nutrition in pregnancy, lactation, infancy and childhood

pregnancy as explained in the slides

• fertilized egg (zygote) travels through the fallopian tube to the uterus where it implants into the uterine lining

• during the embryonic stage of development (2-8 weeks), the cells of the embryo begin to differentiate, arranging themselves and organ development begins

• during the fetal stage of development, the fetus continue to grow, developing the internal and external organ structures

where does nutrient and waste transfer happen

• in the placenta which is the organ that develops during pregnancy to facilitate transfer of nutrients to the growing fetus and the removal of waste products

• it is made up of maternal and fetal tissue that do not mix, however is in close proximity to allow nutrient transfer

• placenta also releases hormones needed for pregnancy

weight gain during pregnancy

• due to the series of changes to support pregnancy, fetal development, birth and lactation there is presence of weight gain and additional energy stores

• this is about 11.5-16 kg

• which about 5 kg or 10 pounds of weight leaves the body after birth 

what are the recommended total weight gain and the pre-pregnancy weight status

outcomes for too little weight gain during pregnancy

• low birth weight or pre-term birth

• increases in the child’s risk of developing heart disease or diabetes later in life

outcomes for too much weight gain during pregnancy

• high blood pressure in both mom and baby

• diabetes in both mom and baby

• difficult delivery due to macrosomia baby, C-sec

• infants large for gestational age

HTN disorder of pregnancy

• 5-10% may experience HTN during pregnancy

• 30% related to pre-existing chronic HTN

GHTN

• abnormal rise in blood pressure that occurs after the 20th week of pregnancy

• may be a signal of a more serious condition, pre-eclampsia (high-blood pressure + loss of protein in urine due to organ damage)

GDM

• may be new or undiagnosed dm that is later diagnosed during pregnancy

• consistently elevated blood glucose level during pregnancy in a person without previously diagnosed diabetes

• occurs in about 3-20% of all pregnancies

• most common in obese individuals and those with a fam hx of T2DM

• increases risk for T2DM later in life in both mom and infant

the spiral uterine artery in preeclampsia vs pregnancy

pregnancy

• the spiral artery runs in a spiral shape within the functional layer, forming a capillary network and blood sinuses when it reaches the superficial layer of the function layer, it then merges into small veins and merges through the muscular later to form the uterine artery

preeclampsia

• the spiral artery recasting disorder, shows shallow implantation of placenta vessels implantation of placenta vessels

• and less richer capillary network which could impede proper fetus development and more risk for complications

effects of hyperglycemia in infants later in life

increased lifelong risk for obesity, metabolic, cardiovascular and malignant diseases

GDM effects in epigenetics

accumulating evidence suggests that fetal overnutrition and similarly undernutrition lead to persistent epigenetic changes in developmentally important genes, influencing neuroendocrine functions, energy homeostasis and metabolism. because during early development the epigenome is much more vulnerable to environmental cues than later in life, avoiding adverse environmental factors in the periconceptional and intrauterine period may be much more important for the prevention of adult disease than any diabetic measures in infants and adults as a successful pregnancy should be defined by outcome at birth AND also the health status in later life

nutrition needs during pregnancy

• 176 g/day minimum of glucose for pregnant people

• vital nutrients during pregnancy includes

  • zinc for the rapid growth and enzymes

  • iron for blood vessels and prevent anemia

  • folate for neural tube development

• other notes

  • calcium intake is normal or does not change for both pregnant and lactating individual as our body during that stages has lots of estrogen which increases calcium absorption

  • RDA for iron in lactating women is lower than normal because we are not menstruating hence no loss of iron

how much extra energy is needed for each trimerster

1st trimester: 0 kcal/day 

2nd trimester: ~350 kcal/day

3rd trimester: ~450 kcal/day

lactation: ~300 to 400 kcal/day

how does diet of pregnancy adolescent differ

as adolescent girls continue to grow and mature physically for about 4 to 7 years after menstruation begins, their diet must provide both for her growth and that of the baby hence certain supplements are higher relative to normal adult pregnancy such as increase in niacin, B6, iron and copper

most vulnerable state of fetus when expose to toxic substances

• teratogens are substances of chemical or biological origin that can cause birth defects

• different organs particularly are susceptible at different times, most are susceptible around the 3 to 8th week of gestation 

what is CPNP

• The Canadian Prenatal Nutrition Program

• provides funding to community groups to help to improve the health of pregnant women, new mother and their babies, who face challenges that put their health at risk such as

  • poverty

  • teen pregnancy

  • social and geographic isolation

  • substance use

  • family violence

lactation

involves the synthesis of milk components, including protein, lactose and lipids and the movement of the milk through the milk ducts to the nipple

let down

the release of milk from the glands through the ducts which is triggered by the hormone oxytocin

colostrum

is immature milk, secreted during the first days after delivery, this is rich in proteins and immune factors

what is known about the nutritional needs of lactating individuals

some of their energy needs come from increase fat intake and stores and the RDA for iron is half of non pregnant, non lactating women

nutritional needs during infancy

• infants require higher percentage of fats than adults (calorie density vs physical space)

• require almost double the amount of protein than adult

• water intake is critical as most common cause of infant mortality in developing world is dehydration due to diarrhea and also of the high surface are to volume ratio and inability to communicate

• breastmilk includes most nutrient for infant growth except vit d and k

• vit b12 needed for moms following a vegan dietary pattern for their infant

• iron-rich food needed at 6 months (when infant iron stores are depleted)

  • fluoride supplement at 6 months in breast-fed infants

how long is breastfeeding recommended for

exclusive breastfeeding for the first 6 months, and sustained for up to 2 years or longer with appropriate complementary feeding to support nutrition needs, for immunological protection and growth and development of infants and toddlers

10 reasons for breastfeeding

1. nutrient and protection: breastmilk contains the perfect amount of nutrients for baby and antibodies that prevent disease

2. brain power: children who were breastfed score higher on IQ test

3. convenient and portable: breastmilk is always safe, fresh and exactly the right temp

4. size does not matter: whatever size breast, it will produce enough milk for baby

5. benefits for mom: breastfeeding can help mom lose weight and reduce risk of some cancers

6. continues the special relationship: breastfeeding can help mothers bond with their babies

7. benefits dont stop: breast milk is all babies need for the first six months of life. after six months babies need additional solid food but continue to benefit from the nutrients in breast milk

8. easy on the budget

9. works for working mothers: breast milk can be expressed with a breast pump so other can help with feeding

10. good for the environment: breast milk does not contribute to waste, pollution or unnecessary packaging 

who were most likely to breastfed

• those who have partners

• do not smoke during pregnancy

• deliver in their home

• do not work

what is growth

defines as a measurable change in body size due to 2 underlying cellular processes

• hyperplasia- increase in cell number

• hypertrophy- increase in cell size

• accretion- increase in intercellular substances

significance of growth chart

can identify malnutrition 

• undernutrition (weight for age)

• stunting (length for age)

• wasting (weight for length, BMI for age)

• overnutrition (weight for length, BMI for age)

how is growth chart used

children’s growth is compared to growth charts of average growth during checkups

• 99th percentile= larger (higher BMI) than 99% of other children (very large for age)

• 50th percentile= larger than 50% of other children

• 3rd percentile= larger than 3% of other children (very small for age, abnormal)

BMI is used after 2 years of age to account for body changes due to puberty

developmental milestones of nutrition during early childhood

birth to 6 months

• the infant takes milk by suckling. solid food placed in the mouth is usually pushed out because the tongue is thrust forward during suckling

• by age 6 this tongue action is sufficiently diminished that baby can accept solid food

6-12 months

• the infant can hold their head up, sit, chew, hold food and easily move hand to mouth

• progresses to drinking from a cup and feeding themselves

12-18 months

• the toddler can feed themselves, can drink from a cup, use spoons, bite food well and eat ground or chopped table food

food changes during early childhood

birth to 6 months

• exclusively breastfeeding

• infant formula if breastfeeding is not possible

• vitamin d supplement if breastfed

6-12 months

• breast milk or formula, meats and beans, iron0fortified infant cereal, pureed or strained veggies, fruits and finger foods such as cooked pasta or cooked and cut vegetables

12-18 months

• breast milk or cow’s milk, meats and beans, iron-fortified cereal, chopped veggies, soft fruit, and finger foods, move towards following Canada’s Food guide

nutrition and health concerns in children

• dental cavities

• food allergies

• diet and hyperactivity

  • evidence is mixed and weak overall

• childhood obesity

  • impact of screen time

  • advertising of unhealthy food

food allergies in children

• more common in infants than adults due to exposure to an allergen for the first time causes the immune system to produce antibodies to the allergen

• symptoms include sneezing, rash, eczema, hives, cramps, aches, vomiting, asthma, diarrhea which may be immediate or take up to 24 hours; can range from mild to life-threatening

food intolerances in children

do not cause antibody production; creates problems during digestion such as lactose intolerance, an inability to digest milk sugar

5-4-3-2-1 GO!

initiative from consortium to lower obesity in Chicago Children

5 servings of fruit and vegetables per day

4 serving of water per day

3 servings of low-fat dairy per day

2 hours or less of screen time per day

1 hour or more physical activity a day

0 sugar-sweetened beverages