Nutrition 526 - 2010 Framing Maternal & Infant Nutrition

1. Nutrition 526 - 2010Framing Maternal & Infant Nutrition

2. Preconception – Conception – Gestation – Birth - Infancy Sexual maturity - Childhood

3. Social-Ecological Model for Determinants of Access to Resources & Nutrition Behaviors Structures, Policies, Systems Local, state, federal policies and laws Institutions Rules, regulations, policies & informal structures Community Social Networks, Norms, Standards Interpersonal Family, peers, social networks, associations Individual Knowledge, attitudes, beliefs

4. Individual - Pregnancy • Physiology and Psychology of Pregnancy • Maternal Preconceptual status • Inter-generational programming • Diet in pregnancy: energy/weight gain, macro & micronutrients • Behaviors that impact nutritional status • Substances: alcohol, caffeine, tobacco, drugs • Physical activity • Oral health • Pregnancy intendedness • Stage of development: adolescence • High risk situations: GDM, PIH,

5. Intrapersonal/Community • Social and cultural environments • Support from friends and family • Health and nutrition care providers

6. Institutional • Hospital breastfeeding & formula policies • Child Care policies • School policies for pregnant and parenting teens • Worksite lactation policies

7. Policy & Environment • Nutrition Assistance Programs for pregnancy, lactation and early childhood. • Insurance policies for lactation support • Parental leave policies

9. Maternal-infant dyad

10. A Public Health Approach to Maternal and Infant Health • Assessment • Policy Development • Assurance: Surveillance and monitoring progress towards goals

11. Assessment • Pregnancy population characteristics • Maternal health indicators • Infant health indicators

12. In 2007 • 4,317,119 births - highest number ever registered for the US • general fertility rate increased by 1 percent in 2007, to 69.5 births per 1,000 women aged 15–44 years, the highest level since 1990 National Vital Statistics Reports. 2009; 57:12

13. In 2008 Births and birth rate were ~ 2% less than 2007. National Vital Statistics Reports. 2010; 58:16

16. In 2008, birth rates for teenagers Dropped 2% National Vital Statistics Reports. 2010; 58:16

17. Percentage of all births to unmarried women by age of mother, 1980 and 2007 In 2007, 40% of all US births were to unmarried women National Center for Health Statistics, National Vital Statistics System.

18. Percentage of Parents Who Were Married or Cohabiting at Birth of First Child, by Race/Ethnicity and Sex MMWR; September 15, 2006 / 55(36);998

19. National Vital Statistics Reports. 2010; 58:16

20. Population Indicators & Trends for Maternal Health • Pre-conceptual indicators • Weight gain • Diabetes in pregnancy • Pre-eclampsia • Cesarean delivery • Maternal death

21. Weight Gain During Pregnancy: Reexamining the Guidelines, IOM. 2009

23. Per birth certificate – includes all diabetes in pregnancy

24. Ferrara. A. Diabetes Care. Jul 2007

26. African American and White Women Who Died of Pregnancy Complications,* United States * Annual number of deaths during pregnancy or within 42 days after delivery, per 100,000 live births. † The apparent increase in the number of maternal deaths between 1998 and 1999 is the result of changes in how maternal deaths are classified and coded. Source: CDC, National Center for Health Statistics.

27. Population Indicators of Infant Health • Infant mortality • Birthweight • Gestational age

28. Infant Mortality • Infant mortality rate – Deaths of infants aged under 1 year per 1,000 or 100,000 live births. The infant mortality rate is the sum of the neonatal and postneonatal mortality rates. • Neonatal mortality rate – Deaths of infants aged 0-27 days per 1,000 live births. The neonatal mortality rate is the sum of the early neonatal and late neonatal mortality rates • Postneonatal mortality rate – Deaths to infants aged 28 days-1 year per 1,000 live births.

29. http://www.chipublib.org/004chicago/disasters/infant_mortality.htmlhttp://www.chipublib.org/004chicago/disasters/infant_mortality.html

31. Infant Mortality • Sensitive indicator of community health because reflects influences by various social factors • E.g. environment (housing, sanitation, safe food and water) • Historically decrease in infant mortality associated with improvements in living conditions and health services

32. INDICATOR HEALTH2: DEATH RATES AMONG INFANTS BY RACE AND HISPANIC ORIGIN OF MOTHER, 1983–2004

34. http://mchb.hrsa.gov/mchirc/chusa_05/healthstat/infants/0307iimr.htmhttp://mchb.hrsa.gov/mchirc/chusa_05/healthstat/infants/0307iimr.htm

35. Muntaner, C et al. ECONOMIC INEQUALITY, WORKING-CLASS POWER,SOCIAL CAPITAL, AND CAUSE-SPECIFICMORTALITY IN WEALTHY COUNTRIES. International Journal of Health Services, Volume 32, Number 4, Pages 629–656, 2002 • “In summary, the rates of low birth weight and infant deaths from all causes were lower in those countries with more voter turnout, more left votes, more left members of parliament, more years of social democratic government, more women in government, a stronger social pact and various aspects of the welfare state, and low income inequality, as measured in a variety of ways.”

36. Health Affairs, Vol 23, Issue 5, 2004

37. Birthweight

38. Defining Small for Gestational Age (SGA) and Large for Gestational Age (LGA)

39. INDICATOR HEALTH1: PERCENTAGE OF INFANTS BORN WITH LOW BIRTHWEIGHT BY MOTHER'S RACE AND HISPANIC ORIGIN, 1980–2005 http://www.childstats.gov/americaschildren/health1.asp

40. Distribution of Births, by Gestational Age --- United States, 1990 and 2005 MMWR, April 2007

41. NGA Center for Best Practices, June 2004

42. Policy approach • Access to food • Individual maternal-infant dyad • Community based • Public health and health services • Knowledge and beliefs • individual • Family, community • Public health and health services

43. Determinants of infant feeding practices • Maternal employment • Health sector activities • Commercial availability and promotion of processed milks and cereals • Urbanization vs.. modernization • Poverty and maternal nutrition • Perceived insufficiency of breast milk

44. History • Child welfare movements became noticeable in industrialized countries (U.S. and Western Europe • “Political, economic, and humanitarian motivations all converged to reduce the large wastage of child life”

45. History • World War 1 and 2 • Recruits unfit for service • “weaklings”

46. History • Child welfare movements directed toward general hygiene for disease prevention, dietary improvements, and antepartum care • Infant Stations: to provide clean milk, instruct new mothers on child/infant care, encourage breastfeed • Innovative approach in 1908 establishment of Division of Child Hygiene in NYC

47. Child Hygiene Bureau NYC • Tracked from register of live births • Home nursing visits • Education on infant care • Milk stations • “there were 1200 fewer deaths when comparable to previous summer”

48. Policy Development: Poor Pregnancy Outcomes are Costly • Medicaid finances 40% of annual births in the US and pays for 50% of hospital stays for premature and LBW. • Medicaid-funded deliveries represented 45.6% of births in WA in 2003. • The care cost for children with one of 17 common birth defects is $8 billion per year in the US.

49. Assurance: Healthy People 2010 Goals Related to Maternal and Infant & Nutrition

50. Reduce low birth weight (LBW) and very low birth weight (VLBW).