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CHS265 Nutrition During Life Cycle Dr. Saada Al-Orf Life Cycle Nutrition: Lactation 5 th lecture Slide 2 Nutrition during Lactation 2009 Cengage - Wadsworth Breastfeeding offers many health benefits to both mother and infant. Nutrient and energy needs are higher. Fluid needs are higher. Drugs, smoking and contaminants may reduce milk production as well as enter breast milk and impair infant growth and development. 2 Slide 3 Nutrition during Lactation Benefits of lactation 2009 Cengage - Wadsworth For infants Appropriate composition and balance of nutrients with high bioavailability Hormones that provide physiological development Improves cognitive development 3 Slide 4 Benefits of Breastfeeding for Infants Nutritional benefits Appropriate composition and balance of nutrients with high bioavailability HMS (Human Milk Subs) are created to meet the standards of Human Milk Nutrients are balanced Human milk is isotonic Meets infants protein needs without overloading the kidneys Contains soft, easily digestible curd Provides generous amounts of the right lipids Minerals more bioavailable Slide 5 Nutrition during Lactation Benefits of lactation cont. 2009 Cengage Wadsworth*Adapted from American Academy of Pediatrics: Breastfeeding and the use of human milk, Pediatrics, 115:496, 2005. For infants Protects against infections( Immunological benefits ):* Bacterial meningitis Bacteremia Diarrhea Respiratory tract infection Necrotizing enterocolitis Otitis media Urinary tract infection Late-onset sepsis in preterm infants May protect against some chronic diseases Protects against food allergies 5 Slide 6 Benefits of Breastfeeding for Infants May protect against some chronic diseases Reduce risk of celiac disease, IBS Reduce risk of allergies and asthmatic disease Protects against food allergies Breastfeeding & childhood overweight Typically breastfed infants are leaner at 1 year of age Slide 7 Nutrition during Lactation Benefits of lactation cont. 2009 Cengage - Wadsworth For mothers Contracts the uterus Delays the return of ovulation, thus increased child spacing Conserves iron stores May protect against breast and ovarian cancer Decreases postpartum bleeding Decreases menstrual blood loss 7 Slide 8 Nutrition during Lactation Benefits of lactation cont. 2009 Cengage - Wadsworth For mothers Earlier return to prepregnant weight Decreases risk of breast and ovarian cancer Possible decreased risk of postmenopausal hip fracture and osteoporosis Other benefits Cost savings Environmental savings Do not have to purchase or prepare formula 8 Slide 9 Nutrition during Lactation 2009 Cengage - Wadsworth Lactation: A Physiological Process Mammary glands secrete milk. Prolactin Stimulates milk production Released in response to suckling, stress, sleep, & sexual intercourse Oxytocin Stimulates letdown Tingling of the breast may occur corresponding to contractions in milk duct Causes uterus to contract, seal blood vessels, & shrink in size 9 Slide 10 The Mammary Gland Slide 11 Physiology of Milk Production 11 2009 Cengage - Wadsworth Slide 12 Nutrition during Lactation 2009 Cengage - Wadsworth Breastfeeding: A Learned Behavior Health care professionals offer information and encouragement. The mothers partner offers support. 12 Slide 13 Nutrition during Lactation 2009 Cengage - Wadsworth Breastfeeding: A Learned Behavior Successful breastfeeding in maternity facilities Breastfeeding policy Training for health care staff Inform pregnant women about the benefits and management of breastfeeding. Help mothers within hour of birth. Techniques for breastfeeding Give newborn infants breast milk only unless medically indicated. Practice rooming-in. Encourage breastfeeding on demand. No artificial nipples or pacifiers Support groups 13 Slide 14 Breast-Feeding: Special Nutrient Needs Energy Protein Carbohydrates Lipids Vitamins Minerals 14 2009 Cengage - Wadsworth Slide 15 Nutrition during Lactation 2009 Cengage - Wadsworth Maternal Energy and Nutrient Needs during Lactation Energy Intake and Exercise +500 kcal per day, 330 kcal from food, rest from fat reserves Losing 1-2 pounds per month is common. Intense physical activity may raise lactic acid levels of the milk. Energy Nutrients Protein and fat the same Carbohydrate and fiber increase 15 Slide 16 Nutrition during Lactation 2009 Cengage - Wadsworth Maternal Energy and Nutrient Needs during Lactation Vitamins and Minerals Inadequacies of nutrients affect milk quantity not quality Uses mothers stores Water as a protection from dehydration Nutrient Supplements Iron may be required to increase depleted stores. Well-balanced diets should provide nutrient needs. 16 Slide 17 Focal Points The Dietary Guidelines provide an appropriate base for counseling women of reproductive age, but there is also need for individualized counseling. Whether defined problems are attributable to: lack of resources, lack of nutrition knowledge self-imposed dietary manipulations, genetic individuality, or a combination of these factors, solutions to defined problems during pregnancy and lactation can usually be found. 17 2009 Cengage - Wadsworth Slide 18 Focal Points cont. A woman of reproductive age needs to know she gets but one chance to create the best baby she can; optimizing nutrition and her environment are critical ingredients. Breastfeeding remains the best source of nutrition for newborns, and new mothers need support to breastfeed as long as possible up to 2 years. 18 2009 Cengage - Wadsworth Slide 19 Breast-Feeding an Infant Breast-Feeding potential problems Preparation Technique Duration of breast-feeding Exercise and breast-feeding Transfer of drugs into human milk Failure to thrive in the breast-fed infant Other problems 19 2009 Cengage - Wadsworth Slide 20 Breast-Feeding Potential Problems Slide 21 Breast-Feeding Problems and Solutions Management of Breast-Feeding Problems ProblemApproaches to Management Retracted nipple(s)Before feeding the infant, roll the nipple gently between the fingers until erect. Babys mouth not open wide enough Before feeding, depress the infants lower jaw with one finger as the nipple is guided into the mouth. Baby sucks poorlyStimulate sucking motions by pressing upward under the babys chin. Expression of colostrums often occurs, and the taste may stimulate sucking. 21 2009 Cengage - Wadsworth Slide 22 Breast-Feeding Problems and Solutions Management of Breast-Feeding Problems ProblemApproaches to Management Baby demonstrates rooting but does not grasp the nipple; eventually cries in frustration Interrupt the feeding, comfort the infant; the mother should take time to relax before trying again. Baby falls asleep while nursing If the infant falls asleep early in the feeding, the mother should awaken the infant by holding him or her upright, rubbing his or her back, talking to him or her, or providing similar quiet stimuli; another effort at feeding can then be made. If the baby falls asleep again, the feeding should be postponed. 22 2009 Cengage - Wadsworth Slide 23 Nutrition during Lactation 2009 Cengage - Wadsworth Maternal Energy and Nutrient Needs during Lactation Food Assistance Programs The poor and least educated are more likely to participate in food programs. Incentives are given to breastfeeding mothers. Particular Foods Strong or spicy foods may flavor breast milk. Food allergies Monitor problem foods 23 Slide 24 Nutrition during Lactation 2009 Cengage - Wadsworth Maternal Health HIV Infections and AIDS mother will transmit virus Diabetes careful monitoring and counseling Postpartum Amenorrhea but still can get pregnant Breast Health Breastfeeding does not change shape and size of breasts after lactation. May protect against cancer 24 Slide 25 Nutrition during Lactation 2009 Cengage - Wadsworth Practices Incompatible with Lactation Medicinal Drugs consult with physician Smoking reduces milk volume and changes flavor and smell Environmental Contaminants get into milk but impact is unclear Caffeine enters breast milk and causes irritability and wakefulness, also affects iron status 25 Slide 26 Fetal Alcohol Syndrome Slide 27 Fetal Alcohol Syndrome (FAS) 2009 Cengage - Wadsworth Fetal alcohol syndrome can only be prevented; it cannot be cured. Thousands of infants are born with FAS because their mothers drank too much alcohol during pregnancy. Some are born with mild symptoms because their mothers drank during pregnancy (prenatal alcohol exposure). It is recommended that women do not consume any alcohol (Islam roles). 27 Slide 28 Symptoms 2009 Cengage - Wadsworth Prenatal and postnatal growth retardation Impairment of brain and central nervous system, called alcohol-related neurodevelopmental disorder (ARND) Abnormalities of face and skull and birth defects, called alcohol-related birth defects (ARBD) Fetal-alcohol effects (FAE) is an older term used to describe ARND and ARBD. 28 Slide 29 2009 Cengage - Wadsworth 29 Slide 30 2009 Cengage - Wadsworth 30 Slide 31 Drinking during Pregnancy 2009 Cengage - Wadsworth Malnutrition Intoxication Interferes with tissue development during critical periods Alcohol crosses the placenta (Islam roles) not to drink it 31 Slide 32 When Is the Damage Done? 2009 Cengage - Wadsworth First two months are critical periods and a woman may not know she is pregnant. Depends on the developmental events occurring at the time of the alcohol exposure Paternal intake of alcohol is also being studied. Dont drink alcohol for ever. 32 Slide 33 Nicotine & Lactation Nicotine (smoking cigarettes) Regardless of feeding choice, the health risks for infants posed by a smoking mother are many Otitis media Exacerbation of asthma Respiratory infections Gastrointestinal dysregulation Levels are 1.5 to 3 times higher in breast milk than mothers blood Slide 34 Slide 35 Stages of Lactogenesis Lactogenesis I (birth to 2-5 days) milk formation begins Lactogenesis II(begins 2-5 days after birth) increased blood flow to breast; milk comes in Lactogenesis III(begins at ~10 day after birth) milk composition is stable Slide 36 Colostrum The first milk secreted during the first few days postpartum Very high in proteins such as secretory IgA & lactoferrin Slide 37 Water and Energy in Human Milk Water Major component in human milk Isotonic with maternal plasma Energy ~0.65 kcal/mL Calories may vary with fat, protein and carbohydrate composition Lower in calories than human milk substitute (HMS) Slide 38 Lipids in Human Milk Lipidsprovide the calories in human milk Effect of maternal diet on fat composition Fatty acid profile reflects dietary intake of mother Very fat diet with adequate CHO & protein, milk is in medium-chain fatty acids Slide 39 DHA, Trans Fatty Acids, and Cholesterol in Human Milk DHA (docosahexaenoic acid) Essential for retinal development Associated with higher IQ scores Trans fatty acids Present in human milk from maternal diet Cholesterol Higher in human milk than HMS Early consumption of cholesterol through breast milk appears to be related to lower blood cholesterol levels later in life Slide 40 Proteins in Human Milk Total proteins Lower than in whole cows milk (0.32 vs. 0.98 g/oz) Have antiviral & antimicrobial effects Casein Main protein in mature human milk Facilitates calcium absorption Slide 41 Proteins in Human Milk Whey A soluble protein that precipitates by acid or enzyme Some minerals, hormones & vitamin binding proteins are part of whey Non-protein nitrogen ~20-25% nitrogen in human milk Used to make non-essential amino acids Slide 42 Milk Carbohydrates Lactose Dominant CHO Enhances calcium absorption Oligosaccharides A medium-length CHO Prevent binding of pathogenic microorganisms to gut, which prevents infection & diarrhea Slide 43 Fat-Soluble Vitamins in Human Milk Vitamin A Content in colostrum is ~double that of mature milk Yellow color from beta-carotene Vitamin D Most as 25-OH2 vitamin D Content reflective of mothers exposure to sun Slide 44 Fat-Soluble Vitamins Vitamin E Level linked to milks fat content Level not adequate to meet needs of preterm infants Vitamin K ~5% of breastfed infants at risk for K deficiency based on clotting factors Infants who did not receive K injection at birth may be deficient Slide 45 Minerals in Human Milk Minerals contribute to osmolality Content related to growth of infant Concentration decreases over 1st 4 months, except for magnesium Bioavailability Most have high bioavailability Exclusively breastfed infants have very low risk of anemia despite low iron content of human milk Slide 46 Twins & breast feeding 6. Twins and other multiples can be successfully breastfed without formula supplementation. Slide 47 Positions for Breastfeeding Slide 48 Attachment Slide 49 Slide 50 The Breastfeeding Infant Feeding frequency 10-12 feedings/day are normal for newborns Stomach emptying occurs in ~1 hours Slide 51 Identifying Breastfeeding Malnutrition Normal weight loss for newborns ~7% of birthweight in 1st week Weight loss of 10% needs evaluation by lactation consultant Malnourished infants become sleepy, non-responsive, have a weak cry, & wet few diapers By day 5 to 7, infants should have 6 wet diapers & 3-4 soiled diapers Slide 52 Other Factors of Maternal Diet Infant Colic Defined as crying for more than 3 hours a day no medical cause Components of maternal diet may be related to infant colic More likely with Cows milk, onions, cabbage, broccoli, & chocolate Slide 53 Barriers to Breastfeeding Initiation Embarrassment Time & social constraints Lack of support from family & friends Lack of confidence Concerns about diet & health Fear of pain Slide 54 2009 Cengage - Wadsworth 54