Y khoa, dược - Chapter 11: Life cycle: maternal and infant nutrition

Recommendations depend on BMI Normal weight (BMI = 19.8–26 kg/m2) Gain 25 to 35 pounds Higher recommended gain for underweight women, teens, and for pregnancies involving multiple fetuses Lower recommended gain for overweight and obese women

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Chapter 11 Life Cycle: Maternal and Infant NutritionNutrition Before ConceptionHealth Care and GuidanceScreening for riskHealth promotion and educationIntervention as neededWeightMaintain a healthy weightLow or high weight increases risk for poor outcomeNot a good time to “diet”Nutrition Before ConceptionVitamins400–800 micrograms synthetic folic acid per day reduces risk of fetal neural tube defectAvoid high doses of vitamin A (retinol) to avoid teratogenic effectNutrition Before ConceptionSubstance useEliminate prior to pregnancyPhysiology of PregnancyStages of Human Fetal GrowthBlastogenic stage: first 2 weeksCells differentiate into fetus and placentaEmbryonic stage: weeks 2 to 8Development of organ systemsFetal stage: week 9 to deliveryGrowthPhysiology of PregnancyMaternal Physiological ChangesGrowth of maternal tissueAdipose, breast, and uterine tissuesIncrease in maternal blood volumeSlower GI motilityMaternal Weight GainRecommendations depend on BMINormal weight (BMI = 19.8–26 kg/m2)Gain 25 to 35 poundsHigher recommended gain for underweight women, teens, and for pregnancies involving multiple fetusesLower recommended gain for overweight and obese womenEnergy and Nutrition During PregnancyEnergyNeeds increase to support fetus and placenta, as well as increased workload on mother’s heart and lungsSupport adequate weight gainNutrients to support pregnancyRecommended that all women planning on pregnancy take a folic acid supplementWell-balanced dietEnergy and Nutrition During PregnancyMacronutrientsModerate-protein, low-fat, and high carbohydrateProteinExtra needed for synthesis of new maternal, placental, and fetal tissuesAdditional 25 gm/d over nonpregnancy needsEnergy and Nutrition During PregnancyMacronutrientsFatFuel for mother and development of placentaStored fat supports breastfeedingCarbohydratesMain source of extra caloriesComplex carbohydratesFiber-richEnergy and Nutrition During PregnancyMicronutrientsIncreased needs for most vitamins and mineralsSupport growth and developmentHighest increase for iron and folateIncreased needs for vitamins A, B, and CFood Choices for Pregnant WomenFollow the USDA’s Daily Food Plan for MomsVariety key to a well-balanced dietAdditional servings of grain, vegetable, fruit, and low-fat milkSupplementationSupplement with prenatal formulaHerbal supplements not recommendedFood Choices for Pregnant WomenFoods to AvoidAlcoholCertain types of fish high in mercuryCaffeine in quantities higher than 300 300 milligrams per daySubstance Use and Pregnancy OutcomeTobaccoIncreases risk for miscarriage, stillbirth, preterm delivery, and low birth weightAlcoholIncreases risk for Fetal Alcohol SyndromePhysical and mental defectsGrowth retardationNo known safe threshold for alcohol useSubstance Use and Pregnancy OutcomeDrugsIncrease risks for low birth weight, preterm delivery, miscarriage, birth defects, and infant addictionMaternal marijuana use can lead to physical abnormalities similar to those caused by Fetal Alcohol SyndromeSpecial Situations During PregnancyGastrointestinal DistressMorning sicknessConstipationHeartburnSpecial Situations During PregnancyFood Cravings and AversionsPica—term for craving nonfood itemsHypertensionPreeclampsiaDiabetesMay need to adjust diet and insulin as neededSpecial Situations During PregnancyGestational diabetesHormones of pregnancy tend to counteract insulinOften controlled through dietMay require insulin therapySpecial Situations During PregnancyHIV/AIDSMedical treatment to reduce risk of transmissionMultiple nutrition problems for motherProtein-energy malnutritionVitamin and mineral deficiencyInadequate weight gainSpecial Situations During PregnancyAdolescenceExtra demands for growth and developmentRisk for preeclampsia, anemia, premature birth, low-birth-weight babies, infant mortality, and sexual transmitted diseasePrepregnancy eating patterns a concernWeight gain toward upper limit recommendedNeed for supplementsLactationBreastfeeding TrendsHealthy People 2020 goalsTo increase the proportion of newborns who are initially breastfed to almost 82%Current stats:77% of infants breastfed initially49% of infants still breastfed at 6 monthsPhysiology of LactationChanges during Adolescence and PregnancyIncreased breast tissueMaturation of structureAfter DeliveryMilk production and secretionColostrum: first milkPhysiology of LactationHormonal ControlsProlactin: stimulates milk productionOxytocin: stimulates milk release“Let-down” reflexNutrition for Breastfeeding WomenEnergyNeeds 330 kcal/day during first six monthsNeeds 400 kcal/day during second six monthsProteinsRDA: 1.3 g per kg/dayNutrition for Breastfeeding WomenVitamins and MineralsNeeds higher or same as during pregnancyExceptionsVitamins D and K remain sameIron and folate needs are lower than during pregnancyWaterAI for total water = 3.8 liters/dayNutrition for Breastfeeding WomenFood ChoicesUSDA’s Daily Food Plan for Moms~2,200–2,800 Kcalories/dayChoose foods high in vitamins and minerals and low in added sugar and solid fatsSupplementationMay be necessary for vegan women and women who do not drink milk or other fortified productsBenefits of BreastfeedingBenefits for infantsOptimal nutritionProtects infant from infections and illness including diarrhea, ear infections, pneumonia, and asthmaConvenienceOther benefitsBenefits of BreastfeedingBenefits for MotherConvenienceEnhanced recovery of uterus sizeHelp women return to pre-pregnancy weight fasterOther benefitsContraindications to BreastfeedingMay be inappropriate due to infant or maternal disease or drug useBreast enlargement or reduction surgeryInfectious or chronic disease (ex. HIV)Prescription and illegal drugsResources for Pregnant and Lactating Women and Their ChildrenPromote health of pregnant and breastfeeding women and their childrenSpecial Supplemental Nutrition Program for Women, Infants, and Children (WIC)Service of USDAProvides food assistanceProvides nutrition educationProvides referralsInfancyGrowth is the best marker of nutritional statusEvaluated using growth chartsWeight gainDouble birth weight by 4 to 6 monthsTriple birth weight by 12 monthsLength gainIncrease length by 50% by 12 monthsHead circumferenceEnergy and Nutrient Needs During InfancyRequirements based on composition of breast milkEnergy and ProteinHighest needs of any life stageCarbohydrate and fatFat: major energy sourceCarbohydrates as simple sugarsWater More needed due to immaturity of organsHuman milk or formula satisfies fluid requirementsEnergy and Nutrient Needs During Infancy Key Vitamins and MineralsVitamin DVitamin KVitamin B12IronFluorideEnergy and Nutrient Needs During Infancy Newborn BreastfeedingIdeal method of feedingFeedings should occur every 2-3 hours with total of 8-12 feedings per dayEnergy and Nutrient Needs During InfancyAlternative feeding: infant formulaStandard infant formulaCow’s milk baseSoy-based formulaSoy proteinUsed to eliminate feeding problems such as vomiting and diarrheaEnergy and Nutrient Needs During InfancySpecial formulaAllergiesPremature babiesDefects in metabolic pathwayUse medium-chain triglycerides as the fat sourceEnergy and Nutrient Needs During InfancyHow much is enough?Guidelines for feeding infantMeasure amount of formula baby takesSix or more wet diapers per dayThree or more stools per dayRegain to birth weight within first two weeksIntroduction of Solid FoodsReadiness for solidsPhysiological readinessDigestive enzymesAbility to maintain hydrationDevelopmental readinessLack of extrusion reflexHead and body controlFeeding scheduleStart Healthy Feeding GuidelinesFeeding Problems During InfancyColicCrying and distressEarly childhood dental cariesAssociated with putting baby to bed with a bottleIron-deficiency anemiaFeeding Problems During InfancyGastroesophageal refluxUsually disappears within 12–18 monthsDiarrheaRequires increased fluidsFailure to thrivePoor growth in absence of disease

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