Download Chpt 10 - Nutrition and Pregnancy/Infancy

Chapter 10
Nutrition Through the Life
Span: Pregnancy and Infancy
© 2007 Thomson - Wadsworth
Nutrition Prior to
Pregnancy
• Achieve &
maintain a
healthy body
weight
• Choose an
adequate &
balanced diet
• Be physically
active
• Avoid harmful
substances
© 2007 Thomson - Wadsworth
Prepregnancy Weight
• Underweight or
overweight before
pregnancy presents
medical risks
© 2007 Thomson - Wadsworth
Underweight
• High risk of
having a lowbirthweight baby
• Low-birthweight
 More risk for
disease
 40 times more
likely to die in first
month
• Long-term effects
 Risk for obesity &
hypertension later
in life
 Lower adult IQ
 Short stature
 Educational
disadvantages
© 2007 Thomson - Wadsworth
Causes of Low-Birthweight
• Mother’s
Poor nutrition
Heredity
Disease conditions
Smoking
Drug & alcohol use
© 2007 Thomson - Wadsworth
Overweight & Obesity
• Babies
• Mom
 Are larger
 Twice as likely to
have neural tube
deficits
 Greater risk of
heart defects
 More likely to need
labor induced
 May need C-section
 More post-partum
hypertension,
infections, &
gestational diabetes
© 2007 Thomson - Wadsworth
Healthy Support Tissues
• Prepregnancy
nutrition needed to
support growth of a
healthy placenta
• Placenta
 Supply depot
 Waste-removal
system
• Umbilical cord
 Pipeline from
placenta to fetus
• Amniotic sac
 Surrounds baby
 Cushions it with
fluids
© 2007 Thomson - Wadsworth
The Events of Pregnancy
• Newly fertilized
ovum called a
zygote
• Implants in uterine
wall in 2 weeks
• Placenta begins to
grow
• Crucial time period
• Adverse influences
can lead to
 Failure to implant
 Neural tube deficits
• Smoking
• Drug abuse
• Malnutrition
© 2007 Thomson - Wadsworth
The Embryo & Fetus
• Embryo develops
into a fetus
• At 8 weeks fetus has
 Complete CNS
 Beating heart
 Fully formed digestive
tract
 Well-defined fingers &
toes
 Beginning facial
features
• Last 7 months
 Grows 50 times
heavier & 20 times
longer
• Pregnancy
 39-41 weeks
duration
• Infant
 Weight 6 ½ - 9
pounds
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Critical Periods
• Development of each organ
takes place at a certain time
(critical period)
• Effects of malnutrition at a
critical period are irreversible
© 2007 Thomson - Wadsworth
Effects of Malnutrition
• Nervous system defects of
the embryo
• Child’s poor dental health
• Adolescent’s & adult’s
vulnerability to infection
• Higher risk of diabetes,
hypertension, stroke, or
heart disease
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Nutrient Needs During
Pregnancy
• Some increase
• Must make careful choices
• Woman’s body
Maximizes absorption
Minimizes losses
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Nutrient Needs
• Energy (kcalories)
 Additional 340 in 2nd
trimester
 Additional 450 in 3rd
trimester
 Select nutrient-dense
foods
• Carbohydrates
 Additional 175 g
 Fiber for constipation
• Protein
 Additional 25 g
 Protein supplements
are discouraged
• Fats
 Little room for oil,
margarine, & butter
 Need essential fatty
acids
© 2007 Thomson - Wadsworth
Special Interest
• Folate
 Role in cell
reproduction
 Increased from 400600 mcg/day
 Prevents neural tube
deficits
• Spina bifida
• Anencephaly
• Vitamin B12
 Needed to assist
folate in manufacture
of new cells
 Found in animal
products
 Vegans need fortified
foods or supplements
 Supplements, fortified
foods or both
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Nutrients for Bones
• Vitamin D, calcium,
phosphorus,
magnesium
• Intestinal absorption
of calcium doubles
early in pregnancy
• Final weeks, more
than 300 mg
transferred to fetus
• Increase milk
products
• May need
supplements
• Calcium-fortified
soy milk & orange
juice
© 2007 Thomson - Wadsworth
Fluoride
• Mineralization of teeth
begins in 5th month
• Fluoride supplements
Recommended if do not
have fluoridated water
Not recommended if
have fluoridated water
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Iron
• Absorption of iron
increases threefold
• Fetus draws heavily
on mother’s stores
• Daily supplement
 30 mg iron
 2nd & 3rd trimester
• Iron-rich food
 Liver, oysters
 Meat, fish
 Dried fruits
 Legumes
 Dark green
vegetables
• Vitamin C-rich
foods enhance
absorption
© 2007 Thomson - Wadsworth
Zinc
• Needed for DNA, RNA &
protein synthesis
• Deficiency predicts low
birthweight
• Found in foods of high
protein content
• Iron interferes with zinc
absorption
• May need zinc supplements
© 2007 Thomson - Wadsworth
Nutrient Supplements
• Prenatal
supplements
provide more
• Needed for
 Those with poor diet
 High-risk pregnancies
 Multiple fetuses
 Cigarette smokers
 Alcohol & drug abusers
 Folate
 Iron
 Calcium
• Reduce risks of
 Preterm delivery
 Low birthweight
 Birth defects
© 2007 Thomson - Wadsworth
Food Assistance Programs
• Women, Infants,
Children (WIC)
 Vouchers for
nutritious food
 Food education
 Iron-fortified formula
• Federal Food Stamps
• Nutrition education
 American Dietetic
Association
 American Diabetes
Association
 Local hospitals
© 2007 Thomson - Wadsworth
Weight Gain
• Essential for healthy pregnancy
• Normal-weight woman
 3 ½ pounds first trimester
 1 pound/week thereafter
© 2007 Thomson - Wadsworth
Physical Activity
• Very important
 Improves her fitness
 Facilitates labor
 Helps to prevent or
manage gestational
diabetes
 Reduces
psychological stress
• Low-impact
activities
• Avoid
 Activities with
potential for falls or
being hit by others
 Saunas
 Steam rooms
 Whirlpools
© 2007 Thomson - Wadsworth
Common
Nutrition-Related Concerns
• Food sensitivities
• Nausea
• Heartburn
• Constipation
© 2007 Thomson - Wadsworth
Food Cravings & Aversions
• Cravings
 Do not seem to
reflect
physiological
needs
• Cravings &
aversions
 Probably due to
© 2007 Thomson - Wadsworth
• Hormone-induced
changes in taste
• Sensitivities to
smells
Nonfood Cravings
• Pica
Craving items such as
laundry starch, clay,
soil, or ice.
Common among
African American
women
Often associated with
iron deficiency
© 2007 Thomson - Wadsworth
Other Concerns
• Morning Sickness
 Comes from hormonal
changes in early
pregnancy
 Mild queasiness to
debilitating nausea
 Smells often trigger it
• Heartburn
 Fetus puts
pressure on
woman’s stomach
 Acid may back up
• Constipation
 High-fiber diet
 Physical activity
 Plentiful fluids
© 2007 Thomson - Wadsworth
Problems in Pregnancy
• Gestational
Diabetes
• Hypertension
 Pre-existing
 Usually resolves
after the birth
 Often leads to
surgical birth &
high infant
birthweight
• Risk of low-birthweight
infant
• Separation of placenta
 Transient
© 2007 Thomson - Wadsworth
• Usually resolves after
the birth
Preeclampsia
• Symptoms
 Hypertension
 Protein in the urine
 Whole body edema
• Usually first
pregnancy
• After 20 weeks
• May experience
convulsions
 Eclampsia
 Need prompt
medical attention
© 2007 Thomson - Wadsworth
Avoid Cigarette Smoking
• Behavioral or
• Nicotine & cyanide
intellectual problems
are toxic to a fetus
later in life
• Second-hand smoke
• Implicated in SIDS
is also problematic
(sudden infant death
• Blood flow is
syndrome)
restricted
• More complicated
• Slows fetal growth
births
• Low birthweight
© 2007 Thomson - Wadsworth
Avoid
• Medicinal drugs
• Drugs of abuse
 No over-the-counter
 No medicines not
prescribed
 No aspirin or ibuprofen in
last 3 months
• Herbal supplements
 Almost none have been
tested for safety during
pregnancy
 Cross the placenta
 Impair growth &
development
• Environmental
contaminants
 Lead & mercury
 Avoid certain types
of fish
© 2007 Thomson - Wadsworth
Avoid
• Foodborne illness
• Dieting
 Listeriosis
• Can cause miscarriage,
stillbirth
• Severe brain injury,
other infections to fetus
& newborn
• Vitamin-mineral
megadoses
 Hazardous during
pregnancy
• Sugar substitutes
 Use in moderation
• Caffeine
 Limit to one cup coffee
or two 12-oz colas
 Many are toxic in excess
 Need care with vitamin A
© 2007 Thomson - Wadsworth
Alcohol
• Fetal alcohol
syndrome (FAS)
Irreversible brain
damage
Mental retardation
Facial abnormalities
Vision abnormalities
• No amount is safe
© 2007 Thomson - Wadsworth
Adolescent Pregnancy
• Intense nutrient
needs
• Often deficient
before pregnancy
• Encouraged to
gain about 35
pounds
• Risks for
 Low-birthweight
Miscarriage
 Stillbirth
 Death of infant in
first year
© 2007 Thomson - Wadsworth
Breastfeeding
• Recommendation
Exclusive
breastfeeding for
6 months
Then
breastfeeding with
complementary
foods through 12
months
© 2007 Thomson - Wadsworth
Nutrition During Lactation
• Eat nutrientdense foods
• Enjoy ample food
& fluids at
frequent intervals
© 2007 Thomson - Wadsworth
Nutrition Needs
• Energy
• Vitamins & minerals
 An extra 330
kcalories/day
• Weight loss
 1 pound/week
• Water
 Need about 13
cups/day
 Milk quality is
maintained at expense
of maternal stores
 Undernourished may
need supplements
• Particular foods
 Some might bother
baby
© 2007 Thomson - Wadsworth
Contraindications to
Breastfeeding
•
•
•
•
•
•
Alcohol
Caffeine
Cigarette smoke
Medications
Illicit drugs
Some maternal
illnesses
• May reduce milk
production
• May enter breast
milk & impair
infant development
© 2007 Thomson - Wadsworth
Nutrition of the Infant
• Affects later
development
• Sets the stage for
eating habits
• Provide a nurturing,
relaxing environment
© 2007 Thomson - Wadsworth
Nutrients to Support
Growth
• Weight doubles by 4-5
months
• Triples by 1 year
• BMR is very high
• Need
 100 kcalories/kg
 Adequate vitamin A, D,
& calcium
 Adequate water
 Dose of vitamin K at
birth
© 2007 Thomson - Wadsworth
Breast Milk
• Energy nutrients
 Carbohydrates
• Lactose
• Enhances calcium
absorption
• Vitamins & Minerals
 Vitamin D
supplement needed
• If breastfed
• If not on vitamin Dfortified formula
 Lipids
• Generous amount
of essential fatty
acids
 Protein
• Alpha-lactalbumin
• Easily digestible
• Lower in sodium
• Highly absorbable
iron & zinc
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Supplements for Infants
• After 6 months
may need
Vitamin D
Iron
Fluoride
© 2007 Thomson - Wadsworth
Benefits of Breast Milk
• Immunological
protection
• Infant has less
 Colostrum (premilk
substance)
 Maternal immune
factors
 Enzymes that offer
protection
 Stomach &
intestinal
disorders
 Middle ear
infections
 Respiratory illness
© 2007 Thomson - Wadsworth
Other Potential Benefits
• May protect
Against adult obesity
Cardiovascular disease
• May have a positive effect
On later intelligence
© 2007 Thomson - Wadsworth
Infant Formula
• Can offer the same
Closeness
Warmth
Stimulation
© 2007 Thomson - Wadsworth
Formula Composition
•
•
•
•
Similar to breast milk
Offers no immunity
Standards have been set
All need to be iron
fortified
• Are special formulas for
allergies & lactose
intolerance
• Risks of over-dilution &
contamination
© 2007 Thomson - Wadsworth
Nursing Bottle Tooth Decay
• Do not put infant
to bed with a
bottle
• Can cause
Dental caries
Bucktoothed
profile
© 2007 Thomson - Wadsworth
Transition to Cow’s Milk
• Not appropriate in
first year
• 1-2 years need
whole milk
• 2-5 years can
transition to lower
fat
• Cow’s milk
 Is a poor source
of iron
 Higher in calcium
but lower in
vitamin C (inhibits
iron absorption)
 Higher protein can
stress infant’s
kidneys
© 2007 Thomson - Wadsworth
Introducing First Foods
• First foods can be
introduced between
4-6 months
• Can sit with support
& control head
movements
© 2007 Thomson - Wadsworth
Foods to Provide Iron &
Vitamin C
• Breast milk & ironfortified formula
• Iron-fortified cereals
• Meat & meat
alternatives
• Fruits & vegetables
for vitamin C
© 2007 Thomson - Wadsworth
Physical Readiness
• 4-6 months can
swallow solids
• 8-12 months
Can handle finger
foods
Begins to teethe
Hard crackers can
be introduced
© 2007 Thomson - Wadsworth
Infant Feeding
• Allergy-causing
foods
 Introduce foods
one at a time
 Rice cereal first
 Wheat last
• Choice of foods
 Baby foods
 Blenderized table
food
• Foods to omit
 Sweets of any kind
 No canned vegetables
• High in sodium
 Honey
• Risk of botulism
 Foods that cause risk
for choking
• Foods at 1 year
 Same foods as rest of
family
© 2007 Thomson - Wadsworth
Looking Ahead
• Introduce a
• Avoid food as
variety of
 A reward
nutritious foods
 Comfort for
unhappiness
• Don’t force to
 Deprivation for
finish food & drink
punishment
© 2007 Thomson - Wadsworth
Feeding Guidelines for
Mealtime
• Discourage
unacceptable
behavior
• Let the child
explore & enjoy
food
• Don’t force food
on children
• Strictly limit
sweets
© 2007 Thomson - Wadsworth