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Nutrion Before Concepon

• Nutrion status of mothers at concepon can influence her Chapter 11 pregnancy, delivery, and baby’s Life Cycle: Maternal and Infant Nutrion health. • Preconcepon Health Care and Guidance BIOL 103, Spring 2016 – Screening for risk – Health promoon and educaon – Intervenon as needed

Nutrion Before Concepon Nutrion Before Concepon • Vitamins – Weight – 400–800 micrograms • Maintain a healthy weight synthec 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 gestaonal diabetes, – Avoid high doses of preeclampsia, C-secon vitamin A (renol) to avoid teratogenic

•Not a good me to “diet” effect

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Nutrion Before Concepon Physiology of Pregnancy

• Substance use • Stages of Human Fetal Growth – Eliminate prior to – Blastogenic stage: Weeks 0-2 pregnancy • Cells differenate 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 • Crical Period of Development pregnancy is likely to have – Fetal stage: Weeks 9 - delivery higher pregnancy-related complicaons 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 molity

Maternal Weight Gain

• Recommendaons 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 mulple fetuses – Lower recommended gain for overweight and obese women

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Energy and Nutrion 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 Nutrion 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 supplementaon – Well-balanced diet

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Energy and Nutrion During Pregnancy Energy and Nutrion 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 breaseeding placental, and fetal ssues – Carbohydrates • Addional 25 gm/d over non-pregnancy needs • Main source of extra calories • Complex carbohydrates • Fiber-rich

Energy and Nutrion 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 – Addional servings of grain, vegetable, fruit, and low-fat milk • Support growth and development • Supplementaon • 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 quanes higher than 300 mg per day

Substance Use and Pregnancy Outcome Fetal Alcohol Syndrome • Tobacco – Increases risk for miscarriage, sllbirth, preterm delivery, and low • Alcohol – Increases risk for Fetal Alcohol Syndrome • Physical and mental defects • Growth retardaon – 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 addicon • 1/33 pregnant women – Maternal marijuana use can lead to physical reported binge drinking abnormalies similar to those caused by in the past 30 days Fetal Alcohol Syndrome • Among women who reported binge drinking: 4.6 episodes/month

Special Situaons During Pregnancy Special Situaons During Pregnancy

• Gastrointesnal • Food Cravings and Aversions Distress – Food cravings/aversions are rarely based on a – Morning nutrient deficiency or a physiological condion. sickness – Pica – consumpons of nonfood items such as dirt, – Conspaon clay, laundry starch, ice, or burnt matches. – Heartburn • Hypertension – Preeclampsia

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Special Situaons During Pregnancy

• Diabetes – May need to adjust diet and insulin as needed • Gestaonal diabetes: a condion that results in high blood glucose during pregnancy. – Hormones of pregnancy tend to counteract insulin • Oen controlled through diet • May require insulin therapy

Special Situaons During Pregnancy Special Situaons 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 – Mulple nutrion problems for mother birth, low-birth-weight babies, infant • Protein-energy malnutrion mortality, and sexual transmied disease • Vitamin and mineral deficiency – Pre-pregnancy eang paerns a concern • Inadequate weight gain – Weight gain toward upper limit recommended – Need for supplements

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Lactaon Physiology of Lactaon

• Breaseeding Trends • Changes during Adolescence and Pregnancy – Healthy People 2020 goals – Increased breast ssue

•To increase the proporon of newborns – Maturaon of structure: who are inially breased to almost 82% ducts, glands, secretory • Current stats: cells – 77% of infants breased inially • Aer Delivery – 49% of infants sll breased at 6 – Milk producon and months secreon • : first milk

Physiology of Lactaon • Hormonal Controls • Colostrum – Prolacn: smulates

– ~5 days: Colostrum milk producon • High in protein and immunoglobulins – Oxytocin: smulates • Beta-carotene milk release – ~10 days: Mature milk • “Let-down” reflex • Lower in protein, higher in fat and lactose

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Nutrion for Breaseeding Women Summary of Lactaon Physiology • Energy •Infant suckling à pituitary gland release – Well-nourished pregnant women will lose prolacn à milk ssue producon weight slowly 1 ¾ lbs/month aer ~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 to the • Proteins baby reduces the me spent nursing at the – RDA: 1.3 g per kg/day breast à milk producon declines

Nutrion for Breaseeding Women Nutrion for Breaseeding 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 – Excepons: – 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 • Supplementaon 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 forfied products

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Benefits of Breaseeding Benefits of Breaseeding

• Benefits for infants • Benefits for Mother – Opmal nutrion – Convenience – Protects infant from infecons and illness – Enhanced recovery of uterus size including diarrhea, ear infecons, 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

Contraindicaons to Breaseeding

• May be inappropriate due to infant or maternal disease or drug use – Breast enlargement or reducon surgery – Infecous or chronic disease (ex. HIV) – Prescripon and illegal drugs

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Resources for Pregnant and Infancy Lactang Women and Their Children • Growth is the best marker of nutrional status • Promote health of pregnant and breaseeding – Evaluated using growth charts women and their children • Weight gain • Special Supplemental Nutrion 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 nutrion educaon • Head circumference – Provides referrals

Energy and Nutrient Needs During Infancy

• Requirements based on composion 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 breased (or receive properly mixed formulas). • This is true even in hot and humid weather. • Once solid foods are introduced, addional water may be required.

Energy and Nutrient Needs During Infancy Energy and Nutrient Needs During Infancy

• Newborn Breaseeding • 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 breased 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 Breaseeding Trends • Alternave feeding: infant formula • Healthy People 2020: increase proporon of newborns who are inially breased to ~82%. – Standard infant formula • Currently: • Cow’s milk base – 77% of infants are now breased inially • “imperfect copy” of breastmilk – 49% of infants are sll being breased at 6 months – Soy-based formula • Top 3 Reasons mothers stop breaseeding: • 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 sasfy my baby” (43.5%) are having feeding problems (voming 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 eliminaon paerns, fat source and sasfied demeanor.

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Introducon of Solid Foods • Readiness for complimentary foods: ~6 months – Physiological readiness • Digesve enzymes • Ability to maintain hydraon – 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 effecve treatment • Early childhood dental caries – Associated with pung baby to bed with a bole • 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 • (FTT) – Poor growth in absence of disease – Can be due to shortage or improper preparaon of foods

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