MATERNAL and INFANT NUTRITION Stages of Fetal Development A newly fertilized ovum (zygote) begins as a single cell, and divides to become many cells during the days after fertilization A newly fertilized ovum (zygote) begins as a single cell, and divides to become many cells during the days after fertilization Within 2 weeks, the zygote embeds itself into the uterine wall (implantation) Within 2 weeks, the zygote embeds itself into the uterine wall (implantation)

Stages of Fetal Development After implantation, the placenta develops and begins to provide nourishment to the developing embryo After implantation, the placenta develops and begins to provide nourishment to the developing embryo The placenta develops inside the uterus, and it provides nutrients and oxygen, as well as a way for the developing embryo to return carbon dioxide and other wastes to be excreted The placenta develops inside the uterus, and it provides nutrients and oxygen, as well as a way for the developing embryo to return carbon dioxide and other wastes to be excreted An embryo at 5 weeks after fertilization is ~ ½ an inch long An embryo at 5 weeks after fertilization is ~ ½ an inch long

Stages of Fetal Development At 8 weeks, the 1¼ inch long embryo has a complete nervous system, a beating heart, a digestive system, well-defined fingers, and toes, and the beginnings of facial features At 8 weeks, the 1¼ inch long embryo has a complete nervous system, a beating heart, a digestive system, well-defined fingers, and toes, and the beginnings of facial features The fetus continues to grow during the next 7 months The fetus continues to grow during the next 7 months Fetal growth is phenomenal – weight increase from less than an ounce to ~ 7.5 pounds Fetal growth is phenomenal – weight increase from less than an ounce to ~ 7.5 pounds

Critical Periods Times of intense development and rapid cell division are called critical periods (cellular activities can only occur at these times) Times of intense development and rapid cell division are called critical periods (cellular activities can only occur at these times) Each tissue and organ is most vulnerable to adverse influences during its own critical period Each tissue and organ is most vulnerable to adverse influences during its own critical period Adverse influences include nutrient deficiencies or toxins Adverse influences include nutrient deficiencies or toxins An adverse influence felt early = irreversibly impairs development An adverse influence felt early = irreversibly impairs development An adverse influence felt late = may only temporarily impair development An adverse influence felt late = may only temporarily impair development

Critical Periods Critical period for neural tube development is 17 to 30 days gestation – folate supplementation reduces the risk for neural tube defects Critical period for neural tube development is 17 to 30 days gestation – folate supplementation reduces the risk for neural tube defects The brain and spinal cord develop from the neural tube, and defects in its orderly formation during the early weeks of pregnancy may result in various central nervous system disorders (spina bifida) The brain and spinal cord develop from the neural tube, and defects in its orderly formation during the early weeks of pregnancy may result in various central nervous system disorders (spina bifida)

Critical Periods Maternal anemia during the critical period of placental growth alters the pattern of blood vessel growth, which may affect the cardiovascular health of the infant Maternal anemia during the critical period of placental growth alters the pattern of blood vessel growth, which may affect the cardiovascular health of the infant Malnutrition during the critical period of pancreatic cell growth may contribute to the development of diabetes in adulthood Malnutrition during the critical period of pancreatic cell growth may contribute to the development of diabetes in adulthood

MATERNAL WEIGHT A woman’s weight prior to conception influences fetal growth A woman’s weight prior to conception influences fetal growth Underweight: higher risk of a LBW infant, higher risk of a preterm infant Underweight: higher risk of a LBW infant, higher risk of a preterm infant Overweight: higher risk of medical complications such as hypertension, gestational diabetes, and postpartum infections. Also since the baby may be larger then normal - may lead to difficult labor, delivery, and birth trauma Overweight: higher risk of medical complications such as hypertension, gestational diabetes, and postpartum infections. Also since the baby may be larger then normal - may lead to difficult labor, delivery, and birth trauma However, weight loss during pregnancy is NEVER advisable However, weight loss during pregnancy is NEVER advisable

Weight Gain During Pregnancy All pregnant women must gain weight – fetal growth depends on it All pregnant women must gain weight – fetal growth depends on it Maternal weight gain during pregnancy correlates closely with infant birthweight, which is a strong predictor of the health of the infant Maternal weight gain during pregnancy correlates closely with infant birthweight, which is a strong predictor of the health of the infant

Weight Gain During Pregnancy Prepregnancy Weight Status Recommended Weight Gain Underweight (BMI<19.8) 28 to 40 pounds Normal Weight (BMI ) 25 to 35 pounds Overweight (BMI 26-29) 15 to 25 pounds Obese (BMI >29) 15 pounds minimum

Weight Gain Patterns Normal weight women should gain ~3 lbs. in the first trimester, and just under 1 lb/week thereafter Normal weight women should gain ~3 lbs. in the first trimester, and just under 1 lb/week thereafter Underweight women: 1 st trimester = 5 lbs., 1 lb/week thereafter Underweight women: 1 st trimester = 5 lbs., 1 lb/week thereafter Overweight women: 1 st trimester = 2 lbs., 2/3 lb/week thereafter Overweight women: 1 st trimester = 2 lbs., 2/3 lb/week thereafter

Most of the weight gain supports the growth and development of the placenta, uterus, blood, and breasts, as well as an optimally healthy infant Most of the weight gain supports the growth and development of the placenta, uterus, blood, and breasts, as well as an optimally healthy infant A small amount goes into maternal fat stores, and that fat has a special purpose: to provide energy for labor and lactation A small amount goes into maternal fat stores, and that fat has a special purpose: to provide energy for labor and lactation Components of Weight Gain

Weight Loss After Pregnancy The pregnant women loses some weight at delivery The pregnant women loses some weight at delivery In the following weeks, she loses more as her blood volume returns to normal and she sheds accumulated fluids In the following weeks, she loses more as her blood volume returns to normal and she sheds accumulated fluids The typical women does not return to prepregnancy weight, most tend to retain a couple of pounds with each pregnancy The typical women does not return to prepregnancy weight, most tend to retain a couple of pounds with each pregnancy In general, the more weight a women gains beyond the needs of pregnancy, the more she will retain In general, the more weight a women gains beyond the needs of pregnancy, the more she will retain

Nutrition During Pregnancy From conception to birth, all parts of the infant – bones, muscles, organs, skin, and other tissues – are made from the nutrients in the food that mother eats From conception to birth, all parts of the infant – bones, muscles, organs, skin, and other tissues – are made from the nutrients in the food that mother eats ENERGY: extra 340 calories in the 2 nd and extra 450 calories in the 3 rd trimester ENERGY: extra 340 calories in the 2 nd and extra 450 calories in the 3 rd trimester PROTEIN: 25 grams per day higher than the RDA (most are already getting that) PROTEIN: 25 grams per day higher than the RDA (most are already getting that)

Nutrition During Pregnancy ESSENTIAL FATTY ACIDS: the brain is largely made up of lipid material, and it depends highly on the omega 3 and omega 6 fatty acids for its growth, function, and structure ESSENTIAL FATTY ACIDS: the brain is largely made up of lipid material, and it depends highly on the omega 3 and omega 6 fatty acids for its growth, function, and structure Pregnant women are advised to include seafood, leafy greens, nuts, and seeds in their diet Pregnant women are advised to include seafood, leafy greens, nuts, and seeds in their diet

Mercury in Fish FDA has issued an advisory to all pregnant women, women who may become pregnant, lactating mothers, and young children – avoid eating large amounts of mackerel, swordfish, shark, tuna, and tilefish FDA has issued an advisory to all pregnant women, women who may become pregnant, lactating mothers, and young children – avoid eating large amounts of mackerel, swordfish, shark, tuna, and tilefish Pregnant and lactating women – one can of tuna per week Pregnant and lactating women – one can of tuna per week Young children – less than a can per month Young children – less than a can per month

Nutrition During Pregnancy Nutrients for: Blood production and cell growth – folate, B12, iron, and zinc Blood production and cell growth – folate, B12, iron, and zinc Bone development – vitamin D, calcium, phosphorus, magnesium, and fluoride Bone development – vitamin D, calcium, phosphorus, magnesium, and fluoride

Supplementation Women who make wise food choices during pregnancy can meet most of their nutrient needs, however, iron and folate are two nutrients that may need to be supplemented Women who make wise food choices during pregnancy can meet most of their nutrient needs, however, iron and folate are two nutrients that may need to be supplemented Women of childbearing age who are capable of becoming pregnant are advised to consume 400 micrograms of folate per day (supplements are convenient, better absorbed) Women of childbearing age who are capable of becoming pregnant are advised to consume 400 micrograms of folate per day (supplements are convenient, better absorbed) Iron supplements are recommended during the 2 nd and 3 rd trimesters of pregnancy (30 mg per day) Iron supplements are recommended during the 2 nd and 3 rd trimesters of pregnancy (30 mg per day)

Nutrition-Related Concerns Nausea – hormonal changes appear to be responsible for a woman’s sensitivities to the appearance, smell, or taste of foods Nausea – hormonal changes appear to be responsible for a woman’s sensitivities to the appearance, smell, or taste of foods Suggestions: Suggestions: On waking, arise slowly On waking, arise slowly Eat small, frequent meals Eat small, frequent meals Avoid foods with offensive odors Avoid foods with offensive odors When nauseated do not drink citrus juice, milk, coffee, or tea When nauseated do not drink citrus juice, milk, coffee, or tea

Nutrition-Related Concerns Constipation – as the hormones of pregnancy alter muscle tone and the growing fetus crowds the intestinal organs Constipation – as the hormones of pregnancy alter muscle tone and the growing fetus crowds the intestinal organs Suggestions: Suggestions: Eat foods high in fiber Eat foods high in fiber Exercise regularly Exercise regularly Drink plenty of fluids Drink plenty of fluids

Nutrition-Related Concerns Heartburn – the hormones relax the digestive muscles, and the growing fetus puts increased pressure on the mother’s stomach Heartburn – the hormones relax the digestive muscles, and the growing fetus puts increased pressure on the mother’s stomach Suggestions: Suggestions: Relax and eat slowly Relax and eat slowly Chew food thoroughly Chew food thoroughly Eat small, frequent meals Eat small, frequent meals Avoid spicy or greasy foods Avoid spicy or greasy foods Sit up while eating, elevate head when sleeping Sit up while eating, elevate head when sleeping Wait an hour after eating before lying down Wait an hour after eating before lying down

Gestational Diabetes A condition of abnormal glucose tolerance, usually during the second half of pregnancy, which resolves after birth A condition of abnormal glucose tolerance, usually during the second half of pregnancy, which resolves after birth Consequences of GD – complications during delivery, high infant birthweight, and birth defects (heart damage, limb deformities, and neural tube defects) Consequences of GD – complications during delivery, high infant birthweight, and birth defects (heart damage, limb deformities, and neural tube defects) Risk Factors: age, obesity, family history, history of abnormal glucose tolerance, ethnicity associated with a high incidence of diabetes Risk Factors: age, obesity, family history, history of abnormal glucose tolerance, ethnicity associated with a high incidence of diabetes

Practices Incompatible with Pregnancy Alcohol – limits oxygen delivery, slows cell division Alcohol – limits oxygen delivery, slows cell division Medicinal and illicit drugs Medicinal and illicit drugs Tobacco – linked to premature labor, breathing problems, and fatal illness among infants Tobacco – linked to premature labor, breathing problems, and fatal illness among infants Environmental contaminants Environmental contaminants Vitamin-Mineral megadoses Vitamin-Mineral megadoses Caffeine Caffeine Weight-loss dieting Weight-loss dieting

Low Birthweight Low birthweight (less than 5.5 lbs. or 2500 grams) is the factor most associated with infant mortality. Low birthweight (less than 5.5 lbs. or 2500 grams) is the factor most associated with infant mortality. Babies who are low birthweight are 40 times more likely to die in their first year than healthy babies. Babies who are low birthweight are 40 times more likely to die in their first year than healthy babies. Those who survive are more vulnerable to serious health and developmental problems, such as blindness, deafness, mental retardation and learning disabilities. Those who survive are more vulnerable to serious health and developmental problems, such as blindness, deafness, mental retardation and learning disabilities.

Causes of Low Birthweight Infants Poor nutrition Poor nutrition Genetics Genetics Disease conditions Disease conditions Smoking Smoking Drug use (including alcohol) Drug use (including alcohol)

LACTATION Lactation is an automatic process that virtually all mothers are capable of doing Lactation is an automatic process that virtually all mothers are capable of doing Breastfeeding is a learned behavior Breastfeeding is a learned behavior

The United States Lags in Breastfeeding The United States has one of the lowest rates of breastfeeding in the industrialized world, and one of the highest rates of infant mortality Data from 1998 indicate that only 64 percent of U.S. mothers initiate breastfeeding, and only 29 percent report feeding any human milk to their infants at six months. Those numbers stand in marked contrast to Sweden, for example, where the breastfeeding initiation rate exceeds 98 percent and the rate at six months is 80 percent.

What are the barriers to breastfeeding in the US? What are the barriers to breastfeeding in the US?

BENEFITS of BREASTFEEDING For Infants: Provides the perfect balance of nutrients with high bioavailability Provides the perfect balance of nutrients with high bioavailability Provides hormones that promote physiological development Provides hormones that promote physiological development Improves cognitive development Improves cognitive development Protects against a variety of infections Protects against a variety of infections May protect against some chronic diseases (IDDM, hypertension) May protect against some chronic diseases (IDDM, hypertension) Protects against food allergies Protects against food allergies

BENEFITS of BREASTFEEDING For Mothers Contracts the uterus Contracts the uterus Delays the return of regular ovulation Delays the return of regular ovulation Conserves iron stores (by prolonging amenorrhea) Conserves iron stores (by prolonging amenorrhea) May protect against breast cancer May protect against breast cancer May help the mother to lose weight gained during pregnancy (~650 cal/day) May help the mother to lose weight gained during pregnancy (~650 cal/day) It’s cheap! (A nursing mother produces over 35 gallons of milk during the first six months, saving ~$450 in formula costs) It’s cheap! (A nursing mother produces over 35 gallons of milk during the first six months, saving ~$450 in formula costs)

Composition of Breast Milk

Lipids: triglycerides are the major energy source, also rich in cholesterol, EFAs(EPA, and DHA) Lipids: triglycerides are the major energy source, also rich in cholesterol, EFAs(EPA, and DHA) Carbohydrates: lactose is the major CHO Carbohydrates: lactose is the major CHO Proteins: Whey proteins predominate, all essential amino acids, lactoferrin (protects infants from infection), other immunoglobulins (antibodies) Proteins: Whey proteins predominate, all essential amino acids, lactoferrin (protects infants from infection), other immunoglobulins (antibodies)

Composition of Breast Milk Vitamins and Minerals: a perfect balance of all essential vitamins and minerals Vitamins and Minerals: a perfect balance of all essential vitamins and minerals Other: digestive enzymes, anti-infective factors, hormones, and growth factors Other: digestive enzymes, anti-infective factors, hormones, and growth factors

Nutrient Needs During Lactation Energy RDA during lactation – extra 500 kcal/day (1800 kcal/day minimum) Energy RDA during lactation – extra 500 kcal/day (1800 kcal/day minimum) Protein RDA during lactation – same as during pregnancy Protein RDA during lactation – same as during pregnancy Vitamins and Minerals – milk quality is maintained at the expense of the maternal stores Vitamins and Minerals – milk quality is maintained at the expense of the maternal stores Nutrients in breast milk most likely to decline in response to inadequate stores are – B6, B12, Vitamin A and D Nutrients in breast milk most likely to decline in response to inadequate stores are – B6, B12, Vitamin A and D In general, nutritional inadequacies reduce the quantity, not the quality of breast milk In general, nutritional inadequacies reduce the quantity, not the quality of breast milk

High Protein Diets There are some concerns that it is not safe for a breastfeeding mother to be in ketosis There are some concerns that it is not safe for a breastfeeding mother to be in ketosis The Atkins Center website’s recommends that pregnant and breastfeeding women adjust their carbohydrate intake to maintenance level (enough carbohydrate to decrease ketone production) The Atkins Center website’s recommends that pregnant and breastfeeding women adjust their carbohydrate intake to maintenance level (enough carbohydrate to decrease ketone production)

Nutrition During Infancy Solid foods are introduced based on an infant’s physiological needs, such as depletion of iron stores, and on physical development, such as the ability to sit up Solid foods are introduced based on an infant’s physiological needs, such as depletion of iron stores, and on physical development, such as the ability to sit up Current recommendation: 4 to 6 months Current recommendation: 4 to 6 months

Foods To Omit Concentrated sweets Concentrated sweets Canned vegetables Canned vegetables Honey and corn syrup Honey and corn syrup Popcorn, whole grapes, whole beans, hot dog slices, hard candies, and nuts Popcorn, whole grapes, whole beans, hot dog slices, hard candies, and nuts Cow’s milk (before 12 months) Cow’s milk (before 12 months)

Food Allergies Experts recommend introducing single-ingredient foods, one at a time, in small portions, and waiting 4 to 5 days to introduce the next food (rice cereal - barley - oats - wheat) Experts recommend introducing single-ingredient foods, one at a time, in small portions, and waiting 4 to 5 days to introduce the next food (rice cereal - barley - oats - wheat) A true food allergy occurs when protein fractions of a food are absorbed into the blood and elicit an immunological response (antibodies, histamines, or other defensive agents) A true food allergy occurs when protein fractions of a food are absorbed into the blood and elicit an immunological response (antibodies, histamines, or other defensive agents) Food intolerances involve symptoms, but no antibodies Food intolerances involve symptoms, but no antibodies

Iron Deficiency Iron deficiency has a well-known and wide spread effect on children’s behavior Iron deficiency has a well-known and wide spread effect on children’s behavior Symptoms include decreased energy, learning ability, attention span, and depressed mood Symptoms include decreased energy, learning ability, attention span, and depressed mood The long-term damaging effects of iron deficiency make its prevention a high priority The long-term damaging effects of iron deficiency make its prevention a high priority

Nutrition During Infancy The two dietary practices that have the most effect on an infant’s nutrition status are the milk the infant receives and the age at which solid foods are introduced The two dietary practices that have the most effect on an infant’s nutrition status are the milk the infant receives and the age at which solid foods are introduced Breast feeding is recommended for at least 6 months, but even 2 to 3 months can give the infant immunological protection Breast feeding is recommended for at least 6 months, but even 2 to 3 months can give the infant immunological protection Breast milk is the prefect infant food, but iron, Vitamin D, fluoride, and Vitamin K may need to be supplemented Breast milk is the prefect infant food, but iron, Vitamin D, fluoride, and Vitamin K may need to be supplemented

Lead Toxicity Children who are malnourished are vulnerable to lead poisoning (they absorb more lead if their stomachs are empty, and if they have iron deficiencies) Children who are malnourished are vulnerable to lead poisoning (they absorb more lead if their stomachs are empty, and if they have iron deficiencies) Lead toxicity is most prevalent in children under 6, and 10-15% of all preschoolers may have blood lead concentrations high enough to cause mental, behavioral, and other health problems Lead toxicity is most prevalent in children under 6, and 10-15% of all preschoolers may have blood lead concentrations high enough to cause mental, behavioral, and other health problems

Lead Toxicity Lead is present in old homes (plumbing), old paint, and in some soil Lead is present in old homes (plumbing), old paint, and in some soil Children can ingest lead by drinking contaminated water, eating paint chips, playing in and around lead contaminated house dust or soil Children can ingest lead by drinking contaminated water, eating paint chips, playing in and around lead contaminated house dust or soil Lead is not easily excreted and accumulates in the bones, brain, teeth, and kidneys Lead is not easily excreted and accumulates in the bones, brain, teeth, and kidneys Deficits in intellectual development are only partially reversed when lead levels decline Deficits in intellectual development are only partially reversed when lead levels decline

Prevalence of Eating Disorders More than 5 million Americans suffer from eating disorders More than 5 million Americans suffer from eating disorders 90% of cases of anorexia and bulimia occur in females 90% of cases of anorexia and bulimia occur in females 15% of young women have substantially disordered eating attitudes or behaviors 15% of young women have substantially disordered eating attitudes or behaviors 8% of overweight women and 30% of those seeking treatment from weight loss programs meet criteria for binge eating disorder; 25% of binge eaters may be male 8% of overweight women and 30% of those seeking treatment from weight loss programs meet criteria for binge eating disorder; 25% of binge eaters may be male

What Causes Eating Disorders?

Nutrition-Related Concerns Nausea – hormonal changes appear to be responsible for a woman’s sensitivities to the appearance, smell, or taste of foods Nausea – hormonal changes appear to be responsible for a woman’s sensitivities to the appearance, smell, or taste of foods Suggestions: Suggestions: On waking, arise slowly On waking, arise slowly Eat small, frequent meals Eat small, frequent meals Avoid foods with offensive odors Avoid foods with offensive odors When nauseated do not drink citrus juice, milk, coffee, or tea When nauseated do not drink citrus juice, milk, coffee, or tea

Nutrition-Related Concerns Nausea – hormonal changes appear to be responsible for a woman’s sensitivities to the appearance, smell, or taste of foods Nausea – hormonal changes appear to be responsible for a woman’s sensitivities to the appearance, smell, or taste of foods Suggestions: Suggestions: On waking, arise slowly On waking, arise slowly Eat small, frequent meals Eat small, frequent meals Avoid foods with offensive odors Avoid foods with offensive odors When nauseated do not drink citrus juice, milk, coffee, or tea When nauseated do not drink citrus juice, milk, coffee, or tea

Nutrition-Related Concerns Constipation – as the hormones of pregnancy alter muscle tone and the growing fetus crowds the intestinal organs Constipation – as the hormones of pregnancy alter muscle tone and the growing fetus crowds the intestinal organs Suggestions: Suggestions: Eat foods high in fiber Eat foods high in fiber Exercise regularly Exercise regularly Drink plenty of fluids Drink plenty of fluids

Nutrition-Related Concerns Heartburn – the hormones relax the digestive muscles, and the growing fetus puts increased pressure on the mother’s stomach Heartburn – the hormones relax the digestive muscles, and the growing fetus puts increased pressure on the mother’s stomach Suggestions: Suggestions: Relax and eat slowly Relax and eat slowly Chew food thoroughly Chew food thoroughly Eat small, frequent meals Eat small, frequent meals Avoid spicy or greasy foods Avoid spicy or greasy foods Sit up while eating, elevate head when sleeping Sit up while eating, elevate head when sleeping Wait an hour after eating before lying down Wait an hour after eating before lying down