down” reflex • Lower in protein, higher in fat and lactose
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Nutri on for Breas eeding Women Summary of Lacta on Physiology • Energy •Infant suckling à pituitary gland release – Well-nourished pregnant women will lose prolac n à milk ssue produc on weight slowly 1 ¾ lbs/month a er ~6 months. •Infant suckling à pituitary gland release – Needs 330 kcal/day during first six months oxytocin à release milk – Needs 400 kcal/day during second six months • Thus, giving water or infant formula to the • Proteins baby reduces the me spent nursing at the – RDA: 1.3 g per kg/day breast à milk produc on declines
Nutri on for Breas eeding Women Nutri on for Breas eeding Women • Food Choices • Vitamins and Minerals – USDA’s Daily Food Plan for Moms – Needs higher or same as during pregnancy – ~2,200–2,800 Kcalories/day – Excep ons: – Choose foods high in vitamins and minerals • Vitamins D and K remain same and low in added sugar and solid fats • Iron and folate needs are lower than • Supplementa on during pregnancy – May be necessary for vegan women and • Water women who do not drink milk or other – AI for total water = 3.8 liters/day for fied products
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Benefits of Breas eeding Benefits of Breas eeding
• Benefits for infants • Benefits for Mother – Op mal nutri on – Convenience – Protects infant from infec ons and illness – Enhanced recovery of uterus size including diarrhea, ear infec ons, pneumonia, – Help women return to pre-pregnancy and asthma weight faster – Reduce risks for chronic diseases: diabetes I/II, – Strong bonding with infant obesity, hypertension, heart disease – Reduce risks for type II diabetes, ovarian – Convenience and breast cancers – Strong bonding with mother
Contraindica ons to Breas eeding
• May be inappropriate due to infant or maternal disease or drug use – Breast enlargement or reduc on surgery – Infec ous or chronic disease (ex. HIV) – Prescrip on and illegal drugs
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Resources for Pregnant and Infancy Lacta ng Women and Their Children • Growth is the best marker of nutri onal status • Promote health of pregnant and breas eeding – Evaluated using growth charts women and their children • Weight gain • Special Supplemental Nutri on Program for – Double birth weight by 4 to 6 months Women, Infants, and Children (WIC) – Triple birth weight by 12 months
– Service of USDA • Length gain
– Provides food assistance – Increase length by 50% by 12 months – Provides nutri on educa on • Head circumference – Provides referrals
Energy and Nutrient Needs During Infancy
• Requirements based on composi on 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 breas ed (or receive properly mixed formulas). • This is true even in hot and humid weather. • Once solid foods are introduced, addi onal water may be required.
Energy and Nutrient Needs During Infancy Energy and Nutrient Needs During Infancy
• Newborn Breas eeding • Key vitamins and minerals – Vitamin D: need adequate sunlight exposure – Ideal method of feeding – Vitamin K: produced by gut bacteria – Feedings should occur every 2-3 hours with • Single dose of vitamin K since gut is sterile total of 8-12 feedings per day at birth – AAP recommends that NO supplements of – Vitamin B12: problem for a strict vegetarian mom formula or water be given to breas ed neonates unless medically indicated • Folate metabolism and cell division – Iron: if formula fed, need iron-fortified formula – Fluoride: at 6 months
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Energy and Nutrient Needs During Infancy Breas eeding Trends • Alterna ve feeding: infant formula • Healthy People 2020: increase propor on of newborns who are ini ally breas ed to ~82%. – Standard infant formula • Currently: • Cow’s milk base – 77% of infants are now breas ed ini ally • “imperfect copy” of breastmilk – 49% of infants are s ll being breas ed at 6 months – Soy-based formula • Top 3 Reasons mothers stop breas eeding: • Soy protein base – “My baby began to bite” (31.7%) – “My baby began to wean him/herself” (47.3%) • Switched to soy-based if formula-fed infants – “Breastmilk does not sa sfy my baby” (43.5%) are having feeding problems (vomi ng and diarrhea).
Energy and Nutrient Needs during Infancy Energy and Nutrient Needs During Infancy – Special formula for formula- fed infants who are: • How much is enough? • Allergic to milk/soy – Guidelines for feeding infant • Premature babies • Measure amount of formula baby takes • Have rare defects in
metabolic • Six or more wet diapers per day pathway • Three or more stools per day • Use medium-chain – Best indicators that baby has enough to eat: triglycerides as the normal growth, regular elimina on pa erns, fat source and sa sfied demeanor.
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Introduc on of Solid Foods • Readiness for complimentary foods: ~6 months – Physiological readiness • Diges ve enzymes • Ability to maintain hydra on – 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 effec ve treatment • Early childhood dental caries – Associated with pu ng baby to bed with a bo le • 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 prepara on of foods
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