Life Cycle: Maternal and Infant Nutrition BIOL 103, Chapter 12

Today’s Topic Pregnancy Lactation Resources for Pregnant and Lactating Women and their Children Infancy

Pregnancy (Pg. 500)“Energy and nutrient needs both increase, but needs for calories increases by a smaller percentage than for most vitamins and minerals. As a result, food choices during pregnancy must be nutrient-dense.”

Pregnancy Nutrition before conception Goals of preconception care is to provide: Screening for risk Health promotion and education Intervention as needed Weight Maintain a healthy weight Low or high weight increases risk for poor outcome If low  If too high  Not a good time to “diet”

Nutrition Before Conception Vitamins (Problem Set 12, Q 1a and 1b) 400-800 micrograms of synthetic folic acid/day Why? Avoid high doses of vitamin A (retinol) Substance use Eliminate alcohol, tobacco, drugs, prior to pregnancy

Physiology of Pregnancy Trimesters: 3 time periods of pregnancy, each lasting ~13-14 weeks Stages of human fetal growth Blastogenic stage: Weeks 0-2 Cells differentiate into fetus and placenta Embryonic stage: Weeks 2-8 Development of organ systems Critical period of development Fetal stage: Weeks 9 to delivery Growth

Physiology of Pregnancy Maternal changes: Growth of maternal tissues  weight gain and lactation. Increase in maternal blood volume Slower GI motility  increases nutrient absorption.

Maternal Weight Gain Recommendations depend on BMI Table 12.3: Guidelines for weight gain during pregnancy. Underweight  Gain 28-40 pounds Normal weight  Gain 25-35 pounds Obese  11-20 pounds Higher recommended gain for underweight women, teens, and multiple fetuses Lower recommended gain for overweight and obese women

Maternal Weight Gain Weight gain occurs mostly during 2nd and 3rd trimester. 40% of weight gain  fetus, placenta, amniotic fluid 60% of weight gain  maternal tissues (adipose stores, breast/uterine growth, expanded blood and ECF)

Energy and Nutrition During Pregnancy REE increases to support increased workload on mother’s heart and lungs, and energy requirements of fetus/placenta. Weight gain Nutrients to support pregnancy Well-balanced diet Often, pregnant women have difficulty consuming enough folic acid and iron

Energy and Nutrition During Pregnancy Macronutrients Moderate-protein, low-fat, and high carbohydrate Protein Synthesis of new maternal, placental, and fetal tissues Additional 25 gram/day over non-pregnancy needs Fat Fuel for mother and development of placenta Stored fat supports breastfeeding Carbohydrates Main source of extra calories Complex carbohydrates Fiber-rich

Energy and Nutrition During Pregnancy Micronutrients Increased need for overall calories Increased needs for most vitamins and minerals Support growth and development Q: How are B vitamins used during pregnancy?

Food Choices for Pregnant Women Follow the USDA’s Daily Food Plan for Moms Variety Additional servings of grain, vegetable, fruit, and low-fat milk Supplement with prenatal formula Herbal supplements? Multi-vitamin supplements?

Food Choices for Pregnant Women Foods to avoid Alcohol Large fish Why? Less than 300 milligrams of caffeine per day

Substance Use and Pregnancy Outcome Tobacco Risk for miscarriage, stillbirth, preterm delivery, and low birth weight Alcohol Risk for fetal alcohol syndrome Drugs Risks for miscarriage, preterm delivery, low birth weight, birth defects, and infant addiction

Strategies to Avoid GI Distress: Slowed GI movement nausea, heartburn and constipation Smaller/frequent meals, drinking liquids between meals, fiber and fluids are recommended

Special Situations During Pregnancy Food cravings and aversions Food cravings/aversions are rarely based on a nutrient deficiency or a physiological condition. Pica Hypertension Preeclampsia: Can progress to eclampsia (seizures)

Special Situations During Pregnancy Diabetes Adjust diet and insulin as needed Gestational diabetes: Hormones of pregnancy tend to counteract insulin Often controlled through diet May require insulin

Special Situations During Pregnancy HIV/AIDS Medical treatment to reduce risk of transmission >90% of childhood HIV infections are from mother-to-child transmission Many times, women with HIV or AIDS are likely to have multiple nutrition problems:

Special Situations During Pregnancy Adolescence Extra demands for growth and development Risk for preeclampsia, anemia, premature birth, low-birth-weight babies, infant mortality, and sexual transmitted disease Pre-pregnancy eating patterns a concern Weight gain toward upper limit recommended Need for supplements

Lactation Breastfeeding trends Healthy People 2020 goals To increase the proportion of newborns who are initially breastfed to almost 82% Current stats: 74% of infants breastfed initially 44% of infants still breastfed at 6 months

Physiology of Lactation Changes during adolescence and pregnancy Increased breast tissue Maturation of structure  ducts/glands and secretory cells are formed After delivery Milk production and secretion Colostrum

Physiology of Lactation Hormonal controls stimulated by infant suckling: Prolactin Oxytocin “Let-down” reflex

Summary of Lactation Physiology Infant suckling  pituitary gland release prolactin  milk tissue production Infant suckling  pituitary gland release oxytocin  release milk Thus, giving water or infant formula to the baby reduces the time spent nursing at the breast  milk production declines

Nutrition for Breastfeeding Energy and protein Higher needs than during pregnancy Well-nourished pregnant women will lose weight slowly 1 ¾ lbs/month after ~6 months. Vitamins and minerals Most are higher or same as during pregnancy Iron and folate needs are lower Water AI for total water = 3.8 liters/day

Nutrition for Breastfeeding Food choices USDA’s Daily Food Plan for Moms ~2,200–2,800 Kcal/day Choose foods high in vitamins and minerals and low in added sugar and solid fats Supplementation is generally not necessary, unless… B12 for vegans Vitamin D for women with irregular sun exposure Practices to avoid during lactation Smoking, Alcohol, Drugs

Benefits of Breastfeeding (PS12, Q3a) Benefits for infants Optimal nutrition Builds stronger immune system: protects infant from infections and illness including diarrhea, ear infections, pneumonia, and asthma Convenience

Benefits of Breastfeeding (PS12, Q3b) Benefits for mother Enhanced recovery of uterus size Help women return to pre-pregnancy weight faster Convenience Contraindications to breastfeeding Infant or maternal disease (HIV) Damaged breast ducts Drug use

Resources for Pregnant and Lactating Women and their Children Promote health of pregnant and breastfeeding women and their children Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Service of USDA Provides food assistance Provides nutrition education Provides referrals

Infancy Infancy: 0 -1 years old Growth is the best marker of nutritional status Evaluated using growth charts Weight gain Length gain (not height B/C infants can’t stand) Head circumference measures brain growth and development

Energy and Nutrient Needs During Infancy Requirements based on composition of breast milk Energy and Protein Highest needs of any life stage 2x adult’s needs Carbohydrate and fat Both are major energy source Carbohydrates as simple sugars Water?

Energy and Nutrient Needs During Infancy Key vitamins and minerals Vitamin D Vitamin K Vitamin B12 Folate metabolism and cell division Iron: if formula fed, need iron-fortified formula Fluoride: at 6 months

Energy and Nutrition needs during Infancy Newborn Breastfeeding Recommended as the ideal method of feeding infants to achieve optimal growth and development. AAP recommends that NO supplements of formula or water be given to breastfed neonates unless medically indicated

Energy and Nutrient Needs during Infancy Alternative feeding: Infant Formula Standard infant formula Cow’s milk base “imperfect copy” of breastmilk Soy-based formula Soy protein base Switched to soy-based if formula-fed infants are having feeding problems

Energy and Nutrient Needs during Infancy Special formula for formula-fed infants who are: Allergic to milk/soy Premature babies Have rare defects in metabolic pathway Use medium-chain triglycerides as the fat source

Energy and Nutrient Needs during Infancy How much is enough? Guidelines for feeding infant 6 or more wet diapers per day 3 or more stools per day Regain to birth weight within the first week Best indicators that baby has enough to eat?

Introduction to Solid Foods Readiness for complimentary foods at ~6 months in addition to breast milk/infant formula Infants show: Physiological readiness: Digestive enzymes Ability to maintain hydration Depletion of iron stores Developmental readiness: Lack of extrusion reflex Head and body control

The Start Healthy Feeding Guidelines Feeding schedule for the first two years

Feeding Problems during Infancy Colic Crying and distress, perhaps from abdominal cramping No clear effective treatment Early childhood dental caries Iron-deficiency anemia For older infants who do not eat enough iron-rich foods.

Feeding Problems during Infancy Gastroesophageal reflux ~3% of newborns, usually male Usually disappears within 12–18 months Diarrhea Failure to thrive (FTT) Poor growth in absence of disease Can be due to shortage or improper preparation of appropriate foods