Nutrition During Pregnancy and Lactation - PowerPoint PPT Presentation

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Nutrition During Pregnancy and Lactation

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  1. Nutrition During Pregnancy and Lactation Nutrition for Infants and Toddlers

  2. Health Threats to Children The most critical threats to the lives of children under age five globally are:  • Pneumonia (18%) • Diarrheal diseases (15%) • Pre-term birth complications (12%) • Birth asphyxia (9%) • Under-nutrition is an underlying cause of ~1/3 U5M Sub-Saharan Africa > 50% deaths due to malaria, diarrhea, pneumonia

  3. Mother’s Day Report Card • Each year Save the Children publishes the Mother’s Day Report Card which includes data on the health of women and children worldwide • Highly recommended reading for anyone who works with children • 2013 Report released this morning!

  4. Best country for women & children Finland • Life expectancy girl born today = 83 • Under 5 mortality rate: 2.9 deaths/1000 live births • Lifetime risk of dying as a result of pregnancy or childbirth: 1 in 12,200 • many countries are lower • E.g. 1/25,500 in Greece • Save the Children, May 2013 Report

  5. United States Data (2010 data) • Life expectancy girl born today = 82 • Under 5 mortality rate: 7.5 deaths/1000 live births • Lifetime risk of dying as a result of pregnancy or childbirth, 1 in 2,400 women

  6. United States Data Childhood Obesity begins young in the US • 9.5 % of children under the age of 2 are overweight, 11.5 % are obese • 23.3 % of children ages 2 – 5 are overweight or obese

  7. Worst country for women & children – DR Congo • Lifetime risk of dying as a result of pregnancy or childbirth: 1 in 30 • 1 in 6 babies born will die before age 5 • 90% of women will have a child die befor age 5 • Life expectancy girl born today = 45

  8. Where is DR Congo?

  9. Afghanistan 10 worst countries for women and children

  10. Somalia • Life expectancy girl born today = 52 • Under 5 mortality rate: 180 deaths/1000 live births • 1 in 16 women die during pregnancy or childbirth • 36% of children under 5 are underweight for their age • 70% lack access to clean water

  11. One island, two health stories

  12. In Haiti, 73% of children 6-24 months and 60% of pregnant women are anemic.

  13. Zambia – Quick Facts 1 in 37 women die from pregnancy related disorders 1 in 82.9 children die before the age of 5

  14. “Life-Saving Six” for Keeping Babies Alive, Nutrition Matters • Iron (mother and child) and folate (mom) • Breastfeeding – 1st 6 months exclusively • Complementary feeding – 6 mos + • Vitamin A ( 2 doses /year, child) • Zinc (child) • Decreases diarrheal deaths • Hygiene, water, sanitation

  15. “Mortality” Definitions • Neonatal mortality rate • death of infants in the 1st 28 days of life • Infant mortality rate • death of infants in the 1st year of life • Both are reported in deaths/1000 live births

  16. Neonatal (<28 days) Mortality Data

  17. Infant (<1 yr) Mortality Data

  18. Infant (<1 yr) Mortality Data

  19. More Recent U.S. Data

  20. Infant mortality rates, by state: U.S. - 2010

  21. Percent change in infant mortality rates, by race and ethnicity: United States, 2005–2011

  22. Leading causes of infant death in 2011 U.S. Congenital malformations Pre-term/low birthweight Sudden infant death syndrome (SIDS) Maternal complications Unintentional injuries Together, these 5 causes accounted for 56% of all infant deaths in the United States in 2011

  23. Infant Mortality • Lowest rates for mothers in their late 20’s- early 30’s • Adolescent mothers have the highest infant mortality rate in US • Infant mortality is • 83% higher in unmarried mothers • Higher in smokers • Higher in pre-term infants

  24. Maternal Mortality • All US women: ~12.7 deaths/100,000 live births • White women: 10.5 (risen) • Black women: 28.4 • Hispanic: 8.9 • 2007 data

  25. Infant Mortality • Many of the deaths can be attributed to: • Poor maternal nutrition • Low birth weight/pre-term babies • Lack of prenatal care • Lack of health insurance • SIDS • Nutrition before and during pregnancy is critical to the health of baby

  26. Nutrition During Pregnancy • Time of significant growth for mother and fetus • Goal is to start pregnancy with full nutritional stores

  27. Nutrition During Pregnancy • Of greatest importance pre-pregnancy are having adequate levels of: • Folate • Iron

  28. Caloric Needs and Weight Gain

  29. Weight Gain Recommendations

  30. Weight Gain • Insufficient maternal weight gain increases risk of low birth weight baby (LBW) • LBW = birth weight less than 5 ½ pounds • LBW are 40x more likely to die in the first year of life than healthy weight baby • 1 in 12 babies in US are of LBW • Black 2x as likely to have a LBW baby as white/Hispanic

  31. “Morning” Sickness (MS) • ~75% of women experience MS during the first months of pregnancy • May be triggered by foods, smells, thought of food • May be related to enhanced sense of smell • Iron supplements may trigger nausea in some • May occur any time of day • Suggestions?......

  32. Weight Gain • Sharp weight gains may signal: • Water retention • Pregnancy induced hypertension ~7% pregnancies • May be associated with low vitamin D levels • Preclampsia – mild hypertension • Eclampsia – more serious • Previously called toxemia

  33. Eclampsia • At greatest risk: • Over 35 and under 17 • Carrying twins or more! • Family/personal history of • Diabetes • First pregnancy • African American descent

  34. Eclampsia • Symptoms/consequences • Edema • Hypertension • Protein in urine • Kidney failure • Liver damage • Convulsions and death of mom and/or baby

  35. Eclampsia • Treatment • Bed rest • Magnesium sulfate (diuretic) • Deliver baby

  36. Nutritional Needs - Pregnancy • Protein • Needs increase by 25 g/day • 1.1 g protein/kg body weight • Page 521 has a good summary of all nutritional needs

  37. Minerals • Minerals • Calcium, no increase • The number of calcium binding proteins increases in the SI. This results in increases absorption. • Critical that diet includes 3-4 servings of calcium rich foods each day. • Iron needs nearly double • Zinc needs go by ~30% • Zinc is found in proteins

  38. Vitamins • B Vitamins • RDA for all goes up by ~30% • Folate needs go up by 50% • Eat more vegetables and select whole grain products. • Vitamin C • Need a little extra

  39. Vitamins • NO EXTRA needed for: • Vitamin D • Vitamin A in the form of active vitamin A • DO NOT TAKE VITAMIN A SUPPLEMENTS DURING PREGNANCY • Increases the risk of serious birth defects • Extra beta-carotene (plant form of vitamin A) is fine and probably good for you

  40. Practices to AVOID • Smoking • Increases risk of LBW, miscarriages, infant death • Caffeine (?) • Heavy coffee drinking may lead to and increased risk of LBW • High levels of caffeine may increase the risk of miscarriage

  41. Practices to AVOID • Fasting or low/no carbohydrate diets • Ketones may slow fetal brain development • Aspartame (?) • Probably OK as long as mom does not have PKU • Recommend no more than 1 Liter of diet soda per day

  42. Practices to AVOID • Eating unpasteurized dairy products, raw cabbage, raw meats • Brie, feta, blue cheeses, goat cheeses • Increased risk of Listeria • Flu-like symptoms • May cause miscarriage and death of mom

  43. Practices to AVOID • Vitamin megadoses • Alcohol • Increases risk of fetal alcohol syndrome (FAS)

  44. FAS • Brains of 6 week old infants No FAS FAS

  45. FAS • Physical Characteristics • Broad, short, flat nose • No dimple above lip • Narrow eyes • Flat face

  46. Practices to AVOID • Illegal Drugs • Marijuana and cocaine can increase risk of: • LBW • Nervous system disorders • Irregular heart rate • Drug withdrawal symptoms in infant • Neonatal death