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XNB151 Week 9 Pregnancy, lactation and infant nutrition


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XNB151 Week 9 Pregnancy, lactation and infant nutrition

  1. 1. Pregnancy,Lactation &Infant NutritionXNB151 Food andNutritionArnolfiniWedding - Jan van Eyck, 1434
  2. 2.  Both a man and woman’s nutrition can affect fertility& possibly genetic contributions to children Woman’s nutrition most direct influence General recommendations to prepare for a healthypregnancy are: Achieve & maintain a healthy body weight Choose and adequate and balanced diet Be physically active Receive regular medical care Manage chronic conditions Avoid harmful influences(Reference: Recommendations to improve preconceptionhealth and health care – United States, Morbidity &MortalityWeekly Report 55 (2006) : 552-561.
  3. 3. Progesterone relaxes smooth musclewhich helps with uterusexpansion ↓ GIT activity  ↑absorption favours maternal fatdepositionOestrogen ↑ fluid retention tomaintain blood volume regulates thyroidhormone production &BMRPlacenta SecretesTwo Main Hormones
  4. 4. Components of body weight gain in normal pregnancy (Wahlqvist 3rd ed, p 385)
  5. 5. If your pre-pregnancy BMI was: You should gainLess than 18.5 kg/m²18.5 to 24.9 kg/m²25 to 29.9 kg/m²Above 30 kg/m²12½ to 18kg11½ to 16kg7 to 11½ kg5 to 9kgShould be used as a general guideValue of weight gain recommendations has been disputedImportant to consider the many individual and multiple factors thatcan influence outcomesInstitute of Medicine, 2009
  6. 6. 3 stages The zygote divides into numerous small cells embeds itself into uterine wall after ~2 weeks no increased requirements for energy or protein in wellnourished women The embryo lasts ~6 weeks rudiments of all principal organs & membranes develop <5g & ~ 3cm long energy requirements not increased but nutrient intake veryimportant
  7. 7.  The foetus lasts ~7 months gets to 2.8-3.5kgi.e. growth = ~200gper week! energy & proteinrequirementsincreased nutrient intakevery important
  8. 8.  Critical periods – rapid cell division duringpregnancy, which if affected, can result inirreversible effects Thought that maternal nutrition prior to &during pregnancy can affect short & longterm health outcomes e.g. CVD, diabetes Critical period for neural tube defects is 17 to30 days gestation minimised by folate supplementation
  9. 9. Orange = major abnormalityLight Orange = minor abnormality
  10. 10.  Current recommendations 2nd trimester ~1.4MJ extra per day 3rd trimester ~1.9MJ extra per day More if underweight & less if overweight atconception Monitor weight gain and appetite
  11. 11. Nutrient Female 19-50yrs PregnancyProtein 46g 60gFats (essentialFAs)8g (n-6)0.8g (n-3)90mg (LC n-3)10g (n-6)1g (n-3)115mg (LC n-3)Fibre 25g 28gFolate 400µg FE 600µg FECalcium 1000mg 1000mgIron 18mg 27mgZinc 8mg 11mgIodine 150µg 220µgVitamin A 700µg RE 800µg REVitamin D 5µg 5µgVitamin C 45mg 60mg
  12. 12.  Folate has a key role in cell division Direct link between folate deficiency & closure of the neuraltube in early pregnancy Critical in 28 days following conception →neural tube defects such as spina bifida folate supplementation of 400µg/d is encouraged for 1 moprior to conception & for 2 mo after + foods rich in folate folic acid is now added to wheat flourfor bread-making (except organic)
  13. 13.  essential for ↑ in maternal red cellmass & for the developing foetus &placenta deficiency may lead to pretermdelivery, low birth weight CNSdevelopment delay iron needs of foetus take precedenceover that of mother Vegetarians advised to have intake80% higher than EAR & RDIs Many women have inadequatestatus before pregnancy Important to optimise safety ofsupplementationCredit: JOHN BAVOSI/SCIENCE PHOTOLIBRARY
  14. 14.  Essential for growth &development, neuronalfunction & development Inadequate intake in pregnancy can lead to: stillbirths miscarriages congenital abnormalities such as cretinism Deficiency is widespread in parts of Australia &NZ table salt can be bought iodised iodised salt now used in bread making in Australia& NZ
  15. 15.  Healthy, well-nourished women whoconsume an adequate & varied diet need onlysmall adjustments to their diet duringpregnancy The poorer the mother’s pre-pregnancynutritional status the more importantnutrition is during pregnancy
  16. 16.  usually only for 1st trimester management via: small, frequent meals dry biscuit before getting outof bed avoid large drinks staying away from strongsmelling foods, etc severe form is calledhyperemesis gravidarum
  17. 17.  cravings & aversions donot seem to reflectphysiological needs but pica may reflect irondeficiency pica is the compulsiveintake of non-nutritivesubstance such as ice dirt,soap, chalk etc
  18. 18.  indigestion occurs later on due to relaxationof GIT muscles & pressure of the growingbaby constipation is exacerbated by iron supp’s needs to be treated with increased fluid &fibre
  19. 19.  No known safe amount 2009 NHMRC Guidelines state that “not drinkingis the safest option” Heavy drinking known to ↑ risk of Foetal AlcoholSyndrome: underdevelopment of the mid-face small body size mental retardation developmental delay behavioural
  20. 20.  crosses the placental barrier mother & foetus clear caffeine more slowly High levels of intake may lead to: delayed conception spontaneous miscarriage foetal growth restriction low birth weight Recommendations – limit to 1 regular espresso style coffee, OR 3 cups instant style coffeeOR 4 cups tea OR 4 cans diet/regular cola drink
  21. 21. Artificial Sweeteners most considered safe should not compromise energy/CHO intakeNutrient supplements folic acid, iron & iodine important anything else not important if a well balanceddiet is consumed ExcessVitamin A in particular needs to beavoided because of detrimental effects on thefoetus
  22. 22.  Guidelines are the same as Physical ActivityGuidelines for Australians: 30 min of moderateintensity exercise on 5 or more days of the week(i.e. brisk walking) Moderate exercise does not harm foetus & hasbenefits for the mother, including: reduced fat gain - shorter labour lower risk of gestational diabetes - quicker delivery maintenance of aerobic fitness - fewer surgicalinterventions High impact exercise or hard physical work canaffect foetal development & result in: low birth weight (LBW) babies Obstetric complicationsCredit: IAN HOOTON/SCIENCE PHOTO LIBRARY
  23. 23.  Restricts the blood flow to the growing foetus& limits O2 & nutrient delivery & waterremoval May cause: birth complications foetal growth retardation (LBW) spontaneous abortion foetal death sudden infant death syndrome (SIDS)
  24. 24.  Contaminated foods can be debilitating &dangerous during pregnancy mainly due todehydration Listeriosis (Listeria monocytogenes) cancause: miscarriage stillbirth severe brain or other infections to the foetus
  25. 25.  To prevent listeriosis: safe handling & storage of food fresh, thoroughly cooked eatenstraight away, wash fresh fruit &vegies avoid raw/uncooked/smokedmeat & seafood, deli meats,leftovers, pre-prepared salads,smorgasbords, soft serve ice-cream, soft cheeses, raw eggs,unwashed raw fruit & vegies
  26. 26. Mercury High levels found in large, long-lived fish Can cross the placenta & have severe negativeeffects on the developing brain & nervoussystem FSANZ recommends: 1 serve (150g)/week of Orange Roughy (Sea Perch) orcatfish & NO other fish that week 1 serve (150g)/fortnight of shark/flake or billfish(swordfish/broadbill & marlin) & NO other fish thatfortnight 2-3 serves of any other fish & seafood not listed above
  27. 27. Adolescent Teenage girls’ requirements are increasedwithout the extra needs of pregnancy More calcium, phosphorous & magnesiumrequiredVegetarian vitamins B12 & D, calcium, zinc, omega-3fatty acids, riboflavin & iron may beproblematic, esp. in vegans
  28. 28.  Begin pregnancy well nourished & physically fit Follow Dietary Guidelines & AGHErecommendations for pregnancy Keep weight gain to less than 13kg Eat safe foods & prepare them safely Exercise regularly Minimise caffeine consumption No smoking or alcohol consumption
  29. 29. Breast oflactatingfemale
  30. 30. PROLACTINStimulates milk productionreleased in response tosucklingOXYTOCINCauses the muscular tissue tocontract & pushes the milkinto the collecting ducts (‘let-down’)Pain, stress & anxiety caninterfere with secretion
  31. 31. I(2nd trimester to birth)glands develop ability to secrete milk componentsLactogenesis II(birth to ~60 hours after birth)milk known as colustrumincreased blood flow to breast, milk ‘comes in’Lactogenesis III(by ~5 days after birth)milk composition is stable
  32. 32. Energy 2-2.1MJ/day extra = ~25% increase in intake Varies considerably between individuals Excessive restriction for weight loss not advisedNutrients Nutrient content/MJ of the Aust diet > human milk for most nutrientsEXCEPT calcium & vitamin C Calcium RDIs not increased as body adapts – encourage to meet RDIs Vitamin C content of milk will fall if Mothers diet low in vitamin C Iron NRV falls to post-menopausal/pre-menstrual level as menstruationceases Vitamin D can be an issue in dark skin/low sun exposure infants
  33. 33. Nutrient Female 19-50yrsPregnancy LactationProtein 46g 60g 67gFats(essential FAs)8g (n-6)0.8g (n-3)90mg (LC n-3)10g (n-6)1g (n-3)115mg (LC n-3)12g (n-6)1.2g (n-3)150mg (LC n-3)Fibre 25g 28g 30Folate 400µg FE 600µg FE 500µg FECalcium 1000mg 1000mg 1000mgIron 18mg 27mg 9mg*Zinc 8mg 11mg 12mgIodine 150µg 220µg 220µgVitamin A 700µg RE 800µg RE 1100µg REVitamin D 5µg 5µg 5µgVitamin C 45mg 60mg 85mg
  34. 34.  some foods may affect some infantse.g. onions, garlic these should be avoided if necessary
  35. 35.  May be associated with: lactation performance earlier cessation of breastfeeding deficits in infant psychomotor development disrupted infant sleep-wake behavioural patterns alcohol consumption while breastfeeding isnot encouraged Avoid for first mo until Breastfeeding established No more than two std drinks per day Avoid immediately before breastfeeding
  36. 36.  Infant Nutrition = First year after birth Rapid growth Poor nutrition results in infant death or death before 5 y Inadequate nutrition causes: wasting stunting deficiency diseases global mortality & disease burden Over nutrition linked with Short-term outcomes Establishment of eating habits & consequent chronic diseasedevelopment
  37. 37. Governed in the 1st 12 months by: small body size small amount of food, frequently rapid growth rate needs influenced by tissue growth level of physiological maturity limits types of foods that can be given
  38. 38.  greater evaporation dehydration a major risk because of: high temperatures too concentrated formula vomiting diarrhoea breastfed infants don’t need extra water formula fed infants may in very hot weather Plain boiled Ensure does not replace feed
  39. 39.  dependent upon BMR, growth & activity 3-4x greater amount per kg body weight thanadults decreases as growth slows but then increasesagain as activity increases• provided by fat & lactose in breast milk or formula for1st 6mths• then introduction of solids contributes energy fromother macronutrients
  40. 40.  In early infancy 60-75% of total protein forgrowth; at one year about 15% Average 3g protein/day required in first year But requirement changes with age Recommendations based on breastmilkintakes of healthy infants + allowances forcomplimentary foods
  41. 41.  main CHO in human & cow’s milk islactose lactose facilitates calcium &magnesium absorption lactose provides ~ 1/3 of energy primary lactose intolerance rare;secondary usually due to repeatedattacks of gastroenteritis Human milk also has ~130oligosaccharides – promote growth ofbacteria responsible for some diarrhoeaCredit: DRTIM EVANS/SCIENCEPHOTO LIBRARYLactose Molecule
  42. 42.  Principal source of energy fornewborn 40-50% energy from fat Important as: concentrated energy when capacity of intakelimited source fat soluble vitamins source essential fatty acids provides energy without increasing soluteload (protein) or loss of water fromhyperosmolar effects ( CHO)
  43. 43.  requirements are based on the amountsestimated to be provided, on average, byhuman milk from a well-nourished mother since not all babies are breast-fed someallowances are made for formula fed babiesCredit: PAUL WHITEHILL/SCIENCE PHOTO LIBRARY
  44. 44.  exclusive breastfeeding for 6 months breastfeeding continued to at least 12months after the introduction of solids at ~6monthsCredit: IAN BODDY/SCIENCEPHOTO LIBRARY
  45. 45.  most mothers can learn to breastfeedsuccessfully but often need support &assistance babies develop an innate reflex to turn theirhead & open their mouth, suckle & swallow mothers need to practise appropriatepositioning & attachment of the baby toallow effective suckling & minimise the risk ofnipple damage & breast problems such asmastitis
  46. 46. World Health Organisation, 2009)
  47. 47.
  48. 48.  changing composition ofvarious stages of lactation tosuit the needs of the infant changing composition withina feed infant’s appetite &consequent suckling regulateamount produced presence of long chain PUFAsCredit: MAURO FERMARIELLO/SCIENCE PHOTOLIBRARY
  49. 49.  immunological lower infant mortality in developing countries fewer acute illnesses physiological jaw development in infant practical economicCredit: MARK THOMAS/SCIENCEPHOTO LIBRARY
  50. 50. Pattern infants should be fed on demand to promote thebest milk supply normally newborns will feed 10-12 times/dayAdequate intake baby is content after feeds feeding 8-10 times/day soaked nappy 6 or more times/day loose & mustard yellow stools following a recommended growth pattern
  51. 51.  Factors influencingsuccess environment &support smoking motivation medicinal drugs illicit drugs Factors influencingprevalence & durationReasons commonly givenby mothers for stoppinginclude: adequacy of milk supply nipple or breastproblems returning to work
  52. 52. Formula needs to be used in infants under 12 monthsif not breastfed based on cow’s or goat’s milk or soy beverage For therapeutic nutrition: partially/substantially digested altered nutrient profile can also be anti-regurgitation (AR)or hypoallergenic (HA) or extensivelyhydrolysed Credit: BETTINASALOMON/SCIENCEPHOTO LIBRARY
  53. 53. Issues with formula use inappropriate/incorrect mixing lack of immunological benefits contamination during preparation expense ? increased risk of chronic diseases later in life– overweight, obesity, diabetes