Pregnancy infancy lactation ch16

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Pregnancy infancy lactation ch16

  1. 1. Pregnancy, Lactation and Infancy LIFECYCLE NUTRITION
  2. 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. 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. 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. 5. Fig. 14.1
  6. 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. 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. 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>
  10. 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>
  11. 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>
  12. 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>
  13. 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>
  14. 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>
  15. 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>
  16. 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>
  17. 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>
  18. 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>
  19. 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>
  20. 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>
  21. 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>
  22. 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>
  23. 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>
  24. 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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