Initial growth stagesZygote0-2 weeksrapid cell divisionembryo2-8 weeksorgan formationfetus8-40 weeksrapid growththe concept of critical periodseach organ and tissue type grows with its own characteristic pattern and timingthe development of each takes place only at a certain time – the critical periodif the development of an organ is limited during a critical period, recovery is impossiblepregnancy outcomegestational lengthnormal = 37 up to 40 weekspremature = less than 37 weeksbirth weightnormal = 5.6 to 9.9 poundslow = less than 5.5 pounds (greater than 36 weeks)low birth weight increases the risk for:infant death (12x)congenital malformationsbehavior and learning problemswhat causes low birth weight?Low maternal weight gain during pregnancyLow maternal pre-pregnancy weightMaternal lifestyle factorsAlcoholSmokingDrugs (cocaine, heroine, etc)Recommended weight gain in pregnancyPre-pregnancy weight (lb) Recommended gain (lb)Normal (BMI= 19-25.9) 25-35Underweight (BMI<18.9) 28-40Overweight (BMI= 26-29.9) 15-25Obese (BMI > 30) 15Pattern of weight gain3-5 lbs during first semester1 lb/wk thereaftercalorie needs during pregnancyno increase during first trimesterimportance of nutrient density~400 kcal/day increase in 2nd and 3rd trimesternutrients of particular importanceironall women receive supplement of 27 mg/dayanemia related to poor birth outcomesfolateall women receive supplement of 400 mcg/daydeficiency leads to neural tube defectscalciumif inadequate intake, will be taken from mother’s bonesother dietary components of interestcholineessential nutrientimportant in fetal developmentbest source: egg yolksDHA/EPABrain developmentMay lower risk of pre-term laborAdded to baby formulasOther recommendations to pregnant womenExercise guidelinesDon’t use over the counter prescription medications without consulting your physicianDon’t smoke while pregnantCaffeine in moderationArtificial sweeteners in moderationFoodborne illness bacteria affects mother and fetusFetal Alcohol SyndromeAlcohol crosses the placenta freely and is directly toxicAlcoholLimits oxygen delivery to the fetusSlows cell division which can cause abnormalities in organsAffects fetal brain cell divisionInterferes with nutrient transport to fetusBefore fertilization, alcohol can damage the ovum or sperm, leading to abnormalities in the childHow much alcohol is too much?Moderate alcohol intake leads to low birth weightFirst month of pregnancy is criticalNo SAFE intakeExercise guidelinesExercise regularly (at least 3 times a week)Warm up with 5 to 10 min of light activity30 min or more of moderate physical activity on most, if not all, days of the weekcool down with 5 to 10 min of slow activity and gentle stretchingdrink water before, during, aftereat enough to support additional needs of pregnancy plus exerciserest adequatelydon’t exercise vigorously after long periods of inactivitydon’t exercise in hot, humid weather or when sick with feverdon’t exercise while lying on your back after 1st trimester or stand motionless for prolonged periodsdon’t exercise if you experience pain or discomfortdon’t participate in activities that may harm the abdomen or involve jerky, bouncy movementsdon’t scuba diveGestational diabetesDiabetes with first occurrence during pregnancyAll women tested at 28 weeks, sooner if high riskManaged with diet and diabetes medications including insulinRaises risk of Type 2 diabetes later in lifeAbility to BreastfeedBreast milkProlactin- synthesis of milkOxytocin- let down of milkCan pass on virus in HIV positive momsCertain drugsOnly 5/100 women not able to produce sufficient milkNutrient needs during lactationEnergy650-800 kcal to produce milkenergy from diet and fat storesproteinvitamins- A, E, C, most Bs not folateminerals- zinc, magnesium, selenium, not ironwater- 2 quarts per day, very important to keep up milk productionother advice for lactationconsume plenty of fluidsrecommend 4+ additional cups per daydecrease use or consumption ofcigarettesalcoholmarijuanacoffeeget plenty of restdon’t restrict food intake to lose weight rapidlyadvantages of breastfeedingcolostrumfirst milk- thin, yellowishfirst few days after birthimmune protection – antibodies produced by motheralso factor to stimulate growth of healthy gut bacteriamature milknutritionally completedaily Vitamin D supplementeasily digested (lactalbumin)high bioavailability of nutrientsprotective against infectionsdecreased risk of food allergiesemotional bondingconvenience and costbenefit to mother: there may be a reduced risk of developing breast cancer over timeFeeding PeriodsNursing (0-4 months)Liquid onlyImmature kidneys- stressed by plain cow’s milkImmature gastrointestinal tractSuckling reflexTransitional (5-12 months)Liquid & semi-solid foodsKidneys and GI tract maturingMature suck and swallow reflexModified adult (1-10 years)Increasing variety and textureGI tract matureFeeds selfWhen to introduce solidsNutritional needsAfter 4-6 months and birth weight doublesNeed additional iron and caloriesDevelopmentAfter 4-6 monthsMature suck and swallow reflexHolds head upMaturing kidneys and GI tractHow to introduce solidsOnly 1 new food per weekStart with iron-fortified cerealIntroduce vegetables before fruitLimit sugar and salt contentHigh water contentNO cow’s milk in first yearNO eggs or honey in first yearAvoid choke foods (hot dogs, peanuts …)feeding a healthy young childat no time in life does the human diet change faster than during the second yearfrom 12-24 months, a child’s diet changes from infant foods consisting of mostly formula or breast milk to mostly modified adult foodsmilk remains a central source of calcium, protein, and other nutrientschanges in eating habits1-2 yearsvariable appetites and tastestaste buds more acute than in adultslearns to feed selfcopies otherslearns to say nofood jagsdon’t want different types of food to touch each otherfood neophobia—fear of new foods2-3 yearscan use utensilsdevelop stronger taste preferencescan make simple choices4-5 yearspeers, television major influence (marketing)appetite gradually increasingenergy and macronutrientsenergyvariable, appx. 800 kcal/day for a 1 year oldincreases to ~1800 kcal/day by age 10importance of nutrient densitycarbohydratesneeded to fuel the brainneeds similar to adultsproteinimportant for growthper pound, protein needs decrease as child agesDRI : 1 g/kg for ages 1-8, then decreases slightlyFatConcentrated source of
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