MATERNAL AND INFANT NUTRITION

1. MATERNAL AND INFANT NUTRITION

2. We have been discussing basic concepts of nutrition: - Food choices and nutritional guidelines - Digestion - Carbohydrates, lipids, and proteins - Energy balance and body composition - Vitamins - Water and mineral balance

3. We have been discussing basic concepts of nutrition: - Food choices and nutritional guidelines - Digestion - Carbohydrates, lipids, and proteins - Energy balance and body composition - Vitamins - Water and mineral balance We then began to specific applications of those concepts: - Sports nutrition

4. We have been discussing basic concepts of nutrition: - Food choices and nutritional guidelines - Digestion - Carbohydrates, lipids, and proteins - Energy balance and body composition - Vitamins - Water and mineral balance We then began to specific applications of those concepts: - Sports nutrition Today we will discuss maternal and infant nutrition

5. Maternal and Infant Nutrition Pregnancy and lactation present some special nutrition concerns for both the mother and the newborn infant. While a pregnant woman has many of the same nutritional needs as anyone else, she must also - ingest additional nutrients for herself - provide nutrients to the embryo/fetus - avoid subtances which could damage the fetus

6. Nutritional Concerns of Pregnancy Pregnancy and lactation present some special nutrition concerns for both the mother and the newborn. These nutritional needs actually begin at the time of fertilization, weeks before she will know she is pregnant.

7. Nutritional Concerns of Pregnancy Pregnancy and lactation present some special nutrition concerns for both the mother and the newborn. These nutritional needs actually begin at the time of fertilization, weeks before she will know she is pregnant. Half of all pregnancies are unplanned (a very large majority of which occur in couples who are using some form of contraception), so it isimportant for all women of child-bearing age to be aware of these nutritonal needs.

8. Nutritional Concerns of Pregnancy Nutrition before conception: Provide Screening for risk Health promotion and education Intervention as needed Maintain a healthy weight (low or high weight increases risk for poor outcome) Not a good time to diet Supplements such as folic acid can be given to minimize risk of problems

9. Nutritional Concerns of Pregnancy Of particular concern are avoiding things which can damage the embryo or fetus - smoking - drugs - inadequate carbohydrates, proteins, fats, vitamins, minerals, etc. - diabetes - hypertension - mineral imbalances - toxic substances such as mercury in fish - excessive caffeine

10. Nutritional Concerns of Pregnancy Certains substances which are safe or even beneficial for the mother can cause damage in her embryo and fetus: - vitamin A - vitamin D - blood pressure medications - acne medications (Accutane) - antibiotics (doxycycline, tetramycin) - alcohol

11. Nutritional Concerns of Pregnancy It is also important for the woman to avoid situations which increase her own health risks during pregnancy - obesity - smoking - alcohol - drugs - inadequate carbohydrates, proteins, fats, vitamins, minerals, etc. - diabetes - hypertension - mineral imbalances

12. Nutritional Concerns of Pregnancy Let’s review pregancy and embryonic/fetal development It begins when one sperm fertilizes the egg.

13. Nutritional Concerns of Pregnancy Let’s review pregancy and embryonic/fetal development It begins when one sperm fertilizes the egg. This occurs in the Fallopian tube a few minutes to a few hours after sexual intercourse.

14. Nutritional Concerns of Pregnancy Over the next few days, the fertilized egg (called a zygote) divides repeatedly as it travels along the Fallopian tube toward the uterus. If the mother is poorly nourished, this may not occur correctly and the dividing embryo may die, ending the pregnancy.

15. Nutritional Concerns of Pregnancy One to two weeks after fertilization the embryo implants itself in the lining of the uterus, where it will continue to grow and develop for the next nine months. Here again, if the mother is poorly nourished this may not occur correctly and the embryo may die, ending the pregnancy.

16. Nutritional Concerns of Pregnancy As the embryo develops, so does its placenta. This is the interface through which - the embryo (later a fetus) gets nutrients from the mother’s blood - waste products from the embryo/fetus are passed into the mother’s blood so she can get rid of them

17. Nutritional Concerns of Pregnancy As the embryo develops, so does its placenta. This is the interface through which - the embryo (later a fetus) gets nutrients from the mother’s blood - waste products from the embryo/fetus are passed into the mother’s blood so she can get rid of them At this stage, the embryo also becomes susceptible to many drugs, chemicals, infections, and other things which can also pass through the placenta, killing it or damaging it and leading to birth defects

18. Nutritional Concerns of Pregnancy

19. Nutritional Concerns of Pregnancy While the embryo or fetus is growing, many change are also occurring to the mother’s body: - Growth of uterus - Growth of breasts - Added adipose tissue, - Increase blood volume - Slower GI motility - Increased stress on heart - Inceased stress on lungs - Increased stress on kidneys - Increased stress on bones and joints

20. Nutritional Concerns of Pregnancy Recommendations for weight gain depend on BMI: Normal weight (BMI 19.8–26) Recommended = 25 - 35 pounds Higher recommended gain for underweight women, teens, and multiple fetuses Lower recommended gain for overweight and obese women

21. Nutritional Concerns of Pregnancy A pregnant woman needs additional calories to provide the energy for this growth. Her Resting Energy Expenditure increases because of the energy needs of the fetus and placenta as well as The increased work of her heart, lungs, muscles, bones, and kidneys During the second and third trimesters, when both the fetal growth and the mother’s growth are greatest, she will need an additional 350 to 450 KCal per day

22. Nutritional Concerns of Pregnancy Most pregnant women who eat a healthy diet have few problems meeting the nutritional needs of the pregnancy. A diet high in complex carbohydrates and low in fat with few saturated or trans fats, plus adequate protein, will continue to meet the nutitional needs even in pregnancy.

23. Nutritional Concerns of Pregnancy Most pregnant women who eat a healthy diet have few problems meeting the nutritional needs of the pregnancy. A diet high in complex carbohydrates and low in fat with few saturated or trans fats, plus adequate protein, will continue to meet the nutitional needs even in pregnancy. Additional protein, ~25g/day, is needed for the growth of fetal, placental, and maternal tissues. Additional fat may be needed as the breasts develop & begin milk production. Essential fatty acids and essential amino acids are needed for both maternal and fetal health.

24. Nutritional Concerns of Pregnancy Most pregnant women who eat a healthy diet have few problems meeting the nutritional needs of the pregnancy. The need for micronutrients such as vitamins and minerals also increases. More of the B vitamins are needed because of the increased activities of the metabolic enzymes for which they are cofacotors. Additionalvitamins C and A provide antioxidants and support bone and muscle growth.

25. Nutritional Concerns of Pregnancy Most pregnant women who eat a healthy diet have few problems meeting the nutritional needs of the pregnancy. The need for micronutrients such as vitamins and minerals also increases. The need for iron to support the increased blood production is markedly increased. Additional calcium, magnesium, and phosphorus may be needed for healthy bone growth in the fetuslater in the pregnancy.

26. Nutritional Concerns of Pregnancy Although their nutritional needs can be effectively met through a healthy diet, pregnant women are almost always advised to take a prenatal supplement of vitamins and minerals.

27. Nutritional Concerns of Pregnancy Although their nutritional needs can be effectively met through a healthy diet, pregnant women are almost always advised to take a prenatal supplement of vitamins and minerals. As long as overdoses are not taken, these assure that adequate levels of these micronutrients are available to both the mother and the fetus.

28. Nutritional Concerns of Pregnancy Although their nutritional needs can be effectively met through a healthy diet, pregnant women are almost always advised to take a prenatal supplement of vitamins and minerals. Prenatal vitamins specifically ensure that the mother is getting enough folic acid (vitamin B9) to minimize the risk of neural tube defects such as spina bifida.

29. Nutritional Concerns of Pregnancy More than half of all pregnant women experience nausea (called “morning sickness” although it can occur at any time of day) during the first trimester, often accompanied by vomiting. Other gastrointestinal problems include constipation, heartburn, or abdominal pain.

30. Nutritional Concerns of Pregnancy More than half of all pregnant women experience nausea (called “morning sickness” although it can occur at any time of day) during the first trimester, often accompanied by vomiting. Other gastrointestinal problems include constipation, heartburn, or abdominal pain. These can often be managed, but probably not eliminated.

31. Nutritional Concerns of Pregnancy Many women have cravings for specific foods, particularly foods which are sweet, salty, or spicy.

32. Nutritional Concerns of Pregnancy Many women have cravings for specific foods, particularly foods which are sweet, salty, or spicy. Many women also develop aversions to particular foods during pregnancy, particularly foods with strong tastes or smells. These generally have no importance.

33. Nutritional Concerns of Pregnancy Many women have cravings for specific foods, particularly foods which are sweet, salty, or spicy. Many women also develop aversions to particular foods during pregnancy, particularly foods with strong tastes or smells. These generally have no importance. However, in some cases, the cravings are for unusual things such as dirt or clay, starch, hair, or paper. Cravings for such things as cigarette butts and feces have been reported. This is called pica and can cause problems if those materials are toxic or if they cause intestinal blockage.

34. The use of tobacco, alcohol, and drugs create special concerns in pregnancy since their effects can be much more pronounced in the fetus than in the mother. - Smoking (including marijuana) increases the risk of miscarriage or stillbirth, premature birth, and low birth weight. Nutritional Concerns of Pregnancy

35. The use of tobacco, alcohol, and drugs create special concerns in pregnancy since their effects can be much more pronounced in the fetus than in the mother. - Smoking (including marijuana) increases the risk of miscarriage or stillbirth, premature birth, and low birth weight. - Alcohol increases the risk of fetal alcohol syndrome which results in growth retardation and physical and mental defects. Nutritional Concerns of Pregnancy

36. The use of tobacco, alcohol, and drugs create special concerns in pregnancy since their effects can be much more pronounced in the fetus than in the mother. - Smoking (including marijuana) increases the risk of miscarriage or stillbirth, premature birth, and low birth weight. - Alcohol increases the risk of fetal alcohol syndrome which results in growth retardation and physical and mental defects. - Drugs such as cocaine, MDMA (ecstasy), ketamine, methamphetamine, or heroin can have similar effects, with the added risk of the newborn being addicted Nutritional Concerns of Pregnancy

37. Nutritional Concerns of Pregnancy Pregnancy can also cause some serious health concerns. a) Hypertension develops in 3 – 5% of pregnancies. It is most common in younger women, older women, obese women, and women with a family history of hypertension.

38. Nutritional Concerns of Pregnancy Pregnancy can also cause some serious health concerns. b) Hypertension with the presence of protein in the urine is called pre-eclampsia. Like hypertension alone it is more common in younger women, older women, and obese women.

39. Nutritional Concerns of Pregnancy Pregnancy can also cause some serious health concerns. c) Rarely, women with pre-eclampsia develop convulsions or go into a coma, called eclampsia. Unless detected and treated quickly it is usually fatal.

40. Nutritional Concerns of Pregnancy Pregnancy can also cause some serious health concerns. d) Gestational diabetes develops in 4 - 6% of pregnancies. It is most common in older women or women with a history of poor blood sugar control. It usually develops later in pregnancy and can usually be controlled with diet, although insulin injections may be necessary. Because the extra glucose in the mother’s blood crosses the placenta, the baby is usually larger than average at birth.

41. Nutritional Concerns of Pregnancy More than 10% of all pregnancies in the US occur in adolescents, creating some special nutritional concerns: - Adolescents are less likely to get prenatal care, including nutritional advice and support. - Adolescents tend to have poorer diets with more prepared foods which are higher in sugars, salt, and fats and lower in vitamins and minerals. - Adolescents are more likely to smoke, drink, or use illicit drugs during pregnancy. - Adolescents are still growing themselves, and their nutritional needs can be compromised by those of the developing fetus.

42. Nutritional Concerns of Pregnancy More than 10% of all pregnancies in the US occur in adolescents, creating some special nutritional concerns Adolescents have higher risks for preeclamsia, anemia, premature birth, low-birth-weight babies, and infant mortality.

43. Lactation and Breastfeeding As the pregnancy progresses, nutritional needs relating to lactation and breastfeeding arise.

44. Lactation and Breastfeeding As the pregnancy progresses, nutritional needs relating to lactation and breastfeeding arise. Breasts begin to grow early in pregnancy as glands and ducts develop under the stimulus of the hormone prolactin from the pituitary gland. Most women begin to produce milk early in the third trimester.

45. Lactation and Breastfeeding During birth the mother’s pituitary gland also produces the hormone oxytocin, which dramatically increases the production of milk during the first few days after birth.

46. Lactation and Breastfeeding During birth the mother’s pituitary gland also produces the hormone oxytocin, which dramatically increases the production of milk during the first few days after birth. Every time the baby nurses it stimulates the mother’s pituitary gland to secrete both prolactin, which stimulates milk production, and oxytocin which stimulates its expression, the “let down reflex”

47. Lactation and Breastfeeding For the first few days, the milk will be more concentrated and will be relatively low in lipids and carbohydrates and relatively high in protein. It also contains large amounts of antibodies. This milk is called colostrum. Within a few days the milk becomes less concentrated and higher in lipids and carbohydrates.

48. Lactation and Breastfeeding Immediately after birth, it is normal for an infant to lose 5 to 6% of her body weight as she adjusts to life outside the uterus and her digestive system adjusts to food. Within a few days of breastfeeding she should begin gaining weight, and within about two weeks should have returned to birth weight. By 4 to 6 months her weight should have doubled, and by 12 months she should have tripled her birth weight.

49. Lactation and Breastfeeding World Health Organization recommendations: - 75% of infants breastfed initially - 50% of infants breast feeding at 6 months • - breastfeeding for at least the first 2 years. • - breast milk or formula should be supplemented • with solid food beginning at 4 to 6 months.

50. Lactation and Breastfeeding Percent of infants exclusively breastfed for first six months