Maternal Infant and Child Care..Pregnancy.pptx

Maternal Infant and Child Care..Pregnancy.pptx

1. MGN MATERNAL INFANT AND CHILD NUTRITION

2. Nutrition through the Lifecycle Chapter 1: Nutrition during Pregnancy Ob j ectives an d Learning o utcom e: A t the en d o f this cha p ter, you should be able to- List major physiological changes that occur in the body during pregnancy and how nutrient needs are altered Understand and discuss modifiable and non-modifiable risk factors in the successful outcome of a pregnancy Specify optimal weight gain during pregnancy and plan an adequate / balanced diet for the same Identify nutrients that may need to be given as supplements and explain the reason / justification for the same Discuss typical discomforts and complications of pregnancy and explain how they can be minimized by dietary and lifestyle modifications Effectively counsel a pregnant woman

3. Nutrition during Pregnancy: The Impact on the Future The woman who is pregnant, or soon will be, must understand that her nutrition is critical to the health of her future child throughout life The nutrient demands of pregnancy are extraordinary

4. Preparing for Pregnancy Adequate Food Intake during Pregnancy is important but a good “pre- pregnancy nutritional status” has many advantages, providing a margin of safety. Before she becomes pregnant, a woman must establish eating habits that will optimally nourish both the growing foetus and herself

5. Ideally, Pregnancy SHOULD BE PLANNED because many practices or conditions of the mother that can harm the developing foetus are modifiable, such as- Alcohol consumption Smoking Use of certain medications / illegal drugs Heavy caffeine use Poorly controlled ongoing diabetes, hypertension, etc. Inadequate diet / poor nutritional status Stress – Job related, family, etc.

6. Many factors affect the development of a fetus into a healthy child, some which are beyond the mother’s control and others that are within her control. Here are ten of the most common pregnancy risk factors that can be controlled or influenced: Smoking – Smoking is not only bad for the mother, but it is worse for the baby. Smoking during pregnancy reduces the amount of oxygen that the baby receives and increases the risk of miscarriage, bleeding, and morning sickness. Pregnant women should also avoid second hand smoke. Alcohol – Drinking can cause fetal alcohol syndrome, including symptoms like low birth weight, medical problems, and behavior abnormalities.

7. Caffeine – There are many conflicting studies about caffeine and pregnancy and some believe that caffeine is not as harmful as it was once thought to be. Nevertheless, the FDA warns against caffeine consumption during pregnancy and suggests quitting or reducing consumption at the very least. Caffeine has been shown to affect fetal heart rates and awake time (fetuses grow when sleeping). Drugs and Herbal Remedies – A pregnant woman needs to be careful about drugs or herbal remedies that are not prescribed by a doctor. These substances may affect the development of the unborn child. Nutrition – Good nutrition is crucial to a developing child, particularly getting enough folic acid. Lack of folic acid can cause birth defects. Exercise – Moderate exercise is helpful as it improves the mother’s mental state and can increase oxygen flow to the fetus. However, over-exertion can be dangerous.

8. Prenatal Care – Regular doctor visits are important to the baby’s development. The body undergoes many changes during pregnancy. Some side effects may be completely normal, whereas others may not be. Multiple sex partners – Multiple sex partners can increase risk of STD’s, which in turn may lead to birth and pregnancy complications, like low birth weight or premature birth. Exposure t o chemic a ls – Dur i ng preg n anc y , reduce exposure to unnatural chemicals, particularly pesticides in food. The simplest precaution to take before consuming vegetables or fruits is to wash them thoroughly. Other factors – M a n y ot h er fac t ors can af f ect fe t al development, including heart disease, the mother’s age (less than 15 years and over 35 years is a risk), asthma, excessive stress or depression, etc.

9. This time period in the human experience- creating a new human being – sets the stage for the health of future generations . Th e q u a lity a n d q u a n tity of n o uris h m e nt o n t he de v el o p ing i n -u t ero z y go t e, then fetus, then neonate, then adult emerges as one explanation for diseases that manifest in adulthood. This concept is known as fetal origins of disease or developmental origins of health and disease . (Niljand, 2008; Solomons, 2009)

10. “Basically, what a mother eats or does during pregnancy, can affect even future generations. So a child’s health depends on not only potentially what the mother ate, but possibly even what the grandmother ate.” – Randy Jirtle in Epigenetics (July 24, 2007) The In t e r gene r a t io n al Effect

11. Manel Esteller in Epigenetics on PBS (July 24, 2007 ) - “One of the main findings of our research is that epigenomes can change in function of what we eat, of what we smoke, of what we drink. And this is one of the key differences between epigenetics and genetics.” From the Dr. Oz website: As DNA, the blueprint of the body, is rolled out during development, it gets copied. And while that copying occurs, the things you are experiencing – what you eat, the toxins you are exposed to – can stop that copy machine from working properly. This basic principle of epigenetics means that, while we can’t control what genes we pass on to our children, we may be able to control which genes get turned on or turned off. … H e r e’ s a nother ex a mp l e that w il l help pu t epi g ene t i cs in perspective. We share 99.8 percent of the same DNA as a monkey, and any two babies share 99.9 percent of the same DNA. Not only that, we even have 50 percent of the same DNA as a banana!!! So genes alone cannot explain the diversity in the way we look, act, behave, and develop. How those genes are expressed plays a huge role in how vastly different we are from monkeys and how explicitly and subtly different we are from each other.

12. Pregnancy- Phase of Rapid Growth The newly fertilized ovum i.e. the Zygote begins as a single cell. Zygote represents the first 2 weeks of the phase of human gestation . Divides into many cells during the days after fertilization Within two weeks, the zygote implants, and the placenta begins to grow inside the uterus Minimal growth takes place at this time, but it is a crucial period in development Adverse influences such as smoking, drug abuse, and malnutrition at this time lead to failure to implant or to abnormalities such as neural tube defects that can cause the loss of the zygote The Embryo and Fetus During the next 6 weeks, the embryo registers astonishing physical changes

13. Embryo : The stage of human gestation from the third to eighth week after conception Foetus (9-40weeks) - The stage of human gestation from the 9 th week after conception until the birth of an infant The woman must be well nourished at the outset because early in pregnancy the embryo undergoes rapid and significant developmental changes that depend on good nutrition Gestation: The period of about 40 weeks (three trimesters) from conception to birth. The term of a pregnancy The mother’s nutrition before pregnancy determines whether her uterus will be able to support the growth of a healthy placenta during the first month of gestation

14. Uterus The muscular organ within which the infant develops before birth Placenta The organ of pregnancy in which maternal and fetal blood circulate in close proximity and exchange nutrients and oxygen (flowing into the fetus) and wastes (picked up by the mother’s blood) If the placenta works perfectly, the fetus also develops perfectly If the placenta does not work efficiently, no alternative source of sustenance is available and the fetus will fail to thrive

15. ..\..\YouTube Video Downloads\NUTRITION through the LIFECYCLE\Maternal-Fetal Circulation.avi

16. Placenta The placenta produces several hormones responsible for regulating fetal growth and development of maternal support tissues. It is the conduit for exchange of nutrients, oxygen, and waste products. Placental insults compromise the ability to nourish the fetus, regardless of how well nourished the mother is. Placental insults can be the result of poor placentation from early pregnancy or small changes associated with preeclampsia or hypertension disorders. Average placental weight at term is about 500gms Placental size can be 15% to 20% lower than normal in fetuses with intrauterine growth restriction (IUGR). A small placenta has a smaller surface area of placental villi, with a reduced functional capacity.

17. Mechanisms of Nutrient Transport across the Placenta Mechanism Examples of nutrients Passive diffusion (also called simple diffusion) Nutrients transferred from blood with higher concentration levels to blood with lower concentration levels Water, some amino acids and glucose, free fatty acids, ketones, vitamins E and K*, some minerals (sodium, chloride), gases. Facilitated diffusion Some glucose, iron, vitamin A and Receptors (“carriers”) on cell vitamin D membranes increase the rate of nutrient transfer Active transport Energy(from ATP) and cell membrane receptors Water- soluble vitamins, some minerals (calcium, zinc, iron, potassium) and amino acids Endocytosis (also called pinocytosis) Nutrients and other molecules are engulfed by placental membrane and released into fetal blood supply Immunoglobulins, albumin * Vitamin k crosses the placenta slowly and to a limited degree

18. If the mother’s nutrient stores are inadequate during the period when her body is developing the placenta, then the placenta will never form and function properly – As a consequence, no matter how well the mother eats later, her fetus will not receive optimal nourishment, and a low birth weight baby with all of the associated risks is likely The amniotic sac surrounds and cradles the foetus- Cushioning it with fluids The umbilical cord is the pipeline from the placenta to the fetus

19. The umbilical cord contains t w o l a r ge arte r i e s, w h ich deliver oxygen and nutrients to the fetus from the placenta, and one large vein, which carries carbon di oxide and other wastes from the fetus to the placenta. Transferred to the bloodstream, most of these wastes are soon eliminated through the mother’s excretory system. As the fetus approaches birth, the umbilical cord is about 50cm (20in) long and has a diameter of 1.5cm (0.5in).

20. The a m ni o tic sac is the fl u i d -fil l ed ba l l o on li k e structure that holds the fetus. The u m b il i c a l c o rd d e li v e r s n u tr i e n ts an d oxygen ; removes wastes. Placenta – respiration, absorption and excretion for fetus.

21. MATERNAL UNDERNUTRITION INFLUENCES PLACENTAL-FETAL DEVELOPMENT: Louiza Belkacemi, et.al. Department of Obstetrics and Gynecology, Washington University School of Medicine, USA Maternal nutrition during pregnancy plays a pivotal role in the regulation of placental and fetal development and thereby affects the life-long health and productivity of offspring. Sub- optimal maternal nutrition yields low birth weights, with substantial effect on the short-term morbidity of the newborn . The placenta is the organ through which gases, nutrients, and wastes are exchanged between the maternal and fetal circulations. The size, morphology and nutrient transfer capacity of the placenta determine the prenatal growth trajectory of the fetus to influence birth weight. Trans-placental exchange depends on uterine, placental and umbilical blood flow. Importantly, maternal nutrition influences factors associated not only with placental homeostasis but with optimal fetal development as well. This review relates fetal growth with maternal nutrition during pregnancy, placental growth and vascular development, and placental nutrient transport.

22. SUMMARY: Maternal nutrition during pregnancy is an important determinant of optimal fetal development, pregnancy outcome and ultimately, life-long health as an adult. Normal placental function fa c ilitates mate r n a l -fet a l tra n sfer of nutrients that are critical for the development of a healthy fetus. MUN reduces fetal growth in part by impairing placental development and function. Placental alterations vary with the nutritional setting, and include either decreases or increases in placental weight, altered vascular development, diminished growth factor expression and reductions in placental glucose, amino acid and lipid transport. The plasticity of the placenta allows this pivotal tissue to respond to exogenous insults and compensate for varying nutritional status of the mother. When this response is not sufficient to maintain fetal growth, IUGR results and sub-optimal outcomes may appear in newborns and persist into adult life Maternal under nutrition affects the placental weight, modifies the nutrient transfer capacity, nutrient levels and fetal growth.

23. More Resources Infant and young child feeding