mother and infant measures of a successful outcome of pregnancy §healthy baby §healthy mother...
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Mother and Infant
Measures of a Successful Outcome of Pregnancy
Healthy BabyHealthy MotherBaby Survives the First Year of Life
Healthy Baby
Still Birth Ratio or Fetal Death Ratio Early in Pregnancy: difficult to have reliable
numbers of death rate• Why?
Later in Pregnancy: numbers are more reliable• About 7.5 stillbirths per 1000 live births
Healthy Mother
7.8 mothers die per 100,000 births.Big racial difference:
White 5.0 Black 20.8 Others 18.2
Infant Mortality
Infancy: First Year of LifeInfant Mortality Rate in US
2000: 6.9; 2001: 6.8; 2002: 7.0/1000 live births Ranked 26nd world-wide 1950 we were ranked 6th world-wide Why? 77 babies (0-1 yr)die per day in the US
Infant Mortality Rates by Maternal Race
0
2
4
6
8
10
12
14
White Black NativeAmer
Asian orPacific
Islander
All Races
Better Infant Mortality Rates
Japan: 4.3#1: Singapore: 2.3; If we had the same rate as
Singapore we would save 18,900 babies per yearSweden: 3.5Finland: 3.9Norway: 4.1Canada: 5.5Cuba: 6.4; If we had this rate we would save 2400
babies per year
Risk of Infant Mortality: Factors
If infant mortality rate was similar to Sweden’s we would save over 40,000 infant deaths per year
Low Birth Weight largest single factor less than 5.5 pounds (2500 grams) LBW risk factors:
• age socioeconomic poverty
• number of pregnancies race
Mechanism for growth retardationM atern a l M a ln u triton
D ec reased p lacen ta l s ize
F e ta l G row th R e ta rd a tion
R ed u ced n u trien t tran s fe r
D ec reased p lacen ta l b lood flow
In ad eq u a te in c rease in ca rd iac ou p u t
R ed u ced b lood vo lu m e exp an s ion
Maternal Malnutrition
Nutrition Influences on Fetal Growth
Deficiency in Calories Too few Calories to allow adequate
reproduction of cells and decreased development
Deficiency of Nutrients Too little of some specific nutrient e.g.: folic acid
• spina bifida
Growth Happens in Two ways
Increased number of cellsIncreased size of cellsCritical times of increased number of cells
1. Increased number hyperplasia 2. Number and size + hypertrophy 3. Size Hypertrophy
Critical Periods
If an embryo or fetus doesn’t receive the nutrition necessary to help with development, the fetus will suffer
Fertilization of the ovum(zygote) happens implantation of the ovum in the uterine wall
happens in the first two weeks Critical period: cigarette smoke, malnutrition
can keep development from occurring
Events of Pregnancy
Time Event0-2 weeks egg fertilized and implanted3-8 weeks Embryo: at end of 8 weeks
is 1 inch and has central nervous system, GI tract, limb, buds, etc.
8-40 weeks Fetal period: growth and development
Role of the Placenta
Nutrient and waste product exchangeHormone production
Estrogen: helps develop the infrastructure of pregnancy
Progesterone:• relaxes smooth muscle• Relaxes the uterus• Relaxes the digestive system: slower movement,
more absorption of most nutrients
PlacentaPlacenta
Nutrient Needs to Support Pregnancy
Energy: No increase in Cal for first trimester
• Why?: 1. Very small embryo; 2. Increased absorption of most nutrients and Cal due to decreased motility of GI tract due to hormones of pregnancy
300 Cal increase during 2nd and 3rd trimester
Nutrient Needs During Pregnancy
Protein: Determine pre-pregnancy needs based on RDA:
0.8 grams protein/kg. This is generally around 45 to 50 grams Protein per day.
• Add 15 grams to this for pregnancy
• Generally around 60 to 65 grams/day is sufficient
Nutrients of Special Interest
Folate: related to neural tube defects and spina bifida Reduced absorption during pregnancy because
of interaction with estrogen Produces folate deficient women Interferes with proper formation of spinal
column: affects 400,000 births per year Folate supplements during pregnancy required
Spina Bifida – A Neural Tube DefectSpina Bifida – A Neural Tube Defect
Nutrients of Special Interest
Iron: Blood volume increases by 50% during pregnancy Body conserves Iron during pregnancy
• No menstruation• 3 time increase in absorption• But still doesn’t keep up with production of red blood
cells• Hemoglobin concentration falls: normal above 13 g/dl.
In pregnancy may fall below 12 g/dl• RDA up from 18 to 27 mg/day
Special Supplemental Food Program for Women, Infants, and Children
To battle against problems during pregnancy and infancy, WIC was developed to provide supplemental food to low socioeconomic and at risk women and infants. Nutrition education also provided Data analysis indicates: for each $1 spent, $4
saved down the road
Weight Gain During Pregnancy
Based on Pre-pregnancy BMIUnderweight (BMI<19.8) : 28-40 #Normal weight(BMI 19.8-26) : 25 to 35 #Overweight(BMI 26-29): 15 to 25 #Obese(BMI over 29): 13 # minimum
Rate of Weight Gain
First Trimester: 2 to 4 poundsSecond and Third Trimester: 1 pound per
week3 pounds + (26 weeks x 1 # per week) =
29#
Components of Weight Gain
Infant 7.5 # amniotic fluid 2 #Placenta 1.5 # mother’s stores 7 #Blood 4 #Fluid 4 #uterus 2 #Breasts 2 # TOTAL 30 #
Fetal Alcohol Syndrome
Physical and Mental Abnormalities attributed to alcohol consumption during pregnancy low nasal bridge small head short nose circumference short eyelid opening delayed thin upper lip development underdeveloped filtrum
Alcohol Effects on Pregnancy
About 1/5 of women continue to drink during pregnancy The first few weeks are critical; many women
don’t know they are pregnantBirth defects have occurred in women who
consume as little as two drinks per day No alcohol is the best if planning pregnancy
Fetal Alcohol Effects: internal damage
Fetal Alcohol Syndrome
A Child with FASA Child with FAS
Maternal Problems of Pregnancy
Gestational Diabetes: Hormones of pregnancy make mother’s body
resistant to insulin Often shows up at 25 weeks of pregnancy Needs to be treated to control growth of the
fetus Macrosomia: large baby and delivery
complications
Problems of Pregnancy
Edema: most women suffer from water retention: due to large blood volume and decreased protein concentration in blood
Pregnancy Induced Hypertension (PIH) massive edema, high blood pressure, protein in
urine If untreated can result in fetal and maternal
injury or death
Breastfeeding: Best Feeding Method
‘Sole’ food for the first 4 to 6 monthsProvides benefits to baby and mother
economic convenience Nutrition immune function bonding Maternal weight loss
When not to breastfeed?
HIV infected mother Although WHO says go ahead in developing
countries• The risk of infection is less than the harm by not
having good nutrition available during early months
Galactosemia: one in 50,000 births Inability to convert galactose to glucose and
developmental problems result
If Breastfeeding is not Chosen?
Infant formula is next best choice: Most are cow’s milk derived and are produced
to be close to human milk in composition Some are soy based Others are specialized to meet certain needs
• e.g.: PKU babies can’t have very much phenylalanine in the diet: Lofenalac
When to Add Solid Foods?
4 to 6 months: when developmental landmarks are met; Continue breastfeeding or formula
Iron fortified rice cerealAdd one food at a time: several days
See if there is an allergic reaction Then add a new food
Problems of Infant Feeding
Failure to Thrive: Baby doesn’t grow as fast as peers Causes? Often inadequate nutrition Monitor weight gain Compare nutrient intake per body weight
• A baby needs more than an adult
Problems of Infant Feeding
Baby Bottle Tooth Decay: Also called Nursing Bottle Syndrome Exposure of teeth to the carbohydrates of
formula
Nursing bottle Nursing bottle syndrome, syndrome,
extreme extreme exampleexample
Nursing Nursing bottle bottle syndrome, syndrome, early stageearly stage
General Feeding Rules for Infants and Children
Caregiver is the gatekeeper: What is offered and when
Infant or child decides whether to eat what is offered and also how much