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Chapter 11 Life Cycle: Maternal and Infant Nutrition
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Nutrition Before Conception
Health Care and Guidance Screening for risk Health promotion and education Intervention as needed Weight Maintain a healthy weight Low or high weight increases risk for poor outcome Not a good time to “diet” 2
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Nutrition Before Conception
Vitamins 400–800 micrograms synthetic folic acid per day reduces risk of fetal neural tube defect Avoid high doses of vitamin A (retinol) to avoid teratogenic effect 3
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Nutrition Before Conception
Substance use Eliminate prior to pregnancy 4
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Physiology of Pregnancy
Stages of Human Fetal Growth Blastogenic stage: first 2 weeks Cells differentiate into fetus and placenta Embryonic stage: weeks 2 to 8 Development of organ systems Fetal stage: week 9 to delivery Growth 5
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Physiology of Pregnancy
Maternal Physiological Changes Growth of maternal tissue Adipose, breast, and uterine tissues Increase in maternal blood volume Slower GI motility 8
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Maternal Weight Gain Recommendations depend on BMI
Normal weight (BMI = 19.8–26 kg/m2) Gain 25 to 35 pounds Higher recommended gain for underweight women, teens, and for pregnancies involving multiple fetuses Lower recommended gain for overweight and obese women 10
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Energy and Nutrition During Pregnancy
Needs increase to support fetus and placenta, as well as increased workload on mother’s heart and lungs Support adequate weight gain Nutrients to support pregnancy Recommended that all women planning on pregnancy take a folic acid supplement Well-balanced diet 13
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Energy and Nutrition During Pregnancy
Macronutrients Moderate-protein, low-fat, and high carbohydrate Protein Extra needed for synthesis of new maternal, placental, and fetal tissues Additional 25 gm/d over nonpregnancy needs 15
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Energy and Nutrition During Pregnancy
Macronutrients Fat Fuel for mother and development of placenta Stored fat supports breastfeeding Carbohydrates Main source of extra calories Complex carbohydrates Fiber-rich 16
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Energy and Nutrition During Pregnancy
Micronutrients Increased needs for most vitamins and minerals Support growth and development Highest increase for iron and folate Increased needs for vitamins A, B, and C 17
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Food Choices for Pregnant Women
Follow the USDA’s Daily Food Plan for Moms Variety key to a well-balanced diet Additional servings of grain, vegetable, fruit, and low-fat milk Supplementation Supplement with prenatal formula Herbal supplements not recommended 18
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Food Choices for Pregnant Women
Foods to Avoid Alcohol Certain types of fish high in mercury Caffeine in quantities higher than milligrams per day 19
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Substance Use and Pregnancy Outcome
Tobacco Increases risk for miscarriage, stillbirth, preterm delivery, and low birth weight Alcohol Increases risk for Fetal Alcohol Syndrome Physical and mental defects Growth retardation No known safe threshold for alcohol use 21
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Substance Use and Pregnancy Outcome
Drugs Increase risks for low birth weight, preterm delivery, miscarriage, birth defects, and infant addiction Maternal marijuana use can lead to physical abnormalities similar to those caused by Fetal Alcohol Syndrome 22
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Special Situations During Pregnancy
Gastrointestinal Distress Morning sickness Constipation Heartburn 24
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Special Situations During Pregnancy
Food Cravings and Aversions Pica—term for craving nonfood items Hypertension Preeclampsia Diabetes May need to adjust diet and insulin as needed 25
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Special Situations During Pregnancy
Gestational diabetes Hormones of pregnancy tend to counteract insulin Often controlled through diet May require insulin therapy 26
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Special Situations During Pregnancy
HIV/AIDS Medical treatment to reduce risk of transmission Multiple nutrition problems for mother Protein-energy malnutrition Vitamin and mineral deficiency Inadequate weight gain 28
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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 Prepregnancy eating patterns a concern Weight gain toward upper limit recommended Need for supplements 29
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Lactation Breastfeeding Trends Healthy People 2020 goals
To increase the proportion of newborns who are initially breastfed to almost 82% Current stats: 77% of infants breastfed initially 49% of infants still breastfed at 6 months 30
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Physiology of Lactation
Changes during Adolescence and Pregnancy Increased breast tissue Maturation of structure After Delivery Milk production and secretion Colostrum: first milk 31
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Physiology of Lactation
Hormonal Controls Prolactin: stimulates milk production Oxytocin: stimulates milk release “Let-down” reflex 32
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Nutrition for Breastfeeding Women
Energy Needs 330 kcal/day during first six months Needs 400 kcal/day during second six months Proteins RDA: 1.3 g per kg/day 33
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Nutrition for Breastfeeding Women
Vitamins and Minerals Needs higher or same as during pregnancy Exceptions Vitamins D and K remain same Iron and folate needs are lower than during pregnancy Water AI for total water = 3.8 liters/day 34
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Nutrition for Breastfeeding Women
Food Choices USDA’s Daily Food Plan for Moms ~2,200–2,800 Kcalories/day Choose foods high in vitamins and minerals and low in added sugar and solid fats Supplementation May be necessary for vegan women and women who do not drink milk or other fortified products 35
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Benefits of Breastfeeding
Benefits for infants Optimal nutrition Protects infant from infections and illness including diarrhea, ear infections, pneumonia, and asthma Convenience Other benefits 36
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Benefits of Breastfeeding
Benefits for Mother Convenience Enhanced recovery of uterus size Help women return to pre-pregnancy weight faster Other benefits
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Contraindications to Breastfeeding
May be inappropriate due to infant or maternal disease or drug use Breast enlargement or reduction surgery Infectious or chronic disease (ex. HIV) Prescription and illegal drugs
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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 40
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Infancy Growth is the best marker of nutritional status
Evaluated using growth charts Weight gain Double birth weight by 4 to 6 months Triple birth weight by 12 months Length gain Increase length by 50% by 12 months Head circumference 41
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Energy and Nutrient Needs During Infancy
Requirements based on composition of breast milk Energy and Protein Highest needs of any life stage Carbohydrate and fat Fat: major energy source Carbohydrates as simple sugars Water More needed due to immaturity of organs Human milk or formula satisfies fluid requirements 43
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Energy and Nutrient Needs During Infancy
Key Vitamins and Minerals Vitamin D Vitamin K Vitamin B12 Iron Fluoride 45
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Energy and Nutrient Needs During Infancy
Newborn Breastfeeding Ideal method of feeding Feedings should occur every 2-3 hours with total of 8-12 feedings per day 46
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Energy and Nutrient Needs During Infancy
Alternative feeding: infant formula Standard infant formula Cow’s milk base Soy-based formula Soy protein Used to eliminate feeding problems such as vomiting and diarrhea 47
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Energy and Nutrient Needs During Infancy
Special formula Allergies Premature babies Defects in metabolic pathway Use medium-chain triglycerides as the fat source 48
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Energy and Nutrient Needs During Infancy
How much is enough? Guidelines for feeding infant Measure amount of formula baby takes Six or more wet diapers per day Three or more stools per day Regain to birth weight within first two weeks 49
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Introduction of Solid Foods
Readiness for solids Physiological readiness Digestive enzymes Ability to maintain hydration Developmental readiness Lack of extrusion reflex Head and body control Feeding schedule Start Healthy Feeding Guidelines 50
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Feeding Problems During Infancy
Colic Crying and distress Early childhood dental caries Associated with putting baby to bed with a bottle Iron-deficiency anemia 53
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Feeding Problems During Infancy
Gastroesophageal reflux Usually disappears within 12–18 months Diarrhea Requires increased fluids Failure to thrive Poor growth in absence of disease 54
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