hi everyone welcome to this presentation today we're going to be starting our fifth unit of the semester we're going to start off with chapter 17 which covers the topics of pregnancy breastfeeding and infancy and then in the remaining two chapters of our semester we'll be looking at nutritional needs for toddlers and adolescents as well as then older adults chapter 17 is one of the lengthiest chapters of our semester but also one of the most interesting chapters the presentations today will consist of pregnancy so special considerations for women before and during pregnancy State we'll also look at changes that are occurring in mom and then nutritional needs how those needs change from the pre-pregnancy state to the pregnancy State then the next recordings will go into lactation so breastfeeding we'll take a look at breast milk versus Formula what are the differences and then also the nutritional recommendations for moms when they are breastfeeding and then finally the last segment will cover infancy which is defined as the first 12 months of life so we'll take a look at the nutritional needs for infants and then also how to start that feeding process first off though let's get into the topic of pregnancy so a woman's choices during her pregnancy related to diet and lifestyle are very very important for the future health of the child and not just as a child but when that child grows up to be an adult there's a lot of interesting research that looks at how the pregnancy State can set up the future health of an adult in terms of mom being pregnant with the child and when you think about it there's a lot of cell division and growth and specialization occurring during pregnancy and we need the diet to be as sufficient as possible to support mom's needs as as well as the needs of the fetus and then the embryo and then the fetus as it continues to grow there during those N9 months so today I'm primarily going to spend time talking about moms and their nutritional needs and considerations but I do think it's important to point out that men are also going to play a role with the development and maintenance of a healthy pregnancy this is summarized a bit in your book and worth mentioning to you here there's a lot of research that suggests poor diet primarily high in saturated fat high in refined sugars is associated with lower quality and quantity of sperm also excess weight and high intake of alcohol can also affect quality and quantity of the sperm there's some interesting bits of research in the textbook that discuss how sperm need adequate zinc and folate for optimal development and even how vitamin C and vitamin E which are antio oxidant how they serve to protect sperm against things like free radicals and oxidative damage so men are certainly not off the hook with this despite that primarily we'll be talking about the health considerations of women oops there we go so let's cover some Basics infant body weight is the most potent indicator of infant health and future adult health I really want to drive this point home we do not want to to be born low birth weight and by definition low birth weight is under 52 PBS neither do we want children to be born extremely large so infants that are 8ish pounds pretty good number as we start getting into 9 10 12 lbs those are going to pose more risks for the child as an infant as well as an adult so the first bup Point here that I have allergies colds chronic disease I would like to talk about these next with with low birth weight infants if they're under 5 1/2 lbs they are 40 times more likely to die within the first four weeks of Life oftentimes it's related to their immune system function we do find that children who go on to be toddlers preschoolers adolescence and such tend to suffer more with allergies and upper respiratory infections if they were born at a low body weight and then also this concept of chronic disease and and Fetal theories of obesity and the first time I say this it may not make sense but I'd like you to think about it when we have a child born under 5 A2 pounds they can actually be more prone to developing chronic diseases and developing obesity as a child and as an adult so you might be thinking well how is that the case right if they're born small don't they always stay small not necessarily what we find is that if there is under nutrition which is leading to the child not growing as well and being low birth weight their their bodies their DNA can become very Thrifty and they can become very good at storing the calories that they are getting so in essence when they're a toddler an adolescent an adult that DNA is still with them and they're still going to be in that mode of when their body takes in energy in the form of calories they may be more apt to hang on to it compared to to the next person so strong link between low birth weight infants and later on in life having overweight and obesity come up with chronic disease there's some research out there that suggests If the child is under 5 A2 pounds their organs may not be fully developed so if it's the kidneys or the heart or whatnot that can actually spur the development of heart disease or kidney disease or whatever condition it is at an earlier age due to just not having proper full development during that fetal stage on the other hand a high birth weight baby is also not ideal uh it can be more of a complication when it comes to delivery so if moms are delivering 10 12 PB infants there's usually going to be some excess blood loss or they have to do a C-section which increases the the risks of complications and there's also links between a heavier infant and chronic disease hypertension diabetes so in general this is my last bullet point here in general we like to see anywhere from 7 to 8 lb but we definitely like to avoid under 5 1/2 lb and over 10 lbs for an infant to give you a little bit of background on pregnancy uh full-term pregnancy is anywhere from 39 to 40 weeks and that's conception all the way through to delivery by definition a premature or pre-term child is under 37 weeks so under 37 weeks and then I've filled in the blanks for you for the others so under 5 1/2 lb and then in general 7 to 8 lb is what we would like to see keep in mind that these are all correlations by no means am I indicating that if a child is under 5 and a half pounds that they will develop these various conditions it just makes it more likely that they will all right so moving on let's go into some of the factors that may influence a pregnancy first off it's worth mentioning that planning really is ideal when it comes to pregnancy up to 75% of us pregnancies are not planned which is one of the reasons why our outcomes really aren't as great as some of those from other developed Nations there's a particular marker that we can look at with this it's called infant mortality rate or IMR and in our nation our infant mortality rate is about six out of a thousand so for every thousand babies that are born six of them die that is actually about 49th or 50th in the world there's a lot of nations in front of us a lot of mainly the European nations as well as Japan Monaco and even some other South American nations so we're really not doing as good with this one reason due to the lack of planning the pregnancy we'll learn here in a few minutes just how important that first trimester is for optimal growth and development so in terms of nutrition and lifestyle factors that may affect a pregnancy there's a nice table in your book that explains these but I thought I would also add some tidbits to them so age is number one for a woman under 18 it is a higher risk pregnancy due to her status and nutritional stores not being fully developed yet and likewise over the age of 35 is considered a higher risk pregnancy that's not to say that women in their late 30s and 40s cannot have a healthy infant however there are greater risks for things like hypertension during pregnancy or gestational diabetes or even birth defects I will tell you about onethird of all pregnancies are from women over 35 and many of them most of them do quite well so keep that in mind we shouldn't be limited just by the age but do know that the younger the woman is the older she is and the older she is excuse me the higher there's a risk for some pregnancy complications with weight and body fat percent underweight women tend to be the ones who have low birth weight infants so under 5 and a half pounds as well as premature infants and that can set them up those children up for problems with their health during infancy childhood and as I alluded to to later on in life so that's something that we really try to avoid is if we have a mom who's planning on pregnancy we we'd love for her to get up to a healthy weight with overweight it tends to uh be a harder pregnancy if Mom is overweight or obese going into a pregnancy uh there's often a correlation with having a larger baby and that can lead to neural tube defects there's also a stronger connection than with C-sections and in some research a higher risk of getting gestational diabetes so if possible it is recommended for someone who is overweight or obese to aim for a bit of weight loss prior to getting pregnant current health status uh what I'm referring to here is whether or not mom has a chronic condition like diabetes or hypertension there may be some factors there that we've got to consider in terms of medications for her during that pregnancy State closely space births uh if Mom isn't fully repleted after one pregnancy she may not be maximizing as much of her nutritional stores for the next one prenatal care this is huge guys there are significant disparities for Health Care access and availability in the United States and bottom line not all women have equal access to appropriate Health Care uh if a woman doesn't have health insurance she's greatly Limited perhaps she can qualify for something like Medicaid however not all individuals fall into that category there's also individuals who do have health insurance yet their health insurance doesn't cover pregnancy or they would have to pay extra to have a coverage for pregnancy I know with my insurance here uh they do cover pregnancy State however you have to pay more of a premium which wouldn't be a terrible thing to to do if one is planning however it's it's tough making ends meet let alone paying a bit extra for having the pregnancy Insurance ultimately what we find is 20% of women who are pregnant receive no prenatal care at all so no doctor's visits no recommendations for nutrition or prenatal vitamins and such no prenatal care literally the first care they're getting is when they go to deliver the baby baby that's very risky uh there's a three times greater risk of having a low birth weight infant so under 5 and 1 half pounds if there's not that appropriate prenatal care during the pregnancy so unfortunately in our nation this has probably been the biggest Factor I've seen is lack of access affordability and availability of prenatal care I wanted to bring in the image here Wick and just to make mention to you all Wick is a fantastic program uh it stands for women infants and children and it's a government program that provides vouchers for foods for women who are lower income it's also up to uh children of age five So a family could qualify if they have a child up to age 5 the income requirements really aren't as strict as one might think and the reason for this is we want women who are pregnant we want infants we want children to be able to access foods like milk and peanut butter and eggs eggs and cheese all those foods that have Rich nutrients the wick program is phenomenal in providing nutrition education and then these vouchers to where moms can go into the stores and get these items for free and feed to their children uh it's probably the most successful and influential government program I've seen to date a research suggest that it is associated with fewer low birth weight babies as well as better ch Childhood Health and then future adult health of that child there's some interesting tidbits of research in your book where they talk about how for every dollar invested into Wick so for every dollar the government puts into the program they get $3 in return in terms of health care savings so really really cost effective and healthful program for women infants and children lifestyle factors what I'm referring to here excessive stress can affect the conception rates as well as the progress of the pregnancy sleep uh physical activity and certainly diet which is what we'll be discussing throughout this chapter the last three points weight gain vitamins and minerals and then substances of abuse I'll have more specifics coming up they certainly are going to play a role in the optimal state of a pregnancy for example something we'll talk about in the next few recordings how caffeine can can increase the risk of premature babies or how full Aid is going to be needed during the first month before we get into specifics with nutrition though I thought it would be helpful to go over pregnancy so yes we've all heard of the trimesters and they're usually the first one is 12 weeks then we have another 12 weeks and then the third trimester but it's important to understand what we're seeing Within These trimesters initially in the first trimester especially the first weeks we see a lot of cell division and specialization and these are very very critical times for the development of organs and body systems after that first trimester or so we start seeing more growth so certainly there's still some cell division and specialization but primarily we're seeing quite a bit of growth uh thus being important to well if possible plan those pregnancies to where we can provide the optimal new nutrition during that first 8 weeks uh the image that you see on the slide is a nice one here just to show you the terminology initially the fertilized egg is called a zygote you can see it being implanted here in the uterine wall and then here we have about week three on we call it an embryo and then about week eighton is when we refer to the child as a fetus within that first trimester into that second trimester we also have the development of this organ called the placenta which I'll get into shortly this is going to be an organ that allows mom's nutrients to diffuse to the child and child's waste to diffuse to Mom's blood vessels so let's talk about some of these critical periods this image is taken from your textbook and it shows you how that first trimester is so so important for the development of very key organ systems such as the central nervous system the heart the eyes the ears the limbs we have a lot of cell division going on at this point and if there's a deficiency in a nutrient or a toxicity of a nutrient or anything any compound too much or not enough of it can create a scenario where these systems don't develop well and an interesting tidbit is that about half of pregnancies will miscarry within the first trimester within the first eight weeks actually and it's often due to some sort of fatal error in the development of one or more of these systems it's important for proper nutrition as well as lifestyle habits to occur during this time frame uh to then set up the remainder of the pregnancy so yes second trimester and third trimester we've gotten through a lot of the initial development but deficiency or toxicities can still produce harm uh one example that I always think of is the lungs the lungs don't actually fully develop until week 36 so if a child is born premature their lungs may not be fully developed to where they have some respiratory distress or respiratory problems so it's not to say that nutrition later on isn't as important it certainly can be but that first 8 weeks is crucial uh in your textbook as I was reading in earlier they had some really interesting tidbits related to these what we call critical periods of development uh they talked about how children conceived during famine actually have higher rates of heart disease and they tend to get heart disease at younger ages and one of the reasons for this is famine or lack of appropriate nutrition can restrict the growth of the organs so for looking at the heart it's being formed in that first 6 weeks if Mom is malnourished the heart doesn't form as well the pregnancy let's say still continues she has the infant but that heart never fully developed during that initial stage it can set up for that child and then later as an adult the development of heart disease or problems within the heart at an earlier age there's also the research as I alluded to earlier with the Obesity so if moms aren't getting enough nutrients earlier in the pregnancy especially calories then it can make the child very prone to uh just being very Thrifty for lack of a better word with the calories and the energy they're taking in so a lot of really neat Research into maternal nutrition during these critical phases uh more research than we've seen in decades past is we can really now see how the impact of diet and lifestyle can how that can influence the genes ultimately the DNA and how that DNA is expressed so just some good tidbits here if it's a topic you're interested in let's switch gears and talk about some of the changes occurring in mom so initially the first part of the pregnancy uh well even the first two trimesters we have a lot of growth anabolism so Mom is building up stores which then during the last part of the pregnancy catabolism there's going to be a favoring of that nutrient delivery to the fetus so many times you'll hear of women who are pregnant or have been pregnant talk about the weight gain that they've had and that is growth that is needed even if someone is overweight or obese we do need anabolism or growth during that pregnancy in terms of some of the specifics body water increases 50% more that's a lot of water uh the kidneys actually function to conserve water better for pregnant women and it is important for pregnant women to drink appropriately when you think about water the infant well I'll use the correct verbage the fetus is primarily water right we're about 80% water when we're born so it and its organs need fluid likewise the blood vessels that the fetus is developing the placenta all of that needs more blood and more volume we certainly see fat Mass which is necessary for lactation and such the placenta I'll show you that image in in just a second we'll talk about that organ and then hormones can get often out of whack uh this is not a time to check regular blood cholesterol levels for women uh many times these values can be off because hormones are either affecting how much certain compounds are being built up or then that release so if we're releasing if the woman is releasing quite a few fatty acids to the infant that's not going to be an ideal time to really assess mom's true cholesterol status hormones are often the culprits for cravings and appetite changes we'll get into that in a in a future recording and then GI concerns this is very common for pregnant women where because they're holding on to more fluid because because of the need for the blood volume uh constipation can become very common also nausea can be common reflux especially if that child is large can become more common so we'll talk a little bit about what we can do for those concerns in a future presentation the last slide I wanted to cover with you in this section is uh this organ the placenta so the placenta is an organ that's developed during pregnancy and it's responsible for transferring nutrients to the fetus and then picking up waste from the fetus and then basically sending that into Mom's blood supply and Mom can excrete that via urine it's a really fascinating organ because there is actually no mixing of blood so you can see in the image here uh we've got the maternal blood vessels we've got the fetal blood vessels they don't actually interconnect but how close they get to one another allows good old diffusion of nutrients so area of high concentration and low concentration allows that to occur to where the infant is getting nutrients or I'm sorry the fetus is getting nutrients and then Mom is excreting the waste the thick lining of the placenta often can prevent the passage of larger molecules like blood cells and uh pathogens from coming across into the fetal blood vessels however there are some compounds that can pass this placental barrier freely uh things like alcohol or certain types of medications which are contraindicated during pregnancy you may have heard of the blood brain barrier or the blood placenta barrier this is what it's referring to the final comment I'll leave you with regarding this placenta as well as the first section of the recording is following delivery of the fetus mom will also deliver the placenta so it actually comes out a little bit after the fetus if Mom becomes pregnant again in the future she develops a new placenta all right everyone I hope you found the first part to be interesting to you in the next section we're going to get more into the nutritional requirements for a healthy pregnancy