Presentation on theme: "Nutrition During Pregnancy and Infancy"— Presentation transcript:
1Nutrition During Pregnancy and Infancy Chapter 11:Nutrition During Pregnancy and Infancy
2Chapter 11: Nutrition During Pregnancy and Infancy LEARNING OBJECTIVESList changes in the body during pregnancyUnderstand nutritional needs, cravings and aversions during pregnancyBe aware of factors that increase the risks associated with pregnancyDiscuss breast feeding vs. formulaCompare nutritional needs during pregnancy, lactation, and infancy
3THINK about this – then share within a PAIR – then SHARE with the class What do you know about nutrient needs of women during pregnancy and breast feeding?What do you know about nutrient needs of infants?
4Fetal development Fertilization: the union of sperm and egg Cells divide and differentiate (specialize) for 40 weeks of gestation (pregnancy)About a week after fertilization, the embryo implants in the lining of the uterusEmbryo - developing human from 2 to 8 weeks after fertilization; implantation – embedding of an embryo in the uterine liningAfter 9 weeks, an embryo becomes a fetus
5Fetal nourishmentWeeks 2–5: embryo receives nourishement from uterine liningAfter week 5 until birth: developing baby receives nourishment from placentaPlacenta: an organ produced from maternal and embryonic tissuesSecretes hormonesTransfers nutrients and oxygen from the mother’s blood to the fetus, removes metabolic wastesTransport via umbilical cord
7Birth weightFull-term infants are usually born at 40 weeks and weigh 3–4 kilograms (6.5–9 pounds)Small for gestational age: born on time but failed to grow well in the uterusLarge for gestational age: > 4 kg (8.8 lbs)Low-birth weight infants: < 2.5 kg (5.5 lbs)Very-low-birth weight infants: <1.5 kg (3.3 lbs)Premature or preterm: born before 37 weeks
9Weight gain during pregnancy Blood volume increases by 50%Placenta develops to nourish the fetus an to produce hormonesAmount of body fat increases to provide energy needed late in pregnancyUterus enlarges and muscles and ligaments relax to accommodate the growing fetus and allow for childbirthBreasts develop in preparation for lactation (milk production and secretion)
10Weight gain during pregnancy The weight of an infant at birth: about 25% of total weight gain during pregnancyThe balance of weight gain:placenta, amniotic fluid, and changes in maternal tissues, including enlargement of the uterus and breasts, expansion of the volume of blood and other extracellular fluids, and increased fat stores.
11Weight gain during pregnancy Healthy, normal-weight woman should gain 11–16 kg (25–35 lbs) during pregnancyRate of weight gain is as important as amountLittle gain is expected in the first 3 months (1st trimester), usually about 1–2 kg (2–4 lbs)In the 2nd and 3rd trimesters, the recommended maternal weight gain is about 0.5 kg (1 lb)/weekWomen who are underweight or overweight/obese at conception should, respectively, have higher and lower weight gain than normal-weight women
12Weight gain during pregnancy Although a similar pattern of weight gain is recommended for women who, at the start of pregnancy, are normal weight, underweight, overweight, or obese, their recommendations for total weight gain differ
13Underweight during pregnancy Being underweight by 10% or more at the onset of pregnancy or gaining too little weight during pregnancy increases the risk of producing a low-birth-weight baby
14Overweight during pregnancy Excess weight before conception or gained during pregnancy increases mother’s risks for high blood pressure, diabetes, a difficult delivery, need for a cesarean section, and having a large-for-gestational-age baby (>4 kg (> 8 lb.)Excessive prenatal weight gain:increased mother’s long-term risk for obesityincreased offspring’s risk for overweight/obesity
15Overweight during pregnancy Dieting during pregnancy is not advised!!Excess weight should be lost before pregnancy begins or after birth and weaning
16Physical activity during pregnancy Moderate physical activity:Improves digestion and prevents constipationImproves mood and self imageReduces stressPrevents excess weight gain and low back painReduces risk of diabetes and high blood pressureSpeeds recovery from childbirth
17Physical activity during pregnancy Guidelines to maximize benefits and minimize risks of injury to mother and fetus:Women physically active before pregnancy can continue a program of about 30 minutes of carefully chosen moderate exercise per dayWomen who weren’t active before pregnancy should slowly add low-intensity, low-impact activitiesBecause intense exercise can limit the delivery of oxygen and nutrients to the fetus, intense exercise should be limited
18Discomforts during pregnancy Edema: accumulation of fluid in tissuesMorning sickness: nausea and vomiting any time of day or night, usually in 1st trimesterEat small, frequent snacks of dry, starchy foodsHeartburnLimit high-fat foods; avoid heartburn-causing substances; eat small, frequent meals; remain upright after eatingConstipation and hemorrhoidsMaintain moderate level of physical activity and consume plenty of fluids and high-fiber foods
20Concept checkHow are nutrients and oxygen transferred from mother to fetus?How does a mother’s weight gain during pregnancy affect the health of her child?Why do heartburn and constipation tend to increase later in pregnancy?
21Pregnancy macronutrient needs 1st trimester: energy needs not increased above non-pregnant levels2nd and 3rd trimesters: 2-3 food servings moreProtein: increased by 25 g, or 1.1 g/kg/day, for the Carbohydrate: increased by 45 g, to 175 g/dayFiber: increased by additional 3 g of fiber/dayFat: increased essential fatty acids and long-chain polyunsaturated fatty acidsSame distribution of calories from protein, carbohydrate, and fat
22Energy and macronutrient recommendations The percentage increase above non- pregnant levels in the recommended daily intake of energy, protein, carbohydrate, fibre, essential fatty acids, and water for a 25-year-old pregnant woman in her 3rd trimester.
23Pregnancy fluid & electrolyte needs Water: increased to 3 L/day during pregnancy (from 2.7 L/day in nonpregnant women)Electrolytes: no evidence that requirements for potassium, sodium, and chloride are different
24Pregnancy micronutrient needs The percentage increase in recommended micronutrient intakes for a 25-year-old woman during the third trimester of pregnancy.
25Pregnancy vitamin & mineral needs Calcium: RDA not increased because calcium absorption doublesNeeded for teeth and bonesFrom dairy, calcium-rich vegetables, fortified foods, supplementsVitamin D: RDA = 600 IU (15 μg/day), the same as for non-pregnant womenNeeded for absorption of calciumFrom fortified foods, supplements, sunlightDeficiencies most common in dark-skinned women
26Pregnancy vitamin & mineral needs Folate: RDIA during preganacy – 600 µg/dayAccording to Public Health Agency, Canada:All women capable of becoming pregnant should take multivitamin supplements with 400 µg of folate per day, in addition to dietary sources such as dark leafy greens, legumes and orange juiceFor synthesis of DNA, cell division, neural tube closure 21–28 days after conception; prevention of megaloblastic (macrocytic) anemia, premature births, and low birth weight
27Folate fortification In 1998, the Canadian and United States governments began requiring the addition of folic acid to pasta and other enriched grain products in an effort to increase the folic acid intake in women of childbearing age, with the goal of reducing the incidence ofneural tube defects.Because high folic acid canmask the symptoms of vitaminB12 deficiency, the amountadded to enriched grains waskept low enough to avoid this problem.
28Pregnancy vitamin & mineral needs Vitamin B12: RDA is 2.6 µg/dayFor regeneration of active forms of folate, prevention of megaloblastic anemiaFrom animal products, fortified foods, supplementsVegan mothers require vitamin B12 supplements or fortified foods
29Pregnancy vitamin & mineral needs Iron: RDA is 27 mg/day (50% higher than for non-pregnanat women)For synthesis of iron-containing proteins (hemoglobin), prevention of iron-deficiency anemiaFrom red meat, leafy greens, fortified foods, supplementsIron absorption can be increased by vitamin C containing foodsZinc: RDA is 13 mg/day (age <18); 11 mg/day (age >19)For synthesis and function of DNA and RNA and synthesis of proteins, prevention of fetal malformations, premature birth, and low birth weightBest absorbed from red meat
30Meeting energy and nutrient needs during pregnancy The Public Health Agency of Canada and the Sensible Guide to a Healthy Pregnancy recommend:Fruits and vegetables, particularly dark green and orange onesWhole grainsMilk (250 mL) and milk alternativesFish, chosen wisely to minimize exposure to mercury and bacteriaDiet low in added sugar, salt and fatZinc, iodine,and calciumare needed for normal growth anddevelopment.
32Meeting energy and nutrient needs during pregnancy The Sensible Guide to a Healthy Pregnancy also recommends:Two to three more food guide servings per dayMultivitamins with iron and 0.4 mg of folate per day in addition to a carefully planned diet
34Food cravings & aversions Common cravingsIce cream, sweets, candy, fruit, fishPica: craving for and ingestion of nonfood substances (clay, laundry starch, ashes) with little or no nutritionCommon aversionsCoffee, highly seasoned foods, fried foodsUnknown cause, possibly hormonal or physiological (for example, taste and smell changes), psychological, or behavioral changes
35Pica Some women crave white clay (kaolin), during pregnancy Eating kaolin is also a traditional remedy for morning sickness and may be related to cultural beliefs and traditionsPica is also believed to be triggered by stress, nutrient deficiencies, and anxiety.
36What should I eat (during pregnancy)? Make nutrient-dense choicesDrink plenty of fluidsIndulge your cravings, within reason
37Concept checkWhat snack could a pregnant woman add to her day to meet her increased calorie and protein needs?Why isn’t the recommendation for dietary calcium increased during pregnancy?Why are iron supplements recommended during pregnancy?
38Increased risks during pregnancy The embryo and fetus are vulnerable to damage because cells are dividing rapidly, differentiating, and moving to form structuresDevelopmental errors can be caused by deficiencies or excesses in maternal diet and by harmful substances in the environment, diet, medications, or recreational drugsTeratogen: agent that causes a birth defect during a critical period in development
40Increased risks during pregnancy Some women are at increased risk for complications during pregnancy due to their:Nutritional statusAgePre-existing health problemsExposure to harmful substances
41Maternal nutritional status Before pregnancy:Importance of proper nutrition for the maintenance of normal body fat, hormone levels and fertilityDuring pregnancy, malnutrition can lead to:growth retardation, low birth weight, birth defects, premature birth, spontaneous abortion, stillbirthincrease child’s risk of developing chronic diseases such as cardiovascular disease, high blood pressure, diabetes mellitus, obesity and osteoporosisfuture food preferences of an infant
42Dutch famine effects on pregnancy During World War II, an embargo on food transport to the Netherlands (winter 1944–1945) led to the average food intake per person < 1,000 kilocalories/dayAs a result:pregnant women gave birth to smaller babiesin adulthood, the affected babies were more likely than others to have diabetes, heart disease, obesity, and other chronic diseases
43Teenage pregnancyNutrient intake must meet their needs for growth and for pregnancyIncreased risk of hypertensive disorders of pregnancy and delivering preterm and low-birth-weight babiesMay stop growing themselves
44Teenage pregnancyNutrient needs of pregnant teens differ from those of pregnant adultsThe percentage increase in micronutrient needs above non-pregnant levels is shown for 14- to 18-year-olds during their second and third trimesters of pregnancy.
45Pregnancy over age 35 More likely to: have preexisting conditions (cardiovascular disease, kidney disorders, obesity, or diabetes) which increase risks associated with pregnancydevelop gestational diabetes, hypertensive disorders of pregnancy, and other complicationshave low-birth-weight infants and chromosomal abnormalities, especially Down syndromehave twins and triplets with increased nutrient needs and preterm delivery
46Increased risks during pregnancy A woman who has hadmany miscarriages is more likely to have anotherone child with a birth defect has increased risk for defects in subsequent pregnancies<18 months between pregnancies has increased risk of delivering a small-for-gestational age infantonly 3 months between pregnancies has increased risk of a preterm infant and neonatal death
47Toxic substances during pregnancy Caffeine in excess associated with increased risk of miscarriage or low birth weightLimit caffeine to <300 mg/day (two 240-mL cups of coffee/day)Mercury in fish can cause developmental delays and brain damageAvoid varieties of fish high in mercury; limit fish with lower amounts mercuryFish - source of lean protein, omega-3 fatty acids, iodine
50Food-borne illness during pregnancy Immune system weakened during pregnancy; increased number and severity of infectionsListeria infections often result in miscarriage, premature delivery, stillbirth, or fetal infectionbacteria commonly found in unpasteurized milk, soft cheeses, and uncooked hot dogs and lunch meatsToxoplasmosis parasitic infections: babies can develop vision and hearing loss, intellectual disability, seizuresparasite found in cat feces, soil, and undercooked infected meat
51Alcohol during pregnancy A leading cause of preventable birth defectsTeratogen that damages nervous systemAffects fetal growth and development because it reduces blood flow to the placentaCan impair maternal nutritional statusCan cause fetal alcohol syndrome (FAS): physical and mental abnormalities in an infant resulting from maternal alcohol consumption during pregnancy
52Alcohol during pregnancy: FAS Facial characteristics associated with FAS: a low nasal bridge, short nose, distinct eyelids, and thin upper lipNewborns with FAS may be shaky and irritable, with poor muscle toneOther problems include heart and urinary tract defects, impaired vision and hearing, and delayed language developmentBelow-average intellectual function is the most common and most serious effect
53Alcohol during pregnancy Other, less severe but more common alcohol-related problems include:Alcohol-related neurodevelopmental disorder (ARND) characterized by mental impairmentsAlcohol-related birth defects (ARBD) – malformations in the skeleton or major organ systemsComplete alcohol abstinence is recommended during pregnancy!!!
54Tobacco and certain drugs Tobacco, marijuana and cocaine should be avoided during pregnancyThese drugs can cross placenta and lead to profound negative effects on the offspring’s development and future health
55High blood pressureAbout 5% to 10% of pregnant women experience hypertension during pregnancyHypertension during pregnancy are due to:Chronic hypertension present before pregnancyGestational hypertension (rise in blood pressure after the 20th week of pregnncy)Preeclampsia: characterized by elevated blood pressure, a rapid increase in body weight, protein in urine and edemaDangerous to the mother and the baby
56Gestational diabetes High glucose levels developing during pregnancy Increased risk (20% to 50%) of diabetes within next 5 to 10 years (mother)Babies large for their gestational ageincreased risk for difficult delivery, abnormal glucose at birth, an future diabetes
57Concept checkWhy does the effect of a given teratogen vary, depending on when a fetus is exposed to it?How does malnutrition during pregnancy affect the child’s health at birth and later in life?Why are requirements for some nutrients different in pregnant teenage girls than in pregnant adult women?How much alcohol can be safely consumed during pregnancy?
58Infant growth and development Growth is the best indicator of adequate nutrition in an infantBirth weight should double by 4 months and triple by 1 yearMost infants increase length by 50%Growth charts: compare weight, length, or head circumference to the populationRanking, or percentile, indicates where the infant’s growth falls in relation to population standards
60Infant growthNot following the established growth curve or a sudden change in growth pattern could indicate overnutrition or undernutritionFailure to thrive - inability of a child’s growth to keep up with normal growth curvesCaused by biological, environmental (e.g., nutrition) or psychosocial problemsCan permanently affect growth, development, learning, behavior, health
61Developmental milestones Adequate nutrition is essential for the physical, intellectual and social developmentRapid growth and high metabolic rate during infancy increase need for energy, protein, and vitamins/minerals intakeInfants may be at risk of developing vitamin D and K, iron and fluoride deficiencies
63Infant nutrient needs Energy recommendations for 3 age groups 0 to 3 months, 4 to 6 months, and 7 to 12 monthsNutrient recommendations for 2 age groups0 to 6 months and 7 to 12 monthsRequire an energy-dense diet1st 6 months: about 55% of energy intake as fat2nd 6 months: about 40% of energy intake as fatThese percentages are far higher than the 20–35% of energy from fat recommended for adults
64Energy and macronutrient needs The total amount of energy required by an infant < the amount needed by an adultWhen expressed as kilocalories per kilogram (kcal/kg) of body weight, however, infants require about 3 x more energy than an adult male
65Infant nutrient needsWater: need to consume more water per unit of body weight than do adultsHealthy infants who are exclusively breast fed do not require additional waterDiarrhea and vomiting – fluid replacement neededIron:AI from 0–6 months = 0.27 mg/dayRDA for 7–12 months = 11 mg/day; formula-fed infants should be fed iron-fortified formula
66Infant nutrient needs Vitamin D: Breast-fed and partially-breast-fed infants should be supplemented with 400 IU (10 µg)/day until consuming about 1 L (4 cups) of vitamin D-fortified formula/milk dailyFormulas contain at least 10 µg vitamin D/LLight-skinned infants synthesize enough vitamin D after 15 min of sun exposure/daydark-skinned infants may require longer exposure
67Infant nutrient needs Vitamin K: Fluoride: All newborns should receive a mg injectionFluoride:Breast-fed infants, infants on pre-mixed formula and on formula mixed with low fluoride water – often given fluoride supplements beginning at 6 month of age
68Breast feedingBreast feeding is the recommended choice for newborns of healthy, well-nourished mothersCanadian health professionals recommend:Exclusive breast feeding for 6 months and breast feeding with complementary foods for at least 1 year and as long thereafter as mutually desiredLactation can continue as long as suckling is maintainedBreast-feeding on demand
70Breast milkColostrum: produced by the breast for up to a week after deliveryHas beneficial effects on the gastrointestinal tractNutrients supplies meet the infant’s needs until mature milk production beginsContains more water, protein, immune factors, minerals, and vitamins and less fat than mature milkMature breast milk: contains an appropriate balance of nutrients in easily-digested forms
72Benefits of breast milk Formula can never exactly duplicate human milk compositionImmune system cells, antibodies, enzymes, and other substances pass to the child, providing immune protectionGrowth factors and hormones promote maturation of the infant’s gut and immune defenses and enhance digestionPhysical, emotional, and financial advantages
74When is formula better?Some substances can be passed to a baby in breast milkTuberculosis bacterium, HIV, nicotine, some medications, alcohol, cocaine, marijuanaFamily members can share responsibilitySpecial formulas available for preterm infants and those with genetic abnormalities
75Alcohol & breast feeding Alcoholic mothers counseled not to breast feedOccasional limited alcohol is probably not harmful if alcohol intake is timed to minimize amount present in milk when infant is fedAfter consuming a single alcoholic drink, wait at least 4 hours before breastfeedingAlternatively, milk can be expressed before consuming the drink and fed to the infant later
76Safe infant feedingWhether infants are breastfed or formula-fed, care must be taken to ensure that their needs are met and their food is safe
77Safe infant feedingBreast milk that is not immediately fed to the baby can be kept refrigerated for 24 to 48 hoursWarming breast milk in a microwave is not recommended because microwaving destroys some of its immune properties and may result in dangerously hot milkThe best way to warm milk is by running warm water over the bottle
78Food allergiesCommon in infants due to immature digestive tracts that allow absorption of incompletely digested proteins, triggering immune responseRisk of developing food allergies reduced after age 3Many children who develop food allergies before age 3 eventually outgrow themAllergies appearing after 3 years more likely remain
79Reducing risk of food allergies Exclusive breast feeding for first 4–6 monthsAppropriate introduction of solid and semisolid foodsFirst: iron-fortified infant rice cereal mixed with formula or breast milkThen: other grains can be introducedLast: wheat cerealEach new food should be offered for a few days without the addition of any other new foods
80Infant feedingSolid and semisolid foods can be gradually introduced starting at 4–6 monthsFoods that can easily lodge in the throat should not be offered to infants or toddlersCow’s milk should never be fed to infantsAt 1 year of age, whole cow’s milk can be offeredAt 2 years of age, reduced-fat or low-fat milk can be used
81Infant feedingFruit juice can be fed from a cup when an infant is 9–10 months oldExcess of apple and pear juices should be avoided; contain sorbitol that can cause diarrheaAdded sugars - in moderationUnpasteurized honey should not be fed to children <1 year oldMay contain Clostridium botulinum causing botulism poisoning
82Concept checkWhat does it mean if a child whose birth weight was in the 50th percentile is now in the 30th percentile for growth?Why do infants need more fat than adults?Why is breast milk the best choice for healthy mothers and babies?When can solid food be introduced into an infant’s diet?
83What are similarities and differences between: Nutrition in teen and adult pregnancy?Nutrition in pregnant and non-pregnant women?Nutrition in breast-feeding and non-breast-feeding women?Colostrum and mature breast milk?Breast milk and formula?
84DebateWill feeding babies DHA-fortified infant formulas make them smarter and see better?
85Nutrition in the news Plastic in infant formula Plastic baby bottles Breast feeding in publicLaws to support breast feeding
86Checking student learning outcomes What advice could you give to a loved one who is thinking of getting pregnant?What advice could you give to a loved one who is thinking of breast feeding?What advice could you give to a loved one about feeding his/her infant?
87Lactation Synthesis of milk components AND Stimulated by pituitary hormone prolactinANDLet down: release of milk from milk-producing glands and movement through the milk ducts to the nippleStimulated by pituitary hormone oxytocinInhibited by nervous tension, fatigue, or embarrassment
89Lactation: Energy and nutrient needs Human milk contains about 70 kilocalories/100 mL (160 kilocalories/cup)During 1st six month of infancy: about 500 kilocalories are required from the mother each dayBecause some energy comes from mother’s fat, energy intake during lactation should be lower than during pregnancy
90Nutrient needs during lactation 1st 6 months: additional 330 Calories/day2nd 6 months: additional 400 CaloriesProtein: RDA increased by 25 g/dayHigher intakes of total carbohydrate, fiber, essential fatty acids, several vitamins, mineralsWater: additional 1 liter/daySome energy and nutrients from maternal stores
91Lactation: energy and macronutrient needs The percentage increase in energy and macronutrient recommendations for a 25-year-old woman during the third trimester of pregnancy and the first six months of lactation.