Optimal Nutrition for Pregnancy and Infancy: A Public Health Approach

1. Nutrition 526 - 2007Introduction

2. Preconception – Conception – Gestation – Birth - Infancy Sexual maturity - Childhood

3. Questions to Consider… • Given individual variations in the physiology of pregnancy and infancy, what ranges of nutrient intake best support optimal outcomes? (and what are those optimal outcomes?) • What are the best indices of nutritional status in pregnancy and infancy? • individual • population • What services & systems best promote nutritional health in pregnancy and infancy? • individual • population

4. Social-Ecological Model for Determinants of Access to Resources & Nutrition Behaviors Structures, Policies, Systems Local, state, federal policies and laws Institutions Rules, regulations, policies & informal structures Community Social Networks, Norms, Standards Interpersonal Family, peers, social networks, associations Individual Knowledge, attitudes, beliefs

5. Individual - Pregnancy • Physiology and Psychology of Pregnancy • Maternal Preconceptual status • Inter-generational programming • Diet in pregnancy: energy/weight gain, macro & micronutrients • Behaviors that impact nutritional status • Substances: alcohol, caffeine, tobacco, drugs • Physical activity • Oral health • Pregnancy intendedness • Stage of development: adolescence • High risk situations: GDM, PIH,

6. Intrapersonal/Community • Social and cultural environments • Support from friends and family • Health and nutrition care providers

7. Institutional • Hospital breastfeeding & formula policies • Child Care policies • School policies for pregnant and parenting teens • Worksite lactation policies

8. Policy & Environment • Nutrition Assistance Programs for pregnancy, lactation and early childhood. • Insurance policies for lactation support

9. Adaptations of the Model for Course Framework Structures, Policies, Systems Institutions Community Interpersonal Individual

11. Maternal-infant dyad

12. A Public Health Approach to Maternal and Infant Health • Assessment: Trends & Demographics • Policy Development: NGA • Assurance: Surveillance and monitoring progress towards goals

13. A Public Health Approach to Maternal and Infant Health • Assessment: Trends & Demographics • Policy Development: NGA • Assurance: Surveillance and monitoring progress towards goals

14. Health, United States, 2005: www.cdc.gov/nchs/hus.htm WA: The total number of live births has remained stable since 1998 at ~ 80,000 births per year.

22. Percentage of Parents Who Were Married or Cohabiting at Birth of First Child, by Race/Ethnicity and Sex MMWR; September 15, 2006 / 55(36);998

23. Distribution of Births, by Gestational Age --- United States, 1990 and 2005 MMWR, April 2007

24. http://www.chipublib.org/004chicago/disasters/infant_mortality.htmlhttp://www.chipublib.org/004chicago/disasters/infant_mortality.html

25. Infant Mortality • Infant mortality rate – Deaths of infants aged under 1 year per 1,000 or 100,000 live births. The infant mortality rate is the sum of the neonatal and postneonatal mortality rates. • Neonatal mortality rate – Deaths of infants aged 0-27 days per 1,000 live births. The neonatal mortality rate is the sum of the early neonatal and late neonatal mortality rates • Postneonatal mortality rate – Deaths to infants aged 28 days-1 year per 1,000 live births.

26. Infant Mortality • Sensitive indicator of community health because reflects influences by various social factors • E.g. environment (housing, sanitation, safe food and water) • Historically decrease in infant mortality associated with improvements in living conditions and health services

27. Factors associated with infant mortality • Birthweight: most critical • Infection: bacterial, viral, parasitic

28. Interconnections • Growth failure • Increased risk for infection • Infection • Increased risk for growth failure

30. http://mchb.hrsa.gov/mchirc/chusa_05/healthstat/infants/0307iimr.htmhttp://mchb.hrsa.gov/mchirc/chusa_05/healthstat/infants/0307iimr.htm

32. INDICATOR HEALTH2: DEATH RATES AMONG INFANTS BY RACE AND HISPANIC ORIGIN OF MOTHER, 1983–2004

33. Causes of Infant Death

34. Health Affairs, Vol 23, Issue 5, 2004

35. INDICATOR HEALTH1: PERCENTAGE OF INFANTS BORN WITH LOW BIRTHWEIGHT BY MOTHER'S RACE AND HISPANIC ORIGIN, 1980–2005 http://www.childstats.gov/americaschildren/health1.asp

36. NGA Center for Best Practices, June 2004

37. Health Affairs, Vol 23, Issue 5, 2004

38. Hispanic-American Infant Mortality Rates by Ethnicity, 2004

39. Policy approach • Access to food • Individual maternal-infant dyad • Community based • Public health and health services • Knowledge and beliefs • individual • Family, community • Public health and health services

40. Determinants of infant feeding practices • Maternal employment • Health sector activities • Commercial availability and promotion of processed milks and cereals • Urbanization v.s. modernization • Poverty and maternal nutrition • Perceived insufficiency of breast milk

41. History • Child welfare movements became noticeable in industrialized countries (U.S. and Western Europe • “Political, economic, and humanitarian motivations all converged to reduce the large wasteage of child life”

42. History • World War 1 and 2 • Recruits unfit for service • “weeklings”

43. History • Child welfare movements directed toward general hygeine for disease prevention, dietary imrpovements, and antepartum care • Infant Stations: to provide clean milk, instruct new mothers on child/infant care, encourage breastfeed • Innovative approach in 1908 establishment of Division of Child Hygeine in NYC

44. Child Hygiene Bureau NYC • Tracked from register of live births • Home nursing visits • Education on infant care • Milk stations • “there were 1200 fewer deaths when comparable to previous summer”

45. Maternal Mortality

46. African American and White Women Who Died of Pregnancy Complications,* United States * Annual number of deaths during pregnancy or within 42 days after delivery, per 100,000 live births. † The apparent increase in the number of maternal deaths between 1998 and 1999 is the result of changes in how maternal deaths are classified and coded. Source: CDC, National Center for Health Statistics.

47. Risk of Maternal Death • The risk of death for African American women is almost four times that for white women. • The risk of death for Asian and Pacific Islander women who immigrated to the United States is two times that for Asian and Pacific Islander women born in the United States. • The risk of death is nearly three times greater for women 35–39 years old than for women 20–24 years old. The risk is five times greater for women over 40.

48. The Most common pregnancy complications • Ectopic pregnancy • Depression • High blood pressure • Infection • Complicated delivery • Diabetes • Premature labor • Hemorrhage

49. Ferrara. A. Diabetes Care. Jul 2007

50. Ferrara. A. Diabetes Care. Jul 2007