Guidelines and recommendations for maternal and infant nutrition. Charlotte Stirling-Reed BSc, MSc, RNutr (Public Health)

Transcription

1 Guidelines and recommendations for maternal and infant nutrition Charlotte Stirling-Reed BSc, MSc, RNutr (Public Health)

2 Overview The first 1000 days of life UK maternal and infant nutrition guidelines SACN report: Future directions? Implications of recommendations Making the guidelines count Future Research

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4 The First 1,000 Days There is growing evidence that malnutrition during the crucial period of human development before and during a woman s pregnancy and during a child s first two years of life programs a person s future ability to regulate weight and affects brain development. The Lancet 2013 Many babies in the womb in the Western world today are receiving unbalanced and inadequate diets. Protecting the nutrition and health of girls and young women should be the cornerstone of public health. Not only will this prevent chronic disease, but it will produce new generations who have better health and well-being through their lives. Barker 2012 We conclude that damage suffered in early life leads to permanent impairment, and might also affect future generations. The Lancet 2008

5 UK maternal and infant nutrition guidelines

6 Nutrition During Pregnancy What Specifics Why? Healthy diet In line with The Eatwell Guide 5-A-Day 200kcals in 3 rd trimester Folic acid Take 400μg until 12 weeks Eat food containing natural folate Specific groups may need higher doses e.g. people with diabetes & previous NTDs (see GP) Help baby grown and develop & help mother and baby meet nutrient demands Reduces the risk of neural tube defects (NTDs) & supports healthy blood for mums-to-be Vitamin D Take 10μg/day throughout pregnancy Lack of vit. D during pregnancy may affect bone mineralisation of foetus and may affect infants own stores Eating fish 2 portions of fish/week (1 oily no more than 2 oily) Avoid shark, marlin, swordfish No more than 2 tuna steaks or 4 cans of tuna/week Vitamin A Avoid supplements with vitamin A Avoid liver & liver products incl Cod liver oil Omega 3 important for brain health High levels of mercury can be found in these fish which could build up in the body before pregnancy Too much vitamin A could harm baby as can be toxic in high amounts.

7 Nutrition During Pregnancy Caffeine risk of low birth weight <200mg/day as higher intakes may increase the risk of miscarriage Tea, coffee, soft drinks, energy drinks, medications and chocolate are all dietary sources of caffeine 1 mug of instant coffee 100mg 1 mug of tea 75mg 1 can of cola 40mg 1 50g bar of milk chocolate 25mg 1 can of energy drink 80mg 4. Adapted from BNF

8 Nutrition During Pregnancy Alcohol *Updated Guidelines* The Chief Medical Officers updated guideline: If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum. Precautionary approach it is safest to avoid drinking in pregnancy. 3. NICE Maternal and Child Nutrition 2008

9 Nutrition During Breastfeeding Exclusive breastfeeding first 6 months BF to continue beyond first six months with intro of appropriate solid foods All infants are individuals and will require a flexible approach to optimise their nutritional needs. Mothers should be supported in their choice of infant feeding. DH 2003

10 Nutrition During Breastfeeding Similar to advice during pregnancy: Take 10μg vitamin D daily (folic acid not needed) Consume a healthy diet in line with DH advice Avoid alcohol OR 1 2 units 1 2x/week Limit caffeine (only consume occasionally) No more than two portions of oily fish/week No more than one portion of shark, swordfish, marlin/week Additionally: 330 kcal/day extra energy in the first 6 months of lactation (SACN 2011) Peanuts OK to eat during breastfeeding as long as mum is not allergic to them Fluid intake mls extra per day

11 Nutrition for Infants Exclusive breastfeeding until around 6 months Solids around 6 months. Not before 4 months Continue BF w. appropriate other food Include meat, fish, pulses, vegetables & fruit without added salt or sugar Certain foods more likely to upset a baby or cause allergic reaction not introduced before 6 months. Healthy Start Drops 6 months (1m)/<500mls formula

12 New Vitamin D Guidelines Age Range Recommendations Restrictions 0-1 Breastfed need daily supplement of mcg Formula fed when receiving <500mls 1-4 years 10mcg Vitamin D daily N/A 5+ years Everyone should consider taking 10mcg from October-March May choose not to take April-September, if access to sun

13 Where are recommendations likely to go? Big changes - unlikely 4-6 months - flexibility Signs of readiness Vegetable lead Early introduction of allergen foods Methods of weaning

14 Implications of Recommendations Translating nutrition messages HCPs Out of date 1994 recommendations Awareness of updates e.g. CMO vitamin D 12 Adherence e.g. < 1% of women BF exclusively until 6 months & only 2% delay introduction of solids until 6m. Pre-pregnancy advice 50% pregnancies unplanned Training and delivery e.g. HS access Provision current cuts

15 Making it count (practical pointers) Read your research! Stay up to date Motivational Interviewing empathy etc Train staff confidence to raise issue Remember food is complex! Don t forget supplements Bring diet up early on Making every contact count?

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17 Thank you for listening Charlotte Stirling-Reed BSc, MSc, RNutr (Public Health) SR Nutrition

18 References 1. DH. Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Report of the Panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy. Report on Health and Social Subjects No.41. London: Her Majesty s Stationery Office (HMSO); DH. COMA Report 45. Weaning and the Weaning Diet. Report on Health and Social Subjects. HMSO, London; WHO. The optimal duration of exclusive breastfeeding: report on an expert consultation. Geneva: WHO; DH Infant Feeding Recommendation. London: DH; 2003a. 5. SACN. The SACN Subgroup on Maternal and Child Nutrition (SMCN): The Influence of maternal, fetal and child nutrition on the development of chronic disease in later life, NICE public health guidance 11 Improving the nutrition of pregnant and breastfeeding mothers and children in lowincome households. NICE, SACN. Folate and Disease Prevention. Scientific Advisory Committee on Nutrition; SACN. Iron and Health. Scientific Advisory Committee on Nutrition; SACN. Draft Vitamin D and Health Report. Scientific Advisory Committee on Nutrition; 2015; 10. World Health Organization. Global strategy for infant and young child feeding. Geneva, Switzerland: World Health Organization, Bhutta, Z.A. Early nutrition and adult outcomes: Pieces of the puzzle. [Comment] Lancet, 382 (9891) (2013), pp Victora CG, Adair L, Fall C, et al, for the Maternal and Child Undernutrition Study Group. Maternal and child undernutrition: consequences for adult health and human capital. Lancet 2008; 371: Barker DJ. Sir Richard Doll lecture: developmental origins of chronic disease. Public Health 2012; 126: DH Infant Feeding Recommendation. London: DH. NB The Department of Health Infant Feeding Recommendations; 2003a. 15. SACN. Dietary Reference values for Energy. Scientific Advisory Committee on Nutrition; Scottish Government. Improving Maternal and Infant Nutrition: A Framework for Action; 2011a.