Lecture 9: Maternal and Infant Nutrition

Question 1

what is the ‘critical window’?and why is it important?

Answer 1

First 1000 days of life
- nutrition during pregnancy and 2 years of the child’s life is key to brain development, healthy growth and strong immune system

Question 2

what are the nutrition and lifestyle guidelines for preconception?

Answer 2

• optimise health
  
  • ensure existing health conditions are treated/managed
• excess weight
  - reduce for men and women
• healthy diet and lifestyle and cease smoking
• folic acid - supplement one month before trying to concieve
• iodine - supplement if planning to conceive

Question 3

what is the need for periconceptional folic acid?

Answer 3

folic acid supplementation 1 month prior to conceiving prevents first and second time occurrence of neural tube defects

Question 4

what are common neural tube defects?

Answer 4

• spina bifida
• anencephaly
• encephalocele

Question 5

what is an issue surrounding folic acid supplementation?

Answer 5

at ~19 days, the neural plate develops and by 23 days it has closed and has formed the neural tube. Because this happens so early, most women won’t even know they’re pregnant! so might not have been taking folic acid beforehand.

Question 6

what are the periconceptional folic acid recommendations?

Answer 6

• if planning pregnancy, take 800mcg folic acid tablet 4 weeks before and 12 weeks after becoming pregnant

Question 7

how compliant are NZ women to the folic acid recommendations?

Answer 7

33% used folic acid as recommended

- they were higher educated, higher income, older age NZ European

Question 8

what are the limitations surrounding the campaigns to promote folic acid supplementation?

Answer 8

• it is very limited

- it increases awareness and knowledge but limited impact on action

Question 9

what are some ways to increase campaign success?

Answer 9

• identify target groups not currently reached
• make campaigns relevant to different cultures, ethnicities and age groups
• include folic acid benefits in lives of reproductive age women (high school, university)

Question 10

what have been some other solutions for increasing folic acid intake?

Answer 10

including folic acid in flour and all products that contain flour!
this has been successful in places like Canada, US and Australia (not nz;-;)

Question 11

was the folic acid fortification of flour successful?

Answer 11

yes! a study in canada saw a decrease in neural tube defects after folic acid was introduced into flour!

Question 12

why did NZ not implement folic acid in flour?

Answer 12

• the plan was to give 136 mcg of folic acid to childbearing age women every day by putting it in bread.
• the goal was to reduce NTD’s by 4-14.
• it was deferred and then withdrawn as people were uneasy about the possibility of prostate cancer developing in men.

Question 13

what is the economic burden of NTD’s?

Answer 13

there are approximately 17 NTD’s per year, with a total cost per case of $5,434,227

Question 14

how was the fortification of iodine in bread for NZ?

Answer 14

quite successful!

• NZ’ers were found to be very iodine deficient.
• since 2009 iodised salt was added to bread to try improve the iodine deficiency in NZ

Question 15

why is iodine important?

Answer 15

• essential for thyroid hormone production
• regulates metabolism
• promotes normal growth
• involved in neurocognitive development of fetus, infant and child

Question 16

what amount of iodine should nonpregnant, nonlactating women have per day?

Answer 16

Estimated Average Requirement (EAR) = 100mcg/d

Recommended Daily Allowance (RDA) = 150mcg/d

Question 17

what amount of iodine should pregnant women have per day?

Answer 17

EAR = 160mcg/d
RDA = 220mcg/d

Question 18

how often should pregnant women have iodine supplements?

Answer 18

150mcg tablet taken once a day when pregnant and breastfeeding

• subsidised tablet - $3 for 3 months :)

Question 19

what is the average weight gain for pregnant women?

Answer 19

11-16kg

Question 20

what are the weight gain expectations for the 1st,2nd and 3rd trimesters?

Answer 20

1st: extra energy not required
2nd: 1400kJ or 340kcal per day
3rd trimester: 1900kJ or 452 kcal per day

Question 21

what is the recommended weight gain for underweight pregnant women?

Answer 21

13-18lbs

0.5-0.6lbs per week

Question 22

what is the recommended weight gain for normalweight pregnant women?

Answer 22

11-16lbs

0.4-0.5lbs per week

Question 23

what is the recommended weight gain for overweight pregnant women?

Answer 23

7-11lbs

0.2-0.3lbs per week

Question 24

what is the recommended weight gain for obese pregnant women?

Answer 24

5-9lbs

0.2-0.3lbs per week

Question 25

what is the adherence to the weight gain guidelines?

Answer 25

in NZ, out of 1950 women recruited between 2004 and 2011, 74% has excessive weight gain.
there was higher risk younger mothers who quit smoking.

Question 26

how can we measure/target weight gain in pregnancy accurately?

Answer 26

• height and weight measured at 10-14 weeks
• make women aware of the guidelines
• monitor weight during pregnancy

Question 27

what are some ways of maintaining healthy growth and development of infants and toddlers?

Answer 27

• provide them with appropriate food and physical activity
• exclusively breastfeed for the first 6 months of age, or until it’s ready
• when ready, introduce them to appropriate complementary food and continue to breastfeed until at least 1 year of age
• if unable to breastfeed, use infant formula as milk source until at least 1 year old.

Question 28

what is complementary feeding?

Answer 28

• the transition of exclusive breastfeeding to family foods is called complementary feeding (old term: weaning)
• at around 6 months, breast milk is not enough to meet energy/nutritional requirements, complementary foods should be added to diet.
• usually occurs from 6 months to 18-24 months

Question 29

what are some issues if complementary feeding is not done well?

Answer 29

this is the time when malnutrition occurs in many infants.

Question 30

what types of food could you give a baby?

Answer 30

• plain, soft or smooth

- iron-fortified, pureed meat, pureed fruit, pureed cooked vegetables

Question 31

when can cows milk be introduced?

Answer 31

• around 12 months, full fat cows milk can be introduced but not more than 500mls/day
• reduced fat milk not recommended until at least after 2 years old