1. MATERNAL AND INFANT NUTRITION

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

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

4. We have been discussing basic concepts of nutrition: - Food choices and nutritional guidelines - Food choices and nutritional guidelines - Digestion - Digestion - Carbohydrates, lipids, and proteins - Carbohydrates, lipids, and proteins - Energy balance and body composition - Energy balance and body composition - Vitamins - Vitamins - Water and mineral balance - Water and mineral balance We then began to specific applications of those concepts: - Sports nutrition - 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 While a pregnant woman has many of the same has many of the same nutritional needs as anyone nutritional needs as anyone else, she must also else, she must also - ingest additional nutrients for herself - ingest additional nutrients for herself - provide nutrients to the embryo/fetus - provide nutrients to the embryo/fetus - avoid subtances which could damage - avoid subtances which could damage the fetus 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 high weight increases risk for poor outcome) poor outcome) Not a good time to diet Supplements such as folic acid can be given to minimize risk of problems can be given to minimize risk of problems

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

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

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

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

13. Let’s review pregancy and embryonic/fetal development Nutritional Concerns of Pregnancy 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 - the embryo (later a fetus) gets nutrients from the mother’s nutrients from the mother’s blood blood - waste products from the embryo/fetus are passed - waste products from the embryo/fetus are passed into the mother’s blood so she can get rid of them 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 - the embryo (later a fetus) gets nutrients from the mother’s nutrients from the mother’s blood blood - waste products from the embryo/fetus are passed - waste products from the embryo/fetus are passed into the mother’s blood so she can get 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. While the embryo or fetus is growing, many change are also occurring to the mother’s body: - Growth of uterus - Growth of uterus - Growth of breasts - Growth of breasts - Added adipose tissue, - Increase blood volume - Added adipose tissue, - Increase blood volume - Slower GI motility - Slower GI motility - Increased stress on heart - Increased stress on heart - Inceased stress on lungs - Inceased stress on lungs - Increased stress on kidneys - Increased stress on kidneys - Increased stress on bones and joints - Increased stress on bones and joints

20. Nutritional Concerns of Pregnancy 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 Recommendations for weight gain depend on BMI:

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 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 and low in fat with few saturated or trans fats, plus adequate protein, will continue to meet the nutitional needs even in pregnancy 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 and low in fat with few saturated or trans fats, plus adequate protein, will continue to meet the nutitional needs even in pregnancy. 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. vitamins and minerals also increases. More of the B vitamins are needed More of the B vitamins are needed because of the increased activities of the metabolic enzymes for which they are cofacotors. Additional vitamins 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. 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 fetus later in the pregnancy. 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 fetus later 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 As long as overdoses are not taken, these assure that adequate levels of these assure that adequate levels of these micronutrients are available to both the micronutrients are available to both the mother and the fetus. 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 Prenatal vitamins specifically ensure that the mother is getting enough folic acid the mother is getting enough folic acid (vitamin B 9 ) to minimize (vitamin B 9 ) to minimize the risk of neural tube the risk of neural tube defects such as spina defects such as spina bifida. 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 Many women also develop aversions to particular foods aversions to particular foods during pregnancy, particularly during pregnancy, particularly foods with strong tastes or smells. foods with strong tastes or smells. These generally have no importance. 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 Many women also develop aversions to particular foods aversions to particular foods during pregnancy, particularly during pregnancy, particularly foods with strong tastes or smells. foods with strong tastes or smells. These generally have no importance. 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 - 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 - Smoking (including marijuana) increases the risk of miscarriage or stillbirth, premature birth, and low birth weight. - Alcohol increases the risk of fetal alcohol - 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 - Smoking (including marijuana) increases the risk of miscarriage or stillbirth, premature birth, and low birth weight. - Alcohol increases the risk of fetal alcohol - 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, - Drugs such as cocaine, MDMA (ecstasy), ketamine, methamphetamine, or heroin can have similar effects, methamphetamine, or heroin can have similar effects, with the added risk of the newborn being addicted with the added risk of the newborn being addicted Nutritional Concerns of Pregnancy

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

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

39. Nutritional Concerns of Pregnancy Pregnancy can also cause some serious health concerns. c) Rarely, women with pre-eclampsia c) Rarely, women with pre-eclampsia develop convulsions or go into a develop convulsions or go into a coma, called eclampsia. Unless coma, called eclampsia. Unless detected and treated quickly it is usually fatal. 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 d) Gestational diabetes develops in 4 - 6% of pregnancies. It is most 4 - 6% of pregnancies. It is most common in older women or women common in older women or women with a history of poor blood sugar with a history of poor blood sugar control. It usually develops later in control. It usually develops later in pregnancy and can usually be controlled with diet, pregnancy and can usually be controlled with diet, although insulin injections may be necessary. although insulin injections may be necessary. Because the extra glucose in the mother’s blood Because the extra glucose in the mother’s blood crosses the placenta, the baby is usually larger than crosses the placenta, the baby is usually larger than average at birth. average at birth.

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

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

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

44. 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. Lactation and Breastfeeding

45. 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. Lactation and Breastfeeding

46. 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” Lactation and Breastfeeding

47. 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. Lactation and Breastfeeding

48. 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. Lactation and Breastfeeding 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. 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. with solid food beginning at 4 to 6 months. Lactation and Breastfeeding

50. Percent of infants exclusively breastfed for first six months

51. Since this breastmilk will be the infant’s only source of nutrition for many months, and a subtantial part of her nutrition for up to two years, it must contain all of the essential nutrients: essential nutrients: - carbohydrates - carbohydrates - lipids, including essential fatty acids - lipids, including essential fatty acids - proteins, including essential amino acids - proteins, including essential amino acids - vitamins - vitamins - minerals - minerals - water - water It also contains antibodies and immune cells to help the infant resist infections, and compounds which are natural laxatives. Lactation and Breastfeeding

52. Breastfeeding continues to offer health benefits well into childhood, including - lower risk of sudden infant death syndrome (SIDS) - fewer infections - lower risk of obesity - lower risk of diabetes - lower risk of diarrhea - lower risk of asthma - fewer allergies - fewer dental problems Some studies indicate it may also increase intelligence throughout life Lactation and Breastfeeding

53. Breastfeeding also provides health benefits for the mother - reduces post-partum bleeding - assists the uterus in returning to its pre-pregnancy size - assists the mother in returning to pre-pregnancy weight - reduces the risk of breast cancer later in life Lactation and Breastfeeding

54. During breastfeeding, of course, the mother’s nutritional needs remain high. - 300 to 400 more Kcal/day than before pregnancy - 25 grams/day more protein - additional vitamins - additional minerals - additional water It is healthier for both her and her infant if she gets these from a broad diet rather than special diets or supplements. Lactation and Breastfeeding

55. Infant Formula In some cases the mother either can not breastfeed her infant or chooses not to. There are a number of infant formulas available which are designed to provide adequate nutrition. Most of these use cows’ milk as the base, although some use soy compounds or other liquids instead.

56. Infant Formula Most infant formulas provide adequate calories in the form of carbohydrates and fats and adequate protein. They are fortified with all of the essential viatmins and minerals. None-the-less, fomulas are not able to completely mimic the content of breastmilk. Many contain fats, proteins, and carbohydrates that are less readily digested and absorbed by the immature digestive system of an infant...

57. Infant Formula Most infant formulas provide adequate calories in the form of carbohydrates and fats and adequate protein. They are fortified with all of the essential viatmins and minerals. None-the-less, fomulas are not able to completely mimic the content of breastmilk. Many contain fats, proteins, and carbohydrates that are less readily digested and absorbed by the immature digestive system of an infant. They may be lacking essential fatty acids or essential amino acids...

58. Infant Formula Most infant formulas provide adequate calories in the form of carbohydrates and fats and adequate protein. They are fortified with all of the essential viatmins and minerals. None-the-less, fomulas are not able to completely mimic the content of breastmilk. Many contain fats, proteins, and carbohydrates that are less readily digested and absorbed by the immature digestive system of an infant. They may be lacking essential fatty acids or essential amino acids. They do not contain the antibodies and other immune components which breastmilk does.

59. Breastmilk and Solid Foods At some point, typically at about four to six months of age in the United States, the infant adds solid foods to the breastmilk or formula.

60. Breastmilk and Solid Foods At some point, typically at about four to six months of age in the United States, the infant adds solid foods to the breastmilk or formula. Initially, most of her total energy expendature is used for basal metabolic processes and growth. As she gets older and more active, more of her energy expendature is used for physical activity.

61. Thus, her diet – usually a mixture of breastmilk or formula and solid foods - must meet the older infant’s increased energy needs. Breastmilk and Solid Foods

62. Thus, her diet – usually a mixture of breastmilk or formula and solid foods - must meet the older infant’s increased energy needs. Compared to an adult, a much higher percentage of an infant’s diet should come from carbohydrate and fat, which are the primary source of calories. Adequate amounts of protein are still important, including essential amino acids, but the small volume of her digestive system, requiring smaller more frequent meals, makes getting enough calories more important for an infant. Breastmilk and Solid Foods

63. The micronutrients – vitamins and minerals – are also important during the first year of infancy. Breastmilk, formula, and solid foods designed for infants normally contain sufficient amounts of these.

64. Breastmilk and Solid Foods Vitamin D is needed for calcium absorption through the intestine and normal bone development. Vitamin K and iron are needed for normal blood development. Vitamin B 12 (cobalamin) is needed for growth, particularly of the brain and nervous system. Flouride is needed for normal tooth development.

65. Most infants are ready to being eating solid foods by the age of about 4 to 6 months. - They can sit with the head upright, - They can sit with the head upright, minimizing risk of choking minimizing risk of choking - They lose the extrusion reflex of the - They lose the extrusion reflex of the tongue and can use it to move food tongue and can use it to move food from the front to the back of the from the front to the back of the mouth where it can be swallowed mouth where it can be swallowed - Their intestines and pancreas are producing enough of - Their intestines and pancreas are producing enough of the necessary digestive enzymes the necessary digestive enzymes - They can drink enough liquids to maintain hydration - They can drink enough liquids to maintain hydration Solid Foods

66. Of course, “solid” foods is a misnomer throughout most of the first year. They include pureed, mashed, or strained foods which the infant can easily swallow. Solid Foods

67. By six to eight months most infants can grasp “finger foods”. Within a year, most infants can begin self-feeding with a spoon. At this point most foods are appropriate, albeit in much smaller portions than for adults.

68. Infants By one year of age, most children need about 850 to 1,000 kilocalories per day, nearly half of what they will require as adults. Their need for carbohydrates and proteins are, pound for pound, much higher than they will ever be again as they get older. One year old: 22 poundsAdult: 150 pounds Total calories850-1000 per day1800-2200 per day Carbohydrate100 grams/day130 grams/day Protein10-13 grams / day50-55 grams /day

69. Like anyone else, infants can have digestive and dietary problems such as - Colic (crying and distress) - Colic (crying and distress) - Gastroesophogeal reflux (heartburn) - Gastroesophogeal reflux (heartburn) - Vomiting - Vomiting - Diarrhea - Diarrhea - Dental caries when teeth come in - Dental caries when teeth come in In some cases infants develop problems with digesting and absorbing nutrients which can lead to malnutrition or anemias. In some cases, the infant simply is not furnished with enough food Infants

70. Let’s move on next to look at the nutritonal needs from childhood through adulthood and into old age