MATERNAL AND
INFANT NUTRITION
We have been discussing basic concepts of nutrition:
-
Food choices and nutritional guidelines
Digestion
Carbohydrates, lipids, and proteins
Energy balance and body composition
Vitamins
Water and mineral balance
We have been discussing basic concepts of nutrition:
-
Food choices and nutritional guidelines
Digestion
Carbohydrates, lipids, and proteins
Energy balance and body composition
Vitamins
Water and mineral balance
We then began to specific applications of those concepts:
- Sports nutrition
We have been discussing basic concepts of nutrition:
-
Food choices and nutritional guidelines
Digestion
Carbohydrates, lipids, and proteins
Energy balance and body composition
Vitamins
Water and mineral balance
We then began to specific applications of those concepts:
- Sports nutrition
Today we will discuss maternal and infant nutrition
Maternal and Infant Nutrition
Pregnancy and lactation present some
special nutrition concerns for both the
mother and the newborn infant.
While a pregnant woman
has many of the same
nutritional needs as anyone
else, she must also
- ingest additional nutrients for herself
- provide nutrients to the embryo/fetus
- avoid subtances which could damage
the fetus
Nutritional Concerns of Pregnancy
Pregnancy and lactation present
some special nutrition concerns for
both the mother and the newborn.
These nutritional needs actually begin
at the time of fertilization, weeks before
she will know she is pregnant.
Nutritional Concerns of Pregnancy
Pregnancy and lactation present
some special nutrition concerns for
both the mother and the newborn.
These nutritional needs actually begin
at the time of fertilization, weeks before
she will know she is pregnant.
Half of all pregnancies are unplanned
(a very large majority of which occur
in couples who are using some form of
contraception), so it isimportant for all women of childbearing age to be aware of these nutritonal needs.
Nutritional Concerns of Pregnancy
Nutrition before conception:
Provide
Screening for risk
Health promotion and education
Intervention as needed
Maintain a healthy weight (low or
high weight increases risk for
poor outcome)
Not a good time to diet
Supplements such as folic acid
can be given to minimize risk of problems
Nutritional Concerns of Pregnancy
Of particular concern are avoiding things
which can damage the embryo or fetus
- smoking
- drugs
- inadequate carbohydrates, proteins,
fats, vitamins, minerals, etc.
- diabetes
- hypertension
- mineral imbalances
- toxic substances
such as mercury in fish
- excessive caffeine
Nutritional Concerns of Pregnancy
Certains substances which are safe or
even beneficial for the mother can cause
damage in her embryo and fetus:
- vitamin A
- vitamin D
- blood pressure medications
- acne medications (Accutane)
- antibiotics (doxycycline, tetramycin)
- alcohol
Nutritional Concerns of Pregnancy
It is also important for the woman to avoid
situations which increase her own health
risks during pregnancy
- obesity
- smoking
- alcohol
- drugs
- inadequate carbohydrates, proteins,
fats, vitamins, minerals, etc.
- diabetes
- hypertension
- mineral imbalances
Nutritional Concerns of Pregnancy
Let’s review pregancy and embryonic/fetal development
It begins when one sperm fertilizes the egg.
Nutritional Concerns of Pregnancy
Let’s review pregancy and embryonic/fetal development
It begins when one sperm fertilizes the egg.
This occurs in the
Fallopian tube a
few minutes to a
few hours after
sexual intercourse.
Nutritional Concerns of Pregnancy
Over the next few days, the
fertilized egg (called a zygote)
divides repeatedly as it travels
along the Fallopian tube toward
the uterus.
If the mother is poorly nourished, this may not occur
correctly and the dividing embryo may die, ending the
pregnancy.
Nutritional Concerns of Pregnancy
One to two weeks after fertilization
the embryo implants itself in the
lining of the uterus, where it will
continue to grow and develop for
the next nine months.
Here again, if the mother is poorly nourished this may not
occur correctly and the embryo may die, ending the
pregnancy.
Nutritional Concerns of Pregnancy
As the embryo develops, so does
its placenta. This is the interface
through which
- the embryo (later a fetus) gets
nutrients from the mother’s
blood
- waste products from the embryo/fetus are passed
into the mother’s blood so she can get rid of them
Nutritional Concerns of Pregnancy
As the embryo develops, so does
its placenta. This is the interface
through which
- the embryo (later a fetus) gets
nutrients from the mother’s
blood
- waste products from the embryo/fetus are passed
into the mother’s blood so she can get rid of them
At this stage, the embryo also becomes susceptible to
many drugs, chemicals, infections, and other things
which can also pass through the placenta, killing it or
damaging it and leading to birth defects
Nutritional Concerns of Pregnancy
Nutritional Concerns of Pregnancy
While the embryo or fetus is growing, many change are
also occurring to the mother’s body:
- Growth of uterus
- Growth of breasts
- Added adipose tissue,
- Increase blood volume
- Slower GI motility
- Increased stress on heart
- Inceased stress on lungs
- Increased stress on kidneys
- Increased stress on bones and joints
Nutritional Concerns of Pregnancy
Recommendations for weight gain depend on BMI:
Normal weight (BMI 19.8–26)
Recommended = 25 - 35 pounds
Higher recommended gain for
underweight women, teens, and
multiple fetuses
Lower recommended gain for
overweight and obese women
Nutritional Concerns of Pregnancy
A pregnant woman needs additional calories to
provide the energy for this growth.
Her Resting Energy Expenditure
increases because of the energy
needs of the fetus and placenta
as well as
The increased work of her heart,
lungs, muscles, bones, and kidneys
During the second and third trimesters, when both the
fetal growth and the mother’s growth are greatest, she
will need an additional 350 to 450 KCal per day
Nutritional Concerns of Pregnancy
Most pregnant women who eat a healthy
diet have few problems meeting the
nutritional needs of the pregnancy.
A diet high in complex carbohydrates
and low in fat with few saturated or
trans fats, plus adequate protein, will
continue to meet the nutitional needs even in pregnancy.
Nutritional Concerns of Pregnancy
Most pregnant women who eat a healthy
diet have few problems meeting the
nutritional needs of the pregnancy.
A diet high in complex carbohydrates
and low in fat with few saturated or trans
fats, plus adequate protein, will continue
to meet the nutitional needs even in pregnancy.
Additional protein, ~25g/day, is needed for the growth of
fetal, placental, and maternal tissues. Additional fat may
be needed as the breasts develop & begin milk production.
Essential fatty acids and essential amino acids are
needed for both maternal and fetal health.
Nutritional Concerns of Pregnancy
Most pregnant women who eat a healthy
diet have few problems meeting the
nutritional needs of the pregnancy.
The need for micronutrients such as
vitamins and minerals also increases.
More of the B vitamins are needed
because of the increased activities of the metabolic
enzymes for which they are cofacotors. Additional
vitamins C and A provide antioxidants and support bone
and muscle growth.
Nutritional Concerns of Pregnancy
Most pregnant women who eat a healthy
diet have few problems meeting the
nutritional needs of the pregnancy.
The need for micronutrients such as
vitamins and minerals also increases.
The need for iron to support the increased
blood production is markedly increased. Additional calcium,
magnesium, and phosphorus may be needed for healthy
bone growth in the fetus later in the pregnancy.
Nutritional Concerns of Pregnancy
Although their nutritional needs can be
effectively met through a healthy diet,
pregnant women are almost always advised
to take a prenatal supplement of vitamins
and minerals.
Nutritional Concerns of Pregnancy
Although their nutritional needs can be
effectively met through a healthy diet,
pregnant women are almost always advised
to take a prenatal supplement of vitamins
and minerals.
As long as overdoses are not taken, these
assure that adequate levels of these
micronutrients are available to both the
mother and the fetus.
Nutritional Concerns of Pregnancy
Although their nutritional needs can be
effectively met through a healthy diet,
pregnant women are almost always advised
to take a prenatal supplement of vitamins
and minerals.
Prenatal vitamins specifically ensure that
the mother is getting enough folic acid
(vitamin B9) to minimize
the risk of neural tube
defects such as spina
bifida.
Nutritional Concerns of Pregnancy
More than half of all pregnant women
experience nausea (called “morning
sickness” although it can occur at any time
of day) during the first trimester, often
accompanied by vomiting.
Other gastrointestinal problems include constipation,
heartburn, or abdominal pain.
Nutritional Concerns of Pregnancy
More than half of all pregnant women
experience nausea (called “morning
sickness” although it can occur at any time
of day) during the first trimester, often
accompanied by vomiting.
Other gastrointestinal problems include constipation,
heartburn, or abdominal pain.
These can often be managed,
but probably not eliminated.
Nutritional Concerns of Pregnancy
Many women have cravings for specific
foods, particularly foods which are sweet,
salty, or spicy.
Nutritional Concerns of Pregnancy
Many women have cravings for specific foods, particularly
foods which are sweet, salty, or spicy.
Many women also develop
aversions to particular foods
during pregnancy, particularly
foods with strong tastes or smells.
These generally have no importance.
Nutritional Concerns of Pregnancy
Many women have cravings for specific foods, particularly
foods which are sweet, salty, or spicy.
Many women also develop
aversions to particular foods
during pregnancy, particularly
foods with strong tastes or smells.
These generally have no importance.
However, in some cases, the cravings are for unusual
things such as dirt or clay, starch, hair, or paper. Cravings
for such things as cigarette butts and feces have been
reported. This is called pica and can cause problems if
those materials are toxic or if they cause intestinal blockage.
Nutritional Concerns of Pregnancy
The use of tobacco, alcohol, and drugs create special
concerns in pregnancy since their effects can be much
more pronounced in the fetus than in the mother.
- Smoking (including marijuana) increases
the risk of miscarriage or stillbirth,
premature birth, and low birth weight.
Nutritional Concerns of Pregnancy
The use of tobacco, alcohol, and drugs create special
concerns in pregnancy since their effects can be much
more pronounced in the fetus than in the mother.
- Smoking (including marijuana) increases
the risk of miscarriage or stillbirth,
premature birth, and low birth weight.
- Alcohol increases the risk of fetal alcohol
syndrome which results in growth
retardation and physical and mental defects.
Nutritional Concerns of Pregnancy
The use of tobacco, alcohol, and drugs create special
concerns in pregnancy since their effects can be much
more pronounced in the fetus than in the mother.
- Smoking (including marijuana) increases
the risk of miscarriage or stillbirth,
premature birth, and low birth weight.
- Alcohol increases the risk of fetal alcohol
syndrome which results in growth
retardation and physical and mental defects.
- Drugs such as cocaine, MDMA (ecstasy), ketamine,
methamphetamine, or heroin can have similar effects,
with the added risk of the newborn being addicted
Nutritional Concerns of Pregnancy
Pregnancy can also cause some serious
health concerns.
a) Hypertension develops in 3 – 5% of
pregnancies. It is most common in
younger women, older women, obese
women, and women with a family history of
hypertension.
Nutritional Concerns of Pregnancy
Pregnancy can also cause some serious
health concerns.
b) Hypertension with the presence of
protein in the urine is called
pre-eclampsia. Like hypertension
alone it is more common in younger women, older
women, and obese women.
Nutritional Concerns of Pregnancy
Pregnancy can also cause some serious
health concerns.
c) Rarely, women with pre-eclampsia
develop convulsions or go into a
coma, called eclampsia. Unless
detected and treated quickly it is usually fatal.
Nutritional Concerns of Pregnancy
Pregnancy can also cause some serious
health concerns.
d) Gestational diabetes develops in
4 - 6% of pregnancies. It is most
common in older women or women
with a history of poor blood sugar
control. It usually develops later in
pregnancy and can usually be controlled with diet,
although insulin injections may be necessary.
Because the extra glucose in the mother’s blood
crosses the placenta, the baby is usually larger than
average at birth.
Nutritional Concerns of Pregnancy
More than 10% of all pregnancies in the US occur in
adolescents, creating some special nutritional concerns:
- Adolescents are less likely to get prenatal care, including
nutritional advice and support.
- Adolescents tend to have poorer diets with more
prepared foods which are higher in sugars, salt, and fats
and lower in vitamins and minerals.
- Adolescents are more likely to smoke, drink, or use
illicit drugs during pregnancy.
- Adolescents are still growing themselves, and their
nutritional needs can be compromised by those of the
developing fetus.
Nutritional Concerns of Pregnancy
More than 10% of all pregnancies in the US occur in
adolescents, creating some special nutritional concerns
Adolescents have higher risks for
preeclamsia, anemia, premature birth,
low-birth-weight babies, and infant
mortality.
Lactation and Breastfeeding
As the pregnancy progresses,
nutritional needs relating to lactation
and breastfeeding arise.
Lactation and Breastfeeding
As the pregnancy progresses,
nutritional needs relating to lactation
and breastfeeding arise.
Breasts begin to grow early in pregnancy
as glands and ducts develop under the
stimulus of the hormone prolactin from the
pituitary gland. Most women begin to
produce milk early in the third trimester.
Lactation and Breastfeeding
During birth the mother’s pituitary
gland also produces the hormone
oxytocin, which dramatically increases
the production of milk during the first
few days after birth.
Lactation and Breastfeeding
During birth the mother’s pituitary
gland also produces the hormone
oxytocin, which dramatically increases
the production of milk during the first
few days after birth.
Every time the baby nurses it
stimulates the mother’s pituitary
gland to secrete both prolactin,
which stimulates milk production,
and oxytocin which stimulates its
expression, the “let down reflex”
Lactation and Breastfeeding
For the first few days, the milk will be
more concentrated and will be relatively
low in lipids and carbohydrates and
relatively high in protein. It also
contains large amounts of antibodies.
This milk is called colostrum.
Within a few days the milk becomes
less concentrated and higher in lipids
and carbohydrates.
Lactation and Breastfeeding
Immediately after birth, it is normal for an infant to lose
5 to 6% of her body weight as she adjusts to life outside
the uterus and her digestive system adjusts to food.
Within a few days of breastfeeding
she should begin gaining weight, and
within about two weeks should have
returned to birth weight.
By 4 to 6 months her weight should
have doubled, and by 12 months she
should have tripled her birth weight.
Lactation and Breastfeeding
World Health Organization recommendations:
- 75% of infants breastfed initially
- 50% of infants breast feeding at 6 months
- breastfeeding for at least the first 2 years.
- breast milk or formula should be supplemented
with solid food beginning at 4 to 6 months.
Lactation and Breastfeeding
Percent of infants exclusively breastfed for first six months
Lactation and Breastfeeding
Since this breastmilk will be the infant’s only source of
nutrition for many months, and a subtantial part of her
nutrition for up to two years, it must contain all of the
essential nutrients:
- carbohydrates
- lipids, including essential fatty acids
- proteins, including essential amino acids
- vitamins
- minerals
- water
It also contains antibodies and immune cells to help the
infant resist infections, and compounds which are natural
laxatives.
Lactation and Breastfeeding
Breastfeeding continues to offer health benefits well into
childhood, including
- lower risk of sudden infant death syndrome (SIDS)
- fewer infections
- lower risk of obesity
- lower risk of diabetes
- lower risk of diarrhea
- lower risk of asthma
- fewer allergies
- fewer dental problems
Some studies indicate it may also
increase intelligence throughout life
Lactation and Breastfeeding
Breastfeeding also provides health benefits for the mother
- reduces post-partum bleeding
- assists the uterus in returning to its pre-pregnancy size
- assists the mother in returning to pre-pregnancy weight
- reduces the risk of breast cancer later in life
Lactation and Breastfeeding
During breastfeeding, of course, the mother’s nutritional
needs remain high.
- 300 to 400 more Kcal/day than before pregnancy
- 25 grams/day more protein
- additional vitamins
- additional minerals
- additional water
It is healthier for both her and her infant
if she gets these from a broad diet rather
than special diets or supplements.
Infant Formula
In some cases the mother either can not breastfeed her
infant or chooses not to.
There are a number of infant formulas
available which are designed to provide
adequate nutrition.
Most of these use cows’
milk as the base, although some use soy
compounds or other liquids instead.
Infant Formula
Most infant formulas provide adequate
calories in the form of carbohydrates and
fats and adequate protein. They are
fortified with all of the essential viatmins
and minerals.
None-the-less, fomulas are not able to
completely mimic the content of breastmilk. Many contain
fats, proteins, and carbohydrates that are less readily
digested and absorbed by the immature digestive system of
an infant...
Infant Formula
Most infant formulas provide adequate
calories in the form of carbohydrates and
fats and adequate protein. They are
fortified with all of the essential viatmins
and minerals.
None-the-less, fomulas are not able to
completely mimic the content of breastmilk. Many contain
fats, proteins, and carbohydrates that are less readily
digested and absorbed by the immature digestive system of
an infant. They may be lacking essential fatty acids or
essential amino acids...
Infant Formula
Most infant formulas provide adequate
calories in the form of carbohydrates and
fats and adequate protein. They are
fortified with all of the essential viatmins
and minerals.
None-the-less, fomulas are not able to
completely mimic the content of breastmilk. Many contain
fats, proteins, and carbohydrates that are less readily
digested and absorbed by the immature digestive system of
an infant. They may be lacking essential fatty acids or
essential amino acids. They do not contain the antibodies
and other immune components which breastmilk does.
Breastmilk and Solid Foods
At some point, typically at about four to six months of age
in the United States, the infant adds solid foods to the
breastmilk or formula.
Breastmilk and Solid Foods
At some point, typically at about four to six months of age
in the United States, the infant adds solid foods to the
breastmilk or formula.
Initially, most of her total energy
expendature is used for basal
metabolic processes and growth. As
she gets older and more active, more
of her energy expendature is used for
physical activity.
Breastmilk and Solid Foods
Thus, her diet – usually a mixture of breastmilk or formula
and solid foods - must meet the older infant’s increased
energy needs.
Breastmilk and Solid Foods
Thus, her diet – usually a mixture of breastmilk or formula
and solid foods - must meet the older infant’s increased
energy needs.
Compared to an adult, a much higher
percentage of an infant’s diet should
come from carbohydrate and fat, which
are the primary source of calories.
Adequate amounts of protein are still
important, including essential amino
acids, but the small volume of her
digestive system, requiring smaller
more frequent meals, makes getting enough calories more
important for an infant.
Breastmilk and Solid Foods
The micronutrients – vitamins and
minerals – are also important during the
first year of infancy.
Breastmilk, formula, and solid foods
designed for infants normally contain
sufficient amounts of these.
Breastmilk and Solid Foods
Vitamin D is needed for calcium
absorption through the intestine and
normal bone development.
Vitamin K and iron are needed for
normal blood development.
Vitamin B12 (cobalamin) is needed for growth,
particularly of the brain and nervous system.
Flouride is needed for normal tooth development.
Solid Foods
Most infants are ready to being eating solid foods by the age
of about 4 to 6 months.
- They can sit with the head upright,
minimizing risk of choking
- They lose the extrusion reflex of the
tongue and can use it to move food
from the front to the back of the
mouth where it can be swallowed
- Their intestines and pancreas are producing enough of
the necessary digestive enzymes
- They can drink enough liquids to maintain hydration
Solid Foods
Of course, “solid”
foods is a misnomer
throughout most of the
first year. They
include pureed,
mashed, or strained
foods which the infant
can easily swallow.
Solid Foods
By six to eight
months most
infants can grasp
“finger foods”.
Within a year,
most infants can
begin self-feeding
with a spoon. At
this point most foods are appropriate, albeit in much smaller
portions than for adults.
Infants
By one year of age, most children need
about 850 to 1,000 kilocalories per day,
nearly half of what they will require as
adults. Their need for carbohydrates and
proteins are, pound for pound, much higher
than they will ever be again as they get
older.
One year old: 22 pounds
Adult: 150 pounds
Total calories
850-1000 per day
1800-2200 per day
Carbohydrate
100 grams/day
130 grams/day
Protein
10-13 grams / day
50-55 grams /day
Infants
Like anyone else, infants can have digestive and dietary
problems such as
- Colic (crying and distress)
- Gastroesophogeal reflux (heartburn)
- Vomiting
- Diarrhea
- Dental caries when teeth come in
In some cases infants develop problems with digesting and
absorbing nutrients which can lead to malnutrition or
anemias.
In some cases, the infant simply is not furnished with
enough food
Let’s move on next to look at the
nutritonal needs from childhood
through adulthood and into old age