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Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
Pregnancy infancy lactation ch16
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Pregnancy infancy lactation ch16

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  • 1. Pregnancy, Lactation and Infancy LIFECYCLE NUTRITION
  • 2. Dangerous Practices <ul><li>Smoking </li></ul><ul><li>Alcohol consumption </li></ul><ul><li>Some prescription and OTC drugs </li></ul><ul><li>Illegal drugs (cocaine, marijuana) </li></ul><ul><li>Job-related stress and hazards </li></ul><ul><li>Inadequate diet </li></ul><ul><li>Excess vitamin A </li></ul><ul><li>Heavy caffeine use </li></ul><ul><li>HIV/AIDS </li></ul><ul><li>Poor control of diabetes or hypertension </li></ul>
  • 3. Normal Pregnancy <ul><li>Gestation = 40 weeks </li></ul><ul><li>Premature/preterm = born prior to 36 weeks </li></ul><ul><ul><li>Main concerns: underdeveloped lungs, high risk for infection, difficulty feeding </li></ul></ul><ul><li>Normal baby weight = 5.5 to 7.5 lb and up </li></ul><ul><ul><li>Low-birth-weight <5.5 lb </li></ul></ul>
  • 4. Trimesters <ul><li>Trimester – approx. 3 months/14 weeks </li></ul><ul><li>½ of all pregnancies are unplanned, many are not recognized for 1 to 3 months, near the end of the first trimester </li></ul><ul><li>1 st trimester: critical growth period </li></ul><ul><ul><li>By day 28, neural tube closes </li></ul></ul><ul><ul><li>By day 35, heart beating, baby 8mm long </li></ul></ul><ul><ul><li>By 13 weeks, most organs formed </li></ul></ul><ul><li>2 nd and 3 rd trimesters: continued growth </li></ul><ul><ul><li>Organ specialization </li></ul></ul><ul><ul><li>After 26 weeks: Good chance of survival (with intensive care) </li></ul></ul><ul><ul><li>Fat accumulation during 3 rd trimester </li></ul></ul>
  • 5. Fig. 14.1
  • 6. Pregnancy Changes <ul><li>Uterus growth </li></ul><ul><li>Placenta </li></ul><ul><li>Mammary tissue growth </li></ul><ul><li>Plasma doubles </li></ul><ul><li>RBC count increases </li></ul><ul><li>Increased work by heart and kidneys </li></ul><ul><li>Increased body fat </li></ul>
  • 7. Weight Gain During Pregnancy <ul><li>3-4 lb during first trimester </li></ul><ul><li>1 lb per week during 2 nd and 3 rd trimesters </li></ul><ul><li>Total weight gain recommendations: 25-35 lb </li></ul><ul><ul><li>If underweight mother or carrying multiples, may need to gain 40 lb or more </li></ul></ul><ul><ul><li>If overweight, still need to gain 15-18 lb during pregnancy (weight of baby, uterus, placenta, mammary tissue, extra blood volume) </li></ul></ul><ul><li>Weight loss NEVER recommended during pregnancy!!! </li></ul>
  • 8. <ul><li>Risks associated with too little weight gain: </li></ul><ul><ul><li>Low-birth-weight baby </li></ul></ul><ul><ul><li>Inadequate development of baby (if nutrients lacking – recall, folic acid and NTDs) </li></ul></ul><ul><ul><li>Nutritional deficiencies in mother </li></ul></ul><ul><li>Risks associated with too much weight gain: </li></ul><ul><ul><li>Difficult delivery with large baby </li></ul></ul><ul><ul><li>Greater likelihood of C-section </li></ul></ul><ul><ul><li>More anesthesia needed </li></ul></ul><ul><ul><li>Difficulty with weight loss after delivery </li></ul></ul>
  • 9.  
  • 10. Nutrient Needs <ul><li>Energy: </li></ul><ul><ul><li>Extra 300 kcal per day during 2 nd and 3 rd trimesters </li></ul></ul><ul><ul><li>NOT “eating for two” </li></ul></ul><ul><ul><li>Should be from nutrient-dense foods </li></ul></ul><ul><li>Protein: </li></ul><ul><ul><li>Extra 25 grams/day </li></ul></ul><ul><li>Micronutrients: </li></ul><ul><ul><li>Vitamins A, C, B-complex (including folic acid), and minerals (iodine, iron, and others) have higher RDAs </li></ul></ul><ul><ul><li>Note: RDA for calcium is not higher (calcium is better absorbed during pregnancy), but most women underconsume calcium </li></ul></ul>
  • 11. Nutrition-related Complications <ul><li>Morning sickness </li></ul><ul><li>Often associated with increased sensitivity to smells </li></ul><ul><ul><li>Strategies for reducing nausea and vomiting: </li></ul></ul><ul><ul><ul><li>Avoid fried/greasy foods </li></ul></ul></ul><ul><ul><ul><li>Cook w/ windows open </li></ul></ul></ul><ul><ul><ul><li>Eat crackers or dry cereal before getting out of bed </li></ul></ul></ul><ul><ul><ul><li>Eat small, frequent meals </li></ul></ul></ul><ul><ul><ul><li>Ask doctor about iron in prenatal supplement </li></ul></ul></ul><ul><ul><ul><li>If food sounds good, eat it! </li></ul></ul></ul>
  • 12. Nutrition-related Complications <ul><li>Placental hormones cause smooth muscle to relax (goal: prevent early contractions of the uterus) </li></ul><ul><li>Constipation </li></ul><ul><ul><li>Peristalsis is weakened </li></ul></ul><ul><ul><li>Fluids, fiber, exercise all help </li></ul></ul><ul><li>Heartburn </li></ul><ul><ul><li>Decreased LES (lower esophageal sphincter tone) </li></ul></ul><ul><ul><li>Sit up after eating meals </li></ul></ul><ul><ul><li>Fluids between meals </li></ul></ul><ul><ul><li>Avoid foods that aggravate reflux </li></ul></ul><ul><ul><ul><li>Caffeine, fatty foods, spicy foods, chocolate </li></ul></ul></ul>
  • 13. Nutrition-related Complications <ul><li>Anemia </li></ul><ul><ul><li>Normal mild anemia </li></ul></ul><ul><ul><li>Low iron intake may exacerbate anemia </li></ul></ul><ul><ul><li>Iron-containing supplement, iron-rich foods </li></ul></ul><ul><li>Pica </li></ul><ul><ul><li>Craving/eating non-food items (clay, ice, laundry starch, dirt) </li></ul></ul><ul><li>Alcohol </li></ul><ul><ul><li>Fetal alcohol syndrome </li></ul></ul>
  • 14. Nutrition-related Complications <ul><li>PIH = pregnancy-induced hypertension </li></ul><ul><ul><li>Preeclampsia, eclampsia </li></ul></ul><ul><ul><li>Placental hormones increase fluid retention </li></ul></ul><ul><ul><li>Symptoms: edema, hypertension, protein in urine, nausea and vomiting, seizures, death </li></ul></ul><ul><li>Gestational diabetes </li></ul><ul><ul><li>Placental hormones increase insulin insensitivity (allows more glucose for baby) </li></ul></ul><ul><ul><li>Risk for large baby </li></ul></ul><ul><ul><li>Higher risk for type 2 diabetes for both mom and baby later in life </li></ul></ul><ul><ul><li>Tx: usually diet and exercise </li></ul></ul><ul><li>Existing chronic diseases </li></ul><ul><ul><li>PKU </li></ul></ul><ul><ul><li>HIV/AIDS </li></ul></ul>
  • 15. Lactation <ul><li>ADA and AAP recommend exclusive breastfeeding for first 6 months of life, then supplemented with “solid” foods </li></ul><ul><li>Only 20% of U.S. mothers still breastfeeding after 5 months </li></ul>
  • 16. <ul><li>Perceived or actual barriers to breastfeeding: </li></ul><ul><ul><li>Return to work, inadequate facilities to pump/store milk </li></ul></ul><ul><ul><li>Inadequate help from medical professionals </li></ul></ul><ul><ul><li>Lack of support, no role models </li></ul></ul><ul><ul><li>Misinformation </li></ul></ul><ul><ul><li>Privacy/modesty issues </li></ul></ul><ul><ul><li>Medical problems (HIV/AIDS, chemo or other Rx) </li></ul></ul>
  • 17. Weight Loss and Lactation <ul><li>Calorie Recommendation: 500 kcal more per day </li></ul><ul><li>Actual Calories needed to maintain lactation: 800 kcal per day </li></ul><ul><li>300 kcal deficit  gradual weight loss </li></ul><ul><li>Rapid weight loss results in decreased milk production </li></ul><ul><ul><li>Difficult to recover milk production </li></ul></ul>
  • 18. Physiology of Lactation <ul><li>Early milk production during pregnancy </li></ul><ul><li>Hormone oxytocin causes uterine contractions and causes milk release </li></ul><ul><ul><li>Infant suckling causes oxytocin release  “let-down reflex” </li></ul></ul><ul><ul><ul><li>Let-down reflex and milk quantity may be inhibited by stress, fatigue, alcohol, smoking, some medications </li></ul></ul></ul>
  • 19. Composition of Breastmilk <ul><li>Colostrum = early milk (first 3 days) </li></ul><ul><ul><li>High in antibodies, protein </li></ul></ul><ul><li>Mature milk </li></ul><ul><ul><li>Foremilk </li></ul></ul><ul><ul><li>Hindmilk </li></ul></ul><ul><ul><li>Nursing session should be about 20 minutes or more to allow infant to obtain lipid-rich hindmilk </li></ul></ul>
  • 20. <ul><li>Commercial formulas </li></ul><ul><ul><li>No antibodies </li></ul></ul><ul><ul><li>Most fortified with iron </li></ul></ul><ul><ul><li>Some fortified with omega-3 fats </li></ul></ul><ul><ul><li>Soy vs. dairy-based </li></ul></ul><ul><ul><li>Expense </li></ul></ul><ul><ul><li>GI distress </li></ul></ul><ul><ul><li>May predispose to picky eating habits </li></ul></ul><ul><li>Breastmilk </li></ul><ul><ul><li>Antibodies, fewer infections </li></ul></ul><ul><ul><li>Very little iron </li></ul></ul><ul><ul><li>Good source of omega-3 fats </li></ul></ul><ul><ul><li>Reduces risk for allergies later in life </li></ul></ul><ul><ul><li>No direct cost, equipment </li></ul></ul><ul><ul><li>Easily-digested proteins </li></ul></ul><ul><ul><li>Moderate mineral level </li></ul></ul>
  • 21. <ul><li>Dairy milk </li></ul><ul><ul><li>Wrong antibodies </li></ul></ul><ul><ul><li>Very little iron </li></ul></ul><ul><ul><li>No omega-3 fats </li></ul></ul><ul><ul><li>Increases risk for allergies, type 2 diabetes, intestinal hemorrhaging </li></ul></ul><ul><ul><li>Low to moderate cost compared to formula </li></ul></ul><ul><ul><li>GI distress </li></ul></ul><ul><ul><li>NOT RECOMMENDED </li></ul></ul><ul><li>Breastmilk </li></ul><ul><ul><li>Antibodies, fewer infections </li></ul></ul><ul><ul><li>Very little iron </li></ul></ul><ul><ul><li>Good source of omega-3 fats </li></ul></ul><ul><ul><li>Reduces risk for allergies later in life </li></ul></ul><ul><ul><li>No direct cost, equipment </li></ul></ul><ul><ul><li>Easily-digested proteins </li></ul></ul><ul><ul><li>Moderate mineral level </li></ul></ul>
  • 22. Nutrient Needs for Infant <ul><li>Double birthweight by 6 mo, triple by 1 yr </li></ul><ul><li>100 kcal/kg </li></ul><ul><li>No restricted fat intake </li></ul><ul><li>Need cholesterol </li></ul><ul><li>Protein needs highest in first 4 months </li></ul><ul><li>Iron depleted around 4 months </li></ul>
  • 23. Other Infant Feeding Topics <ul><li>Baby bottle mouth/tooth decay </li></ul><ul><li>Developmental readiness for solid foods </li></ul><ul><ul><li>Tongue thrust </li></ul></ul><ul><ul><li>Sit with some support </li></ul></ul><ul><ul><li>Show interest in foods </li></ul></ul><ul><ul><li>Move tongue, jaw </li></ul></ul><ul><li>Solid foods – provide iron, calories, flavors, textures </li></ul><ul><ul><li>Introduced 4-6 months old </li></ul></ul>
  • 24. Choking and Food Hazards <ul><li>Dairy products, egg whites, honey </li></ul><ul><li>Choking </li></ul><ul><ul><li>Coin-shaped foods </li></ul></ul><ul><ul><li>Hard candy </li></ul></ul><ul><ul><li>Popcorn </li></ul></ul><ul><ul><li>Peanut butter </li></ul></ul><ul><ul><li>Running with food in mouth </li></ul></ul>
  • 25. Eating Issues <ul><li>Milk before 1 year old, between 1 and 2 years old </li></ul><ul><li>Excessive milk, juice </li></ul><ul><li>Snacking issues, grazing </li></ul><ul><li>Food jags, picky eaters </li></ul><ul><ul><li>Novel foods exposure </li></ul></ul><ul><li>Modeling by adults </li></ul><ul><li>Supplements, multivitamins </li></ul>

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