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Jump-Starting IYCF:

Jump-Starting IYCF:. Infant nutritional status depends on the mother’s status. Starting in Pregnancy?. Or Before?. Nutrient status of the mother. Pre-pregnancy diet Pre-pregnancy nutritional status Pre-pregnancy work load or activity level Spacing between pregnancies.

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Jump-Starting IYCF:

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  1. Jump-Starting IYCF:

  2. Infant nutritional status depends on the mother’s status

  3. Starting in Pregnancy? Or Before?

  4. Nutrient status of the mother • Pre-pregnancy diet • Pre-pregnancy nutritional status • Pre-pregnancy work load or activity level • Spacing between pregnancies

  5. Measuring Adult Nutritional Status Body Mass Index BMI = weight (kg) / height (m)2 60.5 kg / (1.6 m x 1.6 m) = 24

  6. Effects of Maternal Nutrition • Ability to nourish in-utero starting at conception • Ability to provide quality breastfeeding without depleting her own nutrient stores • Maintenance of her quality of life, productivity and capacity to care for child

  7. Changes in Nutrient Needs

  8. Physiological changes during pregnancy • 40% increase in blood volume and 25% increase in red blood cell mass • Increase in lung ventilating capacity and rate • Fat deposition during first half of pregnancy • Rapid growth of fetus and placenta during second half of pregnancy • Synthesis of large quantities of new protein tissue - also require energy

  9. Energy Intake during Pregnancy • Increase roughly 200-300 kilocalories/day during second and third trimester • Depends or pre-pregnancy BMI • Underweight women may need more kcal • Active women must also decrease physical activity

  10. Weight Gain During Pregnancy • Average weight gain is 10 to 12 kg: • Fetus, placenta, amniotic fluid 5 kg • Maternal blood 1 – 1.5 kg • Maternal tissue fluid 1 – 1.5 kg • Uterus, breasts 1 – 1.5 kg • Maternal adipose tissue 4 kg

  11. Energy Needs during Lactation • Increase by up to 500 kilocalories per day • Fat stored during pregnancy can be used to satisfy this energy requirement • Increased energy intake does not result in increased milk production in adequately nourished women • Sufficient amount of milk can be produced by women with low energy intake

  12. Why so much energy for lactation? • Human milk is about 70 kcal/100 ml • Maternal energy is converted with about 80% efficiency to milk energy • ~85 kcal of maternal energy needed to produce 100 ml of breast milk • An average milk secretion of 750 ml per day, requires 640 kcal/day • Some of this can come from stored fat

  13. Nutrient Quality of Breast Milk • Energy, protein, and some mineral content is not affected by maternal dietary intake or stores • Vitamin C, thiamine, riboflavin, B6, B12, Vitamin A, iodine and selenium are dependent on maternal intake or stores • Maternal intake has minimal effect on content of zinc, iron, folate, Vitamin D, calcium and copper content of breast milk

  14. Protein • About 925 g of new protein are synthesized and deposited in mother and fetus • Average breast milk production per day - 750 ml with protein content of 1.25 g/100 ml • Adequate energy intake from carbohydrates is essential to assure new protein synthesis

  15. Iron-deficiency anemia • 50% of anemia is from iron deficiency • Absorption may be as important as low dietary intake • Inhibitors • Heme vs. non-heme • Other major causes of anemia: • Malaria • Helminthes

  16. Efficacy of Iron Supplementation • World Bank review found that distribution was the limiting factor not utilization • Counseling on purpose is as important as counseling on controlling side effects • Some concern that iron inhibits zinc and copper absorption

  17. Actions to Prevent Anemia • Promote intake of iron-rich foods, especially animal products and fortified foods • Provide iron supplementation to pregnant women • Continue supplementation for 3 months post-partum in areas with anemia prevalence >40 percent • De-worming of pregnant women after first trimester, and lactating women, according to WHO protocol • Prevent and control malaria

  18. Vitamin A • Provide post-partum high-dose vitamin A supplementation to women • If breastfeeding, within 8 weeks of delivery • If not breastfeeding, within 6 weeks of delivery • Promote consumption of vitamin A-rich foods, including liver, fish, egg, and red and yellow fruits and vegetables • Promote consumption of vitamin A-fortified foods

  19. Iodine • Sufficient iodine intake in pregnancy and lactation is essential in prevention of maternal and fetal hypothyroidism • Insufficient iodine intake in pregnancy may have an adverse effect on fetus as early as 8-10 weeks of gestation • Iodine content of breast milk depends on iodine intake by lactating mother

  20. Calcium • about 30 g of Ca is accumulated in pregnancy to meet fetal needs and demands of lactation • absorption of Ca increases up to two times in the second half of pregnancy thus reducing needs for increased intake • • Ca content of breast milk does not depend on calcium intake

  21. Zinc • Some data suggest that Zn deficiency may cause intrauterine growth retardation of fetus • Zn levels in maternal serum decline during pregnancy (dilution effect) • When Zn intake is low (less than 7.3 mg/day) absorption of Zn increases; • This may be sufficient to meet maternal needs without extra Zn supplements • • Zn absorption is decreased by Fe supplements

  22. Folic Acid • Folate deficiency during pregnancy may cause megaloblastic anemia • Deficiency of folate in pregnancy is related to occurrence of neural tube defects in fetus • The critical period for preventing neural tube defects is often before pregnancy is diagnosed • Folate in foods is destroyed by boiling

  23. Essential Nutrition Actions 4. Prevention of vitamin A deficiency for women 5. Promotion of adequate intake of iron and folic acid for women 7. Promotion of optimal nutrition for women: • Consume more food during pregnancy and lactation • Pregnancy: 285 extra kcal/day • Lactation: 500 extra kcal/day • Increase protein intake during pregnancy and lactation (e.g. pulses, animal source foods, oilseeds) • Provide iron/folic acid supplementation for pregnant women • Treat and prevent malaria • De-worm during pregnancy in areas where helminths are a determinant of anemia • Provide post-partum vitamin A supplementation • Promote consumption of iodized salt

  24. What to do in the field? At the Community Level: • BCC: incorporate maternal nutrition messages at key contact points • Promote increased caloric consumption of pregnant and lactating women and decreased physical activity • Promote improved dietary diversity among all women of reproductive age • Promote consumption of fortified foods • Engage spouses and in-laws during home visits • Promote uptake of key maternal nutrition services • Home Food Production of nutrient-rich animal foods, fruits and vegetables • Food supplementation to food insecure households • Food fortification: vitamin A, iron/folic acid, and iodine

  25. With the Health Services • Micronutrient supplementation: vitamin A and iron/folic acid • Complementary maternal health services • Malaria prevention and treatment • Helminth prevention and treatment • Develop and strengthen referral systems

  26. When intervention is urgent: • >10% of adult population has a BMI <18.5 • For women, based on pre-pregnancy weight • >15% of newborns are LBW (<2500g) = high public health concern

  27. Thank-you

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