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⁃ the health of a nation is often judged by the health status of its
mothers and infants
⁃ Pregnancy: a period of growth
• Pregnant women have increased nutritional needs to cover the growth and
development of:
• The fetus
• The placenta
• The uterus
• Amniotic fluid
• Extra blood volume
• Growth of the breasts
• And the energy demands of maintaining all of the above
⁃ Recommended increases in food intake ( table )
⁃ Maternal weight gain
• The National Academy of Sciences' recommendations for weight gain take into
account a mother's pre-pregnancy BMI (+ table)
• Low weight gain in pregnancy is associated with increased risk of delivering a
LBW infant > higher mortality rate
• Excessive weight qain increases the risk of complications during labor and
delivery as well as postpartum obesity
• Obese women have an increased risk of complications during pregnancy including HT
and gestational diabetes
• Weight gain should be lowest during the first
trimester > around 1-2kg (2-4lb) followed by a steady weight gain of about
o.45kg/week (lb/wk) thereafter
• Dieting during pregnancies should be avoided even if the mother gains more than
the recommended wt
⁃ Adolescent pregnancy
• Adolescents are at nutritional risk and require early intervention and throughout
pregnancy
• Should strive for wt gain at upper end of range
• Risks include: IDA, pregnancy-related HTN,
premature and stillbirths, LBW infants, and prolonged delivery duration compared to
older women
⁃ Nutrition assessment in pregnancy
• Preconception care:
> Nutrition assessment
> Counseling
> Appropriate supplementation
> Referral to correct nutritional problems existing prior to conception
• Initial prenatal visit:
> Dietary measures: diet history, allergies, use of
supplements, and lifestyles (substance abuse)
> Clinical measures: obstetric history including outcome of previous pregnancies,
interval between pregnancies, history of problems in previous pregnancies including
gestational diabetes, pregnancy-induced HTN, IDA
> Anthropometric measures
> Laboratory measures: screening for anemia, urine analysis for ketones, glucose,
protein spillage.etc
• Subsequent prenatal visits:
> Monitor weight gain and pattern of gain
> Repeat screening for anemia
> Assess dietary practices
• Post-partum care
⁃ Nutritional risk factors in pregnancy ( table )
>Age 15 or under
>Unwanted pregnancy
>Many pregnancies close together
(depletes nutrient stores)
>History of poor pregnancy outcome
>Poverty
>Lack of access to health care
>Low education level
>Inadequate diet (food faddism or
dieting)
>Iron-deficiency anemia early in
>pregnancy
>Cigarette smoking
>Alcohol or drug abuse
>Chronic disease requiring special diet
(diabetes)
>Underweight or overweight
>Insufficient or excessive weight gain
>Carrying twins or triplets
⁃ Healthy babies
• The growth of infants directly reflects their nutritional well-being and is the
major indicator of their nutritional status
• A baby grows most rapidly during the first year of life than ever again- st year
is the most important year in a person's life in terms of nutritional intake
• Double wt during 1st 4-6months
• Triples by the 1st years
⁃ Anthropometric measures in infancy include:
• Weight
• Length
• Head circumference- detect PEM
⁃ Use of charts (CDC,WHO) to interpret measures taken
• >95th percentile wt-for-length: obese
• <5th percentile wt-for-length: FTT
•<10th percentile: suspected FTT
⁃ Birth weight and length of gestation are the primary indicators of the
infant's future health status
• LBW: birth weight <2,500g; used as a predictor of poor health in the newborn and
as a probable indicator of poor nutritional status of the mother during and/or
before pregnancy
• VLBW: <1,500g
⁃ Determinants of BW
• Gestational age
• Gender
• Multiple fetuses
• Maternal size
• Weight gain
• Nutrition
• Genetic defects
• Birth order
• Low oxygen supply
• Maternal hemoglobin level
⁃ Determinants of birth weight
• Smoking
• Alcohol
• Poor placentation
• Infections
• Immune status
• Poverty
⁃ A LBW baby:
•Can be the result of a pregnant woman not receiving adequate nourishment and not
gaining the recommended amount of weight
• Is more likely to experience complications during delivery than a normal weight
baby
• Has a statistically greater chance of having physical and mental birth defects,
of contracting infections and of dying during the first year of life
⁃ Breast milk composition
• Colostrum: early milk, first 2-3 day, rich in antibodies and other immune factors
•whey-casein ratio is high :whey is more soluble than casein and is therefore more
easily digested by infants.
•Fat globules are smaller-> larger surface area for volume encouraging enzymatic
digestion
• Contains long chain PUFAs important for CNS and retinal function
• Bifidus factor- probiotic effect that favors lactobacillus bifidus growth and
prevents growth of harmful bacteria in infant's Gl tract
•Lactoferrin and other factors- including several enzymes and hormones that help
protect the infant against infection
⁃ BF benefits for the mother
• Effect of oxytocin on the involution of the uterus
• Optimal blood glucose profiles in women with gestational diabetes
• Bone re-miniralization to levels exceeding those present before lactation
(protection against osteoporosis)
• Protection against premenopausal breast cancer
• Lactation amenorrhea (contraception)
• Maternal weight or fat loss with prolonged breastfeeding
⁃ WHO recommendations
• "Infants should be exclusively breastfed for the first 6 months of life to
achieve optimal growth, development and health. Thereafter, to meet their evolving
nutritional requirements, infants should receive nutritionally adequate and safe
complementary foods with breastfeeding continued up to 2 years of age or
beyond."
⁃ USA breastfeeding promotion
• Barriers to achieve the nation's health objectives:
> Lack of knowledge
> Absence of work policies and facilities that support lactating women
> The portrayal of bottle feeding rather than breastfeeding as the norm in society
> The lack of breastfeeding incentives and support
Primary nutrition-related problems
of infancy
⁃ Iron deficiency
• An existing problem although rates has decreased due to use of iron-fortified
formulas
• Causes may include:
> Use of cow's milk earlier than recommended which is low in iron and might lead to
Gl blood loss in susceptible infants
> BF for more than 6 months without providing supplemental iron
> Feeding infant formula not fortified with iron
> Infants rapid rate of growth
> LBW
> Low SES
⁃ Food allergies
• genetics is the most significant factor affecting an infants
• Are less prevalent in breastfed babies than formula fed babies
• New foods should be introduced singly to detect allergies (zdays between each
introduction)
• Eggs, milk, wheat, soy, peanuts, tree nuts, shellfish, fish and foods containing
these major food allergens should not be given before 1 year of age for infants
with a strong family history of
food allergies
⁃ Intergenerational growth failure
•Poor nutrition-> cycle of intergenerational growth failure
•Opportunity for nutrition intervention (i.e., an improvement at one point will
have a beneficial knock-on effect)
(+ chart )
⁃ Developmental origins of health and adult
disease
• If a woman's nutrient intake is under or oversupplied particularly at critical
phases of fetal and early infant development- long term alterations may occur in
tissue function
⁃ Maternal mortality rate
• Defined as: women's deaths assigned to causes related to pregnancy
• Number of deaths per 100,000 live births
• Strongest determinant of MM: access to health care-births attended by skilled
personnel
Maternal and infant nutrition
programs
⁃ Special Supplemental Nutrition Program for Women, Infants, and Children
(WIC)
Provides federal grants to states for supplemental foods (checks or vouchers),
health care referrals (BF support, immunizations, family planning), and nutrition
education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum
women, and to infants and children up to age five who are found to be at
nutritional risk Financial eligibility is determined be incomes <= 185% of poverty
guidelines or by participation in SNAP or Medicaid
⁃ Based on two assumptions:
•Inadequate nutritional intakes and health behaviors of low-income women infants,
and children make them vulnerable to adverse health outcomes
•Nutrition intervention at critical periods of growth and development will prevent
health problems and improve health status of participants
WIC benefits and potential program impacts
( table)
⁃ Supplemental Nutrition Assistance Program (SNAP)
•SNAP offers nutrition assistance to eligible, low-income individuals and families
and provides economic benefits to communities
•It's the largest program in the domestic hunger safety net
