MATERNAL and INFANT NUTRITION Stages of Fetal Development A newly fertilized ovum (zygote) begins as a single cell, and divides to become many cells during

MATERNAL and INFANT MATERNAL and INFANT NUTRITIONNUTRITION

Stages of Fetal DevelopmentStages of Fetal Development• A newly fertilized ovum (zygote) A newly fertilized ovum (zygote)

begins as a single cell, and divides to begins as a single cell, and divides to become many cells during the days become many cells during the days after fertilizationafter fertilization

• Within 2 weeks, the zygote embeds Within 2 weeks, the zygote embeds itself into the uterine wall itself into the uterine wall (implantation)(implantation)

Stages of Fetal DevelopmentStages of Fetal Development

• After implantation, the placenta develops and After implantation, the placenta develops and begins to provide nourishment to the developing begins to provide nourishment to the developing embryoembryo

• The placenta develops inside the uterus, and it The placenta develops inside the uterus, and it provides nutrients and oxygen, as well as a way for provides nutrients and oxygen, as well as a way for the developing embryo to return carbon dioxide the developing embryo to return carbon dioxide and other wastes to be excretedand other wastes to be excreted

• An embryo at 5 weeks after fertilization is ~ ½ an An embryo at 5 weeks after fertilization is ~ ½ an inch longinch long

Stages of Fetal DevelopmentStages of Fetal Development

• At 8 weeks, the 1¼ inch long embryo has a At 8 weeks, the 1¼ inch long embryo has a complete nervous system, a beating heart, a complete nervous system, a beating heart, a digestive system, well-defined fingers, and digestive system, well-defined fingers, and toes, and the beginnings of facial features toes, and the beginnings of facial features

• The fetus continues to grow during the next The fetus continues to grow during the next 7 months7 months

• Fetal growth is phenomenal – weight Fetal growth is phenomenal – weight increase from less than an ounce to ~ 7.5 increase from less than an ounce to ~ 7.5 poundspounds

Critical PeriodsCritical Periods

• Times of intense development and rapid cell Times of intense development and rapid cell division are called critical periods (cellular division are called critical periods (cellular activities can only occur at these times)activities can only occur at these times)

• Each tissue and organ is most vulnerable to Each tissue and organ is most vulnerable to adverse influences during its own critical period adverse influences during its own critical period

• Adverse influences include nutrient deficiencies or Adverse influences include nutrient deficiencies or toxinstoxins

• An adverse influence felt early = irreversibly An adverse influence felt early = irreversibly impairs developmentimpairs development

• An adverse influence felt late = may only An adverse influence felt late = may only temporarily impair developmenttemporarily impair development

Critical PeriodsCritical Periods• Critical period for neural tube development Critical period for neural tube development

is 17 to 30 days gestation – folate is 17 to 30 days gestation – folate supplementation reduces the risk for neural supplementation reduces the risk for neural tube defectstube defects

• The brain and spinal cord develop from the The brain and spinal cord develop from the neural tube, and defects in its orderly neural tube, and defects in its orderly formation during the early weeks of formation during the early weeks of pregnancy may result in various central pregnancy may result in various central nervous system disorders (spina bifida)nervous system disorders (spina bifida)

Critical PeriodsCritical Periods

• Maternal anemia during the critical period Maternal anemia during the critical period of placental growth alters the pattern of of placental growth alters the pattern of blood vessel growth, which may affect the blood vessel growth, which may affect the cardiovascular health of the infantcardiovascular health of the infant

• Malnutrition during the critical period of Malnutrition during the critical period of pancreatic cell growth may contribute to the pancreatic cell growth may contribute to the development of diabetes in adulthooddevelopment of diabetes in adulthood

MATERNAL WEIGHTMATERNAL WEIGHT

• A woman’s weight prior to conception A woman’s weight prior to conception influences fetal growthinfluences fetal growth

• Underweight: higher risk of a LBW infant, Underweight: higher risk of a LBW infant, higher risk of a preterm infanthigher risk of a preterm infant

• Overweight: higher risk of medical Overweight: higher risk of medical complications such as hypertension, gestational complications such as hypertension, gestational diabetes, and postpartum infections. Also since diabetes, and postpartum infections. Also since the baby may be larger then normal - may lead the baby may be larger then normal - may lead to difficult labor, delivery, and birth traumato difficult labor, delivery, and birth trauma

• However, weight loss during pregnancy is However, weight loss during pregnancy is NEVER advisableNEVER advisable

Weight Gain During PregnancyWeight Gain During Pregnancy

• All pregnant women must gain weight – All pregnant women must gain weight – fetal growth depends on itfetal growth depends on it

• Maternal weight gain during pregnancy Maternal weight gain during pregnancy correlates closely with infant birthweight, correlates closely with infant birthweight, which is a strong predictor of the health of which is a strong predictor of the health of the infantthe infant

Weight Gain During PregnancyWeight Gain During Pregnancy

Prepregnancy Weight Prepregnancy Weight StatusStatus

Recommended Recommended Weight GainWeight Gain

Underweight Underweight (BMI<19.8)(BMI<19.8) 28 to 40 pounds28 to 40 pounds

Normal Weight Normal Weight (BMI 19.0-26)(BMI 19.0-26) 25 to 35 pounds25 to 35 pounds

Overweight Overweight (BMI 26-29)(BMI 26-29) 15 to 25 pounds15 to 25 pounds

Obese Obese (BMI >29)(BMI >29) 15 pounds minimum15 pounds minimum

Weight Gain PatternsWeight Gain Patterns

• Normal weight women should gain ~3 Normal weight women should gain ~3 lbs. in the first trimester, and just under lbs. in the first trimester, and just under 1 lb/week thereafter1 lb/week thereafter

• Underweight women: 1Underweight women: 1stst trimester = 5 trimester = 5 lbs., 1 lb/week thereafterlbs., 1 lb/week thereafter

• Overweight women: 1Overweight women: 1stst trimester = 2 trimester = 2 lbs., 2/3 lb/week thereafterlbs., 2/3 lb/week thereafter

• Most of the weight gain supports the growth Most of the weight gain supports the growth and development of the placenta, uterus, and development of the placenta, uterus, blood, and breasts, as well as an optimally blood, and breasts, as well as an optimally healthy infanthealthy infant

• A small amount goes into maternal fat A small amount goes into maternal fat stores, and that fat has a special purpose: to stores, and that fat has a special purpose: to provide energy for labor and lactationprovide energy for labor and lactation

Components of Weight GainComponents of Weight Gain

Weight Loss After PregnancyWeight Loss After Pregnancy

• The pregnant women loses some weight at The pregnant women loses some weight at deliverydelivery

• In the following weeks, she loses more as her In the following weeks, she loses more as her blood volume returns to normal and she sheds blood volume returns to normal and she sheds accumulated fluidsaccumulated fluids

• The typical women does not return to The typical women does not return to prepregnancy weight, most tend to retain a prepregnancy weight, most tend to retain a couple of pounds with each pregnancycouple of pounds with each pregnancy

• In general, the more weight a women gains In general, the more weight a women gains beyond the needs of pregnancy, the more she beyond the needs of pregnancy, the more she will retain will retain

Nutrition During PregnancyNutrition During Pregnancy

• From conception to birth, all parts of the From conception to birth, all parts of the infant – bones, muscles, organs, skin, and infant – bones, muscles, organs, skin, and other tissues – are made from the nutrients other tissues – are made from the nutrients in the food that mother eatsin the food that mother eats

• ENERGY: extra 340 calories in the 2ENERGY: extra 340 calories in the 2ndnd and and extra 450 calories in the 3extra 450 calories in the 3rdrd trimester trimester

• PROTEIN: 25 grams per day higher than PROTEIN: 25 grams per day higher than the RDA (most are already getting that)the RDA (most are already getting that)


• ESSENTIAL FATTY ACIDS: the brain ESSENTIAL FATTY ACIDS: the brain is largely made up of lipid material, is largely made up of lipid material, and it depends highly on the omega 3 and it depends highly on the omega 3 and omega 6 fatty acids for its growth, and omega 6 fatty acids for its growth, function, and structurefunction, and structure

• Pregnant women are advised to include Pregnant women are advised to include seafood, leafy greens, nuts, and seeds seafood, leafy greens, nuts, and seeds in their dietin their diet

Mercury in FishMercury in Fish

• FDA has issued an advisory to all pregnant FDA has issued an advisory to all pregnant women, women who may become pregnant, women, women who may become pregnant, lactating mothers, and young children – avoid lactating mothers, and young children – avoid eating large amounts of mackerel, swordfish, eating large amounts of mackerel, swordfish, shark, tuna, and tilefishshark, tuna, and tilefish

• Pregnant and lactating women – one can of tuna Pregnant and lactating women – one can of tuna per weekper week

• Young children – less than a can per monthYoung children – less than a can per month• http://www.doh.wa.gov/fish/FishAdvWomen.htmhttp://www.doh.wa.gov/fish/FishAdvWomen.htm


Nutrients for:Nutrients for:• Blood production and cell growth – folate, Blood production and cell growth – folate,

B12, iron, and zincB12, iron, and zinc• Bone development – vitamin D, calcium, Bone development – vitamin D, calcium,

phosphorus, magnesium, and fluoridephosphorus, magnesium, and fluoride

SupplementationSupplementation• Women who make wise food choices during Women who make wise food choices during

pregnancy can meet most of their nutrient needs, pregnancy can meet most of their nutrient needs, however, iron and folate are two nutrients that however, iron and folate are two nutrients that may need to be supplementedmay need to be supplemented

• Women of childbearing age who are capable of Women of childbearing age who are capable of becoming pregnant are advised to consume 400 becoming pregnant are advised to consume 400 micrograms of folate per day (supplements are micrograms of folate per day (supplements are convenient, better absorbed)convenient, better absorbed)

• Iron supplements are recommended during the 2Iron supplements are recommended during the 2ndnd and 3and 3rdrd trimesters of pregnancy (30 mg per day) trimesters of pregnancy (30 mg per day)

Nutrition-Related ConcernsNutrition-Related Concerns• Nausea – hormonal changes appear to be Nausea – hormonal changes appear to be

responsible for a woman’s sensitivities to responsible for a woman’s sensitivities to the appearance, smell, or taste of foodsthe appearance, smell, or taste of foods

• Suggestions:Suggestions:• On waking, arise slowlyOn waking, arise slowly• Eat small, frequent mealsEat small, frequent meals• Avoid foods with offensive odorsAvoid foods with offensive odors• When nauseated do not drink citrus juice, When nauseated do not drink citrus juice,

milk, coffee, or teamilk, coffee, or tea

Nutrition-Related ConcernsNutrition-Related Concerns

• Constipation – as the hormones of Constipation – as the hormones of pregnancy alter muscle tone and the pregnancy alter muscle tone and the growing fetus crowds the intestinal growing fetus crowds the intestinal organsorgans

• Suggestions:Suggestions:• Eat foods high in fiberEat foods high in fiber• Exercise regularlyExercise regularly• Drink plenty of fluidsDrink plenty of fluids

Nutrition-Related ConcernsNutrition-Related Concerns• Heartburn – the hormones relax the digestive Heartburn – the hormones relax the digestive

muscles, and the growing fetus puts increased muscles, and the growing fetus puts increased pressure on the mother’s stomachpressure on the mother’s stomach

• Suggestions:Suggestions:• Relax and eat slowlyRelax and eat slowly• Chew food thoroughlyChew food thoroughly• Eat small, frequent mealsEat small, frequent meals• Avoid spicy or greasy foodsAvoid spicy or greasy foods• Sit up while eating, elevate head when sleepingSit up while eating, elevate head when sleeping• Wait an hour after eating before lying downWait an hour after eating before lying down

Gestational DiabetesGestational Diabetes• A condition of abnormal glucose tolerance, A condition of abnormal glucose tolerance,

usually during the second half of pregnancy, usually during the second half of pregnancy, which resolves after birthwhich resolves after birth

• Consequences of GD – complications during Consequences of GD – complications during delivery, high infant birthweight, and birth delivery, high infant birthweight, and birth defects (heart damage, limb deformities, and defects (heart damage, limb deformities, and neural tube defects)neural tube defects)

• Risk Factors: age, obesity, family history, Risk Factors: age, obesity, family history, history of abnormal glucose tolerance, history of abnormal glucose tolerance, ethnicity associated with a high incidence of ethnicity associated with a high incidence of diabetesdiabetes

Practices Incompatible with Practices Incompatible with PregnancyPregnancy

• Alcohol – limits oxygen delivery, slows cell Alcohol – limits oxygen delivery, slows cell divisiondivision

• Medicinal and illicit drugs Medicinal and illicit drugs • Tobacco – linked to premature labor, breathing Tobacco – linked to premature labor, breathing

problems, and fatal illness among infantsproblems, and fatal illness among infants• Environmental contaminantsEnvironmental contaminants• Vitamin-Mineral megadosesVitamin-Mineral megadoses• CaffeineCaffeine• Weight-loss dietingWeight-loss dieting

Low BirthweightLow Birthweight

Low birthweightLow birthweight (less than 5.5 lbs. or 2500 (less than 5.5 lbs. or 2500 grams) is the factor most associated with grams) is the factor most associated with infantinfant mortality. mortality.

Babies who are Babies who are low birthweightlow birthweight are 40 times are 40 times more likely to die in their first year than healthy more likely to die in their first year than healthy babies. babies.

Those who survive are more vulnerable to serious Those who survive are more vulnerable to serious health and developmental problems, such as health and developmental problems, such as blindness, deafness, mental retardation and blindness, deafness, mental retardation and learning disabilities.learning disabilities.

Causes of Low Birthweight InfantsCauses of Low Birthweight Infants

Poor nutritionPoor nutrition GeneticsGenetics Disease conditionsDisease conditions Smoking Smoking Drug use (including alcohol)Drug use (including alcohol)

LACTATION LACTATION

• Lactation is an automatic process that Lactation is an automatic process that virtually all mothers are capable of virtually all mothers are capable of doingdoing

• Breastfeeding is a learned behaviorBreastfeeding is a learned behavior

The United States Lags in BreastfeedingThe United States Lags in Breastfeeding

The United States has one of the lowest rates of The United States has one of the lowest rates of breastfeeding in the industrialized world, and one breastfeeding in the industrialized world, and one of the highest rates of infant mortalityof the highest rates of infant mortality

Data from 1998 indicate that only 64 percent of U.S. Data from 1998 indicate that only 64 percent of U.S. mothers initiate breastfeeding, and only 29 percent mothers initiate breastfeeding, and only 29 percent report feeding any human milk to their infants at report feeding any human milk to their infants at six months. six months.

Those numbers stand in marked contrast to Sweden, Those numbers stand in marked contrast to Sweden, for example, where the breastfeeding initiation for example, where the breastfeeding initiation rate exceeds 98 percent and the rate at six months rate exceeds 98 percent and the rate at six months is 80 percent.is 80 percent.

What are the barriers to breastfeeding in the What are the barriers to breastfeeding in the US?US?

BENEFITS of BENEFITS of BREASTFEEDINGBREASTFEEDING

For Infants:For Infants:• Provides the perfect balance of nutrients with Provides the perfect balance of nutrients with

high bioavailabilityhigh bioavailability• Provides hormones that promote physiological Provides hormones that promote physiological

developmentdevelopment• Improves cognitive developmentImproves cognitive development• Protects against a variety of infectionsProtects against a variety of infections• May protect against some chronic diseases May protect against some chronic diseases

(IDDM, hypertension)(IDDM, hypertension)• Protects against food allergiesProtects against food allergies

BENEFITS of BENEFITS of BREASTFEEDINGBREASTFEEDING

For MothersFor Mothers• Contracts the uterusContracts the uterus• Delays the return of regular ovulationDelays the return of regular ovulation• Conserves iron stores (by prolonging amenorrhea)Conserves iron stores (by prolonging amenorrhea)• May protect against breast cancerMay protect against breast cancer• May help the mother to lose weight gained during May help the mother to lose weight gained during

pregnancy (~650 cal/day)pregnancy (~650 cal/day)• It’s cheap! (A nursing mother produces over 35 It’s cheap! (A nursing mother produces over 35

gallons of milk during the first six months, saving gallons of milk during the first six months, saving ~$450 in formula costs)~$450 in formula costs)

Composition of Breast MilkComposition of Breast Milk


• Lipids: triglycerides are the major energy Lipids: triglycerides are the major energy source, also rich in cholesterol, EFAs(EPA, source, also rich in cholesterol, EFAs(EPA, and DHA)and DHA)

• Carbohydrates: lactose is the major CHOCarbohydrates: lactose is the major CHO• Proteins: Whey proteins predominate, all Proteins: Whey proteins predominate, all

essential amino acids, lactoferrin (protects essential amino acids, lactoferrin (protects infants from infection), other infants from infection), other immunoglobulins (antibodies)immunoglobulins (antibodies)


• Vitamins and Minerals: a perfect balance of Vitamins and Minerals: a perfect balance of all essential vitamins and mineralsall essential vitamins and minerals

• Other: digestive enzymes, anti-infective Other: digestive enzymes, anti-infective factors, hormones, and growth factors factors, hormones, and growth factors

Nutrient Needs During LactationNutrient Needs During Lactation

• Energy RDA during lactation – extra 500 kcal/day Energy RDA during lactation – extra 500 kcal/day (1800 kcal/day minimum)(1800 kcal/day minimum)

• Protein RDA during lactation – same as during Protein RDA during lactation – same as during pregnancypregnancy

• Vitamins and Minerals – milk quality is maintained at Vitamins and Minerals – milk quality is maintained at the expense of the maternal storesthe expense of the maternal stores

• Nutrients in breast milk most likely to decline in Nutrients in breast milk most likely to decline in response to inadequate stores are – B6, B12, Vitamin response to inadequate stores are – B6, B12, Vitamin A and DA and D

• In general, nutritional inadequacies reduce the In general, nutritional inadequacies reduce the quantityquantity, not the , not the qualityquality of breast milk of breast milk

High Protein DietsHigh Protein Diets

• There are some concerns that it is not safe There are some concerns that it is not safe for a breastfeeding mother to be in ketosis for a breastfeeding mother to be in ketosis

• The Atkins Center website’s recommends The Atkins Center website’s recommends that pregnant and breastfeeding women that pregnant and breastfeeding women adjust their carbohydrate intake to adjust their carbohydrate intake to maintenance level (enough carbohydrate to maintenance level (enough carbohydrate to decrease ketone production)decrease ketone production)

Nutrition During InfancyNutrition During Infancy

• Solid foods are introduced based on an Solid foods are introduced based on an infant’s physiological needs, such as infant’s physiological needs, such as depletion of iron stores, and on physical depletion of iron stores, and on physical development, such as the ability to sit updevelopment, such as the ability to sit up

• Current recommendation: 4 to 6 monthsCurrent recommendation: 4 to 6 months

Foods To OmitFoods To Omit

• Concentrated sweetsConcentrated sweets• Canned vegetablesCanned vegetables• Honey and corn syrupHoney and corn syrup• Popcorn, whole grapes, whole beans, hot Popcorn, whole grapes, whole beans, hot

dog slices, hard candies, and nutsdog slices, hard candies, and nuts• Cow’s milk (before 12 months)Cow’s milk (before 12 months)

Food AllergiesFood Allergies

• Experts recommend introducing single-ingredient Experts recommend introducing single-ingredient foods, one at a time, in small portions, and waiting foods, one at a time, in small portions, and waiting 4 to 5 days to introduce the next food (rice cereal - 4 to 5 days to introduce the next food (rice cereal - barley - oats - wheat)barley - oats - wheat)

• A true food allergy occurs when protein fractions A true food allergy occurs when protein fractions of a food are absorbed into the blood and elicit an of a food are absorbed into the blood and elicit an immunological response (antibodies, histamines, immunological response (antibodies, histamines, or other defensive agents)or other defensive agents)

• Food intolerances involve symptoms, but no Food intolerances involve symptoms, but no antibodiesantibodies

Iron DeficiencyIron Deficiency

• Iron deficiency has a well-known and wide Iron deficiency has a well-known and wide spread effect on children’s behaviorspread effect on children’s behavior

• Symptoms include decreased energy, Symptoms include decreased energy, learning ability, attention span, and learning ability, attention span, and depressed mooddepressed mood

• The long-term damaging effects of iron The long-term damaging effects of iron deficiency make its prevention a high deficiency make its prevention a high prioritypriority

Nutrition During InfancyNutrition During Infancy

• The two dietary practices that have the most The two dietary practices that have the most effect on an infant’s nutrition status are the effect on an infant’s nutrition status are the milk the infant receives and the age at milk the infant receives and the age at which solid foods are introducedwhich solid foods are introduced

• Breast feeding is recommended for at least Breast feeding is recommended for at least 6 months, but even 2 to 3 months can give 6 months, but even 2 to 3 months can give the infant immunological protectionthe infant immunological protection

• Breast milk is the prefect infant food, but Breast milk is the prefect infant food, but iron, Vitamin D, fluoride, and Vitamin K iron, Vitamin D, fluoride, and Vitamin K may need to be supplemented may need to be supplemented

Lead ToxicityLead Toxicity

• Children who are malnourished are Children who are malnourished are vulnerable to lead poisoning (they absorb vulnerable to lead poisoning (they absorb more lead if their stomachs are empty, and more lead if their stomachs are empty, and if they have iron deficiencies)if they have iron deficiencies)

• Lead toxicity is most prevalent in children Lead toxicity is most prevalent in children under 6, and 10-15% of all preschoolers under 6, and 10-15% of all preschoolers may have blood lead concentrations high may have blood lead concentrations high enough to cause mental, behavioral, and enough to cause mental, behavioral, and other health problemsother health problems

Lead ToxicityLead Toxicity

• Lead is present in old homes (plumbing), Lead is present in old homes (plumbing), old paint, and in some soilold paint, and in some soil

• Children can ingest lead by drinking Children can ingest lead by drinking contaminated water, eating paint chips, contaminated water, eating paint chips, playing in and around lead contaminated playing in and around lead contaminated house dust or soilhouse dust or soil

• Lead is not easily excreted and accumulates Lead is not easily excreted and accumulates in the bones, brain, teeth, and kidneysin the bones, brain, teeth, and kidneys

• Deficits in intellectual development are only Deficits in intellectual development are only partially reversed when lead levels declinepartially reversed when lead levels decline

Prevalence of Eating DisordersPrevalence of Eating Disorders

• More than 5 million Americans suffer from eating More than 5 million Americans suffer from eating disorders disorders

• 90% of cases of anorexia and bulimia occur in 90% of cases of anorexia and bulimia occur in femalesfemales

• 15% of young women have substantially 15% of young women have substantially disordered eating attitudes or behaviorsdisordered eating attitudes or behaviors

• 8% of overweight women and 30% of those 8% of overweight women and 30% of those seeking treatment from weight loss programs meet seeking treatment from weight loss programs meet criteria for binge eating disorder; 25% of binge criteria for binge eating disorder; 25% of binge eaters may be maleeaters may be male

What Causes Eating Disorders?What Causes Eating Disorders?









Nutrition-Related ConcernsNutrition-Related Concerns

• Constipation – as the hormones of Constipation – as the hormones of pregnancy alter muscle tone and the pregnancy alter muscle tone and the growing fetus crowds the intestinal growing fetus crowds the intestinal organsorgans

• Suggestions:Suggestions:• Eat foods high in fiberEat foods high in fiber• Exercise regularlyExercise regularly• Drink plenty of fluidsDrink plenty of fluids

Nutrition-Related ConcernsNutrition-Related Concerns• Heartburn – the hormones relax the digestive Heartburn – the hormones relax the digestive

muscles, and the growing fetus puts increased muscles, and the growing fetus puts increased pressure on the mother’s stomachpressure on the mother’s stomach

• Suggestions:Suggestions:• Relax and eat slowlyRelax and eat slowly• Chew food thoroughlyChew food thoroughly• Eat small, frequent mealsEat small, frequent meals• Avoid spicy or greasy foodsAvoid spicy or greasy foods• Sit up while eating, elevate head when sleepingSit up while eating, elevate head when sleeping• Wait an hour after eating before lying downWait an hour after eating before lying down

Documents

MATERNAL and INFANT NUTRITION Stages of Fetal Development A newly fertilized ovum (zygote) begins as a single cell, and divides to become many cells during