1. Judith E. Brown Prof. Albia Dugger Miami-Dade College www.cengage.com/nutrition/brown Good Nutrition for Life: Pregnancy, Breast-Feeding, and Infancy Unit 29

2. A Healthy Start There are steps parents can take to make sure their baby is as strong and healthy as possible – starting even before pregnancy

3. Unhealthy Starts Among countries worldwide, the United States rates 29 th in infant mortality, primarily due to low birthweights and pre- term births 1 in 12 is born too small 1 in 8 is born too early

4. Key Terms Infant mortality rate Deaths within 1 st year of life per 1000 live births Low-birthweight infants Weighing less than 5.5 pounds at birth Preterm infants Born at or before 37 weeks gestation

5. Key Terms Fetus A baby in the womb from 8 th week of pregnancy until birth (1-8 weeks = embryo) Growth Processes that increase cell number and size Development Processes that enhance functional capabilities

6. Improving Health of US Infants Factors in poor infant outcomes: Poverty Poor nutrition Limited access to health care Maternal lifestyle (drugs, cigarettes, alcohol)

7. Critical Periods Critical period Specific interval of time in which cells of a tissue or organ are genetically programmed to multiply If nutrients are not available during the specific time interval, growth and development of the tissue or organ are permanently impaired most intensive in the first months of pregnancy, when fetal tissues and organs form rapidly

8. Critical Periods Ultrasound: 16 weeks

9. The Fetus Is Not a Parasite The fetus receives an adequate supply of nutrients only if the mother’s intake is sufficient to maintain her own health Newborns can have nutrient deficiencies or overdoses not seen in their mothers

10. Factors Influencing Birthweight

11. Right Amount of Weight Gain Recommended weight gain depends on the mother’s weight (BMI) entering pregnancy Weight gain should result from a high-quality diet that leads to gradual and consistent weight gain throughout pregnancy

12. Weight Status and Weight Gain

13. Calories and Key Nutrients Primary nutritional concerns during pregnancy are calories, folate, vitamin B 6, vitamin A, calcium, vitamin D, iron, iodine, EPA and DHA

14. Calories Additional calories required: 2 nd trimester, 340 calories/day 3 rd trimester, 450 calories/day More for underweight or active mothers

15. Folate Required for protein tissue construction Deficiency is associated with fetal growth failure and malformations, especially neural tube defects such as spina bifida

16. Key Terms Neural tube defects Malformations of the spinal cord and brain Common: 1 in 1,000 pregnancies Includes spina bifida (spinal cord fluid protrudes through a gap in the spinal cord), anencephaly (absence of brain or spinal cord), and encephalocele (protrusion of brain through skull)

17. Spina Bifida After back surgery to close the defect

18. Getting Enough Folate Neural tube defects form before 30 days after conception – it is important that women consume enough folate before pregnancy 600 mcg/day Sources: Fortified cereals Folic acid supplements

19. Vitamin A Too little vitamin A causes poor fetal growth Too much vitamin A (retinol supplement) causes fetal malformations Upper limits: 5,000 IU retinol/day Beta-carotene is not harmful

20. Calcium Women who consume low-calcium diets lose calcium from long bones during pregnancy Calcium uptake is highest during fetal bone mineralization (third trimester)

21. Vitamin D Vitamin D deficiency compromises fetal growth and bone development, and may increase risk of chronic disease later in life Current recommendations: 200 IU/day Upper limits: 2,000 IU/day

22. Iron Because of large increases in need, it is difficult for pregnant women to get enough iron from foods Current recommendations: Supplemental iron, 30 mg/day in 2 nd and 3 rd trimesters

23. Iodine Iodine is important for thyroid function, and protein tissue construction and maintenance Deficiency can cause mental and growth retardation and malformation in children Common sources: In iodized salt, fish, shellfish, seaweed

24. EPA and DHA EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) Essential fatty acids required for development of vision and central nervous system Current recommendations: 300 mg/day during pregnancy and breast feeding In salmon, herring, anchovies, shrimp, halibut

25. Good Diet A good diet for pregnancy and breastfeeding must be planned

26. Alcohol and Pregnancy Fetal alcohol syndrome Permanent damage Malformation, retarded physical and mental development, small size No amount of alcohol is safe during pregnancy

27. Teen Pregnancy Each year in the US, 4% of teen girls between ages 15-19 give birth Poor lifestyle habits increase risk of low- birthweight and preterm infants born to teens

28. Breast Feeding Breast milk is ideally suited for infant nutrition and health

29. Benefits of Breast Milk Breast milk: Is complete nutrition for infants 4-6 months old Protects against infectious diseases Decreases risk of some diseases in childhood Promotes optimal development of nervous system and eyes

30. Benefits of Breast Milk

31. Reasons to Breast-Feed

32. Breast-Feeding in the US

33. Support for Breast-Feeding Health initiatives recommended that: Health care workers encourage and facilitate breastfeeding “How-to “advice and problem solving be available from qualified health-care staff Workplaces have on-site child care facilities and private rooms for breast-feeding

34. Key Terms Colostrum Thick, yellowish milk produced during the first few days after delivery Contains more antibodies, protein, and certain minerals than milk produced later

35. Nutrition and Breast-Feeding Breast-feeding requires a nutrient-dense diet 15% more calories from food High DHA requirement Insufficient calories reduces milk production Limit weight loss to 1 pound/week

36. Dietary Cautions for Breast-Feeding Supplements are not recommended Anything a woman consumes is also in breast milk Caffeine, alcohol, drugs Environmental contaminants (lead, chlordane, PCBs, PBBs) stored in fat

37. Infant Nutrition Infants develop rapidly and require a steady supply of calories and essential nutrients

38. Infant Growth

39. Growth charts for infants Used to screen for growth problems Body composition changes with growth Changes in bone mass, organ size, body proportions and composition

40. CDC Growth Charts

41. Changing Body Proportions

42. Infant Feeding Recommendations

43. Introducing Solid Foods Infants should get iron- fortified cereal, and basic strained foods At 9 months, infants are ready for soft, mashed foods Adult-type foods after 12 months

44. Foods to Avoid

45. Sweetened beverages cause “baby bottle tooth decay” No low-fat foods or un- pasteurized honey

46. Supplements for Infants Fluoride supplements if water supply is not fluoridated Vitamin D if not regularly exposed to sunlight

47. Healthy Eating Habits Food preferences are learned, and are unique to each individual Infants and young children should be offered a wide variety of nutritious foods – how much to eat is left up to the child

48. Clara Davis’ Feeding Experiment

49. Lessons About Food

50. Make Feeding Pleasurable Mealtimes can also provide lessons in communication, relationships, and independence that support psychological as well as physical health