Nutrition 526 2012 framing maternal infant nutrition
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Nutrition 526 - 2012 Framing Maternal & Infant Nutrition. Healthy People 2020 Maternal, Infant and Child Health. Why do we care about maternal and infant nutritional health? What are the determinants of maternal and infant health?

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Nutrition 526 - 2012 Framing Maternal & Infant Nutrition

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Nutrition 526 2012 framing maternal infant nutrition

Nutrition 526 - 2012Framing Maternal & Infant Nutrition


Healthy people 2020 maternal infant and child health

Healthy People 2020 Maternal, Infant and Child Health

  • Why do we care about maternal and infant nutritional health?

  • What are the determinants of maternal and infant health?

  • What are some key indicators of maternal and infant nutritional health: preconceptionally,in the fetus & infant, during pregnancy?


A life course framework t2 e2

A Life Course Framework: T2 E2

Timeline: todays exposures influence tomorrows health

Timing: health trajectories are particularly affected during critical periods

Environment: the broader community environment strongly affects the capacity to be healthy

Equity: inequality in health reflects more than genetics and personal choice


A public health approach to maternal and infant health

A Public Health Approach to Maternal and Infant Health

  • Assessment

  • Policy Development

  • Assurance: Surveillance and monitoring progress towards goals


Assessment

Assessment

  • Pregnancy population characteristics

  • Maternal health indicators

  • Infant health indicators


Nutrition 526 2012 framing maternal infant nutrition

In 2008 births and birth rate were ~ 2% less than 2007; in 2009 they were ~ 3% less than 2008. http://www.cdc.gov/nchs/products/nvsr.htm


Nutrition 526 2012 framing maternal infant nutrition

http://www.cdc.gov/nchs/products/nvsr.htm


Birth rates for females ages 15 17 by race and hispanic origin 1980 2010

Birth rates for females ages 1517 by race and Hispanic origin, 19802010

America's Children in Brief: Key National Indicators of Well-Being, 2012: Http://childstats.gov/americaschildren/fam_fig.asp#fam2a


Percentage of all births to unmarried women by age of mother 1980 and 2010

Percentage of all births to unmarried women by age of mother, 1980 and 2010

America's Children in Brief: Key National Indicators of Well-Being, 2012: Http://childstats.gov/americaschildren/fam_fig.asp#fam2a


Population indicators trends for maternal health

Population Indicators & Trends for Maternal Health

  • Pre-conceptual indicators

  • Weight gain

  • Diabetes in pregnancy

  • Pre-eclampsia

  • Cesarean delivery

  • Maternal death


Nutrition 526 2012 framing maternal infant nutrition

Weight Gain During Pregnancy: Reexamining the Guidelines, IOM. 2009


Nutrition 526 2012 framing maternal infant nutrition

Per birth certificate includes all diabetes in pregnancy


Nutrition 526 2012 framing maternal infant nutrition

African American and White Women Who Died of Pregnancy Complications,* United States

* Annual number of deaths during pregnancy or within 42 days after delivery, per 100,000 live births. The apparent increase in the number of maternal deaths between 1998 and 1999 is the result of changes in how maternal deaths are classified and coded. Source: CDC, National Center for Health Statistics.


Population indicators of infant health

Population Indicators of Infant Health

  • Infant mortality

  • Birthweight

  • Gestational age


Infant mortality

Infant Mortality

  • Infant mortality rate Deaths of infants aged under 1 year per 1,000 or 100,000 live births. The infant mortality rate is the sum of the neonatal and postneonatal mortality rates.

  • Neonatal mortality rate Deaths of infants aged 0-27 days per 1,000 live births. The neonatal mortality rate is the sum of the early neonatal and late neonatal mortality rates

  • Postneonatal mortality rate Deaths to infants aged 28 days-1 year per 1,000 live births.


Nutrition 526 2012 framing maternal infant nutrition

http://www.chipublib.org/004chicago/disasters/infant_mortality.html


Death rates among infants by race and hispanic origin of mother 1983 1991 and 1995 2010

Death rates among infants by race and Hispanic origin of mother, 19831991 and 19952010

America's Children in Brief: Key National Indicators of Well-Being, 2012: Http://childstats.gov/americaschildren/fam_fig.asp#fam2a


Nutrition 526 2012 framing maternal infant nutrition

QuickStats: Infant Mortality Rates, by Mother's Place of Birth and Race/Ethnicity --- United States,* 2007

MMWR

July 8, 2011 /

60(26);891


Nutrition 526 2012 framing maternal infant nutrition

Muntaner, C et al. ECONOMIC INEQUALITY, WORKING-CLASS POWER,SOCIAL CAPITAL, AND CAUSE-SPECIFICMORTALITY IN WEALTHY COUNTRIES. International Journal of Health Services, Volume 32, Number 4, Pages 629656, 2002

  • In summary, the rates of low birth weight and infant deaths from all causes were lower in those countries with more voter turnout, more left votes, more left members of parliament, more years of social democratic government, more women in government, a stronger social pact and various aspects of the welfare state, and low income inequality, as measured in a variety of ways.


Birthweight gestational age

Birthweight & Gestational Age


Birthweight definitions

Birthweight Definitions

  • LBW = low birthweight (less than 2,500 grams)

  • VLBW = Very low birthweight (less than 1,500 g

  • ELBW = Extremely low birthweight (less than 1,000 g)

  • LGA = Large for gestational age (macrosomia); > 90th %; 4,000 (ICD9) or 4,500 g


Nutrition 526 2012 framing maternal infant nutrition

Defining Small for Gestational Age (SGA) and Large for Gestational Age (LGA)


Percentage of infants born preterm and percentage of infants born with low birthweight 1990 2010

Percentage of infants born preterm and percentage of infants born with low birthweight, 19902010

America's Children in Brief: Key National Indicators of Well-Being, 2012: Http://childstats.gov/americaschildren/fam_fig.asp#fam2a


Nutrition 526 2012 framing maternal infant nutrition

Percentage of infants born with low birthweight by race and Hispanic origin of mother, 1990, 2006, and 2010

America's Children in Brief: Key National Indicators of Well-Being, 2012: Http://childstats.gov/americaschildren/fam_fig.asp#fam2a


Social determinants

Social Determinants


Nutrition 526 2012 framing maternal infant nutrition

Percentage of children ages 017 living in poverty by race, Hispanic origin and family type, 19802010

America's Children in Brief: Key National Indicators of Well-Being, 2012: Http://childstats.gov/americaschildren/fam_fig.asp#fam2a


Nutrition 526 2012 framing maternal infant nutrition

Social-Ecological Model for Determinants of

Access to Resources & Nutrition Behaviors

Structures, Policies, Systems

Local, state, federal policies and laws

Institutions

Rules, regulations, policies & informal structures

Community

Social Networks, Norms, Standards

Interpersonal

Family, peers, social networks, associations

Individual

Knowledge, attitudes, beliefs


Individual pregnancy

Individual - Pregnancy

  • Physiology and Psychology of Pregnancy

  • Maternal Preconceptional status

    • Inter-generational programming

  • Diet in pregnancy: energy/weight gain, macro & micronutrients

  • Behaviors that impact nutritional status

    • Substances: alcohol, caffeine, tobacco, drugs

    • Physical activity

    • Oral health

    • Pregnancy intendedness

  • Stage of development: adolescence

  • High risk situations: GDM, Hypertensive disorders of pregnancy


Intrapersonal community

Intrapersonal/Community

  • Social and cultural environments

  • Support from friends and family

  • Health and nutrition care providers


Institutional

Institutional

  • Hospital breastfeeding & formula policies

  • Child Care policies

  • School policies for pregnant and parenting teens

  • Worksite lactation policies


Policy environment

Policy & Environment

  • Nutrition Assistance Programs for pregnancy, lactation and early childhood.

  • Insurance policies for lactation support

  • Parental leave policies


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