© 2006 Thomson-Wadsworth Chapter 10 Mothers and Infants: Nutrition Assessment, Services and Programs

© 2006 Thomson-Wadsworth

Chapter 10

Mothers and Infants: Nutrition Assessment, Services and

Programs


Learning Objectives

• List the recommendations for maternal weight gain during pregnancy.

• Explain the relationship of maternal weight gain to infant birthweight.

• Identify nutritional factors and lifestyle practices that increase health risk during pregnancy.

• Describe the benefits of breastfeeding.


Learning Objectives

• Describe the purpose, eligibility requirements, and benefits of the federal nutrition programs available to assist low-income women and their children.

• Identify the common nutrition-related problems of infancy.

• Describe current recommendations for feeding during infancy.


Introduction

• The effects of nutrition extend from one generation to the next and this is especially evident during pregnancy.

• If a mother’s nutrition stores are inadequate early in pregnancy when the placenta is developing, the fetus will develop poorly.


Introduction

• Infants born of malnourished mothers are more likely than healthy women’s infants to become ill, to have birth defects, and to suffer retarded mental or physical development.

• It is critical to provide the best nutrition possible at the early stages of life.


Trends in Maternal and Infant Health

• The United States spends more money on health care than most other countries, but its infant mortality rate (IMR) of 7.0 is considerably higher than several industrialized countries.

• Disparities in IMRs persist between ethnic groups and between poor and non-poor infants.



IMRs by Race and Ethnicity,2002



• Failure to improve the IMR in the U.S. has been attributed to the number of infants born with low birthweights.

• Birthweight and length of gestation are the primary indicators of an infant’s future health status.



• Several factors must be addressed to reduce incidence of low birthweight:– Poverty– Minority status– Lack of access to health care– Inability to pay for health care– Poor nutrition– Low level of educational achievement– Unsanitary living conditions– Unhealthful habits such as smoking, drinking,

and drug use


% of Low-Birthweight and Very-Low-Birthweight Infants


National Goals for Maternal and Infant Health

• To further reduce infant mortality, the U.S. must focus on changing protective and risky behaviors that affect pregnancy outcomes.

• These factors should be addressed in preconception screening and counseling.



• The use of timely prenatal care can also help mitigate risks by identifying women who are at high risk of high blood pressure and other maternal complications.



• Healthy People 2010 Progress Review– Progress toward the Healthy People

2010 maternal and infant objectives is uneven.







• Healthy People 2010 Progress Review (continued)– Improvement is seen in:

• The decline in infant mortality rates for Hispanics, Whites, and American Indians

• A decreased incidence of spina bifida• An increase in breastfeeding by women in

all race and ethnic groups• A continued decline in cigarette smoking

during pregnancy



• Healthy People 2010 Progress Review (continued)– No progress or movement in the

wrong direction occurred in the areas of: • Maternal death for African American

women• Iron deficiency in women aged 12 to 49

years• Fetal alcohol syndrome• Low birthweight


Healthy Mothers


Healthy Mothers

• Maternal Weight Gain– Normal weight gain and adequate nutrition

support the health of the mother and the development of the fetus.

– A woman who begins pregnancy at a healthful weight should gain between 25 and 35 pounds.

– Low weight gain in pregnancy is associated with increased risk of delivering a low-birthweight infant.



• B-C = normal weight women• A-B = underweight women• D = overweight women


Healthy Mothers – Maternal Weight Gain

• Excessive weight gain increases the risk of complications during delivery, as well as postpartum obesity.

• The suggested rate of weight gain is 2-4 pounds for the first trimester, followed by a steady gain of about one pound per week thereafter.




Healthy Mothers

• Adolescent Pregnancy– Adolescent pregnancy is associated

with higher rates of pregnancy-related hypertension, iron-deficiency anemia, premature birth, low-birthweight infants, and prolonged labor.


Healthy Mothers

• Nutrition Assessment in Pregnancy– Dietary measures including foods habits and

use of vitamin and mineral supplements.– Clinical measures including outcome of

previous pregnancies and obstetric history.– Anthropometric measures such as weight

for height and weight.– Laboratory values including screening for

anemia.





Healthy Babies

• A baby grows faster during the first year of life than ever again.

• A baby’s birthweight doubles during the first 4 to 6 months and triples by the end of the first year.

• Adequate nutrition is critical to support this rapid growth and development.


Nutrient Needs and Growth Status in Infancy

• Infants need smaller total amounts of the nutrients than adults do...

• ...but, based on body weight, infants need over twice as much of many of the nutrients.



• Anthropometric Measures in Infancy– Length should be measured in the

recumbent position on a measuring board.

– Head circumference confirms that growth is proceeding normally and can also detect protein-energy malnutrition.



• Anthropometric Measures (continued)– Length-for-age less than the 5th percentile

reflects chronic undernutrition.– Weight-for-length less than the 5th

percentile may reflect acute malnutrition.– Excessive weight-for-length (above the 95th

percentile) indicates overweight.


% of Mothers Breastfeeding


Breastfeeding Recommendations

• Breastfeeding offers both emotional and physical health benefits.

• During the first 2-3 days, the breasts produce colostrum that contains antibodies and white cells from the mother’s blood, which favors the growth of friendly bacteria.

• Breast milk also contains a powerful antibacterial agent, lactoferrin.



• Breast milk is tailor made to meet the nutrient needs of the young infant and breastfed infants usually require no supplements except for vitamin D and fluoride.

• At 4 to 6 months, infants may require an iron supplement.

• Breastfeeding protects against allergy development and favors normal tooth and jaw alignment.



• Breastfeeding Promotion– One of the Healthy People goals is to

increase the incidence of breastfeeding although there are a number of barriers to achieving this objective.

– One example of a successful approach to increasing breastfeeding rates in low-income, urban populations is the peer counseling method promoted by the La Leche League International.



Using Peer Counselors to Change Culturally Based Behaviors

• Best Beginnings of Forsyth County - demonstrates motivational potential of peer counselors



• Goals and Objectives– Goals

• Increase the number of women who breastfeed their newborn infants

• Increase the number of women who continue to breastfeed past the first few weeks of their baby’s life

– Objectives • Develop the curriculum for the didactic and

experiential components of the training • Add group discussions and breastfeeding classes



• Target Audience– Pregnant women who applied for WIC

in Forsyth County– 1/3 were Hispanic

• Rationale for the Intervention– 10% of mothers in the target

audience initiated breastfeeding– Almost none of these women

continued past six weeks



• Methodology– Received grant in 1992– Peer counselor training

• 20 hours of didactic instruction on lactation and counseling

• Written test• Course information - advantages, myths,

physiology, mechanics, common problems, high-risk situations

• Competency exam• 6-week internship



• Methodology (continued)– Peer counselors:

• Encouraged breastfeeding among WIC participants

• Increased public awareness of breastfeeding



• Results– Within 6 months after start, the

breastfeeding initiation rate had increased from 10% to 26%

– In fiscal year 1997–1998, almost 50% of Forsyth Co. women in WIC had initiated breastfeeding

– In 1996-1997, over 27% of participants continued breastfeeding for more than 6 weeks



• Lessons Learned– Enthusiasm of the peer counselors

was important to program success– Peer counselor programs can have a

positive influence on the peer counselors themselves


Using Focus Group Findings

• Best Start breastfeeding promotion project guidelines were derived from focus groups

• Campaign tone - emotional • Message design

– Educational messages - succinct and easily understood

– Promotional messages - emphasize confidence and the pride breastfeeding mothers gain



• Spokespersons– Celebrities, wealthy women not

credible– Women featured should be of the

same economic, ethnic, and age groups as those targeted

– Print/broadcast materials should communicate modernity and confidence



• Educational approaches - need to be redesigned to refute perceptions of breastfeeding as difficult– Avoid emphasis on being healthy,

relaxed; special dietary guidelines – Reassurance that most women

produce sufficient quantities/quality of breast milk



• Professional training - – Materials should counter belief that

economically disadvantaged clients are not interested/do not value health professionals’ advice

– Counseling strategies should address special needs of low-income women

• Program activities/components - variety of mutually reinforcing activities


Other Recommendations on Feeding Infants

• Whole cow’s milk is not recommended during the first year of life but iron-fortified formulas can be used to support normal development in the baby’s first months of life.

• Solid foods should not be introduced too early because infants are more likely to develop allergies to them in the early months.







Primary Nutrition-Related Problems of Infancy

• Iron Deficiency– Iron deficiency can be prevented by:

• Breastfeeding • If not breastfeeding, using iron-fortified

formula for the first year of life • Adding appropriate foods between the

ages of 4 and 6 months


Primary Nutrition-Related Problems of Infancy

• Food Allergies– Food allergies are much less

prevalent in breastfed babies.– New foods should be introduced

singly to facilitate prompt detection of allergies.



Domestic Maternal and Infant Nutrition Programs

• The WIC Program– WIC stands for Special Supplemental

Nutrition Program for Women, Infants, and Children.

– Provides supplemental foods to infants, children up to age five, and pregnant, breastfeeding, and non-breastfeeding postpartum women.


Domestic Maternal and Infant Nutrition Programs – WIC

• WIC participants must qualify financially and be considered at nutritional risk.





• WIC foods include the following:– Iron-fortified infant formula and infant

cereal.– Iron-fortified breakfast cereal.– Vitamin C-rich fruit or vegetable juice.– Eggs, milk, cheese, and peanut butter

or dried beans and peas.



• WIC is distinguished among federal assistance programs by the combination of: – Supplementary foods– Nutrition education– Preventive health care



• Program benefits of WIC include:– Improved dietary quality.– More efficient food purchasing.– Better use of health services.– Improved maternal, fetal, and child

health and development.




• WIC Works– WIC has been described as one of the

most efficient programs undertaken by government...

– ...but it is not an entitlement program and can only serve as many people as its annual appropriation from Congress permits.


Annual Growth in WIC Participation



• Other Nutrition Programs of the U.S. Department of Agriculture– Food Stamp Program– WIC Farmers’ Market Nutrition

Program– Commodity Supplemental Food

Program


Domestic Maternal and Infant Nutrition Programs – Other USDA Programs

• Expanded Food and Nutrition Education Program (EFNEP)– This program is directed at low-

income families.– It is delivered by trained nutrition

aides from the local community and is administered by the USDA Extension Service.



• Nutrition Programs of the U.S. Department of Health and Human Services– Title V Maternal and Child Health Program

• Maternity and infant care• Intensive infant care• Family planning• Health care for children and youth• Dental care for children


Domestic Maternal and Infant Nutrition Programs – Other DHHS Programs

• Medicaid and EPSDT– EPSDT is a mandatory Medicaid

service to improve the health status of children from low-income families by providing services not typically found under the current Medicaid program.



• Community Health Centers– Program designed to provide health

services and related training in medically underserved areas

– Focuses on comprehensive primary care services



• The Healthy Start Program– Goal is to identify and develop

community-based approaches to: • Reducing infant mortality• Improving the health of low-income

women, infants, children and their families


Looking Ahead: Improving the Health of Mothers and Infants

• Many of the existing health care programs do not have nutrition counseling or education available within their own sites.

• The increasing numbers of working women along with the growth in worksite health promotion programs have implications for community nutritionists in providing nutrition education and related services to this population.


Looking Ahead: Improving the Health of Mothers and Infants

• Recommendations:– Provide food supplementation and nutrition

education to all pregnant women with low incomes.

– Appropriate additional federal funds to WIC.– Include prenatal nutrition counseling as a

reimbursable service in health insurance policies for all pregnant women in the U.S.

Documents

© 2006 Thomson-Wadsworth Chapter 10 Mothers and Infants: Nutrition Assessment, Services and Programs