Transcript breast milk
Pregnancy is the greatest physiological stress accompanied with major alternation of the normal biological changes to which the mother has to adjust hers nutritional requirements during the period of pregnancy as well as the period of lactation. Normal endocrine pregnancy and is metabolic associated changes with which result in altered nutritional requirements. Pituitary Growth Hormone Sex Hormones (Estrogen & Progesterone) Protein Catabolism Retention of calcium Iron (storage & absorption) The amount iron stored = Amount utilized by the fetus + amount secreted in breast milk Dilution of the maternal blood during pregnancy is partly due to general retention of water in the body during the latter months of pregnancy which decreases the hemoglobin content below the normal by 10-15%. Hemoglobin concentration of 12 gm/100 ml is considered normal. On the hypochromic other hand, anaemia may a microcytic, occur during pregnancy in women who had deficiency in iron before pregnancy and in woman greater demands of pregnancy has aggravated the severity of this deficiency. Life long marginal diet Folic Acid Pregnancy • Spontaneous abortion. • Toxaemia • Intrauterine growth retardation Rate • Premature delivery • Fetal malformation • Antepartum haemorrhage Macrocytic megaloblasitc anaemia Macrocytic megaloblasitc anaemia Niacin Requirements Derivatives of niacin Tryptophan Oestrogens Thiamin Requirements Thiamin deficiency during pregnancy Severe cardiac decompensation occurs in pregnant women. Congestive heart failure in their new babies. • Stillbirths Rate • Maternal mortality • Perinantal mortality •Toxaemia Thiamin supplementation Vit. B6 Requirements Protein needs Coenzyme for transamination Inadequate Vitamin B6 •Toxaemia. • Low birth weight. • Poor general condition of infants of deficient mothers at birth. Vitamin C Levels And thus due to normal expansion of blood volume Because of the Vitamin D increased utilization of Requirement calcium and Phosphorous Calcium Magnesium Intake Activity of Thyroid Gland Metabolic Rate Demands for Iodine 23% Dietary Recommendations is Pregnancy These nutrients could be achieved through the proper selection of food and without the addition of special supplements except for Iron and vitamin D. Pregnancy diet is a well-balanced ordinary diet modified through an increase in animal protein intake and a decrease in fat and carbohydrate foods. Less expensive protein foods like dried skim milk, beans or peas may be partially substitute the good quality protein, occasionally, when there is a tight budget. A lot of citrus fruits, tomatoes, and deep yellow and dark green leafy vegetables should be eaten daily. The higher intake of fruits and vegetable supply a sufficient amounts of fibers which maintain normal bowel function and counteracts the tendency to constipation during pregnancy. Foods known to cause digestive distress or gaseousness, highly spiced foods, fried foods, heavy desserts should be avoided. Intake of butter, cream, margarine, or other fat, and noodles, pies, pastries, rich desserts, soft drinks and sweets should be decreased. Fluid intake should be adequate ~ 2 liters of fluids or more is required. This may be in the form of water, fruit juices, soups, and coffee and tea in moderate amounts. Excessive amounts of salt or salted foods are not advised especially during the last 2 months of pregnancy. Five to six small meals are preferable to three large ones. As the enlargement of uterine mass begins to gastrointestinal capacity, indigestion, “heart-burn” and affect gaseonsness, are more effectively controlled by small frequent feedings especially in the third trimester. It is known that the energy allowance should be increased during the second and third trimesters in order to cope with the increase in metabolism. This will help sparing protein for use by the fetus and storage by the mother. This increase in caloric intake is justified even in the case of the overweight pregnant women. In order to avoid excessive weight gain, the total amount of food eaten during the first 4 months should be unchanged if the expectant mother has normal body weight. During the 2nd and 3rd trimester, the total intake may be increased to permit a gradual weight gain I kg/week. The nutritional demands of pregnancy in adolescence, are critical since the growing pregnant youngster has the task of developing another human being before her body has completed its own growth. Pregnancy may compromise their growth potential and increase the risk in complications such as iron-deficiency anemia, prolonged labor, premature labor and toxemia, the average birth weight of infants born to adolescent mothers is lower with higher infants mortality rates. So the nutritional requirement of adolescent pregnant women should be higher than the adult pregnant women and this increase should be translated into higher dietary intakes of calories, protein, calcium, iron, and folic acid. Underweight pregnant women who fails to gain acceptably weight during first and second trimesters requires strict dietary attention. Underweight pregnant patients are more prone to premature labor. A subsequent excessive weight gain during the late second trimester or third trimester is undesirable because it is usually associate with a greater incidence of preeclampsia. A Vitamin D supplement is desirable during the second half of pregnancy, especially in the fall and winter. Iodized salt should be used. Dietary Recommendations During Lactation During lactation, the energy requirement increases considerably over the normal requirements because of the caloric value of the milk secreted. The daily meal plan should include 1.5 liter of milk to satisfy additional protein, calcium, phosphorous and riboflavin needs. Free amounts of vegetables and fruits, especially citrus fruits, will take care of increased vitamin A and ascorbic acid. Nutrition In Infancy Breast feeding Artificial feeding Breast feeding Advantages: Many advantages. Breast milk has about as many white blood cells as specialized blood itself, monocytes immunoprotection against most which of them convey microorganisms and antigens encountered by the mother and to which the baby will exposed. It is higher concentration in which aminopolysaccharides, stimulate a rapid development of a favorable microflora in the intestinal tract of infants. Such flora is characterized by the prevalence of lactobacilli, e.g. L. bifidus. which have a protective action against growth undesirable pathogenic enteric bacteria. of It has higher content of immune supportive protein, e.g. complement, protective enzymes, e.g. lysozymes, and antiviral substances. beta-lactoglobulin of cow’s milk is completely absent from human milk. Since it is a foreign protein, it is the most common food allergen in infancy. Lactoferrin is another milk protein found in human milk but not in cow neutralizers bacterial infection. milk. It Absorption of zinc from breast milk is better because human zinc binding protein is different from the cow. Human enzymes in breast milk facilitate the baby’s digestion, absorption, and use of the nutrients. 1. Mother should be in good health previous history of tuberculosis must prevent breast feeding. 2. Mother’s diet must be adequate. 3. Mother’s should be free from emotional stress since psychological upsets interfere with a normal flow of milk. 4. Beginning soon after delivery. This preliminary nursing stimulates milk production. Precaution The average nursing time is about 15 min., longer periods will not produce additional milk but may lead to injury of nipples. If possible, only one breast should be offered at each nursing, this facilitates complete emptying and stimulates lactation. Regularity of nursing and the complete emptying of the breast after each feeding help to maintain lactation on the desired level. In case of prolonged insufficient lactation, the material milk supply must be supplemented with bottle-feeding and a gradual change over to the bottle is indicated. The most frequent cause for early weaning from the breast is an inadequate milk supply which is frequently a result of inadequate emptying of the breast several times daily. Beginning with the first month, breast-fed infants should receive 400 I.U. of Vitamin D daily and if not breast fed, orange Juice or a similar source of vitamin (supplying 35 mg/day or more). Artificial feeding Cow milk contains about 7 times as casein as in human milk. The excess proteins in cow milk is catabolized for energy purposes. This will pose a higher load on the infants kidney and increases the water requirements for renal clearance of the large amounts of urea and of other solutes which are present in cow’s milk in greater concentration then in breast milk. The higher concentration of urea will lead to greater ammonia production by urea-forming bacteria in the diaper leading to diaper rash. In addition ,the use of cow’s milk for infants younger than 140 days is associated with (minor) bleeding into the G.I.T. It carries an increased risk of anemia due to copper and iron deficiency besides it is zinc deficient. The number of feedings per day differs according to infant age. A fixed schedule is not mandatory where spontaneous feeding demand by the baby is popular. The appetite of infant changes from time to time. So, he has not to finish his prescribed bottle at each feeding. With the beginning of the second or third week, formula-fed infants should receive 400 I.U. Vitamin D daily, as well as orange juice or a similar source of vitamin C supplying 35 mg or more. A number of proprietary formulas which simulate the composition of human milk are specifically formulated allergic to cow’s milk. to serve infants In order to ensure the freedom from pathogenic microorganisms, one of two methods of sterilization may be used. 1. The fluid mixture is boiled for 3 min. And then poured into presterilized bottles which are capped and refrigerated. 2. The other methods where the formula is divided into clean bottles which are capped and then replaced in a closed vessel, half filled with boiling water. Boiling, is continued for 25 min. and the pasteurized bottles are refrigerated. It is important that the milk be boiled both for digestibility and freedom from pathogenic organisms until the infant is at least 6 months old, then pasteurized milk may be used. Introduction of solid food: There is a general agreement that introduction of solid food should not be given later than the third or fourth months to either breast fed or formula-fed babies, since a prolonged exclusive milk diet does not supply all the essential nutrients, particularly iron and thiamin.