Transcript Chapter 12: Life Cycle: Maternal and Infant Nutrition

Chapter
16
Life Cycle:
Maternal and
Infant Nutrition
Pregnancy
• Nutrition before conception
• Risk assessment, health
promotion, intervention
• Weight
• Maintain a healthy weight
• Vitamins
• 400 micrograms folic acid/day
• Avoid high doses of retinol
• Substance use
• Eliminate prior to pregnancy
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Pregnancy
• Physiology of pregnancy
• Stages of human fetal growth
• Blastogenic stage: first 2 weeks
• Cells differentiate into fetus, placenta
• Embryonic stage: weeks 3–8
• Development
of organ systems
• Fetal stage:
week 9–delivery
• Growth
Pregnancy
• Physiology of
pregnancy
• Maternal changes
• Growth of adipose,
breast, uterine
tissues
• Increase blood
volume
• GI changes
Pregnancy
• Maternal weight gain
• Recommendations depend on BMI
• Normal weight (BMI = 19.8–26 kg/m2)
• Gain 25–35 pounds
• Energy and nutrition during pregnancy
• Energy
• Nutrients to Support Pregnancy
• Macronutrients
• Low-fat, moderate-protein, highcarbohydrate
Pregnancy
• Energy and nutrition during pregnancy
• Micronutrients
• Increase need for most vitamins and minerals
• Highest increase for iron and folate
• Food choices for pregnant women
• Pyramid-style diet
• Supplements of iron and folate
• Foods to avoid
• Substance use
• Risk for birth defects,
low birth weight, preterm delivery
Special Situations During Pregnancy
Special Situations During Pregnancy
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Food cravings and aversions
Hypertension
Diabetes
Gestational diabetes
HIV/AIDS
Adolescence
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Lactation
• Physiology of lactation
• Changes during pregnancy
• Increased breast tissue
• Maturation of structure
• After delivery
• Hormonal controls
• Prolactin
• Oxytocin
Lactation
• Nutrition for breastfeeding women
• Energy
• Protein
• Higher needs than pregnancy
• Vitamins and minerals
• Most are higher or same as
pregnancy
• Iron and folate needs are lower
• Water
• Food choices
Lactation
• Supplementation
• Practices to avoid while breastfeeding
• Alcohol, drugs, smoking, excess caffeine
Lactation
• Benefits of breastfeeding
• Benefits for infants
• Optimal nutrition
• Reduced incidence of
respiratory, GI, and ear
infections
• Convenience
• Other benefits
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Lactation
• Benefits of breastfeeding
• Benefits for mother
• Convenience
• Enhanced recovery of uterus size
• Other benefits
• Contraindications to breastfeeding
Resources for Pregnant and
Lactating Women and Their Children
• Agencies and education programs
• March of Dimes
• La Leche League
• WIC
Infancy
• Growth is the best marker of nutritional
status
• Evaluated using growth charts
• Weight gain
• Double birth weight by 4–6 months
• Triple birth weight by 12 months
• Length gain
• Increase length by 50 percent by 12 months
• Head circumference
Infancy
• Energy and nutrient needs of infants
• Based on composition of breast milk
• Energy
• Highest needs of any life stage
• Protein
• Highest needs of any life stage
• Carbohydrate and fat
• Fat: major energy source
• Carbohydrates: simple sugars
• Water
Infancy
• Energy and nutrient needs of infants
• Key vitamins and minerals
• Vitamin D
• Vitamin K
• Vitamin B12
• Iron
• Fluoride
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Infancy
• Newborn breastfeeding
• Alternative feeding:
Infant formula
• Standard
• Soy-based
• Other
• Formula preparation
Infancy
• Breast Milk or Formula: How Much Is Enough?
• Feeding Technique
Infancy
• Introduction of solid foods
• Readiness for solids
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Increased digestive enzymes
Loss of extrusion reflex
Able to sit without support
Age of about 4–6 months
Infancy
• Developmental Readiness for Solid Foods
• Start Healthy Feeding Guidelines
• Baby rice cereal
• Strained fruits, vegetables, and meats
• Add one food at a time
Infancy
• Feeding Problems During Infancy
• Colic
• Early childhood caries
• Iron-deficiency anemia: milk anemia
• Gastroesophageal reflux
• Diarrhea
• Failure to thrive
Promoting and Supporting Breastfeeding
• It is the position of the Academy of Nutrition and
Dietetics (AND) that exclusive breastfeeding provides
optimal nutrition and health protection for the first 6
months of life, and breastfeeding with complementary
foods for at least 12 months is the ideal feeding
pattern for infants. Breastfeeding is also a public
health strategy for improving infant and child health
survival, improving maternal morbidity, controlling
health care costs, and conserving natural resources.
Eating for Two
• Pregnant women do not obtain adequate iron
from diet alone, and should follow current
recommendations for iron supplementation
during pregnancy.
• For other nutrients, the mother’s diet quality
should be evaluated before recommending
nutrient supplements.
• Most pregnant women probably need folic
acid supplements to meet increased
requirements of pregnancy.
Energy-Yielding Nutrients for Infants
• To support growth, protein needs (per kg
body weight) are higher in infancy than in any
other life stage.
• The best diets for infants are high in fat and
moderate in carbohydrate.
Nutrition to Prepare for Pregnancy
• Ideally, the time to prepare nutritionally for
pregnancy is well before conception. A
woman who has adequate nutrient stores,
particularly of folic acid, and is at a healthy
weight can reduce the risk for maternal and
fetal complications during pregnancy.
• In addition to healthful diet selections,
avoiding cigarettes, alcohol, and other drugs
is important when contemplating pregnancy.
Cow’s Milk and Iron Deficiency
• The use of cow’s milk for children younger
than 1 year is a common cause of iron
deficiency.
• Cow’s milk is low in iron, and drinking cow’s
milk can cause intestinal bleeding in infants.
• The amount of iron in breast milk is low, but
this iron is highly bioavailable.
ADA: Key Recommendations
• Women of childbearing age who may become
pregnant. Eat foods high in heme iron and/or
consume iron-rich plant foods or iron-fortified foods
with an enhancer of iron absorption, such as vitamin
C-rich foods.
• Women of childbearing age who may become
pregnant and those in the first trimester of pregnancy.
Consume adequate synthetic folic acid daily (from
fortified foods or supplements) in addition to food
forms of folate from a varied diet.
Weight During Pregnancy
• Maternal obesity can complicate pregnancy
and delivery and may compromise a baby’s
health. Being too thin, meanwhile, carries its
own risks.
• Lean women with a BMI less than 20 kg/m2
have increased risks of preterm delivery and
delivering a low-birth-weight infant.
Weight During Pregnancy
• Overweight and obese women have increased risks
of several problems, including preterm delivery and
stillbirth.
• In addition, obese women are at higher risk for:
• high blood pressure
• gestational diabetes (a form of diabetes that is
associated with pregnancy; it often is controlled
through diet alone)
• preeclampsia (a condition marked by high blood
pressure, fluid retention, and protein in the urine)
• prolonged labor
• unplanned cesarean section
• difficulty initiating and continuing breastfeeding