Transcript No Slide Title - University of Illinois at Chicago

PERINATAL NUTRITION
•Nutrition during pregnancy and lactation
•Nutrition during infancy.
Rama Bhat , MD.
Department of Pediatrics,
University of Illinois Hospital
Chicago, Illinois.
Nutrition During Pregnancy
• Improved maternal nutrition benefits both mother
and infant.
• Maternal nutrition has a major influence on birth
weight.
FETAL ORIGINS OF ADULT DISEASE
• DEVELOPMENTAL PLASTICITY
•
A PHENOMENA BY WHICH ONE GENOTYPE CAN GIVE RISE TO A
RANGE OF DIFFERENT PHYSIOLOGICAL OR MORPHOLOGICAL
STATES IN RESPONSE TO DIFFERENT ENVIRONMENTAL
CONDITIONS DURING DEVELOPMENT.
Birth Weight as an Indicator of Risk
a) Low birth weight has high risk for coronary
heart disease
b) Higher risk for hypertension
Godfrey and Barker, 2001
Godfrey and Barker, 2001
Godfrey and Barker, 2001
Weight gain recommendations for pregnancy
BMI(Weight for height)
Recommended
gain
Low BMI ( <19.8 )
12.5 - 18 kg (28-40 lbs)
Normal BMI (19.8 - 26.0)
11.5 - 16 kg (25 - 35 lbs)
High BMI (26.0 - 29.0 )
7 - 11.5 kg(15 - 23 lbs)
Obese (BMI > 29.0)
6 + kg (15 + lb.).
BMI = ( Wt. In kg./ht. In m2)
National Academy of Sciences 1990.
RDAs of Nutrients during Pregnancy
Non-Pregnant
Energy(Kcal)
Protein(g)
Calcium(g)
Iron(mg)
Folate(mcg)
Zinc(mg)
Phosphorus(mg)
Vitamin D (mg)
2200
44-50
0.8
15
180
12
800
5
Pregnant
2500
60
1.2
30
400
15
1200
10
NUTRITION DURING PREGNANCY
Energy Requirement
•Cost of extra work during pregnancy has
been estimated 85,000 calories.
•41,000 calories for protein and fat stored in
products of conception.
•36,000 calories from increased O2
consumption.
•8,000 calories to convert dietary to
metabolizable energy.
CALCIUM METABOLISM IN PREGNANACY
99% of calcium is in the skeleton
Total body calcium: 1200 grams.
1.0 % of calcium is in the ECF.
Calcium is essential for:
• nerve conduction
• muscle contraction
• blood clotting
• membrane permeability
CALCIUM METABOLISM IN PREGNANACY
• Calcium requirements increase by
33 % during pregnancy.
• Net transfer across placenta is about 25
- 30 grams.
• Calcium transfer is active.
• RDA for calcium during pregnancy is
1200 mg.
IRON METABOLISM IN PREGNANCY
Iron is needed for:
• Expansion of red cell mass.
• The fetus and placenta
• Replace the blood loss at delivery
IRON METABOLISM IN PREGNANCY
•Iron requirements double during pregnancy
•Estimated total pregnancy iron needs is 1000
mg
•Mother transfers about 200 - 300 mg of iron
to the fetus.
•Iron absorption during pregnancy increases
to 20 - 40 %.
•Iron deficiency in the mother does not lead to
iron deficiency in her infant
ADVERSE EFFECTS OF IRON DEFICIENCY
Mother:
• Fatigue
• Leucocyte function
• Tolerance at delivery
• Preterm delivery ( OR 1.9)
Neonate:
Low birth weight
Neonatal death(developing countries)
Vitamins
Folic acid:
• helps to produce additional blood cells
• helps to support rapid growth of placenta and fetus
(needed for DNA)
Deficiency increases:
• NTD (Meningomyelocele and anencephaly).
• Low birth weight
• Prematurity
VITAMINS
Folic acid:
• Supplementation decreases NTDs (3.6 - 1.0 %).
• In USA alone 2000 - 3000 infants are born
with NTDs.
• Worldwide incidence 300 -400,000/yr.
MRC VITAMIN STUDY
• Randomized control trial
• Double blind using a placebo
• Four treatment groups
• A.
• B.
• C.
• D.
Mineral + folic acid
Mineral + Folic acid + M.V.
Mineral + Placebo
Mineral + MV (- Folic acid)
Comparison:
A + B vs C + D Folic acid effect
B + D vs A + C Effect of other vitamins
MRC Vitamin Study
Relative Risk = 0.29
(95% CI 0.12 - 0.71, p< 0.001)
5
21/602 (3.5%)
4
3
2
NTD risk (%)
6/593 (1.0 %)
1
0
A+B
WITH FOLIC ACID
C+D
WITHOUT FOLIC ACID
RECOMMENDED COMPOSITION OF
MULTIVITAMIN AND MINERAL SUPPLEMENTS
FOR PREGNANT WOMEN
Mineral
Calcium
Copper
Folate
Iron
Vitamin B6
Vitamin D
Zinc
Requirement
250 mg
2 mg
300 ug
30 mg
2 mg
5 ug
15 mg
National Academy of Sciences 1990.
Pregnancy and Physical Activity
• Source of considerable debate
• Outcome of well conducted studies
• Increased activity does not result in
increased absorption.
• Active women have less difficulty
during labor.
• Infants of very active women were
smaller.
Advice: Exercise in moderation during 3rd
trimester.
FOOD CRAVINGS AND AVERSIONS
Dietary changes during pregnancy:
•
•
•
Some by advice of the physician.
Some by folk medical beliefs.
Some by change in appetite.
Food cravings:
•
Sweets and dairy products.
Aversions:
•
Alcohol, coffee and meats.
FOOD CRAVINGS AND AVERSIONS
Cravings and Aversions are not
necessarily deleterious.
SOCIAL AND
ENVIRONTMENTAL FACTORS
• Drug abuse
• HIV infection
DRUG ABUSE DURING
PREGNANCY
• Prevalence 10 - 15%.
• Commonly Abused drugs:
* Cocaine
* Heroin
* Marijuana
* Tobacco
* Alcohol
* PCP
ALCOHOL ABUSE
• Increased incidence of addiction (18 52%).
• Poor maternal nutrition.
• Fetal Alcohol Syndrome ( 1.9 - 2.2
/1000)
• CNS involvement
• growth retardation
• fetal dysmorphology
HIV INFECTION
• Nutritional Deficiency with AIDS
•
•
•
•
protein caloric Malnutrition
Zinc and selenium deficiency
Calcium and Magnesium
Vitamin A, B6, B12, C, E deficiency
BABY BUILDING BASICS
• Choose food from all FIVE food groups.
• Aim of 25-35 lbs weight gain.
• Add 300 calories/day to your diet.
• Add calcium supplement (1000 mg/day).
• Add daily prenatal vitamins.
• Avoid alcohol and smoking.
• Do not eat raw or uncooked foods.
• Drink 64 ounces of fluid.
Nutritional Assessment
Dietary Evaluation &Recommendation
Access to Registered Dietician
Evaluation Nutritional Status
Weight for Height
Eating Habits.
Modification of the Diet to Existing Medical
Condition
Benefits of Maternal Nutrition Services
Preconceptional
Prenatal
Postpartum
Improves overall
maternal health
Allows time to
change habits
Allows reduction
of risk factors
prior to
conception
Improves birth
weight,may
reduce
perinatal morb.
Impr. Maternal
health &
comfort, incr.
initiation of
breast feeding.
Increases breastfeeding success
improves mat.
nutrition.
Provides
opportunity to
promote healthful
eating for entire
family.