Life Cycle Maternal and Infant Nutrition BIOL 103

Life Cycle: Maternal and Infant Nutrition BIOL 103, Chapter 12

Today’s Topic • Pregnancy • Lactation • Resources for Pregnant and Lactating Women and their Children • Infancy

Pregnancy • (Pg. 500)“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. ”

Pregnancy • Nutrition before conception – Goals of preconception care is to provide: 1. Screening for risk 2. Health promotion and education 3. Intervention as needed – Weight • Maintain a healthy weight • Low or high weight increases risk for poor outcome – If low – If too high • Not a good time to “diet”

Nutrition Before Conception • Vitamins (Problem Set 12, Q 1 a and 1 b) – 400 -800 micrograms of synthetic folic acid/day • Why? – Avoid high doses of vitamin A (retinol) • Why? • Substance use – Eliminate alcohol, tobacco, drugs, prior to pregnancy

Physiology of Pregnancy • Trimesters: 3 time periods of pregnancy, each lasting ~13 -14 weeks • Stages of human fetal growth 1. Blastogenic stage: Weeks 0 -2 • Cells differentiate into fetus and placenta 2. Embryonic stage: Weeks 2 -8 • Development of organ systems • Critical period of development 3. Fetal stage: Weeks 9 to delivery • Growth

Physiology of Pregnancy • Maternal changes: – Growth of maternal tissues weight gain and lactation. – Increase in maternal blood volume – Slower GI motility increases nutrient absorption.

Maternal Weight Gain • Recommendations depend on BMI – Table 12. 3: Guidelines for weight gain during pregnancy. • Underweight Gain 28 -40 pounds • Normal weight Gain 25 -35 pounds • Obese 11 -20 pounds – Higher recommended gain for underweight women, teens, and multiple fetuses – Lower recommended gain for overweight and obese women

Maternal Weight Gain • Weight gain occurs mostly during 2 nd and 3 rd trimester. • 40% of weight gain fetus, placenta, amniotic fluid • 60% of weight gain maternal tissues (adipose stores, breast/uterine growth, expanded blood and ECF)

Energy and Nutrition During Pregnancy • Energy – REE increases to support increased workload on mother’s heart and lungs, and energy requirements of fetus/placenta. – Weight gain • Nutrients to support pregnancy – Well-balanced diet – Often, pregnant women have difficulty consuming enough folic acid and iron

Energy and Nutrition During Pregnancy • Macronutrients – Moderate-protein, low-fat, and high carbohydrate • Protein – Synthesis of new maternal, placental, and fetal tissues – Additional 25 gram/day over non-pregnancy needs • Fat – Fuel for mother and development of placenta – Stored fat supports breastfeeding • Carbohydrates – Main source of extra calories – Complex carbohydrates – Fiber-rich

Energy and Nutrition During Pregnancy • Micronutrients – Increased need for overall calories – Increased needs for most vitamins and minerals • Support growth and development – Q: How are B vitamins used during pregnancy?

Food Choices for Pregnant Women • Follow the USDA’s Daily Food Plan for Moms – Variety – Additional servings of grain, vegetable, fruit, and low-fat milk • Supplement with prenatal formula – Herbal supplements? – Multi-vitamin supplements?

Food Choices for Pregnant Women • Foods to avoid 1. Alcohol 2. Large fish • Why? 3. Less than 300 milligrams of caffeine per day

Substance Use and Pregnancy Outcome 1. Tobacco – Risk for miscarriage, stillbirth, preterm delivery, and low birth weight 2. Alcohol – Risk for fetal alcohol syndrome 3. Drugs – Risks for miscarriage, preterm delivery, low birth weight, birth defects, and infant addiction

Strategies to Avoid GI Distress: • • Slowed GI movement nausea, heartburn and constipation Smaller/frequent meals, drinking liquids between meals, fiber and fluids are recommended

Special Situations During Pregnancy • Food cravings and aversions – Food cravings/aversions are rarely based on a nutrient deficiency or a physiological condition. – Pica • Hypertension – Preeclampsia: • Can progress to eclampsia (seizures)

Special Situations During Pregnancy • Diabetes – Adjust diet and insulin as needed • Gestational diabetes: – Hormones of pregnancy tend to counteract insulin • Often controlled through diet • May require insulin

Special Situations During Pregnancy • HIV/AIDS – Medical treatment to reduce risk of transmission – >90% of childhood HIV infections are from mother-to-child transmission – Many times, women with HIV or AIDS are likely to have multiple nutrition problems:

Special Situations During Pregnancy • Adolescence – Extra demands for growth and development – Risk for preeclampsia, anemia, premature birth, low-birth-weight babies, infant mortality, and sexual transmitted disease – Pre-pregnancy eating patterns a concern – Weight gain toward upper limit recommended – Need for supplements

Lactation • Breastfeeding trends • Healthy People 2020 goals – To increase the proportion of newborns who are initially breastfed to almost 82% – Current stats: • 74% of infants breastfed initially • 44% of infants still breastfed at 6 months

Physiology of Lactation • Changes during adolescence and pregnancy – Increased breast tissue – Maturation of structure ducts/glands and secretory cells are formed • After delivery – Milk production and secretion • Colostrum

Physiology of Lactation • Hormonal controls stimulated by infant suckling: – Prolactin – Oxytocin • “Let-down” reflex

Summary of Lactation Physiology • Infant suckling pituitary gland release prolactin milk tissue production • Infant suckling pituitary gland release oxytocin release milk • Thus, giving water or infant formula to the baby reduces the time spent nursing at the breast milk production declines

Nutrition for Breastfeeding • Energy and protein – Higher needs than during pregnancy – Well-nourished pregnant women will lose weight slowly 1 ¾ lbs/month after ~6 months. • Vitamins and minerals – Most are higher or same as during pregnancy – Iron and folate needs are lower • Water – AI for total water = 3. 8 liters/day

Nutrition for Breastfeeding • Food choices – USDA’s Daily Food Plan for Moms – ~2, 200– 2, 800 Kcal/day – Choose foods high in vitamins and minerals and low in added sugar and solid fats • Supplementation is generally not necessary, unless… – B 12 for vegans – Vitamin D for women with irregular sun exposure • Practices to avoid during lactation – Smoking, Alcohol, Drugs

Benefits of Breastfeeding (PS 12, Q 3 a) • Benefits for infants 1. Optimal nutrition 2. Builds stronger immune system: protects infant from infections and illness including diarrhea, ear infections, pneumonia, and asthma 3. Convenience

Benefits of Breastfeeding (PS 12, Q 3 b) • Benefits for mother 1. Enhanced recovery of uterus size 2. Help women return to pre-pregnancy weight faster 3. Convenience • Contraindications to breastfeeding – Infant or maternal disease (HIV) – Damaged breast ducts – Drug use

Resources for Pregnant and Lactating Women and their Children • Promote health of pregnant and breastfeeding women and their children • Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) – Service of USDA – Provides food assistance – Provides nutrition education – Provides referrals

Infancy • Infancy: 0 -1 years old • Growth is the best marker of nutritional status – Evaluated using growth charts 1. Weight gain 2. Length gain (not height B/C infants can’t stand) 3. Head circumference measures brain growth and development

Energy and Nutrient Needs During Infancy • Requirements based on composition of breast milk – Energy and Protein • Highest needs of any life stage • 2 x adult’s needs – Carbohydrate and fat • Both are major energy source • Carbohydrates as simple sugars – Water?

Energy and Nutrient Needs During Infancy • Key vitamins and minerals – Vitamin D – Vitamin K – Vitamin B 12 • Folate metabolism and cell division – Iron: if formula fed, need iron-fortified formula – Fluoride: at 6 months

Energy and Nutrition needs during Infancy • Newborn Breastfeeding – Recommended as the ideal method of feeding infants to achieve optimal growth and development. – AAP recommends that NO supplements of formula or water be given to breastfed neonates unless medically indicated

Energy and Nutrient Needs during Infancy • Alternative feeding: Infant Formula 1. Standard infant formula • Cow’s milk base • “imperfect copy” of breastmilk 2. Soy-based formula • Soy protein base • Switched to soy-based if formula-fed infants are having feeding problems

Energy and Nutrient Needs during Infancy – Special 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 1. 6 or more wet diapers per day 2. 3 or more stools per day 3. Regain to birth weight within the first week – Best indicators that baby has enough to eat?

Introduction to Solid Foods • Readiness for complimentary foods at ~6 months in addition to breast milk/infant formula • Infants show: 1. Physiological readiness: • Digestive enzymes • Ability to maintain hydration • Depletion of iron stores 2. Developmental readiness: • Lack of extrusion reflex • Head and body control

The Start Healthy Feeding Guidelines • Feeding schedule for the first two years

Feeding Problems during Infancy 1. Colic – Crying and distress, perhaps from abdominal cramping – No clear effective treatment 2. Early childhood dental caries 3. Iron-deficiency anemia – For older infants who do not eat enough ironrich foods.

Feeding Problems during Infancy 4. Gastroesophageal reflux – ~3% of newborns, usually male – Usually disappears within 12– 18 months 5. Diarrhea 6. Failure to thrive (FTT) – Poor growth in absence of disease – Can be due to shortage or improper preparation of appropriate foods