Chapter 10

Mothers and Infants: Nutrition Assessment, Services and Programs

Lecture Launcher

One of the noted strategies is to implement outreach activities to increase assess to WIC program benefits by all who are eligible. What are some possible outreach strategies appropriate for this target population?

Chapter Outline

I.Introduction

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

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

C.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.

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

II.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.
  • 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 the incidence of low-birthweight babies:
  • 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.

A.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.

1.Healthy People 2010 Progress Review. Progress toward the Healthy People 2010 maternal and infant objectives is uneven.

a.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; and a continued decline in cigarette smoking during pregnancy.

b.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, and low birthweight.

III.Healthy Mothers

A.Maternal Weight Gain. Normal weight gain and adequate nutrition support the health of the mother and the development of the fetus.

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

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

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

4.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.

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

C.Nutrition Assessment in Pregnancy. Prenatal visits of pregnant women should include assessment in the following components.

1.Dietary measures including foods habits and use of vitamin and mineral supplements.

2.Clinical measures including outcome of previous pregnancies and obstetric history.

3.Anthropometric measures such as weight for height and weight.

4.Laboratory values including screening for anemia.

IV.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.

A.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.

1.Anthropometric Measures in Infancy. Anthropometric measures that are routinely obtained in the examination of infants include length, weight, and head circumference.

a.Length should be measured in the recumbent position on a measuring board.

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

c.Length-for-age less than the 5th percentile reflects chronic undernutrition.

d.Weight-for-length less than the 5th percentile may reflect acute malnutrition.

e.Excessive weight-for-length (above the 95th percentile) indicates overweight.

B.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.

1.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.

a.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.

C.Other Recommendations on Feeding Infants

1.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.

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

D.Primary Nutrition-Related Problems of Infancy. Some of the primary nutrition-related problems of infancy include:

1.Iron Deficiency. Iron deficiency can be prevented by either breastfeeding or using iron-fortified formula for the first year of life and adding appropriate foods between the ages of 4 and 6 months.

2.Food Allergies. Food allergies are much less prevalent in breastfed babies.

a.New foods should be introduced singly to facilitate prompt detection of allergies.

V.Domestic Maternal and Infant Nutrition Programs

A.The WIC Program. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides supplemental foods to infants, children up to age five, and pregnant, breastfeeding, and non-breastfeeding postpartum women.

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

2.WIC foods include the following:

a.Iron-fortified infant formula and infant cereal.

b.Iron-fortified breakfast cereal.

c.Vitamin C-rich fruit or vegetable juice.

d.Eggs, milk, cheese, and peanut butter or dried beans and peas.

3.The combination of supplementary foods, nutrition education, and preventive health care distinguishes WIC from other federal food assistance programs.

4.Program benefits of WIC include:

a.Improved dietary quality.

b.More efficient food purchasing.

c.Better use of health services.

d.Improved maternal, fetal, and child health and development.

5.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.

B.Other Nutrition Programs of the U.S. Department of Agriculture. Other nutrition programs of the USDA also provide nutrition support during pregnancy and infancy.

1.Food Stamp Program

2.WIC Farmers’ Market Nutrition Program

3.Commodity Supplemental Food Program

4.Expanded Food and Nutrition Education Program (EFNEP)

a.This program is directed at low-income families.

b.It is delivered by trained nutrition aides from the local community and is administered by the USDA Extension Service.

C.Nutrition Programs of the U.S. Department of Health and Human Services. Nutrition programs for pregnancy and infancy of the U.S. Department of Health and Human Services include some of the following:

1.Title V Maternal and Child Health Program. Title V Maternal and Child Health Program (MCH) includes five areas:

a.Maternity and infant care.

b.Intensive infant care.

c.Family planning.

d.Health care for children and youth.

e.Dental care for children.

2.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.

3.Community Health Centers. Community Health Centers program is designed to provide health services and related training in medically underserved areas and it focuses on comprehensive primary care services.

4.The Healthy Start Program. The Healthy Start Program‘s goal is to identify and develop community-based approaches to reducing infant mortality and improving the health of low-income women, infants, children and their families.

VI.Looking Ahead: Improving the Health of Mothers and Infants

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

B.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.

C.Recommendations for assuring that all pregnant women have access to satisfactory prenatal services in the future include some of the following:

1.Provide food supplementation and nutrition education to all pregnant women with low incomes.

2.Appropriate additional federal funds to WIC.

3.Include prenatal nutrition counseling as a reimbursable service in health insurance policies for all pregnant women in the U.S.

IM for Community Nutrition in Action 4e, by Melanie Burns of Eastern Illinois University