Lifecycle nutrition: Pregnancy and Lactation

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  • Maternal nutrition status prior to pregnancy can have a significant impact on fetal growth and development, as well as a woman ’s ability to conceive in the first place! Weight: both underweight and overweight are associated with infertility and increased risk of complications; excess body fat can disrupt menstruation and hormone production. Achieve a healthy weight prior to pregnancy as dieting while pregnant is never a good idea! Importance of a balanced diet: Malnutrition reduces fertility and impairs early development of the fetus. Problems with nutrients can occur very early in pregnancy before woman recognizes she is pregnant. Folate, Iron, and B12 are especially important for fetal development; increased needs during pregnancy Vitamin A supplementation should be avoided as this may adversely affect the pregnancy Conditions such as diabetes, HIV/AIDS, PKU, and STDs can adversely affect a pregnancy and should be managed prior to pregnancy to ensure a healthy outcome Harmful substances, such as cigarettes, alcohol, drugs or environmental contaminants, can can cause miscarriage, birth defects, and can impair fertility -> eliminate use prior to pregnancy
  • Although the woman ’s nutrition has the most direct influence on the developing fetus, the man’s nutrition status is also important, since malnutrition can affect male fertility Overweight and obese men have low sperm counts and hormonal changes that reduce fertility Zinc is a cofactor for enzymes involved in testosterone production, DNA replication, protein synthesis, and cell division. Zinc helps protect sperm from bacteria and chromosomal damage and also plays a role in sexual organ development. A deficiency of zinc can impair male fertility but this can be reversed over time with supplementation. Antioxidants can help protect sperm from oxidative damage (free radicals). Men with diets rich in antioxidant nutrients have higher sperm counts and motility Heavy alcohol use can lower sperm production, but light to moderate intake does not appear to have an effect. Remember, the dietary guideline for alcohol use is no more than 2 drinks per day for males
  • Ovum (egg) + sperm = zygote Once the ovum is fertilized, it becomes a zygote. About 30 hours after fertilization, the zygote reproduces itself by dividing in half. Although the zygote begins as a single cell, it rapidly divides to become a blastocyst
  • Zygote travels down fallopian tube and continues to rapidly divide (to become blastocyst). Blastocyst arrives in uterus about 4-5 th day after conception. Implants into lining of uterus, usually within two weeks of fertilization. When the blastocyst has implanted, at around two weeks after conception the developing infant becomes an embryo .
  • Placenta is embedded in the uterine wall that develops in the early days of pregnancy. Placenta performs the respiratory, absorptive, and excretory functions that the fetus ’ lungs, digestive system, and kidneys will provide after birth. Placenta also produces an array of hormones involved in pregnancy and lactation. Amniotic sac: a fluid-filled balloonlike structure that houses the developing fetus; provides protection to developing fetus Umbilical cord: a ropelike structure containing fetal blood vessels that extends through the fetus ’s belly button-to-be to the placenta These three structures are expelled from the uterus during childbirth
  • As you can see from this diagram there is no actual mingling of fetal and maternal blood (placental villi are fingerlike projections, much like intestinal villi) Maternal arteries bring fresh blood with oxygen and nutrients to the fetus, while maternal veins carry fetal wastes away
  • During zygotic stage, cells rapidly divide; differentiate into fetus and placenta During embryonic stage, you see the beginning development of major organs; by the end of 8 weeks, the embryo (1.25in) has a complete central nervous system, a beating heart, a digestive system, well-defined fingers and toes and the beginnings of facial features During the fetal stage is when the major growth occurs: this infant grew 20 times longer and 50 times heavier during the fetal stage
  • Embryonic stage
  • Embryonic stage
  • By the end of the first trimester, the fetus weighs about 1 oz. Arms, hands, fingers, legs, feet and toes are fully formed. Organs begin to grow and mature. Still affected by nutritional deficiencies and other insults, but not as severe and a full recovery is possible (if not entirely likely).
  • Beginning of third trimester fetus weighs 2-3 lbs. Another time of rapid growth, and fetus will double in length and will multiply its weight by 5 times. An infant that is born at about 26 weeks has a good chance of surviving a premature delivery, with care in neonatal ICU. Lungs are not well developed. Baby will not have enough calcium and iron stored in its body, and also will not have much fat. Preterm infants also have less ability to suck and swallow, so feeding is challenging.
  • LBW infants < 5.5lbs; LBW infants more likely to have complications, birth defects, early death VLBW infants (<3.5lbs) struggle both in immediate survival and long-term development Preterm infants may be small, but if their size and weight are appropriate for their age, they can catch up in growth given adequate nutritional support; SGA infants have suffered growth failure in the uterus and do not catch up as well Infants, whether full or preterm, who weight less than they should for a fetus at their stage of gestation are called small for gestational age. For example, a baby born at 30 weeks, who is less than 5.5 lbs, may still be the appropriate weight for 30 weeks gestation – so it is LBW but not SGA. But baby born at 37 weeks but who weights less than 5.5 lbs is SGA but not preterm.
  • Nutritional deficiencies, some medications, high intakes of vitamin A, or radiation can change or stop development. The effects are often irreversible. Most spontaneous abortions, or miscarriages, happen during this time. (This is why most people wait until the second trimester to announce they are pregnant)
  • Each organ/tissue grows to maturity according to its own schedule, with greater intensity at some times more than others Each organ and tissue is most vulnerable to nutrient deficiencies or toxins during its own critical period. If the adversity occurs during the purple timeframe, the damage is likely to be severe and unlikely to be reversible. If it happens in the green timeframe, it is probably going to be less severe and possible reversible. Notice that CNS development begins after only two weeks of gestation; many women may not realize that they are pregnant at this time.
  • Anencephaly often results in miscarriage; infants born with anencephaly die shortly after birth
  • If the upper end of the neural tube fails to close, the brain will not develop, resulting in anencephaly. If it fails to close in the lower parts, spina bifida results.
  • Spina bifida is characterized by incomplete closure of the spinal cord and its bony encasement. The meninges membranes covering the spinal cord often protrude as a sac, which can rupture and lead to meningitis. Spina bifida is accompanied by varying degrees of paralysis depending on damage to spinal cord. Mild cases may not even be noticed, while severe cases can lead to death
  • High dose folate supplements require a prescription due to the fact that folate can mask vitamin B12 deficiency (pernicious anemia) Neural tube defects occur early in development before most women realize they are pregnant. Grain products are therefore fortified to ensure adequate intake in women of childbearing age. Fortification has been successful in improving folate status in women and reducing occurrence of neural tube defects
  • There ’s some evidence that certain adverse influences may set the stage for chronic disease later in life. For example, poor maternal nutrition may affect the baby’s blood vessel growth in the uterus, and may set the stage for lipid metabolism and lean body mass development in a way that will put the baby at risk for CVD later in life. Pancreatic (beta) cells are responsible for producing insulin. Malnutrition during the critical period of pancreatic cell growth may develop fewer beta cells, which may be insufficient in times of overnutrition during adulthood when body needs more insulin
  • Organ & tissue enlargement: heart, thyroid, liver, kidneys, uterus, breasts, adipose tissue Uterus and its supporting muscles increase in size and strength BMR increases dramatically; energy needs of prengant woman are greater Blood volume doubles to carry additional nutrients and other materials Joints become more flexible to prepare for pregnancy Estrogen promotes water retention, which can cause swelling Breasts enlarge in preparation for lactation
  • Mom: Obese women have high risk of medical complications, such as hypertension, gestational diabetes, and postpartum infections; have more complications with labor and delivery Infants of obese women: more likely to be post term & larger (>9lbs) -> this increases likelihood for difficult labor/delivery, birth trauma and cesarean section Poor development -> higher risk of heart defects and other abnormalities, likely due to poor glycemic control and undiagnosed diabetes Maternal obesity may double the risk for neural tube defects
  • Health care professionals monitor weight gain using prenatal weigh-gain grids like these A larger weight gain in a short time indicates excessive fluid retention and may be the first sign of preeclampsia
  • Only about 7 lbs of the 30 lbs is fat. That fat serves a necessary purpose, too: to provide energy for labor and lactation. Lose most, but not all of the weight fairly immediately after delivery. Most women do not return to their pre-pregnancy weight.
  • Inactive women may start moderate exercise program (e.g. walking) upon physicians approval Women with high-risk pregnancies will likely have to restrict physical activity
  • Many of exercise guidelines aimed at preventing excessively high internal body temperature and hydration, both of which can harm fetal development
  • Nutrient needs during pregnancy and lactation are higher than at any other time.
  • Pregnant woman have higher energy needs than non-pregnant women, due to increased BMR (2nd and 3rd trimester) Increase in nutrient needs is often greater than extra energy needs (15-20%), so nutrient-dense foods should be chosen to supply the extra calories Ample carbohydrate is necessary to fuel fetal brain; protein-sparing action Protein needs are higher; avoid high-protein supplements
  • It is best to obtain sufficient folate from a combination of supplements, fortified foods, and a diet that includes fruits, juices, green vegetables, and whole grains Slightly greater need for B12, which activates the folate enzyme. Need for B12 can easily be met by a diet that includes even modest amounts of meat, fish, eggs, or milk products together with body stores Vegans need to take daily supplements of B12 or B12-fortified foods to prevent neurological complications of a deficiency
  • Pregnant women need iron to support their enlarged blood volume and to provide for placental and fetal needs Body makes several adaptations to help meet exceptional needs for iron: menstruation stops & iron absorption improves Most women of childbearing age have inadequate iron stores and may need to take a supplement Zinc is required for DNA and RNA synthesis and thus for protein synthesis and cell development Zinc absorption increases when intakes are low; routine zinc supplementation is not advised
  • Vitamin D plays a role in calcium absorption and utilization; consequently, severe maternal vitamin D deficiency interferes with normal calcium metabolism, resulting in rickets in the infant and osteomalacia Although AI does not incease for either vitamin D or calcium, it is important that women get sufficient amounts of these nutrients in their diets
  • Pregnant women who make wise food choices can meet most of their nutrient needs, with the possible exception of iron Supplements are routinely prescribed by for pregnant women by most physicians. Some are over-the-counter, others by prescription because of their high folate content (1000 ug), which could be problematic for certain non-pregnant people, such as the elderly, since it would mask a vitamin B12 deficiency.
  • Giving infants vitamin B12 supplements corrects the blood and neurological symptoms of deficiency, as well as structural abnormalities, but cognitive and language development delays may persist
  • NAUSEA & VOMITING About 75% of women experience in early stages. Begins about 3 weeks, ends usually around 3 months. Pregnancy hormones: increases sense of smell; may be related to this. Probably evolved to serve a useful function: to protect pregnant women and embryo from food-borne infections and toxins. To help: avoid spicy or greasy foods, eat smaller, more requent meals; eat slowly and drink liquids between meals. CONSTIPATION & HEMORRHOIDS Pregnancy hormones alter muscle tone. Slowed movement of GI tract, possibly aggravated by high doses of iron. Later, fetus crowds out intestine. Generous amounts of fiber, adequate fluids and regular exercise. Hemorrhoids often accompany: straining. HEARTBURN Relaxed GI muscles: cardiac sphincter. Growing fetus puts increasing pressure on the mother ’s stomach. Avoid lying down right after eating; eat smaller, more frequent meals; eat less fat, so the stomach will empty faster; avoid spicy foods. May need to take an antacid, should consult MD but many are safe for pregnancy. FOOD CRAVINGS & AVERSIONS Most commonly craved items: fruit and juices; sweets; desserts and chocolates. Myth that mothers instinctively know what to eat and cravings are the result of a natural desire to consume needed nutrients. This isn ’t really the case (I.e. cravings do not reflect physiological needs). Cravings more likely to be related to hormonal changes or to family traditions. Some crave strange, non-food items, such as starch, chalk, soap, or dirt: pica . Can be risky, craved substances can be toxic and harmful. Not known why this occurs. Most common aversions are to non-alcoholic caffeinated beverages, meat, fish, poultry, and eggs.
  • Malnutrition can prevent the placenta from developing fully, so the placenta can ’t deliver optimal nutrients to the fetus.
  • Without adequate nutrition during pregnancy, fetal growth and infant health are compromised
  • GESTATIONAL DIABETES Usually develops during the second half of pregnancy, with subsequent return to normal after childbirth Some of the hormones of the placenta antagonize the action of insulin. This can lead to gestational diabetes, which is a high blood glucose concentration that develops during pregnancy and returns to normal after birth. Usually develops in the second half of pregnancy. Screening between 24 and 28 weeks recommended for all woman at “average” risk non fasting oral tolerance test (one hour after 50 g load) If positive, Oral glucose tolerance test: 100 grams glucose with measurements hourly for three hours: at one hour, over 180; at 2 hours over 155 and at 3 hours, over 140. More common in women with a family history of diabetes or who are obese. The fetus grows to be quite large – increased risk of c-section. Birth defects: heart damage, limb deformities, and neural tube defects Diet and exercise are the first two approaches Probably 3 regular meals with small snacks is the cornerstone of the diet. Also important to limit high GI foods. Glucose monitoring becoming increasingly common. If not normalized in two weeks, insulin is added to regimen If it ’s not controlled, there’s an increased risk of type 2 diabetes and hypertension later in life.
  • Blood flow through the vessels that supply oxygen and nutrients to the placenta diminishes. Preeclampsia is the most serious maternal complication of pregnancy. Symptoms include: upper abdominal pain, severe headaches, swelling, vomiting, blurred vision, sudden weight gain, fetal growth retardation
  • Head: small in size; forehead narrow and receding Nose short and upturned Jaw underdeveloped, receding chin, receding or flattened upper jaw Eyes: extra skinfolds on eyelids; drooping eyelids; downward slant of eyes; small eyes Ears: uneven in placement and size, poorly formed outer ear Lips: absence of groove in upper lip; flat & thin upper lip Irreversible mental retardation – one of the leading causes of MR.
  • Limits oxygen and nutrient delivery and waste removal
  • Provides optimal nutrition to the infant – and it ’s always safe & ready to go, does not require any preparation Less diarrhea, ear infections. Reduces the chances of some allergies Cognitive benefits on IQ are unclear. Thought to be due to ARA and DHA (docosahexanoic acid ). They ’ve started adding these to formula. Obesity. Not sure why. Could be self-regulation of energy intake, or lifestyle of families who breast feed. Overall seems to have a beneficial but small effect on overweight. Arthritis, heart disease, diabetes. Decreased cost of medical care for the infants. Don ’t need to purchase formula, which is still more expensive than the extra food a mother needs to eat to support breastfeeding.
  • Reduced risk of breast cancer related to lifetime duration of breast feeding. Evidence for ovarian cancer is less clear. Not reliable method of birth control though.
  • During pregnancy, hormones from the placenta stimulate cells in the breast to form milk-producing lobules.
  • After birth, the mother produces the hormone prolactin to maintain the changes in the breast and the ability to produce milk. The sucking of the infant stimulates the release of prolactin from the pituitary gland. Milk synthesis occurs as the infant nurses. The more the infant suckles, the more milk is produced – supply follows demand.
  • Can eat an extra 300 calories or so per day and let the fat stores of pregnancy provide the rest. In this way may help with the return to pre-pregnancy weight. Should not diet – may hinder milk production. Protein and fats about the same, need more carbs because glucose is used to make lactose in breast milk. Fluid demands increase; women should drink to thirst. One recommendation is to drink a glass of water every time the baby nurses.
  • Mixed messages!
  • Lifecycle nutrition: Pregnancy and Lactation

    1. 1. Lifecycle Nutrition: Pregnancy and Lactation TA: Helen Corless
    2. 2. Nutrition before Pregnancy • Maintain a healthy weight • Nutrient status – Folate – Iron – Vitamin B12 – Vitamin A • Chronic conditions • Substance use
    3. 3. Nutrition & Male Fertility• Weight• Zinc• Antioxidants• Alcohol
    4. 4. Fetal Development
    5. 5. Physiology of Pregnancy• Fetal growth: – Zygote: fertilized ovum – Blastocyst: first 2 weeks • Cells differentiate into fetus & placenta – Embryo: weeks 2-8 • Development of organ systems – Fetus: week 9-delivery • Growth – Newborn
    6. 6. Physiology of Pregnancy• Placental Development – Placenta: metabolically active organ • Interwoven fetal and maternal blood vessels • Exchange of oxygen, nutrients, and waste products – Amniotic sac – Umbilical cord
    7. 7. Placental Development
    8. 8. Stages of Development
    9. 9. Day 23 • 2mm long (=) • Beginning development of major organs • Critical stage for neural tube development
    10. 10. Day 28 • 6mm long (===) • At this point, the heart is beating, • Lim buds will form the arms and legs
    11. 11. Week 9 • 44mm long • Embryo has become a fetus • Complete CNS, beating heart, digestive system, well- defined fingers and toes, beginnings of facial features
    12. 12. Week 12 • 82mm long, weighs about 1oz • Arms, hands, fingers, legs, feet and toes formed • Organs grow and mature • Less affected by nutritional deficiencies
    13. 13. Week 26 • 250mm long, weighs 2-3 lbs • 3rd trimester • Rapid growth • Able to survive if born prematurely – Lungs – Nutrient stores – Feeding
    14. 14. Week 40 • Baby ready to be born • Less amniotic fluid, baby almost fills uterus • Plump arms and legs
    15. 15. • Full term fetus usually weighs between 7 and 9 lbs at birth• Full term: 38-42 weeks
    16. 16. Definition of a Successful Pregnancy• Gestation at least 37 weeks – Lung development• Birth weight >5.5 lb• Otherwise – Low birth weight (LBW) – Small for gestational age (SGA) – Preterm vs. SGA • Potential for catch-up growth • Malnutrition
    17. 17. If a baby is born at 38 weeks andweighs 4lbs, he/she would beconsidered:a) Low birth weight (LBW)b) Small for gestational age (SGA)c) Pretermd) Both a and be) All of the above
    18. 18. If a baby is born at 38 weeks andweighs 4lbs, he/she would beconsidered:a) Low birth weight (LBW)b) Small for gestational age (SGA)c) Pretermd) Both a and be) All of the above
    19. 19. Critical Periods• Times of intense development and rapid cell division – Cellular activities can occur only during these times• Organ and tissue development most vulnerable to adverse influences• First trimester
    20. 20. Neural Tube Development• Critical period is 17-30 days gestation• Most women unaware they are pregnant during this time• Vulnerable to – Nutrient deficiencies – Nutrient excesses – Toxins
    21. 21. Neural Tube Defects • Anencephaly – Brain either missing or fails to develop • Spina bifida – Incomplete closure of spinal cord and its bony encasement • Affects 30/100,000 newborns in US
    22. 22. Neural Tube Development
    23. 23. Spina Bifida
    24. 24. Neural Tube Defects• Cause unknown• Risk factors – Family history – Maternal diabetes – Maternal obesity – Anti-seizure medications – Mutations in enzymes
    25. 25. Which of the following has beenshown to prevent neural tubedefects?a) Vitamin B12b) Vitamin Dc) Calciumd) Folate
    26. 26. Which of the following has beenshown to prevent neural tubedefects?a) Vitamin B12b) Vitamin Dc) Calciumd) Folate
    27. 27. Folate Supplementation• Prevents & reduces severity of neural tube defects• Folate status important prior to pregnancy and during 1st trimester• RDA: 600 micrograms• Fortification of grains – 50% of pregnancies are unplanned
    28. 28. Fetal Programming• Adverse influences at critical stages in utero may set the stage for chronic disease development later in life• Maternal nutrition status may change gene expression in fetus• Examples: – beta cell growth and diabetes – blood vessel growth, lipid metabolism and CVD
    29. 29. Maternal Factors
    30. 30. Physiology of Pregnancy • Organ & tissue enlargement – Breasts – Uterus – Adipose tissue • BMR increases • Circulatory system changes • Joint flexibility • Fluid retention – Estrogen
    31. 31. How much weight should a healthy-weight woman carrying a singlefetus gain during pregnancy?a) 5-15 poundsb) 15-25 poundsc) 25-35 poundsd) 35-45 pounds
    32. 32. How much weight should a healthy-weight woman carrying a singlefetus gain during pregnancy?a) 5-15 poundsb) 15-25 poundsc) 25-35 poundsd) 35-45 pounds
    33. 33. Maternal Weight• Birth weight is most reliable indicator of infant health• Maternal weight prior to conception influences fetal growth – Underweight • Risk of LBW, preterm, infant death – Overweight and obesity • Medical complications for mother • Risks for infant
    34. 34. Maternal Weight• Weight gain during pregnancy – Correlates closely to infant birth weight – Recommendations (single birth) • Healthy weight: 25-35lbs • Underweight: 28-40lbs • Overweight: 15-25lbs – Most women gain more than recommended!
    35. 35. Maternal Weight Gain•Normal: 3.5lbs in 1st tri, then 1lb/week after that•Underweight: 5lbs in 1st tri, then just over 1lb/week•Overweight: 2lbs in 1st tri, then 2/3lb per week
    36. 36. What makes up the weight?• Weight gain supports growth and development of… – Placenta – Uterus – Blood supply – Fluid volume – Breasts – Infant• Fat stores (small amount)
    37. 37. Weight gain (lb) Increase in 2 breast size Increase 4 mothers fluid volume Placenta 1 1/2 Increase in 4 blood supply to the placenta Amniotic fluid 2 Infant at birth 7 1/2 Increase in size 2 of uterus and supporting muscles Mothers 7 necessary1st trimester 2nd trimester 3rd trimester 30 fat stores Stepped Art Fig. 15-8, p. 502
    38. 38. Which of the following is true aboutexercise and pregnancy?a) Pregnant women should exercise very little and rest as much as possibleb) Pregnant women should get as much exercise as possible, even if they did not exercise prior to getting pregnantc) Pregnant women can continue an exercise regimen that they had prior to getting pregnant with some adjustments
    39. 39. Which of the following is true aboutexercise and pregnancy?a) Pregnant women should exercise very little and rest as much as possibleb) Pregnant women should get as much exercise as possible, even if they did not exercise prior to getting pregnantc) Pregnant women can continue an exercise regimen that they had prior to getting pregnant with some adjustments
    40. 40. Exercise during Pregnancy• Benefits of physical activity – improve fitness – manage or prevent gestational diabetes – facilitate labor – reduce stress – fewer discomforts – strength to carry weight• Inactive women should not begin an intense exercise program during pregnancy
    41. 41. Exercise during Pregnancy Recommendations • Regular, mild to moderate • Low-impact • Avoid sports with risk of falling or being hit • Protect abdomen • Maintain adequate diet • Heat and hydration
    42. 42. Nutrition during Pregnancy
    43. 43. Energy & Nutrient Needs• Needs tend to be higher than any other time in life• To meet needs – Make careful selections – Body maximizes absorption – Body minimizes losses
    44. 44. Key Nutrients During Pregnancy • Calories • First trimester: No or little extra • Second trimester: +340 kcals/day • Third trimester: +450 kcals/day • Protein • +25 g/day (or 1.1 g/kg body weight) • Carbohydrate • 175 g/day
    45. 45. Key Nutrients During Pregnancy • Folate • B12 • Iron • Zinc These nutrients are needed for the synthesis of DNA and new cells
    46. 46. Key Nutrients During Pregnancy • Folate – Non-pregnant women: 400 µg/day – Pregnant women: 600 µg/day • B12 – Non-pregnant women: 2.4 µg/day – Pregnant women: 2.6 µg/day
    47. 47. Key Nutrients During Pregnancy • Iron – Premenopausal women: 18 mg/day – Pregnant women: 27 mg/day • Zinc – Non-pregnant women: 8 mg/day – Pregnant women: 11 mg/day
    48. 48. Key Nutrients During Pregnancy • Vitamin D – AI does not increase during pregnancy – Critical for bone and teeth development • Calcium – AI does not increase during pregnancy – Absorption and retention increases – Deficiency common; needed to conserve maternal stores
    49. 49. Nutrition during Pregnancy• Vegetarians – Able to meet most nutrient needs through diet alone – Exception: iron• Vegans – May require supplementation for B12, calcium, vitamin D – B12 deficiency: spinal chord damage, psychomotor retardation
    50. 50. Common Concerns• Nausea & vomiting – “Morning sickness” – Hormonal changes• Constipation and hemorrhoids• Heartburn• Food cravings and aversions – Hormone changes – Pica
    51. 51. Malnutrition and Pregnancy• Fertility – Amenorrhea – Sperm – Loss of sexual interest• Placental development – Poor development – Risk of LBW, physical and cognitive abnormalities
    52. 52. Malnutrition and Pregnancy• Fetal development – Fetal growth retardation – Birth defects – Miscarriage and stillbirth – Premature birth – LBW
    53. 53. Risks During Pregnancy• Gestational diabetes – Affects 1/25 women – Increased risk of type 2 diabetes and hypertension later in life – Complications during labor & delivery – Effects on infant • High birth weight • Birth defects – Avoid excessive weight gain
    54. 54. Risks During Pregnancy• Preexisting hypertension – Risk of LBW infant – Risk of placental separation; stillbirth• Gestational hypertension – 50% mild, no adverse effect – 50% early sign of preeclampsia
    55. 55. Risks During Pregnancy• Preeclampsia (pregnancy-induced) – Gestational hypertension + protein in urine – Affects nearly all maternal organs; may retard fetal growth – Risk of placental separation – Cause unknown – Genetic predisposition?• Eclampsia: seizures & coma
    56. 56. Risks During Pregnancy Fetal Alcohol Syndrome • Irreversible mental and physical retardation • Recall CNS critical period • Entirely preventable
    57. 57. Risks during Pregnancy Smoking • Restricts blood supply to fetus • Lung development • Increased risk for: – Complications – LBW infant – Lung problems – SIDS • Preventable!
    58. 58. Risks during Pregnancy Mercury • Omega-3 fatty acids • Fish contain high amounts of mercury • Mercury can impair fetal growth and CNS development
    59. 59. Lactation
    60. 60. Were you breastfed as aninfant?a) Yesb) Noc) Unsure
    61. 61. Which of the following istrue for you (females)?a) I plan to breastfeedb) I plan to formula feedc) I plan to do a combination of bothd) I have never thought about how I am going to feed my offspringe) I do not plan on having children
    62. 62. Which of the following istrue for you (males)?a) I want my future wife to breastfeedb) I do not care whether my children are breastfed or notc) I have never thought about how I want my offspring to be fedd) I do not plan on having children
    63. 63. Recommendations• American Academy of Pediatrics• American Academy of Family Physicians• American College of Obstetricians and Gynecologists• American College of Nurse-Midwives• American Dietetic Association,• American Public Health Association – Officially recommend that most infants breastfeed for at least 12 months. – Also recommend that for about the first six months infants be exclusively breastfed, meaning that they not be given any foods or liquids other than breast milk.
    64. 64. Healthy People 2020• Breastfeeding ever – 81.9%• Breastfeeding at 6 months – 60.5%• Breastfeeding at 1 year – 34.1%• Exclusively through 3 months – 44.3%• Exclusively through 6 months – 23.7%• Reduce the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life – to 15.6% (from 25.6%)
    65. 65. How far is the US from these goals? U.S. Rates Healthy People 2020 Goals Breastfeeding 75% 81.9% Ever Breastfeeding 43% 60.5% at 6 months Breastfeeding 22.4% 34.1% at 12 months
    66. 66. Benefits for infant• Optimal nutrition – Nutritionally superior to formula – Sterile and always fresh – More easily digestible• Immune protection• Fewer allergies and intolerances• Fewer respiratory, GI, and ear infections• Cognitive benefits• Infant-led feeding• May protect against some chronic diseases later in life
    67. 67. Benefits to Mother• Increased rate of uterine contraction after childbirth and consequent reduced risk of postpartum blood loss• Possible reduced risk of pre-menopausal breast and ovarian cancers• Amenorrhea and decreased fertility• Promotes mother-infant bond• Weight loss• Convenience• Economic benefits
    68. 68. Anatomy of the Breast
    69. 69. Hormonal Control of Lactation • Hormonal controls – Prolactin – Oxytocin: MER • Sucking stimulus signals release of prolactin • Supply follows demand
    70. 70. Composition of Breast Milk• Colostrum – First fluid, thick, yellowish – Rich in immune factors and protein – About 20 kcal/oz – Bifidus flora• In first 24hrs, total intake: 10-108ml• Transitional milk: 6-13 days postpartum
    71. 71. Composition of Breast Milk• 20 calories per ounce• Whey:Casein (70:30) – More easily digested• Foremilk vs. hindmilk: fat content – Don’t limit time at breast – No clear distinction• Contains small amount of Fe – Sufficient for first 6 months – Absorption is facilitated by high vitamin C concentration
    72. 72. A newborn baby needs to be givensmall amounts of water in additionto breastmilk to meet his/her needsa) Trueb) False
    73. 73. Nutrient Requirements for Lactation• Energy requirement – Extra 500 kcals/day – Higher needs than pregnancy• Increased need for carbohydrate• Fluid intake• Inadequacies reduce quantity and not quality of milk
    74. 74. Contraindications to Breastfeeding• Maternal HIV• Inborn errors of metabolism of child (galactosemia)• Alcohol• Certain medications• Smoking• Illicit drugs• Caffeine
    75. 75. Common Problems• Sore nipples• Engorgement• Plugged duct• MastitisBreastfeeding is a LEARNED SKILL!
    76. 76. Improper Latch!
    77. 77. That’s Better!
    78. 78. Formula Feeding• Safety and adequacy• Preparation• Can interfere with breastfeeding – Supply & demand – Nipple confusion/preference• More likely to be overfed – Increased risk of obesity?
    79. 79. Nipple Confusion
    80. 80. Nipple Confusion
    81. 81. Baby Friendly Hospital Initiative1. A written bf policy routinely communicated to staff2. Train staff in skills to implement policy3. Inform pregnant women about benefits and management of breast feeding4. Help mothers initiate bf within 30 minutes of delivery5. Show mothers how to initiate and maintain bf6. Give newborns no food or drink other than breast milk unless medically indicated7. Practice rooming in: allow mothers and infants to stay together8. Encourage breast feeding on demand9. Give no pacifiers10. Foster establishment of support groups and refer mothers to them
    82. 82. Ban the Bags Campaign
    83. 83. Questions?

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