NUTRITION IN PREGNANCY & INFANCY

Transcription

1 NUTRITION IN PREGNANCY & INFANCY NUTR 2050 Nutrition for Nursing Professionals Mrs. Deborah A. Hutcheon, MS, RD, LD Lesson Objectives At the end of the lesson, the student will be able to: 1. Define the fetal origins hypothesis. 2. Explain how both underweight and overweight can interfere with a healthy pregnancy, particularly in relationship to fetal programming. 3. Outline healthy patterns of weight gain during pregnancy. 4. Summarize the nutrient needs of women during pregnancy: energy, protein, & key micronutrients. 5. Discuss dietary interventions to moderate and alleviate common nutrition concerns during pregnancy. 6. Define LBW, VLBW, FTT, overweight, & obesity in infants. 7. List and explain the benefits of breastfeeding. 8. Summarize the nutrient needs of women during lactation: energy, protein, & key micronutrients. 9. Compare and contrast the nutrient composition of human milk with infant formula and cow s milk. 10. Match infant age with feeding ability and the introduction of solid foods. 11. Discuss principles related to the introduction of solid foods to infants. Preparing for Pregnancy **Fetal Origins Hypothesis** Adequate Nutrition Decrease risk of maternal complications. Ensure normal fetal tissue growth. Increase likelihood of optimal birth weight. Decrease risk of chronic disease. Inadequate Nutrition Increase risk of maternal complications. Increase prenatal morbidity & mortality. Increase risk of chronic disease including obesity. 1

2 Maternal Weight Gain Low Weight Gain v. Excessive Weight Gain LBW Infants HTN preeclampsia ( risk infant mortality) ( risk obesity) Gestational Diabetes ( risk chronic disease) Post-Partum Obesity LBW Risk Groups 1. Teenagers Infant Chronic Disease 2. African Americans (fetal programming) Maternal Weight Gain in Pregnancy **Dieting is NEVER advised during pregnancy!** Recommendations by The Institute of Medicine Maternal Weight Gain Pattern First Trimester: 2 to 4 pounds total Components of Weight Gain 2 nd & 3 rd Trimesters: 1 pound per week +340 to 450 kcal/day +25 grams protein/day Avoid dieting or sudden gain. Large, sudden gain could be fluid retention. 2

3 Nutritional Needs During Pregnancy Energy: BMR increasing energy (kcal) needs +340 kcal (2 nd trimester) & +450 kcal (3 rd trimester) Select nutrient-dense foods: 135 (minimum) to 175 grams CHO/day (~12 servings) Protein: support fetal growth (+25 grams/day) Essential Fatty Acids: fetal growth & development Caution with fatty fish consumption: mercury contamination. Avoid: shark, swordfish, king mackerel. <12 oz of seafood or 6 oz white (albacore) tuna per week Avoid fish oil supplements during pregnancy. Nutritional Needs During Pregnancy Folic Acid: support fetal neural development Prevent: Must be consumed pregnancy & continue during. RDA: mcg prior to & mcg during. Vitamin B12: assist metabolism Nutritional Needs During Pregnancy Iron: support larger blood volume & transport Iron-deficiency anemia common in woman & infant. RDA (pregnancy): mg/day. Zinc: DNA, RNA, & protein synthesis & cell development Calcium: development Absorption increases with pregnancy. Adequate intake to conserve maternal bone structure. RDA (women 19 to 50): mg/day. Vitamin D: absorption & bone homeostasis 3

4 Nutritional Concerns During Pregnancy Morning Sickness (Hyperemesis gravidarum) Pica Food Craving/Aversions Constipation and Hemorrhoids Heartburn Listeriosis Consumption of Non-Nutritive Sweeteners Caffeine: limit to 200 mg/day Alcohol (fetal alcohol syndrome), Smoking, Drugs Nutritional Concerns During Pregnancy Source: IFIC Review on Caffeine & Health: Clarifying the Controversies, 2008 Nutritional Overview During Pregnancy Source: AND Nutrition & Lifestyle for a Healthy Pregnancy Outcome,

5 Trends in Infant Health Leading Causes of Death Among Infants 1. Birth Defects 2. Pre-Term Delivery 3. Low Birth Weight (LWB) LBW = 5.5# (2500 g) or less VLBW = 3.25# (1500 g) or less 4. Sudden Infant Death Syndrome (SIDS) 5. Maternal Complications During Pregnancy Primary Indicators of Infant Health 1. Birth Weight 2. Length of Gestation CDC Growth Charts & Body Weight CDC Growth Charts & Body Weight Weight Status Category Underweight/FTT Healthy weight Percentile Range <5th percentile 5th percentile to <85th percentile Overweight 85th to <95th percentile Obese 95th percentile 5

6 Breastfeeding is Best! Nutritionally adequate Immune support (colostrum, antibodies, bifidus factors) Protect against some chronic diseases Provides hormones for physiological development Supports cognitive development Prevention of food allergies Breastfeeding is Best! Bonding between mother & child Weight loss for mother May protect mother from some chronic diseases Delays regular ovulation (birth spacing) Reduced food costs Breastfeeding is Best! Recommendation by AND, AAP, WHO: Women should breastfeed an infant exclusively during first 6 months of life and should breastfeed while supplementing diet with solid foods up to 12 months. Nutrient Needs for Mother: Energy: +500 kcal/day during 1 st 6 months (+330 kcal food intake & 170 from fat stores) Protein: +25 grams/day Essential Fatty Acid Intake Adequate Vitamin & Mineral Intakes (Iron & Calcium) Avoid foods with strong or spicy flavors. Limit/avoid common allergen foods. 6

7 Hindrances to Breastfeeding Lack of knowledge Lack of work support Lack of family support (husband) Portrayal of bottle feeding in society Lack of incentives for low-income women Nutritional Comparison Nutrient Human Milk Formula Cow's Milk Energy (kcal) Protein (g) 10 (whey) (casein) Carbohydrate (g) 69 (lactose) (galactose) Fat (g) 44 (EFA) (SFA) Calcium (mg) Iron (mg) Trace Source: Krause s Nutrition & Diet Therapy, 12 th ed by Mahan & Escott-Stump Nutrition & Breastmilk Complete nutrition for 1 st 6 months of life. Breast milk is more easily & completely digested than formula more frequent feedings. Iron: Infant iron stores sufficient for 1 st 4 to 6 months of life; supplementation with food after 6 months. Vitamin D: need supplementation, even with breastfeeding. Formulas: prepared to mimic human milk with some extra fortification of essential fat, vitamins, & minerals. 7

8 Feeding Ability 0 to 4 4 to 6 6 to 9 9 to 12 Extrusion Able to transfer food from spoon to back of mouth to swallow. Begins chewing action. Brings hand to mouth & can grasp food with palm of hand. Begin picking up foods with foods. Holds bottle & drinks from a cup. Able to chew up & down. Picks up food with fingers. Rotary chewing. Able to sit-up unsupported. Introduction of Solid Food 0 to 4 4 to 6 6 to 9 9 to 12 Breast Milk/ Formula Breast Milk/ Formula Breast Milk/ Formula Breast Milk/ Formula Pureed/ strained foods (Cereal) Strained Vegetables/ Fruits Meats Soft Solid Foods & Finger Foods Introduction of Solid Food Introduce solid foods with iron-fortified rice cereal first. Add single food ingredients one at a time at intervals of 2 to 4 days between to assess for allergies & intolerances. (Top 8 Food Allergens) Add vegetables before fruits. DO NOT feed cow s milk until after 1 year of age, & then only provide WHOLE milk. Caution with choking hazard foods: hot dogs, grapes, popcorn, raisins, nuts, hard candy. 8

9 Juice Intake Excessive juice intake associated with tooth decay and failure to thrive. Serve in a cup (not a bottle) and dilute Limit Juice Intake 4 oz to 6 oz for infants >6 months & toddlers 6 oz to 12 oz for children & adolescents Additional Items to Note Essential Fatty Acids (cognitive & physical development): Linoleic, Linolenic, arachidonic acid (AA), EPA & DHA NEVER feed an infant (up to 1 year) honey or corn syrup risk of Clostridium botulinum poisoning. 9