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