Mothers and Infants: Nutrition

Assessment, Services, and Programs

FSHN4306
Introduction

• Effects of nutrition extend from one generation to

the next as evident during pregnancy
• Fetus may develop poorly

• Infants are more likely to be ill

• Learning abilities and/or physical development may be

impaired

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Trends in Maternal and Infant Health

Infant mortality rate (IMR)

• Number of infant deaths under one year of age per
1000 births
• Used as indicator of health status
• U.S. rates are higher than many other industrialized
countries
• More than twice as high in black than in white infants

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Trends in Maternal and Infant Health

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Trends in Maternal and Infant Health

• Birth weight and length of gestation

• Primary indicators of the infant’s future health status

• Low birthweight (LBW)

• More likely to experience complications during delivery
• Increased risk for physical and mental complications
• Major contributor to infant mortality

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Healthy Mothers

• A number of factors contribute to maternal and

infant health
• Genetic, environmental, and behavioral factors affect
risk and the outcome of pregnancy

• Woman’s nutrition prior to and throughout pregnancy is

crucial

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Maternal Weight Gain

• National Academy of Sciences recommendations

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Maternal Weight Gain

• About three-quarters (75%) of married women

who deliver at full term gain recommended weight

• African-American women and pregnant teenagers gain

less than recommended

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Adolescent Pregnancy

• Pregnant adolescents are nutritionally at risk and

require intervention early and throughout
pregnancy
• Risks include hypertension, iron-deficiency anemia,
premature birth, stillbirth, LBW infants, and prolonged
labor

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Nutrition Assessment in Pregnancy

• Categories of nutrition assessment and monitoring

during pregnancy:
• Preconception care

• The initial prenatal visit

• Subsequent prenatal visits

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Nutrition Assessment in Pregnancy

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Nutrition Assessment in Pregnancy
• Preconception care
• Nutrition assessment, counseling, supplementation and
referral

• Initial prenatal visit

• Dietary measures (e.g. food habits, use of vitamin and
mineral supp.)
• Clinical measures (e.g. outcome of previous pregnancies,
obstetric history)
• Anthropometric measures
• Laboratory values (screening for anemia, GDM,
preeclampsia)

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Nutrition Assessment in Pregnancy

• Subsequent prenatal visits

• Weight gain monitoring
• Anemia screening
• Dietary practice assessment
• Food assistance program referral

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Healthy Babies

• Growth of infants:
• Reflects nutritional well-being
• A major indicator of nutritional status
• Adequate nutrition is critical to support rapid
growth and development
• Birthweight doubles first four to six months; triples by
the end of the first year

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Nutrient Needs and Growth Status in
Infancy
• Rapid growth and metabolism require adequate
supply of all essential nutrients

• Relative to body weight, infants need more than twice

as much of many nutrients as adults

• Growth rate begins to slow down after six months

• However, some energy spent on increased activity

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Anthropometric Measures in Infancy

• Assessment of physical size and growth

• Length, weight, and head circumference are typical
measurements
• Head circumference measures can help detect
protein-energy malnutrition (PEM)
• Growth charts are used to analyze measures of growth
status in infants
• Can assess obesity or failure to thrive

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Breastfeeding Recommendations

• Benefits
• Promotes emotional bonding
• Helps protect against infection
• Protects against allergy development
• Favors normal tooth and jaw alignment
• Decreases obesity risk
• Provides convenience and lower cost

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Breastfeeding Promotion

• Breastfeeding barriers
• Lack of knowledge or experience of how best to support
mothers and babies
• Not enough opportunities to communicate with other
breastfeeding mothers
• Lack of up-to-date instruction and information from
health care professionals
• Non-supportive hospital practices
• Lack of work place accommodation

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Breastfeeding Promotion

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Breastfeeding Promotion

• Peer counseling method promoted by the La

Leche League
• Best Start: Breastfeeding for Healthy Mothers,
Healthy Babies
• Organized by a coalition of nutrition and public health
officials concerned about southeastern United States
breastfeeding rates

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Breastfeeding Promotion

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Other Recommendations on Feeding
Infants
• Plain milk not recommended during first year of life
• Breast milk or iron-fortified formula during first six
months
• Begin adding solid foods at six months
• Special formulas are available for infants with
special problems
• Soy-based formulas – allergies to milk protein
• Formulas with lactose removed – lactose intolerance

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Primary Nutrition-Related Problems of
Infancy
• Iron deficiency
• Causes include:
• Use of cow’s milk earlier than recommended
• Breast feeding after six months without iron
supplementation
• Food allergies
• Genetics is the most significant factor in susceptibility
• Food allergies less prevalent in breastfed infants
• Introduce foods singly to facilitate prompt detection

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Domestic Maternal and Infant
Nutrition Programs
• The WIC program
• WIC is federally funded but administered by the states
• The program plays both a corrective and a preventive
role
• Provides monthly checks or vouchers for foods
• Offers nutrition education and counseling
• Gives screening and referrals to health care services
• WIC works
• One of the most efficient programs undertaken by the
federal government

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Domestic Maternal and Infant
Nutrition Programs

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Domestic Maternal and Infant
Nutrition Programs

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Other Nutrition Programs of the U.S.
Department of Agriculture
• Several programs provide nutrition support during
pregnancy and infancy
• Supplemental Nutrition Assistance Program (SNAP)
• WIC Farmers’ Market Nutrition Program
• Commodity Supplemental Food Program (CSFP)
• Expanded Food and Nutrition Education Program
(EFNEP)

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U.S. Department of Health and Human
Services’ Nutrition Programs
• Several programs concerned with health and
nutritional status during pregnancy and infancy
• Title V Maternal and Child Health Program
• Medicaid and EPSDT
• Elements of EPSDT: Early, Periodic, Screening,
Diagnosis, Treatment
• Health Center Program
• The Healthy Start Program

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U.S. Department of Health and Human
Services’ Nutrition Programs

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Looking Ahead: Improving the Health
of Mothers and Infants
• Ensure quality nutrition counseling is available and
accessible
• Provide nutrition education online
• Use grant funds to hire public health nutritionists
• Ask voluntary health organizations to help
• Provide adolescent pregnancy prenatal care, as well as
counseling in the classroom and in physicians’ offices

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Looking Ahead: Improving the Health
of Mothers and Infants
• Convince policymakers of the importance of these
recommendations
• Food supplementation and nutrition education available
to all low-income pregnant women
• Enough federal funds to make WIC available to all
pregnant low-income women
• Nutrition counseling and education

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Looking Ahead: Improving the Health
of Mothers and Infants
• Additional recommendations to policymakers
• State Medicaid programs required to include nutrition
counseling and education as reimbursable services
• Federal and state funds provided to offer nutrition
counseling to all pregnant women who use public
facilities
• Health insurance policies including prenatal nutrition
counseling as a reimbursable service

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