Nutrition During Pregnancy and Lactation

1. Nutrition During Pregnancy and Lactation Nutrition for Infants and Toddlers

3. Mother’s Day Report Card • For many years, Save the Children published the Mother’s Day Report Card which includes data on the health of women and children worldwide • Highly recommended reading for anyone who works with children • https://www.savethechildren.net/state-worlds-mothers-infographics

4. Health Threats to Children The most critical threats globally are:  • Pneumonia (18%) • Diarrheal diseases (15%) • Pre-term birth complications (12%) • Birth asphyxia (9%) • Under-nutrition is an underlying cause of ~1/2 under 5 mortality Sub-Saharan Africa > 50% deaths due to malaria, diarrhea, pneumonia

5. Risk Factors Infant Mortality U.S. • Many of the deaths can be attributed to: • Poor maternal nutrition • Low birth weight/pre-term babies • Lack of prenatal care • Lack of health insurance • SIDS • Nutrition before and during pregnancy is critical to the health of baby

6. One of the best countries for women & children - Finland • Life expectancy girl born today = 84 • Under 5 mortality rate: 2.9 deaths/1000 live births • Infant mortality rate: 2 deaths/100 live births • Lifetime risk of dying as a result of pregnancy or childbirth: 1 in 12,200 • many countries are lower • E.g. 1/25,500 in Greece • Save the Children, May 2014 Report

7. United States Data • Life expectancy girl born today = 82 • Under 5 mortality rate: 6.9 deaths/1000 live births • Infant mortality rate 6 deaths/1000 live births • Lifetime risk of dying as a result of pregnancy or childbirth, 1 in 1,800 (may be higher)

9. One of the worst countries for women & children – Somalia • Lifetime risk of dying as a result of pregnancy or childbirth: 1 in 18 • 1 in 6 infants born die before age 5 • 90% of women have a child die before age 5 • Life expectancy girl born today = 58 • 36% of children under 5 are underweight for their age • 70% lack access to clean water

10. Where is Somalia?

11. Afghanistan Haiti 10 worst countries for women and children

12. One island, two health stories

15. “Mortality” Definitions • Neonatal mortality rate • death of infants in the 1st 28 days of life • When most child deaths occur • Infant mortality rate • death of infants in the 1st year of life • Both are reported in deaths/1000 live births

16. Neonatal (<28 days) Mortality Data

17. Infant (<1 year) Mortality Data

18. Maine Birth and Infant Deaths

19. Infant (<1 yr) Mortality Data

20. Infant (<1 yr) Mortality Data

21. Infant mortality rates, by state: U.S. - 2010

22. Leading causes infant death U.S. ‘13 • Congenital malformations • Pre-term/low birth weight • Sudden infant death syndrome (SIDS) • Maternal complications -------- • 80% infant deaths in developing countries occur in pre-term babies • 50% of infant deaths related to infection

23. Pre-Term Births by Race

24. Infant Mortality • Lowest rates for mothers in their late 20’s- early 30’s • Adolescent mothers have the highest infant mortality rate in US • Infant mortality is • 83% higher in unmarried mothers • Higher in smokers • Higher in pre-term infants

25. Maternal Mortality • All US women: ~14 deaths/100,000 live births* • White women: 10.5 • Black women: 34.8 • Somalia: 732 • Haiti: 359 *28 in another source

26. Doing Pregnancy Well Matters! It matter for mom and it matters for baby.

27. “Life-Saving Six” for Keeping Babies Alive, Nutrition Matters • Iron and folate (mom) • Breastfeeding – 1st 6 months exclusively • Complementary feeding – 6 mos + • Vitamin A ( 2 doses /year, child) • Zinc (child) • Decreases diarrheal deaths • Hygiene, water, sanitation

28. Nutrition During Pregnancy • Time of significant growth for mother and fetus • Goal is to start pregnancy with full nutritional stores

29. Nutrition During Pregnancy • Of greatest importance pre-pregnancy are having adequate levels of: • Folate • Iron • In Haiti, 73% of children 6-24 months and 60% of pregnant women are anemic.

30. Caloric Needs During Pregnancy~2,200 - 2,900 kcal/day

31. Weight Gain Recommendations

32. Weight Gain • Insufficient maternal weight gain increases risk of low birth weight baby (LBW) • LBW = birth weight less than 5 ½ pounds • LBW are 40x more likely to die in the first year of life than healthy weight baby • 1 in 12 babies in US are of LBW • Black 2x as likely to have a LBW baby as white/Hispanic

33. “Morning” Sickness (MS) • ~75% of women experience MS during the first months of pregnancy • May be triggered by foods, smells, thought of food • May be related to enhanced sense of smell • Iron supplements may trigger nausea in some • May occur any time of day • Suggestions?......

34. Weight Gain • Sharp weight gains may signal: • Water retention • Pregnancy induced hypertension ~7% pregnancies • May be associated with low vitamin D levels • Preclampsia – mild hypertension • Eclampsia – more serious • Previously called toxemia

35. Eclampsia • At greatest risk: • Over 35 and under 17 • Carrying twins or more! • Family/personal history of • Diabetes • First pregnancy • African American descent

36. Eclampsia • Symptoms/consequences • Edema • Hypertension • Protein in urine • Kidney failure • Liver damage • Convulsions and death of mom and/or baby

37. Eclampsia • Treatment • Bed rest • Magnesium sulfate (diuretic) • Deliver baby

38. Nutritional Needs - Pregnancy • Protein • Needs increase by 25 g/day • 1.1 g protein/kg body weight • Page 521 has a good summary of all nutritional needs

39. Minerals • Minerals • Calcium, no increase • The number of calcium binding proteins increases in the SI. This results in increases absorption. • Critical that diet includes 3-4 servings of calcium rich foods each day. • Iron needs nearly double • Zinc needs go by ~30% • Zinc is found in proteins

40. Vitamins • B Vitamins • RDA for all goes up by ~30% • Folate needs go up by 50% • Eat more vegetables and select whole grain products. • Vitamin C • Need a little extra

41. Vitamins • NO EXTRA needed for: • Vitamin D • Vitamin A in the form of active vitamin A • DO NOT TAKE VITAMIN A SUPPLEMENTS DURING PREGNANCY • Increases the risk of serious birth defects • Extra beta-carotene (plant form of vitamin A) is fine and probably good for you

42. Practices to AVOID • Smoking • Increases risk of LBW, miscarriages, infant death • Caffeine (?) • Heavy coffee drinking may lead to and increased risk of LBW • High levels of caffeine may increase the risk of miscarriage

43. Practices to AVOID • Fasting or low/no carbohydrate diets • Ketones may slow fetal brain development • Aspartame (?) • Probably OK as long as mom does not have PKU • Recommend no more than 1 Liter of diet soda per day

44. Practices to AVOID • Eating unpasteurized dairy products, raw cabbage, raw meats • Brie, feta, blue cheeses, goat cheeses • Increased risk of Listeria • Flu-like symptoms • May cause miscarriage and death of mom

45. Practices to AVOID • Vitamin megadoses • Alcohol • Increases risk of fetal alcohol syndrome (FAS)

46. FAS • Brains of 6 week old infants No FAS FAS

47. FAS • Physical Characteristics • Broad, short, flat nose • No dimple above lip • Narrow eyes • Flat face

48. Practices to AVOID • Illegal Drugs • Marijuana and cocaine can increase risk of: • LBW • Nervous system disorders • Irregular heart rate • Drug withdrawal symptoms in infant • Neonatal death

49. Practices to AVOID • Over the Counter Medications (most) • Can cause complications during pregnancy and increase risk of birth defects • No aspirin or ibuprofen in the last trimester • Both interfere with blood clotting

50. Nutrition During Lactation • Energy needs • ~+500 kcal/day for the first 6 months • Maternal weight loss during lactation • Recommend a loss of a maximum of 1-2 pounds/month