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Life Cycle: Maternal and Infant Nutri8on
BIOL 103, Chapter 12
Today’s Topic
• Pregnancy • Lacta8on • Resources for Pregnant and Lacta8ng 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
• Nutri8on before concep8on – Goals of preconcep8on care is to provide:
1. Screening for risk 2. Health promo8on and educa8on 3. Interven8on as needed
– Weight • Maintain a healthy weight • Low or high weight increases risk for poor outcome
– If low à – If too high à
• Not a good 8me to “diet”
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Nutri8on Before Concep8on • Vitamins (Problem Set 12, Q 1a and 1b)
– 400-‐800 micrograms of synthe8c folic acid/day • Why?
– Avoid high doses of vitamin A (re8nol) • Why?
• Substance use – Eliminate alcohol, tobacco, drugs, prior to pregnancy
Physiology of Pregnancy
• Trimesters: 3 8me periods of pregnancy, each las8ng ~13-‐14 weeks
• Stages of human fetal growth 1. Blastogenic stage: Weeks 0-‐2
• Cells differen8ate into fetus and placenta 2. Embryonic stage: Weeks 2-‐8
• Development of organ systems • Cri$cal period of development
3. Fetal stage: Weeks 9 to delivery • Growth
Physiology of Pregnancy
• Maternal changes: – Growth of maternal 8ssues à weight gain and lacta8on.
– Increase in maternal blood volume
– Slower GI mo8lity à increases nutrient absorp8on.
Maternal Weight Gain
• Recommenda8ons depend on BMI – Table 12.3: Guidelines for weight gain during pregnancy.
• Underweight à Gain 28-‐40 pounds • Normal weight à Gain 25-‐35 pounds • Obese à 11-‐20 pounds
– Higher recommended gain for underweight women, teens, and mul8ple fetuses
– Lower recommended gain for overweight and obese women
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Maternal Weight Gain • Weight gain occurs mostly during 2nd and 3rd trimester. • 40% of weight gain à fetus, placenta, amnio8c fluid • 60% of weight gain à maternal 8ssues (adipose stores, breast/uterine growth, expanded blood and ECF)
Energy and Nutri8on 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 – Ofen, pregnant women have difficulty consuming enough folic acid and iron
Energy and Nutri8on During Pregnancy
• Macronutrients – Moderate-‐protein, low-‐fat, and high carbohydrate
• Protein – Synthesis of new maternal, placental, and fetal 8ssues – Addi8onal 25 gram/day over non-‐pregnancy needs
• Fat – Fuel for mother and development of placenta – Stored fat supports breasheeding
• Carbohydrates – Main source of extra calories – Complex carbohydrates – Fiber-‐rich
Energy and Nutri8on 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?
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Food Choices for Pregnant Women
• Follow the USDA’s Daily Food Plan for Moms – Variety – Addi8onal servings of grain, vegetable, fruit, and low-‐fat milk
• Supplement with prenatal formula – Herbal supplements? – Mul8-‐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 ànausea, heartburn and cons8pa8on • Smaller/frequent meals, drinking liquids between meals, fiber and
fluids are recommended
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Special Situa8ons During Pregnancy
• Food cravings and aversions – Food cravings/aversions are rarely based on a nutrient deficiency or a physiological condi8on.
– Pica • Hypertension
– Preeclampsia: • Can progress to eclampsia (seizures)
Special Situa8ons 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 Situa8ons 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 Situa8ons 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
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Lacta8on
• 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 Lacta8on
• Changes during adolescence and pregnancy – Increased breast tissue – Maturation of structure à
ducts/glands and secretory cells are formed
• After delivery – Milk production and
secretion • Colostrum
Physiology of Lacta8on
• Hormonal controls stimulated by infant suckling: – Prolactin – Oxytocin
• “Let-down” reflex
Summary of Lacta8on Physiology
• Infant suckling à pituitary gland release prolacIn à milk 8ssue produc8on
• Infant suckling à pituitary gland release oxytocin à release milk
• Thus, giving water or infant formula to the baby reduces the 8me spent nursing at the breast à milk produc8on declines
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Nutri8on for Breasheeding
• 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
Nutri8on for Breasheeding
• 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… – B12 for vegans – Vitamin D for women with irregular sun
exposure • Practices to avoid during lactation
– Smoking, Alcohol, Drugs
Benefits of Breasheeding (PS12, Q3a)
• 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 Breasheeding (PS12, Q3b)
• 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
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Resources for Pregnant and Lacta8ng 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 • 2x 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 B12
• Folate metabolism and cell division
– Iron: if formula fed, need iron-fortified formula – Fluoride: at 6 months
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Energy and Nutri8on 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 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
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?
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Introduc8on 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 iron-rich 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
