Transcript The Prenatal Prescription - Pennington Biomedical Research Center

The Prenatal Prescription
By: Peter Nathanielsz
Pennington Biomedical Research Center
Division of Education
The following information has been obtained from:
The Prenatal Prescription
A state-of-the-art program for optimal prenatal care
Copyright © 2001 by Peter Nathanielsz, M.D., Ph.D.
HarperCollins Publishers
PBRC 2009
Prenatal Programming
• Believed that nutritional health during pregnancy imprints us
for health during the rest of our life, and that the chronic diseases
we may experience later, either begin or are prevented during
prenatal life.
• Dr. David Barker was the originator of this idea
• He related the high rates of heart disease in middle aged men to
industrial and coal mining areas of England and Wales.
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Prenatal Programming:
The New Science of Life in the Womb
• States that our bodies are programmed in analogous and far-reaching
ways by our experiences before birth. The events to which we are
exposed as we develop our body’s structure and functions during our
life in the womb can improve or worsen our:
–Emotional resilience
–Intelligence
–Susceptibility to Cancer
–Resistance to Infection
–Blood Pressure
–Cardiovascular health
–Eating patterns
–Tendency to gain weight
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Prenatal Programming:
The New Science of Life in the Womb
In short, prenatal programming
affects every aspect of our
physical and mental health, at ever
stage of our lives.
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Findings:
From Chapter 1
•
Leading researchers studying prenatal life now believe that the nutritional
quality of the womb environment is often a more important predictor for risk of
heart disease than either genetic predisposition or post-birth influences like
diet and exercise.
•
Studies show that blood pressure in mothers during pregnancy correlate
directly with the blood pressure of their offspring in adulthood.
•
Newborns who have a disproportionate head-to-waist size, a hallmark of
detrimental prenatal programming due to poor nutrition, are more likely to
develop elevated levels of cholesterol as adults.
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10 Principles:
Of Prenatal Planning
1.
There are critical periods of vulnerability to sub-optimal conditions for the
fetus during development in the womb, occurring at different times for
different organs in the body.
2.
Programming has permanent effects that alter the body’s responses in later
life and can modify susceptibility to disease.
3.
Fetal development is actively dependent. Normal development is
dependent on the baby’s continuing normal activity in the womb.
4.
Programming involves several different structural changes in important
organs.
5.
The placenta plays a key role in programming.
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10 Principles:
Of Prenatal Planning
6.
Compensation carries a price. In unfavorable environments, the developing
baby makes attempts to compensate for deficiencies .
7.
Attempts made after birth to reverse the consequences of programming
may have their own unwanted consequences.
8.
Fetuses react differently to sub-optimal conditions than do newborn babies
or adults.
9.
The effects of programming may pass across generations by mechanisms
that do not involve changes in the genes.
10.
Programming has different effects in males and females.
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Principle #1 says:
• There are critical periods when certain parts of the
fetus are vulnerable to stress from exposure to
toxins or from lacking nutrients or lacking oxygen.
• Cells must make a fundamental choice between
growth and specialization.
• These can become competing processes.
• Each cell must make a choice to divide or specialize
at some point, and the process is irreversible.
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• Some types of cells, like nerve cells, never divide again after they specialize.
• It is very important that each developing cell makes the right decision at
the right time.
• If a decision is made too early, an organ will end up with too few cells and
thus be unequal to the challenges of later life.
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Principle #2 says:
• That programming has permanent effects.
• When nutrition is deficient in the womb early in gestation, cells divide
less frequently, resulting in fewer total cells in the baby’s body.
• So, this fetus would be smaller overall, but all the body parts will be
proportionately relatively normal, known as symmetrical growth
retardation.
• However, when stress is making things difficult in the 2nd and 3rd
trimester, the cellular community of the growing fetus prioritizes where
nutrients will go.
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• Since the brain is the organ most important for survival both inside and
outside the womb, the largest share of blood, nutrients, and oxygen
gets routed towards the head.
• Many other tissues suffer and don’t grow as they should, leading to a
newborn with a head that is slightly large in comparison to the body,
referred to as asymmetrical growth .
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• Researchers recently found that not only did girls born with low birth
weights have a smaller final stature when they have grown to their
full height decades later, but also that many such girls reach sexual
maturity an average of 1.6 years earlier than girls with normal birth rate.
• Which makes evolutionary sense in some ways
• If a girl had been born into a world that is dangerous, or subject to
famine, it would make sense to reproduce early, since there would be
no guarantee that she would survive long enough to reproduce
otherwise.
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Principle #3 says:
• Fetal development is activity dependent, or as put, the fetus
must “use it or lose it”.
• The way that fetal cells develop depends on how the fetus is
using his body.
• He is able to swallow and suck at birth because he is
practicing sucking and swallowing the amniotic fluid that
bathes him in the womb.
• The nerve cells in the brain wire up correctly because signals
are running through them, testing them, throughout the whole
time they are developing.
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Principle #4 says:
• Programming involves structural changes in the developing organs.
• One cause of the structural changes is the altered growth of blood
vessels in a challenged fetus.
• If an organ developed too few blood vessels in utero, it will be harder for
the body to increase the blood supply to that organ during times of need
later in life.
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Example of a Structural Change
Fingerprint Patterns
• Fingerprints are not solely determined by your genes.
• The specific pattern of fingerprint ridges that form is determined by the
extent of swelling in the finger pads when fingerprints are forming, ~ the
10th week of development.
• When the prenatal environment is challenging, the fetus makes a
priority of getting blood to the brain, thus pushing more blood upwards
and into the developing finger pads.
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Example: Fingerprint Patterns
• More swelling produces a whorl pattern; whereas, the loop or
arch pattern is observed with less swelling.
• If the fetus has been short on oxygen for a prolonged period
around the time when fingerprints are forming, it is very likely for
the whorl pattern to be observed.
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Principle #5 says:
• The placenta is a crucial organ in development, the bridge
between you and your child.
• The baby’s placenta not only acts as a gatekeeper for everything
that comes into and leaves your baby, but it is an important
hormone-producing organ that affects the way you and your child
change physically and psychologically.
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Principle #6 says:
• Compensation for shortcomings during development carries a price.
• An example is how your baby’s digestive tract and liver are affected by
detrimental conditions.
• Since most of the baby’s waste can be processed by the mother’s liver,
and glucose comes across the placenta all the time from the mother’s
bloodstream, the baby’s liver operates at less than 100 percent efficiency
until after birth.
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The liver and
cholesterol transport
• When oxygen or nutrients are low,
the baby tries to adapt.
• The baby deprives the unessential
organs of blood, sending the majority
of the blood supply to the essential
organs.
• However, the rerouting of blood away
from the liver forces the baby to grow
a small liver.
• As a result, the organ continues to
function less than it should throughout life.
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• Since the liver is central in regulating cholesterol, it is not hard to see
why growing a small liver, thereby reducing abdominal girth, will lead to
higher cholesterol later in life.
• Inadequate growth of the liver and the pancreas is likely responsible for
the glucose control problems in later life, which can lead to adult-onset
diabetes (Type 2 DM).
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Principle #7 says:
• Attempts made to reverse programming after birth can have unwanted
consequences.
• This is because so many of the decisions that cells make during growth
are irreversible.
• For a baby who had little food during intrauterine life, he/she may not
be able to cope with plentiful, rich food afterwards and will have a
greater likelihood of becoming obese.
• In animal studies, food restriction during prenatal life actually led to
shorter life during plenty after birth.
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Principle #8 says:
• Fetuses react differently to sub-optimal conditions than do adults.
• Growing cells need more oxygen, amino acids, vitamins, and
glucose than those that are not trying to expand their activities.
• Small shortages can actually kill cells during development.
•
These may never be replaced.
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Principle #9 says:
• The prenatal effects may carry from one generation to another.
• For example, if the developing fetus is female and has to compromise
leading to smaller organs, when she grows up and becomes pregnant,
those smaller organs may not be able to keep up with the demand,
affecting her fetus.
• Another example would be if there were blood sugar problems during your
pregnancy damaging the blood sugar regulation in your daughter.
This could lead to the same problems during her pregnancy, and
so on through generations.
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Principle #10 says:
• Programming is different in male and female fetuses.
• Boys and girls grow in slightly different hormonal environments.
• These differences are subtle but may play a major role in behavioral
and other functional differences between men and women.
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The First and Best Home
for your Baby: The placenta
Chapter
2
• The placenta has its own blood supply that is kept separate from the mothers.
• The placenta takes the place of the lungs, kidney, and digestive system for baby
• The biochemistry of the body changes to promote energy conservation over
usage.
• Sound, touch, and taste are developed in utero.
• Biorhythms
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The Placenta
• The placenta shared with your baby is probably the most talkative and
bossy biological organ there is.
• It sends firm instructions to you as well as to the baby.
• Placental lactogen is one of the many hormonal signals that the baby
and placenta send to reshape your body and bend it to the baby’s
needs.
• The baby always gets top priority between the two of you.
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The Fetus
• The fetus keeps tabs on energy supply.
• If there is a shortage of energy, he learns to prepare for shortage of
food and how to cope with it later.
• The baby also monitors the mother’s stress level and high stress
hormone levels will make the baby hypersensitive to stress hormones
after birth.
• Important for the mother to monitor stress levels throughout pregnancy.
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Biochemistry of the Body:
Sound
• Hearing is a critical skill after birth, and preparation to hear what
is going on in the world has to begin long before delivery.
• The womb is awash with sound that can help the brain wire up its
sound circuits.
• Research has shown that newborns prefer the sound of their
own mother’s voice over the voices of others, since her voice has
been the clearest and most familiar sound all through pregnancy.
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Biochemistry of the Body:
Touch
• The gentle bump and caress of the womb’s wall is a critical part
of learning to respond to touch.
• The occasional gentle contractions of the mother’s womb during
pregnancy – known as contractures - stimulate the baby’s
nervous system to begin working properly.
• Helps to integrate sensory and motor nerurons in
the body and brain
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Biochemistry of the Body:
Taste
• Even while in the womb, your baby is swallowing fluid
and taste buds are learning to recognize differing tastes.
• Some recent research suggests that taste preferences
for garlic, spices, an other foods may be set and
programmed before birth.
• The idea is that these flavors filter into the amniotic fluid
from the mother’s blood .
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Biorhythms
• Certain chemical compounds have distinct twenty-fourhour rhythms in your blood even when you are not
pregnant.
• Stress hormones, kidney hormones, and melatonin
naturally rise and fall over the course of the day and
night.
• Human fetuses seem to use these signals to learn about
the cycles of the world outside and to try to adapt their
own cycles to them.
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Nutrition in the Womb
Chapter
3
• Nutritional status before conception is probably as important as
nutrition during pregnancy.
• The mother’s nutritional status during pregnancy is the single most
important factor in baby’s growth.
• Deprivation during pregnancy can take generations to overcome.
• The effects of poor nutrition vary according to the trimester
in which problems occur.
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Prenatal Eating Habits
• Over the whole course of prenatal development, the kind of food
your child gets before birth can affect his lifelong:
– Weight
– Blood Pressure
– Blood sugar profile
– Cardiovascular Health
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Dutch Hunger Winter
Winter 1944-1945
• Individuals affected by the famine were only receiving 450 to 750
calories a day compared to 2500 kcal/day before that.
•
Babies that were conceived where the entire intrauterine life was
deprived of calories and nutrients were small and light weight and had
the most health problems growing up.
• Mortality was ten times higher than normal in these individuals.
• Those that had starvation in the first half of pregnancy had the most
incidence of obesity in later life.
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Modern Effects of Past Poor
Nutrition…
•
Animal studies have shown that poor nutrition in
the womb alters the growth of the pancreas and the
functions of insulin.
•
Diabetes can be thought of as a “cash flow” disease,
where glucose is the main form of “cash” that makes
the body run.
•
When you eat, glucose leaves the gut and enters
the bloodstream.
•
In response to the rising blood glucose, the pancreas
releases insulin, which allows glucose to leave the
bloodstream and enter muscle and fat cells where it can
be used.
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Modern Effects of Past Poor
Nutrition…
• In diabetes, the insulin doesn’t work as it should.
• These starved cells are forced to consume their
own fats and proteins as an alternate source of energy.
• When there is a high level of fat circulating, it deposits in wrong
places and can weaken cells and produce problems with eyes,
heart and many other precise organs.
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Special Components of
a Healthy Diet
• Iron:
– Needed in order to allow your blood supply to increase and help your
baby build her own blood supply from scratch
– 30-60 mg a day in pregnancy
– Found in red meat (especially liver), eggs, and dried beans
• Calcium:
– Main building block of bones and teeth, and also critical for the proper
function of your own and your baby’s nerve cells and muscles
– 1200-1500 mg per day in pregnancy
– Found in milk and cheese, also in broccoli, kale, legumes, and tofu
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Special Components of
a Healthy Diet
• Chromium
– Helps insulin work to keep your baby’s blood sugar at the right level
– 50-200 micrograms per day in pregnancy
– Found in whole grains, meats and brewer’s yeast
• Zinc
– Important for tissue growth and the reproduction of genes in DNA
– 15 mg per day in pregnancy
– Found in whole grains, nuts, dried beans, meat, and eggs
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Special Components of
a Healthy Diet
• Folic Acid:
– Vital for the synthesis of DNA every cell in your baby’s body
and the placenta need an adequate supply
– 400 micrograms a day in pregnancy
– Found in enriched flours, fresh fruit, and green vegetables
• Vitamin A:
– Helps build key components of the baby’s skin, eyes, and other tissues
– 800 IU (international units) a day in pregnancy
– Found in fruits and vegetables (equivalents), meat and dairy
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Special Components of
a Healthy Diet
• Vitamin B6:
– Helps baby create new tissue he needs to grow, especially in the brain
– ~2.2 mg per day in pregnancy
– Found in eggs, whole grains, lean meat, oatmeal, nuts, dried beans,
peas, and bananas
• Vitamin B12
– Plays a central role in the production of new DNA your baby needs as cells
multiply
– 2.0-2.2 micrograms a day in pregnancy
– Found in meat, fish, eggs, and cheese
• Vitamin C:
– Crucial for cell repair after injury and for the development of new tissues
– 70 mg per day in pregnancy
– Found in fruits (especially citrus), and dark green, leafy vegetables
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Nutrition by Trimester:
First
• You should only gain a pound a month in the first trimester; therefore, an
increase in caloric intake shouldn’t be necessary.
• Iron is crucial for the expansion of the blood supply.
• Meeting folic acid requirements is very important in the first trimester
because this is when the spinal cord is being created.
• If morning sickness leads to vomiting, extra fluids and salts
like potassium will be required.
• These can come from sports drinks; however, they
should not be the main source of fluid since they
contain a lot of glucose.
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Nutrition by Trimester:
Second
• Consumption of 300 calories more per day
• Protein intake, along with iron and calcium are crucial.
• Even if you don’t have gestational diabetes, you may have some
episodes of hyperglycemia that are exacerbated by pregnancy.
• Keep trying to eat small snacks more often.
• Avoid fatty or oily foods because fats interfere
with insulin activity.
• Eat carbohydrate products made with whole wheat, bran, or
other fiber sources.
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Nutrition by Trimester:
Third
• Calcium continues to be a focus of the diet.
• The baby is becoming much more physically demanding and he is
growing rapidly, needing more nutrients daily.
• Frequent small meals are still important .
• You should continue to gain about a pound a week, and if you do
happen to be gaining more, never try to lose weight during the
pregnancy, you should speak with the doctor about possibly cutting
back a little on total caloric consumption.
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Stress in the Womb
High Maternal Stress can:
• Put the pregnancy at a risk
• Have lifelong effects on how the baby’s
brain and body develop
• Affect the child’s temperament
• Make the child overreact to stress
• Make child more susceptible to depression
later in life
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Chapter
4
Effects of Stress
• People under stress tend not to eat well.
• They either eat too much, too little, or the wrong kind of food.
• Our bodies respond to stress by releasing cortisol and other
hormones that give us energy to respond to a crisis.
• With stress present all the time, the individual will have a higher than
normal cortisol level, causing the baby to be hyper sensitized to stress.
• The child is then more likely to be unable to concentrate,
leading to learning difficulties later in life.
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Defeating Stress
• It is very important that the mother is not overly stressed during
pregnancy and is allowed to relax and enjoy things.
• Good ideas for stress relief include the following:
Exercise
Progressive relaxation
Meditation
Yoga
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Exercising for Two
Chapter
5
• A mother in good shape creates a healthier newborn with higher
initial scores on tests of physical well-being.
• Exercise helps to:
– Allow mothers to cope with stress, lessening mood swings
– Lessen many of the bothersome physical side effects of pregnancy
– Make labor and delivery easier and faster
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The History:
Exercise during Pregnancy
• Exercise during pregnancy was generally not accepted by
doctors or the women themselves in the past.
• During this time, women under physical or psychological stress
did not fare well.
• This began to change in the 1950’s when a French doctor started
to study the effects of exercise on pregnancy .
• He found that when the woman eats healthily, does not have
psychological stress, and exercises within reason, it is good for
the mother and the baby.
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Exercise:
The benefits
• Exercise fosters growth of new blood vessels and increases
cells metabolic efficiency.
• The body also learns to dissipate the heat better with
regular challenges.
• When the woman exercises, she also provides small physical
challenges for the baby, making the baby better able to handle stress
later in life.
• Also, stimulation of the baby in the womb also helps in brain
development.
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Important Considerations:
During Exercise
• Don’t overheat
• Be sure to take in enough fluids and salts
• Stop if you feel pain
• Make the exercise a positive experience
• Do it right
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A Woman Should Absolutely
Not Exercise :
If any of the following conditions exist
Premature labor
History of miscarriages
Incompetent cervix
Persistent bleeding
Placental disease
Poor fetal growth
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Pregnancy-induced
hypertension
Ruptured membrane
Twins or other multiple
pregnancy
A Woman Should Probably Not Be
Exercising:
If any of the following conditions exist
Anemia
Breech presentation
after 28-weeks
History of poor fetal
growth
Early pregnancy
bleeding
History of rapid labor
Palpitations or
arrhythmia of the heart
Extremely overweight or
underweight for your
height
Sedentary lifestyle prior
to pregnancy
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Drinks, Pills, and Toxic Spills
Scientists are finding that:
Chapter
6
• The fetus is very vulnerable- Substances can be toxic or challenging
to the fetus in ways that these substances are not for adults.
• Smoking is bad for the fetus in many ways.
• Alcohol has clearly defined adverse effects on the embryo and fetus.
• Coffee, in high doses, can cause problems during pregnancy.
• Some OTC medications can be very toxic.
• Health foods, nutritional supplements, and herbal teas can be bad.
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Negative Effects:
Of Smoking
• The fetus is more vulnerable to the effects of cigarettes than
anyone else.
• Tobacco is a powerful drug which acts on the neurotransmitter system
that controls the heart.
• It also causes constriction of blood vessels in the placenta,
causing increased blood pressure and heart rate.
• When the mother smokes, she increases the concentration of
carbon monoxide and reduces oxygen levels to the baby.
• Smoking slows the growth of the placenta.
• It disrupts sleep of the baby and reduces REM sleep.
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Negative Effects:
Of Alcohol
• Alcohol cuts the blood supply to fetal brain & affects how nerves
communicate.
• In 1968, scientists from France were the first to describe fetal alcohol
syndrome (FAS), in which babies repeatedly exposed to alcohol in the womb
are born with mental retardation and physical abnormalities.
• But, how much is too much?
• Research shows that the likelihood of miscarriage in the first trimester is
doubled in women who drink as little as one ounce of alcohol twice in a week.
• Also, drinking as little as two drinks a week has shown increased
agitation and stressful behavior in newborn babies.
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Negative Effects:
Of Caffeine
• Caffeine is not eliminated as efficiently during pregnancy
and the concentration can get high quickly.
• It speeds up cell activity and acts as a stimulant.
• Caffeine seems to be safe in terms of miscarriage risk if
you limit yourself to one or two cups of coffee a day.
• In high amounts, coffee has been shown to potentially
increase the risk for miscarriage, along with interfering with
the baby’s sleep patterns in the womb.
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OTC Meds and Health foods
• It is important to talk to your doctor about any prescription or
over the counter meds you are taking.
• Also, health foods may have high bacterial counts, may be
contaminated with heavy metals or other contaminants, or
may contain a naturally occurring drug or stimulant.
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Chapter
Preventing Premature Delivery
7
• Babies born before 37 weeks of gestation are considered premature.
• Premature birth often happens because the baby is under some
sort of stress.
• It may be that when conditions in the womb environment become overly
threatening to the babies health, the child has a better chance of surviving
outside the womb rather than within it.
• The most common reasons for this are infection in the womb or birth canal,
and stressful situations for either mother or child.
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Premature Delivery
Stress
• When the baby finds that there is no more room to grow or when there is
a lack of food or oxygen, stress hormone concentrations in the baby’s
blood may rise, stimulating the production of estrogen and the beginning
of labor.
• And if the mother is under enough stress, her increased production of
androgen may cause the level of estrogen to rise far sooner than it
should, initiating premature delivery.
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Ways to Help Prevent
Premature Delivery
• Avoid stress most of all
– Learn stress management
– Learn coping skills for emotional stress
• Treat all cuts and blisters promptly
– A small bit of redness around a cut is extremely unlikely to
contribute to premature labor, but if an infection gets
started and spreads to surrounding tissue or throughout
the body it can set off the immune and hormonal changes
that stimulate contractions .
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Ways to Help Prevent
Premature Delivery
• Brush and floss teeth regularly
– Recent studies have shown that women with gum
disease have perhaps six times the risk of premature
labor compared to women with normal gums.
• Don’t smoke
– Smoking increases the risk of premature labor by 25%.
– Smoking also promotes gum disease because it lowers
the normal resistance to bacteria in the mouth.
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Birth and Beyond
Researchers have found that:
Chapter
8
• The baby’s environment after birth influences the quality of neural
connections in the growing brain.
• The amount and quality of breast milk is directly related to the mother’s
diet and stress levels.
• Antibodies in breast milk beneficially change the
baby’s immune system.
• Touching, talking to, and playing with your infant can actually affect
neural development and improve brain growth.
• Growth promoting factors are present in breast milk.
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Recommendations:
For Mothers
• Try to breast-feed your infant for at least the first three months.
• Use stress reduction techniques in your daily life.
• Continue to exercise benefits you and your baby
• Enjoy your baby!
– Playing, hugging, touching, and talking with your baby creates the
physical and mental foundation upon which she will build future
security and happiness PBRC 2009
Breastfeeding
• Requires that the mother consume 500 more calories per day
than the pre-pregnancy diet
• Mothers will also need to eat more:
–
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•
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Protein
Calcium
Iron
Fats
Alcohol and drugs pass through the breast and into the baby.
As well as painkillers and OTC medications.
Also caffeine.
Important to avoid these toxins the same as during pregnancy.
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Information provided by:
The Prenatal Prescription
By: Peter Nathanielsz, M.D., Ph.D
Images provided by: http://www.google.com/imghp?hl=en&tab=wi&q=
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Pennington Biomedical Research Center
Division of Education
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Heli J. Roy, PhD, RD
Shanna Lundy, BS
Beth Kalicki
Phillip Brantley, PhD, Director
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Edited : October 2009
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About Our Company
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The Pennington Biomedical Research Center is a world-renowned nutrition research center.
Mission:
To promote healthier lives through research and education in nutrition and preventive medicine.
The Pennington Center has several research areas, including:
Clinical Obesity Research
Experimental Obesity
Functional Foods
Health and Performance Enhancement
Nutrition and Chronic Diseases
Nutrition and the Brain
Dementia, Alzheimer’s and healthy aging
Diet, exercise, weight loss and weight loss maintenance
The research fostered in these areas can have a profound impact on healthy living and on the prevention of common
chronic diseases, such as heart disease, cancer, diabetes, hypertension and osteoporosis.
The Division of Education provides education and information to the scientific community and the public about research
findings, training programs and research areas, and coordinates educational events for the public on various health issues.
We invite people of all ages and backgrounds to participate in the exciting research studies being conducted at the
Pennington Center in Baton Rouge, Louisiana. If you would like to take part, visit the clinical trials web page at
www.pbrc.edu or call (225) 763-3000.
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