Lecture 5: Effects of Nutritional Insult at Diff Points in Lifestyle Flashcards
Define Infant Mortality Rate
The number of kids per 1,000 live births who die before their 1st bday
US mortality rate
5.1-5.5
India: 30.4
Somalia: 83.6
Global Nutrition Targets 2025 WHO Members States endorsement
- Stunting: 40% decrease under A5
- Anemia: 50% decrease in women of reproductive age
- Low birth weight: 30% decrease
- Childhood overweight: no increase
- Breastfeeding: increase rate of exclusive breastfeeding in first 6 months up to at least 50%
- Wasting: reduce and maintain childhood wasting to <5%
Effect of PEM on pregnancy outcome
Early pregnancy: increased rate of fetal loss and malformations
Late pregnancy: low-birth-weight babies
Effect of anemia on pregnancy
- Increased blood volume in pregnancy results in increased iron needs
- Maternal anemia associated with low birth weight and then low/no stores for the infant
* Affect on infant cognition if born with low stores - Anemia in mother also results in decreased work capacity
- Increased maternal mortality rate
* Severe anemia accounts for up to 20% of maternal deaths in developing
countries
Effect of maternal iodine deficiency on pregnancy
Congenital Hypothyroidism in infant
—> decreased development of brain growth
Effect of maternal size variations on pregnancy
- Stunted women likely have smaller babies
- Smaller pelvic area can result in higher incidence of difficult births
(difficult births -> increase in infant and maternal mortality)
Pregnancy: smaller pelvic area can result in what?
Which leads to what?
Result in higher incidence of difficult births
Leads to increase in infant/maternal mortality
Effects of Intra Uterine Growth Restriction (IUGR) on pregnancy
- Inadequate maternal nutritional status before conception
- Short maternal stature (Principally due to undernutrition and infection during childhood)
- Poor maternal nutrition during pregnancy
- If in urban countries: CIGARETTE -> low weight gain of mother during pregnancy, low prepreganncy BMI, placental insufficiency
What Is the most important determinant of IUGR in industrialized countries?
Cigarette smoking
How is cigarette smoking a determinant of IUGR?
It is followed by low weight gain of mother during pregnancy, low pre-preganncy BMI, placental insufficiency
Describe IUGR newborns
partially catch up to controls during the first 2 years of life
But usually about 5 cm shorter and 5 kg lighter in adulthood
Neuro dysfunctions with IUGR
Increased learning difficulties,
defects in speech,
neurological deficits,
and behavioral problems
Barkers fetal origins of disease hypothesis (DOHaD)
Nutritional insults during critical periods of gestation and early infancy, followed by relative affluence, increase the risks of chronic diseases in adulthood
Baby programmed for a life of scarcity and then confronted with a world of plenty
* See increases in cardiovascular disease, diabetes and high blood pressure
Low birthweight (<2500) results in
- Higher mortality rate
- Impaired mental function (majority of brain growth occurs during fetal period and first 18 months of life)
- Increased risk of adult disease, esp. cardiovascular disease
Preventing Low Birth Weight
- Nutritional supplementation
- Improves birth weight in malnourished women
- In marginally malnourished women the mother benefits but there is no effect on maternal weight gain or birth weight - Micronutrient supplementation during pregnancy increased birth weigh was well as balanced protein-energy micronutrient supplements
- many micronutrient supplements yield a bigger increase than just iron and folate supplements alone - Mothers should be reached prior to or in 1st trimester for greatest effect of supplementation
When should mothers be reached out for greatest supplementation effect regarding Preventing Low Birth Weight?
prior or in 1st trimester
Infant Nutritional Status is influenced by
- Inadequate feeding
- Frequent infections
- Inadequate food
- Health
- Care
Why is is that babies who breast feed have better nutri status than those who don’t?
– Infant does not compete with food supply for family
– Breast milk is a clean food supply in a clean container
– Breast milk has immunologic benefits so
decreases disease
Effect of maternal malnutrition on breastfeeding
Quality fo milk stays the same but quantity diminished
Nutrients such as calcium and iron are taken from the maternal stores
What usually extends the time between
children?
Why?
Exclusive breast feeding
As length of the birth interval strongly related to in fact and child survival
Links of breastfeeding?
– Stronger intellectual development of the child
– Reduced risk of cancer, obesity and several chronic diseases
– Women who were breastfed as infants have a reduced risk of breast cancer
Infant Feeding Recommendations
- Exclusive breast feeding for 6 months
- Breastfeeding with complementary feedings (i.e. solid foods) starting at 6 months of age
- Continued breastfeeding in the second year of life and beyond
- Field studies show no advantage in growth or development
when complementary foods introduced between 4 and 6 months
– Exclusive (only) breastfeeding until 6 months is now the recommendation - Interventions to improve intake of complementary foods
can result in improved infant and child growth among populations at risk of undernutrition - Complementary foods are required in the second 6 months of life to provide adequate nutrition and stimulate development
Role of National and International Initiative in Support of Optimal Infant Feeding
3 particularly important national and international
initiatives to promote breastfeeding
a. The International Code of Marketing of Breastmilk Substitutes – “The Code”
b. The Innocenti Declaration
c. The WHO/UNICEF Baby Friendly Hospital Initiative
“The Code”
- Provides guidelines for the marketing of breast milk
substitutes, bottles and teats - Aims to restrict practices that make infant feeding decisions
responsive to market pressures
– Especially restricts direct promotion to the public
*had a major impact
on the way formula is advertised and
marketed
The Innocent Declaration
- Focuses on the need to protect,
promote, and support breastfeeding - One operational target of this is the
universal implementation of the Ten
Steps to Successful Breastfeeding
– Forms the basis for the WHO/UNICEF
Baby Friendly Hospital Initiative
The WHO/UNICEF Baby Friendly Hospital
Initiative
A hospital is designated as Baby Friendly when it has agreed not to accept free or low-cost breastmilk substitutes, feeding bottle and teats and to implement practices that protect, promote and support breastfeeding
Actions of increase exclusive breastfeeding
- Provide hospital- and health facilities-based capacity to support exclusive BF, including revitalizing, expanding and institutionalizing the Baby-friendly Hospital Initiative in health systems.
- Provide community-based strategies to support exclusive
breastfeeding, including implementing communication campaigns tailored to the local context. - Significantly limit the aggressive and inappropriate marketing of
break-milk substitutes by strengthening the monitoring, enforcement
and legislation related to the International code of marketing of breast-milk substitutes and subsequent relevant World Health
Assembly resolutions. - Empower women to exclusively breastfeed, by enacting 6 months
of mandatory paid maternity leave as well as policies that encourage women to breastfeed in the workplace and in public. - Invest in training and capacity-building in breastfeeding protection, promotion and support.
Reasons for not breastfeeding
Health Concerns
Lack of Support. Return to Work or
School. Influence of Providers.
Financial Barriers. Personal Issues.
WHO - HIV and Infant Feeding Takeaways
- Mothers living with HIV should breastfeed for at least 12 months and
may continue for 24 months or beyond while being fully supported for
ART adherence - There should be services to protect and promote breastfeeding in
women living with HIV - If a mother living with HIV does not exclusively breastfeed, mixed
feeding with ART is better than no breastfeeding at all - Mothers who are returning to work or school and do not intend to
breastfeed for 12 months should be reassured that shorter durations of
breastfeeding are better than none at all.
