Chapter 13 LIFE CYCLE NUTRITION by 1a0cw2

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									                      Chapter 13 LIFE CYCLE NUTRITION
                               Mother and Infant
                            Preparing for Pregnancy
• A mother’s nutritional status before and during pregnancy can affect a
    child’s health for the rest of its life.
• Mothers should establish good eating habits prior to becoming pregnant.
    Nutrient stores are especially important for early development – even
    before the mother learns she is pregnant.
                           Preparing for Pregnancy
•   Dads should also focus on good nutrition and avoid alcohol.
•   Prepregnancy weight
    – Mother too thin-low birth weight babies with a variety of health
       problems:
        • Low IQ, other brain impairments & learning difficulties
        • Short stature
        • Babies under 5 ½ lbs. are 40X more likely to die in the 1st year.
    – Mother too fat: gestational diabetes, hypertension & infections in the
       mother. Babies are large (even when premature) and may have:
        • Heart defects
        • Neural tube defects*
• Implantation of zygote and development of the placenta depends on good
    nutritional status – prior to conception.
• Placenta is the connection between the baby’s and the mother’s blood, fig
    13.2.
     – Provides nutrients, hormones & antibodies to the fetus.
     – Removes waste products from the fetus.
•   Placenta also secretes hormones and enzymes that support pregnancy and
    prepare the mother’s breasts for lactation.

                                Events of Pregnancy
•   1st 2 weeks, fig 13.3:
    – Fertilized egg divides repeatedly and implants in the uterine wall.
    – Placenta begins to develop and embryonic tissues form.
    – Problems: failure to implant, neural tube defects.
•   2-8 weeks:
    – Continued development of the placenta.

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    – At 8 weeks the embryo has complete nervous and digestive systems, a
      beating heart, defined fingers and toes, and beginnings of facial
      features.
    – Calcification of the skeleton begins.
•   8 weeks – term: rapid growth and development of organ systems in fetus.
    Mother’s uterus expands and supporting muscles strengthen, breasts
    prepare for lactation, blood volume increases by ½.
•   Critical periods
    – Times during which tissues and organs differentiate and mature.
    – If proper “building” blocks (proteins, carbohydrates, lipids) are not
     present the tissue/organ does not develop properly and cannot catch
     up.
• Good nutrition is vital for the mother’s and the developing child’s health
  throughout pregnancy.
• Nutritional risk factors, table 13.1:
   – Teen mother
   – Frequent pregnancies, close together
   – Poor nutrition, smoking
   – Underweight or overweight
   – Multiple births
   – Gain insufficient or excessive weight during pregnancy.


                               Nutritional Needs
• Food energy, fig 13.4. Balanced meals are especially important.
    – 1st trimester – none
    – 2nd trimester - extra 340 calories per day
    – 3rd trimester- extra 450 calories per day
• Protein: increase by 25 g/day??. Vegans need to be especially vigilant.
•   Carbohydrates: extra 175 g/day needed to spare protein. Fiber needed
    to prevent constipation.
•   Lipids: omega 3 and omega 6 vital for nervous system development. BUT
    - Minimal fish intake is recommended because of the mercury, etc.
•   Vitamins: especially folate and B12. Deficiencies result in neural tube
    defects: anencephaly, spina bifida.
•   Minerals:
    – Calcium, phosphorus & magnesium are needed for growth of bones and


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        teeth.
    – Iron is necessary for RBCs, supplement of 30 mg/day.
    – Zinc is required for protein synthesis and cell development.
•   Supplements: avoid with the exception of iron and a multi-vitamin as
    prescribed by your doctor.
•   Food Assistance – WIC

                                  Weight Gain
• Depends on prior weight status, table 13.4
    –   Normal weight: 25-35 pounds
    –   Underweight: 28-40 pounds
    –   Overweight: 15-25 pounds
    –   Obese: 15 pounds minimum
• Pregnancy is not a time to diet or overeat.
• Teen mothers need to gain more because they are still growing.

                                Physical Activity?
•   Yes with precautions, fig 13.8. Low impact, safe exercise.
•   Consult your physician!
                         Cravings and Morning Sickness
•   Cravings usually do not indicate need but different smell and taste
    sensitivities.
•   Morning sickness and other discomforts are due to hormonal changes.
•   Table 13.5: tips for relieving discomforts.
                                   What to Avoid
• Cigarette smoking (incl. second-hand):
    –   Decreases vitamin C absorption
    –   Produces toxins - nicotine and cyanide
    –   Causes vasoconstriction
    –   Is associated with low birth weights, SIDS.
• Medicinal drugs and herbal supplements: NO, incl. aspirin and ibuprofen;
    consult your physician.
• Illegal drugs: no brainer.
• Environmental contaminants: mercury and lead (some large ocean fish).
• Mega vitamins/minerals: no, especially vitamin A. Prenatal vitamins – YES.


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• Dieting: NO
• Sugar substitutes and caffeine – avoid or limit.
• ALCOHOL: NO, NO, NO; abnormalities seen with intakes as low as 1-2
    drinks/day.
     – Decreased oxygen and nutrient delivery to fetus.
     – Slows cell division and damages DNA.
     – During the 1st month it is detrimental to brain development.
     – Often associated with malnutrition in the mother.
     – Before fertilization can damage egg and *SPERM.

                                Alcohol and Babies
• FAS, ARND, ARBD
    –   Irreversible brain damage.
    –   Growth retardation.
    –   Mental retardation, mild to severe.
    –   Behavior abnormalities.
    –   Facial abnormalities, fig 13.10.
    –   Vision abnormalities.
• Stop before you become pregnant, dads included.

                               Pregnancy Problems
•   Gestational diabetes - after 24 weeks.
    – Usually resolves after birth of baby, but 1/3 develop Type 2 diabetes.
    – Risk is increased in overweight/obese women.

• Preeclampsia/eclampsia:
    – Dangerous increases in blood pressure, protein in urine and edema of
      face & hands in addition to feet & ankles. Convulsions and death.
    – Leading cause of maternal death. Increased in African American
      women.
    – No clear relationship to dietary intake but is increased in areas where
      nutrition is compromised. Inadequate calcium intake may play a role.

                                    Lactation
•   Cost to mother is ~500 calories/day above normal needs. Recommended –
    extra 330 calories/day; the remainder coming from stored fat.
•   Fig 13.4: nutritional requirements are higher than those for pregnancy in


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    most categories.
•   Volume of milk produced adjusts to baby’s demand.
•   Recommended fluid intake – 13 cups per day.
•   Nutrient deficiencies usually result in lower quantity not quality of milk.
•   Avoid excess intake of fat soluble vitamins (esp. vit A) and foods that
    disagree with the baby.
•   NO to alcohol, nicotine, and other drugs (except as prescribed by a
    doctor), limit caffeine.
•   Most infections, treated properly, are not transmitted via breast milk.
    Exception - HIV.

                                Feeding the Infant
•   Rapid growth during the 1st year requires an ample supply of nutrients,
    more than twice that of adults, per pound body weight, fig 13.12.
•   Iodine, vitamins A,D, & C are needed in especially high quantities.
• The baby adjusts energy intake to growth rate and physical activity. Do
    not force infants to eat.
• **Vitamin K
• Water – breast milk and formulas contain plenty. No need for other fluids
    except during episodes of vomiting and diarrhea.
•   Breast milk – 6 benefits:
    – Easily digested
    – Nutrient rich and adjusts to baby’s needs (if mother practices good
        nutrition). Exception – vitamin D and iron.
    –   Immune factors: colostrum provides antibodies and WBCs.
    –   Promotes growth of beneficial bacteria in intestines
    –   Hormones promote development of digestive tract
    –   Supplements are not necessary except perhaps vitamin D, iron (after 4-
        6 months and fluoride (after 6 months).
•   Breast fed babies
    – May have increased intelligence
    – Are less likely to become obese
•   Breast feeding also benefits the mother, table 13.7




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•   Formulas
    – Derived from cow’s milk that is diluted and fortified.
    – Plain cow’s milk is not recommended for babies under 1yr; low-fat milk
       only after 2yrs.
    – No human antibodies
•   Formulas cont’d
    – Soy based formulas for premature infants, infants with allergies and
       for vegan families.
    – Advantages: allows for monitoring of intake and developing
       relationships with other family members.
•   Solid foods: after 4-6 months, depending on baby’s development.
    – Fortified cereals; rice first, wheat last.
    – 4-6 months: pureed vegetables and fruits introduced one at a time to
       check for allergies.
    – Ability to chew properly does not develop until 2nd year.
•   Fluids:
    – Increased need with the introduction of solid food.
    – Best - water, 2nd - unsweetened fruit juices offered in a cup not a
       bottle.
    – Common Allergies: wheat, egg whites, soy, peanuts, cow’s milk, citrus
       fruits.
•   1st year
    – Model and teach good eating habits
    – Do not use food as a reward or to stop crying; do not withdraw food as
       punishment.
    – Do not use a bottle as a pacifier – dental problems, p.512.
    – Do not underfeed or overfeed

                          Controversy – Childhood Obesity
• Genetic and environmental (incl. poor nutrition).
• Type 2 diabetes: obesity, increased blood lipids, CVD.
• Obesity: risk increased if parents are obese, high birth weight ?, formula
    fed ?, physical inactivity.
• Other – OYO, pp 514-518


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