Maternal and child nutrition

1. Nutrition
By : Muhammad Awais
Nutritionist
DHQ Hospital Hafizabad
M.Phil. Human Nutrition And Dietetics (UAF)

2. Outline
• Nutrition basics
– Food, Diet , Nutrition
– Nutrients, Macro-micro Nutrients
• Maternal Nutrition
• Infant and child nutrition
• Malnutrition
– Acute malnutrition screening methods
– MUAC measurements

3. Nutrition Basics
Nutrition
• Nutrition is a fate of food in the
body .
• A sum of all process ingestion,
digestion, absorption,
transportation and metabolism,
by which an organism uses food
to support its life
Food
• Food is any substance solid or
liquid when consumed provide
nutrients for the maintenance ,
growth and development
Diet
• Diet is the sum of food consumed
by a person in a whole day
– Balanced diet
– Soft diet
– High protein diet

4. Nutrients
• A nutrient is a substance present in food used by an
organism to survive, grow, and reproduce e.g.
carbohydrates , fats , protein , vitamins and minerals
• Macro nutrients body needs in large amounts
• Micro nutrients body needs in lower amounts

5. Macro-nutrient and food sources
• Three major nutrients required in
larger quantity
• Carbohydrate (Polymer of
monosaccharide)
– Primary source of energy
– Sources are grains, cereals, fruits
• Protein (Polymer of amino acids)
– Building block of human body
– Sources are meat, poultry , fish
• Fat (Polymer of fatty acids )
– Energy growth and maintenance
– Sources are butter, ghee , seed oils and
nuts

6. Micro-nutrient
• Two type of nutrients
require in smaller
quantity
• Vitamin
– Water soluble (B
COMPLEX , C)
– Fat soluble (A,D,E,K)

7. continue
• Minerals

8. Energy calorie
• A calorie is a unit of energy
• 1 kcal the amount of heat needed to raise the
temperature of one kilogram of water by one
degree Celsius
• 1 g fat provide 9 kcal
• 1g carbohydrates provide 4 kcal
• 1g protein provide 4 kcal

9. MATERNAL NUTRITION

10. Pregnancy Physiology That Alters
Nutritional Needs
1- Altered Metabolism:
• Increase the basal metabolic rate: by the fourth month of
gestation and rises to 15 - 20% above normal by term.
• Altered the metabolism of nutrients: fat becomes the
major source of maternal fuel, making glucose available for
the fetus.

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2- Gastrointestinal Changes:
• Slow gastrointestinal motility: an advantage of slowed motility
is that nutrient absorption increases
• Nausea and vomiting are common in the first trimester and may
be related to hypoglycemia, decreased gastric motility, relaxation
of the cardiac sphincter, or anxiety.
• Increases in appetite and thirst
• Heartburn and constipation: due to slow motility or enlarging
uterus

12. COUNTINUE
3- Blood Volume Changes:
• Increase total body water throughout pregnancy.
• Hemodilution or a physiologic anemia of pregnancy: due
to the increase in blood volume.
• Minor edema: may be considered normal if it is not
accompanied by hypertension and proteinuria.

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• Recommendations for weight
gain are divided into three
categories based on the
woman’s pre-pregnancy
weight.
• The weight category is
determined using body mass
index (BMI).
• The range for women carrying
twins is 35 lb to 45 lb (16 - 20
kg).
4- Ideal Weight Gain:
• The average weight gain is
about 25 to 30 lb (11.5 kg to
14.0 kg).
• Weight gain during pregnancy
consists of the weight of the
fetus and associated fetal
tissues (e.g. placenta), plus
the weight increases in
maternal tissue.

14. Recommended total weight gain ranges for pregnant
women*
Pre-pregnancy
Weight-for-Height
Recommended Total
Gain
Category (lb) (kg)
Low (BMI < 19.8) 28 - 40 12.5 - 18.0
Normal (BMI 19.8 - 26.0) 25 - 35 11.5 - 16.0
High (BMI >26 - 29) 15 - 25 7.0 - 11.5
Obese (BMI > 29)  15  7

15. Nutrition During Pregnancy
• Maternal diet and nutritional status have a direct impact on
the course of pregnancy and its outcome
• Malnutrition that occurs in
– Early months of pregnancy affects development and the
capacity of the embryo to survive
– Poor nutrition in the latter part of pregnancy affects fetal
growth

16. Nutrient Requirements During Pregnancy
• Actual requirements during pregnancy are influenced by
previous nutritional status and health history, including:
chronic illnesses, multiple pregnancies
• The requirement for one nutrient may be altered by the intake
of another. E.g., women who do not meet their calorie
requirements need higher amounts of protein.
• Nutrient needs are not constant throughout the course of
pregnancy - nutrient needs change little during the first
trimester and are at their highest during the last trimester.

17. ENERGY
Energy needs increase because of:
• The increase in basal metabolic rate.
• Weight gain increases the amount of calories burned during
activity.
• Uses additional calories to store energy in preparation for
lactation after delivery.
• An additional 300-340 kcalories per day during the second
trimester
• An extra 450 kcalories per day during the third trimester

18. Carbohydrates
• Ample carbohydrate (ideally, 175 grams or more per
day and certainly no less than 135 grams) is
necessary to fuel the fetal brain
• Sufficient carbohydrate ensures that
• the protein needed for growth will not be broken
down and used to make glucose

19. Protein
The protein RDA ◆ for pregnancy is an additional 25 grams per day
higher than for nonpregnant women.
Sources: meats, milk products, and protein-containing plant foods
such as legumes, whole grains, nuts, and seeds
Protein needs increase to support :
• Fetal growth and development.
• The formation of the placenta and amniotic fluid.
• The growth of maternal tissues and the expanded blood volume.

20. Fats and Essential Fatty Acids
• Intake of 30g of visible fat/day is recommended during pregnancy
• The high nutrient requirements of pregnancy leave little
room in the diet for excess fat
• But the essential long-chain polyunsaturated fatty acids are
particularly important to the growth and development of the fetus.
• The brain is largely made of lipid material,
– Requires the long-chain omega-3 and omega-6 fatty acids for its
growth, function, and structure

21. Nutrients for Blood Production and Cell
Growth
• New cells are laid down at a tremendous pace as the fetus grows
and develops. At the same time, the mother’s red blood cell mass
expands.
• All nutrients are important in these processes, but folate, vitamin
B12, iron, and zinc needs more
• The increased requirement for vitamin B6 is proportional to the
increase in protein because it is involved in protein metabolism.

22. Folate And Vitamin B12
• The requirement for folate
increases dramatically during
pregnancy
• Prevent neural tube defect
Folate RDA : 600 μg/day
Folic acid sources:
• Natural form of folic acid
(folate): orange juice, other
citrus fruits and juices, green
leafy vegetables, dried peas
and beans, broccoli, and
whole-grain products.
• Because vitamin B12 is
necessary for the metabolism
of folate, a slight increase in
intake is recommended.
• Vitamin B12 RDA during
pregnancy: 2.6 μg/day

23. Iron
• A daily supplement of 30 mg
of ferrous iron is
recommended for all women
during the second and third
trimesters.
• It is preferably taken between
meals or at bedtime on an
empty stomach to maximize
absorption.
Importance for iron during
pregnancy:
• To support the increase in
maternal blood volume.
• To provide iron for fetal liver
storage, which will sustain the
infant for the first 4 - 6
months of life.
• Iron RDA during
pregnancy:27 mg/day

24. Nutrients for Bone Development
• Vitamin D and the bone-building minerals calcium, phosphorus,
magnesium, and fluoride are in great demand during pregnancy
• The calcium requirement for an adult woman is 400mg/day. During
pregnancy the need increases to 1000mg/day.
• Insufficient intakes may produce abnormal fetal bones and teeth
• Vitamin D plays a vital role in calcium absorption and utilization
• severe maternal vitamin D deficiency
– Rickets in the infant
– Osteomalacia in the mother
• Regular exposure to sunlight and consumption of vitamin D–fortified
milk

25. Dietary Guide Lines for pragnant
1- Eat in moderation.
2- Aim for balance.
3- Eat three meals daily plus two or three snacks.
4- Drink adequate fluids.
5- Do not restrict salt intake
6- Be aware of food borne risks during pregnancy.

26. Daily food guide for pregnancy and breastfeeding
Pregnancy
Food Group Adult Woman Adolescent Breastfeeding
Woman
Milk, Yogurt,
Cheese
3 - 4 servings 4 - 5 serving 4 - 5 servings
Meat and Meat
substitutes
5 - 6 oz 6 - 7 oz 6 - 7 oz
Fruits 2 - 4 servings 2 - 4 servings 2 - 4 servings
Vitamin C-rich 1 - 2 servings 1 - 2 servings 2 servings
Vegetables 3 - 5 servings 3 - 5 servings 3 - 5 servings
Vitamin A-rich 1 serving 1 serving 1 serving
Breads, Cereals,
Rice, Pasta
6 -11 servings 6 - 11 servings 6 - 11 servings

27. Nutritional concerns during pregnancy and
intervention
1- Nausea and Vomiting
Women should be advised to:
• Eating small, frequent meals every 2 to 3 hours.
• Eat carbohydrate foods such as: dry crackers, Melba toast, dry cereal, or
hard candy before getting out of bed in the morning.
• Avoid drinking liquids with meals.
• Avoid coffee, tea and spicy foods.
• Limit high-fat foods, because they delay gastric emptying time.
• Eliminate individual intolerances.

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2. Constipation
may be caused by:
• Relaxation of gastrointestinal
muscle tone and motility
• Pressure of the fetus on the
intestines.
• Decrease in physical activity
• Inadequate intake of fluid and
fiber.
• Side effect of the consumption
of iron supplements.
Intervention
• Increase fiber intake.
• Drink at least eight 8-ounce
glasses of liquid daily.
• Try hot water with lemon or
prune juice upon waking to
help stimulate peristalsis
• Participate in regular
exercise.

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3- Heartburn:
• Eat small, frequent meals and eliminate liquids immediately
before and after meals to avoid gastric distention.
• Avoid coffee, high-fat foods and spices.
• Eliminate individual intolerances.
• Avoid lying down or bending over after eating.

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4- Inadequate Weight Gain:
• Inadequate weight gain during pregnancy increases the
risk of giving birth to a low-birth-weight (LBW) infant
(i.e., a baby weighing less than 2500 g).
• The recommended weight gain for normal weight women
is @ 0.44 kg/week,
• Underweight women more than 0.44 kg/week whilst
overweight women about 0.29 kg/week and women
pregnant with twins at least 0.44 kg/week.

31. Continue
5- Excessive Weight Gain, may be related to:
• Overeating.
• Stress.
• Decrease in physical activity.
• Counsel the client on the recommended rate and quantity of
weight gain associated with optimal maternal and infant health
and successful breast-feeding.

32. Prevalence Iron Deficiency Anemia In
Pakistan
• NNS 2018 confirms that micronutrient deficiencies are
widespread in Pakistan.
• Anemia was common in non-pregnant women of
reproductive age 43.0% and 53.1% in girls
• Iron deffieciency anemia 21.2% s in women of reproductive
age 15–49 years
(NNS 2018)

33. Infant and young child
nutrition

34. Infants (0-6 months)
• During this period, infants on an average gain
about 4-5 kg weight and 15-16 cm length .
• Exclusive breastfeeding is recommended due to its
unique nutrients composition best suited for the
baby.
• Practice exclusive breastfeeding from 0 – 6
months
• Try to start breastfeeding within an hour of your
baby's birth
• Avoid pre-lacteal feeds and bottle feeding
• Do not start complementary feeding until the baby
is 6 months old
Energy requirement
kcal/kg
age Boy Girls
birth 113 107
6monh 81 82

35. Infants and young children (6-24 months
Introduce complementary food at 6 months of age while
continuing breastfeeding.
Increase food consistency and variety gradually as a child gets
older.
Increase the number of times that the child is fed complementary
foods, as a child gets older.
Ensure complementary foods are adequate in quality and quantity;
2-4 times/day from a variety of foods, starting from semi-solid to
solid foods gradually suitable for young children under 2 years of
age, e.g., eggs, cereals, fruits and vegetables, dairy products,
meats and pulses.

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Salt and sugar should not be added to complementary foods
Provide nutrients dense snacks from fresh foods (1-2 times/day) as per child's
appetite and requirement.
Practice good hygiene and proper food handling.
Store food safely and serve food immediately after preparation.
Use clean utensils for preparation, serving and feeding
children.
Avoid the use of bottles, which are difficult to clean.
Increase liquid intake during illness, including more frequent breastfeeding.
Encourage
child to eat

37. Malutrition
Malnutrition (Bad Nutrition)
when an organism gets too few or too many nutrients,
resulting in health problems
• Under nutrition
• Over nutrition

38. Malnutrition types

40. Screening Methods for acute malnutrition
• Screening is the rapid process used to assess whether a child
have acute malnutrition.
• Children aged 6-59 months are screened using:
– Mid-upper arm circumference (MUAC)
– Bilateral pitting edema.
• Children aged <6 months are screened using
– Bilateral pitting edema
– Visible signs of acute wasting
• MUAC should not be used for children <6 months

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Bilateral pitting edema MUAC

42. Mid-upper Arm Circumference
• Children aged 6-59 months only.
• Taken on left arm.
• Remove clothing on left arm.
• Measure the length of the child’s
upper arm, between the bone at
the top of the shoulder and the
elbow bone
• The child’s arm should be bent
• Divide the number by two to get
the midpoint
• Mark the middle of the
child’s upper with pen
• The child’s arm should then
be relaxed, falling along the
body.
• Place the MUAC tape
around the mid-point of the
arm so that it is flat around
the skin not too tight or too
loose
• Take the measurement.

44. MUAC Color Nutritional status
>12.5 Green No acute malnutrition
11.5 -12.5 Yellow MAM
<11.5 Red SAM

46. Thanks