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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