Why is nutrition during pregnancy and lactation important?
1. Mother’s and infants are one of the most nutritionally vulnerable groups
2. All women need to eat a healthy balanced diet and gain weight to sustain a healthy preganany and childbirth
3. A fetus’s weight doubles in the first 6 weeks
4. Infant doubles in weight from birth to 4-5 months
5. Barker hypothesis - poor nutrition in utero may increase risk of chronic disease later in life.
6. Fetus has limited ability to compensate for limited supplies.
7. Growth depends on a supply of nutrients via placenta and then breatmilk
8. Marginal nutrients are more important in developmental peroid than steady state (adulthood)
What is the Barker Hypothesis?
It is an hypothesis concerning how early nutrition can affect health outcomes in adult life. It proposes that there is a correlation between in-uterine growth retardation, low birth weight and premature birth and developing hypertension, CHD and Type 2 diabetes in adult life.
What is Barker’s hypothesis proposed mechanism?
- Peroids of rapid post-natal growth (high E intake, Western dietary pattern)
-Transgenerational epigenetic inheritance (peroid of nutritional deprivation)
What is the drawback of Barker hypothesis?
A overview of nutritional needs during pregnancy
Are you eating for two during preganany?
- Nutrients for two
- 10% extra energy
- Nutrient rich diet recommended
Preganant wo have an healthy weight should gain
Between 11.5- 16 kg
Prégnant women who are underweight should gain
Prégnant women for are obese should gain
between 7pm 11.5 kg
Summary of macronutrient needs during preganany
First trimester: no change
Second trimester: increases 340kcal/day
Third trimester: increases 452 kcal/day
Protein needs: increases from 46g/day to 71 g/day
Iron needs in preganany
increased need for iron in diet:
- increased blood volume
-develpoing fetus draws enough iron to last 0-6 months
-iron loss reduced but overall need for iron much greater
Calcium in pregnancy:
Foetus retains about 25-30g calcium (predom. 3rd trimester).
‒ RDI = 1000 mg same for non-pregnant as calcium absorption increased in pregnancy
‒ Dietary calcium does not appear to influence maternal bone mass inpregnancy
‒ Support concept of maternal adaptive mechanism
Vitamin A needs in preganany
Why should pregnant women be wary about some types of fish?
mercury in fish: pregnant women and women planning pregnancy should avoid fish with high levels of mercury such as billfish, gemfish, southern blue fin tuna
-should safely eat 2-3 meals of fish each week though, but choose the type of fish carefully.
Why are vitamin supplements in preganancy controversial?
not usually recommended but may be needed for:
-teenagers who have inadequate food intake
- obese women who are restricting their energy intake to prevent large weight gains
What was the impact of mandatory folate fortification in Australia?
-NTDs fell by 14%
-NTDs fell by 74% for Indigenous Australians
-NTDs fell by 55% among teenagers giving birth
What was the impact of mandatory iodine fortification?
Iodine intakes by children increased by 29%
-Iodine intake in women of childbearing age increased by 52%
Why is the nutritional status of the father important?
Age of father is associated with reduced sperm quality:
-May lead to structural defect
-increased DNA fragmentation
-more gene mutations
- more children carrying heritable genetic defects
What are the advantages of breatfeeding for the mother?
Involution of uterus, decreased haemorrhage risk
• Return to pre-pregnancy weight more quickly
• More hygienic, less hassle
• Amenorrhoea – recoup iron stores, increased time to next pregnancy
• Beautiful experience and bonding with infant
What are the advantages of breastfeeding for the infant?
• Breast milk design for optimal growth of infant
• Supply determined by demand – rare to be overfed
• Breast milk adjusted to needs of infant
• Iron in breast milk more easily absorbed
• Formula fed babies may be more likely
to develop obesity later in life
What are the nutritional needs of infants 0-6 moths?
What is the prevalence of breastfeeding in Australia
-90% of women commence breastfeeding
- 50% by 6 months
- Almost 39% exclusively breastfeed to 4 months
What is the Australian National Breastfeeding strategy?
‐ Aims to support all mothers, fathers/partners and babies in Australia by providing support for mothers to breastfeed their infants.
‐ Provides framework for integrated, coordinated approach to other local policies and
‐ The strategy is evidence based
‐ DoH will establish and advisory committee to oversee implementation of strategy
How frequently do you need to breastfeed and how long?
- Breast is best fo rythme young baby but as they get older, milk alone is not enough to meet nutrient needs
-Continued breastfeeding recommended to 18 months-two years along with complementary foods
-Frequent feeding (4-5 times a day) in addition to breast milk ensures sufficient energy and nutrients.
-First foods are usually introduced at around 6 months to meet increasing nutritional requirements.
-At this age most babies are developmentally ready for first foods and the feeding relationship takes on new dimensions.
-Breast milk or formula continues to be the main source of nutritio
What are the types of first foods?
- cooked potato
-mashed smooth foods
-grilled chicken or meat
Solid foods for toddlers:
Children’s appetite begin to decrease around 12 months age – then will vary intake to coincide with growth patterns
Children’s intake also varies from meal to meal – but total average intake over a few days is usually constant
Individual needs vary widely depending on growth and activity levels
What is the parents role in feeding a toddler
Toddlers can explore and enjoy food
Parents role is to continue offering a wide selection of food from the five food groups – their choice is whether to eat or not.
Rejecting new foods is normal – acceptance is more likely as become familiar with food through repeated opportunities to taste them
Sweet foods should be limited
What are the factors affecting children’s growth?
How is a child’s growth monitored?
NHMRC recommends children's growth should be monitored at regular intervals
Each state and territory in Australia has health monitoring schedules for infants and young children when growth measures are taken and plotted on the relevant charts.
These schedules are for otherwise healthy children and allow for early detection of altered growth should it occur.
Children with ongoing health concerns may need to have their growth monitored more frequently.