Nutrition 526 - 2012
Framing Maternal & Infant
Nutrition
Healthy People 2020 Maternal, Infant
and Child Health
• Why do we care about maternal and
infant nutritional health?
• What are the determinants of maternal
and infant health?
• What are some key indicators of
maternal and infant nutritional health:
preconceptionally,in the fetus & infant,
during pregnancy?
A Life Course Framework: T2 – E2
• Timeline: today’s exposures influence
tomorrow’s health
• Timing: health trajectories are
particularly affected during critical
periods
• Environment: the broader community
environment strongly affects the
capacity to be healthy
• Equity: inequality in health reflects
more than genetics and personal choice
A Public Health Approach to
Maternal and Infant Health
• Assessment
• Policy Development
• Assurance: Surveillance and monitoring
progress towards goals
Assessment
• Pregnancy population characteristics
• Maternal health indicators
• Infant health indicators
In 2008 births and birth rate were ~ 2% less than 2007;
in 2009 they were ~ 3% less than 2008.
http://www.cdc.gov/nchs/products/nvsr.htm
http://www.cdc.gov/nchs/products/nvsr.htm
Birth rates for females ages 15–17 by
race and Hispanic origin, 1980–2010
America's Children in Brief: Key National Indicators of Well-Being, 2012:
Http://childstats.gov/americaschildren/fam_fig.asp#fam2a
Percentage of all births to unmarried
women by age of mother, 1980 and 2010
America's Children in Brief: Key National Indicators of Well-Being, 2012:
Http://childstats.gov/americaschildren/fam_fig.asp#fam2a
Population Indicators & Trends
for Maternal Health
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Pre-conceptual indicators
Weight gain
Diabetes in pregnancy
Pre-eclampsia
Cesarean delivery
Maternal death
Weight Gain During Pregnancy: Reexamining the Guidelines, IOM. 2009
Per birth certificate – includes all diabetes in pregnancy
African American and White Women Who Died of Pregnancy
Complications,* United States
* Annual number of deaths during pregnancy or within 42 days after delivery, per 100,000
live births.
† The apparent increase in the number of maternal deaths between 1998 and 1999 is the
result of changes in how maternal deaths are classified and coded.
Source: CDC, National Center for Health Statistics.
Population Indicators of Infant
Health
• Infant mortality
• Birthweight
• Gestational age
Infant Mortality
• Infant mortality rate – Deaths of infants
aged under 1 year per 1,000 or 100,000 live
births. The infant mortality rate is the sum of
the neonatal and postneonatal mortality rates.
• Neonatal mortality rate – Deaths of infants
aged 0-27 days per 1,000 live births. The
neonatal mortality rate is the sum of the early
neonatal and late neonatal mortality rates
• Postneonatal mortality rate – Deaths to
infants aged 28 days-1 year per 1,000 live
births.
http://www.chipublib.org/004chicago/disasters/infant_mortality.html
Death rates among infants by race and
Hispanic origin of mother, 1983–1991 and
1995–2010
America's Children in Brief: Key National Indicators of Well-Being, 2012:
Http://childstats.gov/americaschildren/fam_fig.asp#fam2a
QuickStats: Infant Mortality Rates, by
Mother's Place of Birth and Race/Ethnicity --United States,* 2007
MMWR
July 8, 2011 /
60(26);891
Muntaner, C et al. ECONOMIC INEQUALITY, WORKING-CLASS
POWER,SOCIAL CAPITAL, AND CAUSE-SPECIFIC
MORTALITY IN WEALTHY COUNTRIES. International Journal of Health
Services, Volume 32, Number 4, Pages 629–656, 2002
• “In summary, the rates of low birth weight and
infant deaths from all causes were lower in
those countries with more voter turnout, more
left votes, more left members of parliament,
more years of social democratic government,
more women in government, a stronger social
pact and various aspects of the welfare state,
and low income inequality, as measured in a
variety of ways.”
Birthweight & Gestational Age
Birthweight Definitions
• LBW = low birthweight (less than 2,500
grams)
• VLBW = Very low birthweight (less than
1,500 g
• ELBW = Extremely low birthweight (less
than 1,000 g)
• LGA = Large for gestational age
(macrosomia); > 90th %; 4,000 (ICD9) or
4,500 g
Defining Small for Gestational Age (SGA) and Large for
Gestational Age (LGA)
Percentage of infants born preterm and
percentage of infants born with low
birthweight, 1990–2010
America's Children in Brief: Key National Indicators of Well-Being, 2012:
Http://childstats.gov/americaschildren/fam_fig.asp#fam2a
Percentage of infants born with low
birthweight by race and Hispanic origin of
mother, 1990, 2006, and 2010
America's Children in Brief: Key National Indicators of Well-Being, 2012:
Http://childstats.gov/americaschildren/fam_fig.asp#fam2a
Social Determinants
Percentage of children ages 0–17 living in
poverty by race, Hispanic origin and
family type, 1980–2010
America's Children in Brief: Key National Indicators of Well-Being, 2012:
Http://childstats.gov/americaschildren/fam_fig.asp#fam2a
Social-Ecological Model for Determinants of
Access to Resources & Nutrition Behaviors
Structures, Policies, Systems
Local, state, federal policies and laws
Institutions
Rules, regulations, policies &
informal structures
Community
Social Networks, Norms, Standards
Interpersonal
Family, peers, social networks,
associations
Individual
Knowledge, attitudes,
beliefs
Individual - Pregnancy
• Physiology and Psychology of Pregnancy
• Maternal Preconceptional status
– Inter-generational programming
• Diet in pregnancy: energy/weight gain, macro
& micronutrients
• Behaviors that impact nutritional status
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Substances: alcohol, caffeine, tobacco, drugs
Physical activity
Oral health
Pregnancy intendedness
• Stage of development: adolescence
• High risk situations: GDM, Hypertensive
disorders of pregnancy
Intrapersonal/Community
• Social and cultural environments
• Support from friends and family
• Health and nutrition care providers
Institutional
• Hospital breastfeeding & formula
policies
• Child Care policies
• School policies for pregnant and
parenting teens
• Worksite lactation policies
Policy & Environment
• Nutrition Assistance Programs for
pregnancy, lactation and early
childhood.
• Insurance policies for lactation support
• Parental leave policies