maternal and infant nutrition

MATERNAL AND INFANT NUTRITION

We have been discussing basic concepts of nutrition:

- Food choices and nutritional guidelines - Digestion - Carbohydrates, lipids, and proteins - Energy balance and body composition - Vitamins - Water and mineral balance



We then began to specific applications of those concepts:

- Sports nutrition



We then began to specific applications of those concepts:

- Sports nutrition

Today we will discuss maternal and infant nutrition

Maternal and Infant Nutrition

Pregnancy and lactation present some special nutrition concerns for both themother and the newborn infant.

While a pregnant woman has many of the same nutritional needs as anyone else, she must also - ingest additional nutrients for herself - provide nutrients to the embryo/fetus - avoid subtances which could damage the fetus

Nutritional Concerns of Pregnancy

Pregnancy and lactation present some special nutrition concerns forboth the mother and the newborn.

These nutritional needs actually beginat the time of fertilization, weeks beforeshe will know she is pregnant.


Pregnancy and lactation present some special nutrition concerns forboth the mother and the newborn.

These nutritional needs actually beginat the time of fertilization, weeks beforeshe will know she is pregnant.

Half of all pregnancies are unplanned(a very large majority of which occurin couples who are using some form of contraception), so it isimportant for all women of child-bearing age to be aware of these nutritonal needs.


Nutrition before conception:Provide

Screening for riskHealth promotion and educationIntervention as needed

Maintain a healthy weight (low or high weight increases risk for poor outcome)Not a good time to dietSupplements such as folic acid can be given to minimize risk of problems

Of particular concern are avoiding things which can damage the embryo or fetus - smoking - drugs - inadequate carbohydrates, proteins, fats, vitamins, minerals, etc. - diabetes - hypertension - mineral imbalances - toxic substances such as mercury in fish - excessive caffeine


Certains substances which are safe or even beneficial for the mother can causedamage in her embryo and fetus: - vitamin A - vitamin D - blood pressure medications - acne medications (Accutane) - antibiotics (doxycycline, tetramycin) - alcohol


It is also important for the woman to avoid situations which increase her own health risks during pregnancy - obesity - smoking - alcohol - drugs - inadequate carbohydrates, proteins, fats, vitamins, minerals, etc. - diabetes - hypertension - mineral imbalances


Let’s review pregancy and embryonic/fetal development


It begins when one sperm fertilizes the egg.

Let’s review pregancy and embryonic/fetal development


It begins when one sperm fertilizes the egg.

This occurs in the Fallopian tube a few minutes to a few hours after sexual intercourse.


Over the next few days, the fertilized egg (called a zygote) divides repeatedly as it travels along the Fallopian tube toward the uterus.

If the mother is poorly nourished, this may not occur correctly and the dividing embryo may die, ending the pregnancy.


One to two weeks after fertilization the embryo implants itself in the lining of the uterus, where it will continue to grow and develop for the next nine months.

Here again, if the mother is poorly nourished this may not occur correctly and the embryo may die, ending the pregnancy.


As the embryo develops, so doesits placenta. This is the interface through which - the embryo (later a fetus) gets nutrients from the mother’s blood - waste products from the embryo/fetus are passed into the mother’s blood so she can get rid of them


As the embryo develops, so doesits placenta. This is the interface through which - the embryo (later a fetus) gets nutrients from the mother’s blood - waste products from the embryo/fetus are passed into the mother’s blood so she can get rid of them

At this stage, the embryo also becomes susceptible to many drugs, chemicals, infections, and other things which can also pass through the placenta, killing it or damaging it and leading to birth defects


While the embryo or fetus is growing, many change are also occurring to the mother’s body:

- Growth of uterus - Growth of breasts - Added adipose tissue, - Increase blood volume - Slower GI motility - Increased stress on heart - Inceased stress on lungs - Increased stress on kidneys - Increased stress on bones and joints


Normal weight (BMI 19.8–26) Recommended = 25 - 35 pounds

Higher recommended gain for underweight women, teens, and multiple fetuses

Lower recommended gain for overweight and obese women

Recommendations for weight gain depend on BMI:


A pregnant woman needs additional calories to provide the energy for this growth.Her Resting Energy Expenditureincreases because of the energy needs of the fetus and placenta as well as The increased work of her heart, lungs, muscles, bones, and kidneys

During the second and third trimesters, when both the fetal growth and the mother’s growth are greatest, she will need an additional 350 to 450 KCal per day


Most pregnant women who eat a healthy diet have few problems meeting the nutritional needs of the pregnancy.

A diet high in complex carbohydrates and low in fat with few saturated or trans fats, plus adequate protein, will continue to meet the nutitional needs even in pregnancy.



A diet high in complex carbohydrates and low in fat with few saturated or trans fats, plus adequate protein, will continue to meet the nutitional needs even in pregnancy.

Additional protein, ~25g/day, is needed for the growth of fetal, placental, and maternal tissues. Additional fat may be needed as the breasts develop & begin milk production.

Essential fatty acids and essential amino acids are needed for both maternal and fetal health.



The need for micronutrients such as vitamins and minerals also increases.

More of the B vitamins are neededbecause of the increased activities of the metabolic enzymes for which they are cofacotors. Additional vitamins C and A provide antioxidants and support bone and muscle growth.



The need for micronutrients such as vitamins and minerals also increases.

The need for iron to support the increased blood production is markedly increased. Additional calcium, magnesium, and phosphorus may be needed for healthy bone growth in the fetus later in the pregnancy.


Although their nutritional needs can be effectively met through a healthy diet, pregnant women are almost always advisedto take a prenatal supplement of vitamins and minerals.



As long as overdoses are not taken, these assure that adequate levels of these micronutrients are available to both the mother and the fetus.



Prenatal vitamins specifically ensure that the mother is getting enough folic acid (vitamin B9) to minimize the risk of neural tube defects such as spina bifida.


More than half of all pregnant women experience nausea (called “morning sickness” although it can occur at any time of day) during the first trimester, often accompanied by vomiting.

Other gastrointestinal problems include constipation, heartburn, or abdominal pain.


More than half of all pregnant women experience nausea (called “morning sickness” although it can occur at any time of day) during the first trimester, often accompanied by vomiting.

Other gastrointestinal problems include constipation, heartburn, or abdominal pain. These can often be managed, but probably not eliminated.


Many women have cravings for specific foods, particularly foods which are sweet, salty, or spicy.



Many women also develop aversions to particular foods during pregnancy, particularly foods with strong tastes or smells. These generally have no importance.



Many women also develop aversions to particular foods during pregnancy, particularly foods with strong tastes or smells. These generally have no importance.

However, in some cases, the cravings are for unusual things such as dirt or clay, starch, hair, or paper. Cravingsfor such things as cigarette butts and feces have been reported. This is called pica and can cause problems if those materials are toxic or if they cause intestinal blockage.

The use of tobacco, alcohol, and drugs create special concerns in pregnancy since their effects can be much more pronounced in the fetus than in the mother. - Smoking (including marijuana) increases

the risk of miscarriage or stillbirth, premature birth, and low birth weight.




- Alcohol increases the risk of fetal alcoholsyndrome which results in growth retardation and physical and mental defects.




- Alcohol increases the risk of fetal alcoholsyndrome which results in growth retardation and physical and mental defects.

- Drugs such as cocaine, MDMA (ecstasy), ketamine, methamphetamine, or heroin can have similar effects, with the added risk of the newborn being addicted



Pregnancy can also cause some serious health concerns.

a) Hypertension develops in 3 – 5% of pregnancies. It is most common in younger women, older women, obese women, and women with a family history of hypertension.



b) Hypertension with the presence of protein in the urine is called pre-eclampsia. Like hypertension alone it is more common in younger women, older women, and obese women.



c) Rarely, women with pre-eclampsia develop convulsions or go into a coma, called eclampsia. Unless detected and treated quickly it is usually fatal.



d) Gestational diabetes develops in 4 - 6% of pregnancies. It is most common in older women or women with a history of poor blood sugar control. It usually develops later in pregnancy and can usually be controlled with diet, although insulin injections may be necessary.

Because the extra glucose in the mother’s blood crosses the placenta, the baby is usually larger than average at birth.

More than 10% of all pregnancies in the US occur in adolescents, creating some special nutritional concerns:

- Adolescents are less likely to get prenatal care, including nutritional advice and support.

- Adolescents tend to have poorer diets with more prepared foods which are higher in sugars, salt, and fats and lower in vitamins and minerals.

- Adolescents are more likely to smoke, drink, or use illicit drugs during pregnancy.

- Adolescents are still growing themselves, and their nutritional needs can be compromised by those of the developing fetus.


More than 10% of all pregnancies in the US occur in adolescents, creating some special nutritional concerns

Adolescents have higher risks for preeclamsia, anemia, premature birth, low-birth-weight babies, and infant mortality.


As the pregnancy progresses, nutritional needs relating to lactation and breastfeeding arise.

Lactation and Breastfeeding

As the pregnancy progresses, nutritional needs relating to lactation and breastfeeding arise.

Breasts begin to grow early in pregnancy as glands and ducts develop under the stimulus of the hormone prolactin from the pituitary gland. Most women begin to produce milk early in the third trimester.


During birth the mother’s pituitary gland also produces the hormone oxytocin, which dramatically increases the production of milk during the first few days after birth.


During birth the mother’s pituitary gland also produces the hormone oxytocin, which dramatically increases the production of milk during the first few days after birth.

Every time the baby nurses it stimulates the mother’s pituitary gland to secrete both prolactin, which stimulates milk production, and oxytocin which stimulates its expression, the “let down reflex”


For the first few days, the milk will be more concentrated and will be relatively low in lipids and carbohydrates and relatively high in protein. It also contains large amounts of antibodies. This milk is called colostrum.

Within a few days the milk becomes less concentrated and higher in lipids and carbohydrates.


Immediately after birth, it is normal for an infant to lose 5 to 6% of her body weight as she adjusts to life outside the uterus and her digestive system adjusts to food.


Within a few days of breastfeeding she should begin gaining weight, and within about two weeks should have returned to birth weight.

By 4 to 6 months her weight should have doubled, and by 12 months she should have tripled her birth weight.

World Health Organization recommendations:- 75% of infants breastfed initially- 50% of infants breast feeding at 6 months

- breastfeeding for at least the first 2 years.- breast milk or formula should be

supplemented with solid food beginning at 4 to 6 months.



Percent of infants exclusively breastfed for first six months

Since this breastmilk will be the infant’s only source of nutrition for many months, and a subtantial part of hernutrition for up to two years, it must contain all of the essential nutrients: - carbohydrates - lipids, including essential fatty acids - proteins, including essential amino acids - vitamins - minerals - water

It also contains antibodies and immune cells to help the infant resist infections, and compounds which are natural laxatives.


Breastfeeding continues to offer health benefits well into childhood, including

- lower risk of sudden infant death syndrome (SIDS) - fewer infections - lower risk of obesity - lower risk of diabetes - lower risk of diarrhea - lower risk of asthma - fewer allergies - fewer dental problems

Some studies indicate it may alsoincrease intelligence throughout life


Breastfeeding also provides health benefits for the mother

- reduces post-partum bleeding - assists the uterus in returning to its pre-pregnancy size - assists the mother in returning to pre-pregnancy weight - reduces the risk of breast cancer later in life


During breastfeeding, of course, the mother’s nutritional needs remain high.

- 300 to 400 more Kcal/day than before pregnancy - 25 grams/day more protein - additional vitamins - additional minerals - additional water

It is healthier for both her and her infant if she gets these from a broad diet rather than special diets or supplements.


Infant Formula

In some cases the mother either can not breastfeed her infant or chooses not to.

There are a number of infant formulas available which are designed to provideadequate nutrition.

Most of these use cows’milk as the base, although some use soy compounds or other liquids instead.

Infant Formula

Most infant formulas provide adequatecalories in the form of carbohydrates andfats and adequate protein. They are fortified with all of the essential viatminsand minerals.

None-the-less, fomulas are not able tocompletely mimic the content of breastmilk. Many containfats, proteins, and carbohydrates that are less readily digested and absorbed by the immature digestive system of an infant...

Infant Formula


None-the-less, fomulas are not able tocompletely mimic the content of breastmilk. Many containfats, proteins, and carbohydrates that are less readily digested and absorbed by the immature digestive system of an infant. They may be lacking essential fatty acids or essential amino acids...

Infant Formula


None-the-less, fomulas are not able tocompletely mimic the content of breastmilk. Many containfats, proteins, and carbohydrates that are less readily digested and absorbed by the immature digestive system of an infant. They may be lacking essential fatty acids or essential amino acids. They do not contain the antibodies and other immune components which breastmilk does.

Breastmilk and Solid Foods

At some point, typically at about four to six months of age in the United States, the infant adds solid foods to the breastmilk or formula.


At some point, typically at about four to six months of age in the United States, the infant adds solid foods to the breastmilk or formula.

Initially, most of her total energy expendature is used for basal metabolic processes and growth. As she gets older and more active, more of her energy expendature is used for physical activity.

Thus, her diet – usually a mixture of breastmilk or formula and solid foods - must meet the older infant’s increased energy needs.


Thus, her diet – usually a mixture of breastmilk or formula and solid foods - must meet the older infant’s increased energy needs.

Compared to an adult, a much higher percentage of an infant’s diet should come from carbohydrate and fat, which are the primary source of calories.

Adequate amounts of protein are still important, including essential amino acids, but the small volume of her digestive system, requiring smaller more frequent meals, makes getting enough calories more important for an infant.



The micronutrients – vitamins and minerals – are also important during the first year of infancy.

Breastmilk, formula, and solid foods designed for infants normally contain sufficient amounts of these.


Vitamin D is needed for calcium absorption through the intestine and normal bone development.

Vitamin K and iron are needed for normal blood development.

Vitamin B12 (cobalamin) is needed for growth, particularly of the brain and nervous system.

Flouride is needed for normal tooth development.

Most infants are ready to being eating solid foods by the age of about 4 to 6 months. - They can sit with the head upright, minimizing risk of choking - They lose the extrusion reflex of the tongue and can use it to move food from the front to the back of the mouth where it can be swallowed - Their intestines and pancreas are producing enough of the necessary digestive enzymes - They can drink enough liquids to maintain hydration

Solid Foods

Of course, “solid” foods is a misnomer throughout most of the first year. They include pureed, mashed, or strained foods which the infant can easily swallow.

Solid Foods

Solid Foods

By six to eightmonths most infants can grasp “finger foods”.

Within a year,most infants canbegin self-feeding with a spoon. Atthis point most foods are appropriate, albeit in much smaller portions than for adults.

Infants

By one year of age, most children need about 850 to 1,000 kilocalories per day, nearly half of what they will require as adults. Their need for carbohydrates and proteins are, pound for pound, much higher than they will ever be again as they get older.

One year old: 22 pounds

Adult: 150 pounds

Total calories 850-1000 per day 1800-2200 per

dayCarbohydrate 100 grams/day 130 grams/day

Protein 10-13 grams / day 50-55 grams /day

Like anyone else, infants can have digestive and dietary problems such as - Colic (crying and distress) - Gastroesophogeal reflux (heartburn) - Vomiting - Diarrhea - Dental caries when teeth come in

In some cases infants develop problems with digesting and absorbing nutrients which can lead to malnutrition or anemias.

In some cases, the infant simply is not furnished with enough food

Infants

Let’s move on next to look at the nutritonal needs from childhood through adulthood and into old age

maternal and infant nutrition

Documents

nutritional needs

mineral balance

pregnancy obesity

basic concepts of nutrition

proteins energy balance

body composition vitamins

food choices

newborn infant