Nutrition During Pregnancy and Lactation

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

3. Health Threats to Children The most critical threats to the lives of children under age five globally are:  • Pneumonia (18%) • Diarrheal diseases (15%) • Pre-term birth complications (12%) • Birth asphyxia (9%) • Under-nutrition is an underlying cause of ~1/3 U5M Sub-Saharan Africa > 50% deaths due to malaria, diarrhea, pneumonia

4. Mother’s Day Report Card • Each year Save the Children publishes 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 • 2013 Report released this morning!

5. Best country for women & children Finland • Life expectancy girl born today = 83 • Under 5 mortality rate: 2.9 deaths/1000 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 2013 Report

6. United States Data (2010 data) • Life expectancy girl born today = 82 • Under 5 mortality rate: 7.5 deaths/1000 live births • Lifetime risk of dying as a result of pregnancy or childbirth, 1 in 2,400 women

7. United States Data Childhood Obesity begins young in the US • 9.5 % of children under the age of 2 are overweight, 11.5 % are obese • 23.3 % of children ages 2 – 5 are overweight or obese

9. Worst country for women & children – DR Congo • Lifetime risk of dying as a result of pregnancy or childbirth: 1 in 30 • 1 in 6 babies born will die before age 5 • 90% of women will have a child die befor age 5 • Life expectancy girl born today = 45

10. Where is DR Congo?

11. Afghanistan 10 worst countries for women and children

12. Somalia • Life expectancy girl born today = 52 • Under 5 mortality rate: 180 deaths/1000 live births • 1 in 16 women die during pregnancy or childbirth • 36% of children under 5 are underweight for their age • 70% lack access to clean water

13. One island, two health stories

14. In Haiti, 73% of children 6-24 months and 60% of pregnant women are anemic.

15. Zambia – Quick Facts 1 in 37 women die from pregnancy related disorders 1 in 82.9 children die before the age of 5

16. “Life-Saving Six” for Keeping Babies Alive, Nutrition Matters • Iron (mother and child) 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

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

18. Neonatal (<28 days) Mortality Data

20. Infant (<1 yr) Mortality Data

21. Infant (<1 yr) Mortality Data

23. More Recent U.S. Data

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

25. Percent change in infant mortality rates, by race and ethnicity: United States, 2005–2011

26. Leading causes of infant death in 2011 U.S. Congenital malformations Pre-term/low birthweight Sudden infant death syndrome (SIDS) Maternal complications Unintentional injuries Together, these 5 causes accounted for 56% of all infant deaths in the United States in 2011

27. 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

28. Maternal Mortality • All US women: ~12.7 deaths/100,000 live births • White women: 10.5 (risen) • Black women: 28.4 • Hispanic: 8.9 • 2007 data

29. Infant Mortality • 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

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

31. Nutrition During Pregnancy • Of greatest importance pre-pregnancy are having adequate levels of: • Folate • Iron

32. Caloric Needs and Weight Gain

33. Weight Gain Recommendations

34. 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

35. “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?......

36. 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

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

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

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

40. 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

41. 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

42. 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

43. 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

44. 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

45. 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

46. 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

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

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

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

50. 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