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Nutrition 526 2007 Introduction

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Title: Nutrition 526 2007 Introduction


1
Nutrition 526 - 2007Introduction
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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, feder
al policies and laws
Institutions Rules, regulations, policies infor
mal structures
Community Social Networks, Norms, Standards
Interpersonal Family, peers, social networks, ass
ociations
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
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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.
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Percentage of Parents Who Were Married or
Cohabiting at Birth of First Child, by Race/Ethn
icity 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/infa
nt_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

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http//mchb.hrsa.gov/mchirc/chusa_05/healthstat/in
fants/0307iimr.htm
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INDICATOR HEALTH2 DEATH RATES AMONG INFANTS BY
RACE AND HISPANIC ORIGIN OF MOTHER, 19832004
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, 19802005
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 3539 years old than for women 2024
    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
51
Chu SY, Diabetes Care. August 2007
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Dabelea, D Diabetes care. July, 2007
55
Pettit DJ. Diabetes Care, July 2007.
56
Policy Development Poor Pregnancy Outcomes are
Costly
  • Medicaid finances 40 of annual births in the US
    and pays for 50 of hospital stays for premature
    and LBW.
  • Medicaid-funded deliveries represented 45.6 of
    births in WA in 2003.
  • The care cost for children with one of 17 common
    birth defects is 8 billion per year in the US.

57
Top Three Best Practices to Improve Birth
Outcomes and Reduce High Risk Births (NGA, June
2004)
  • Improve access to medical care and health care
    services
  • Encourage good nutrition and healthy lifestyles
  • Eating healthy foods
  • Taking folic acid
  • Harmful substances
  • Violence
  • Reduce use of harmful substances

Oconnor J et al. Health Promotion Practice, (1)
2005
58
NGA Specific policy actions for nutrition
  • WIC serves 45 of all US infants, governors can
    increase access
  • Folic Acid initiatives
  • Office-based education of health care providers
  • College outreach programs
  • Social marketing

59
Healthy People 2010 Goals Related to Maternal and
Infant Nutrition
60
Reduce low birth weight (LBW) and very low birth
weight (VLBW).
61
Reduce preterm births
62
Reduce the occurrence of spina bifida and other
neural tube defects (NTDs)
  • Target 3 new cases per 10,000 live births.
  • Baseline 6 new cases of spina bifida or another
    NTD per 10,000 live births in 1996.

63
Increase the proportion of pregnancies begun with
an optimum folic acid level.
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Multivitamin Use
65
Multivitamin Use
66
Increase abstinence from alcohol, cigarettes, and
illicit drugs among pregnant women
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MMWR, December 24, 2004
68
Alcohol
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Smoking
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Increase the proportion of mothers who breastfeed
their babies
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Increase smoking cessation during pregnancy
  • Target 30 percent.
  • Baseline 12 percent smoking cessation during the
    first trimester of pregnancy in 1991 (age
    adjusted to the year 2000 standard population).

76
Breastfeeding Duration
77
Breastfeeding Duration
78
Reduce growth retardation among low income
children under age 5 years
  • Target 5 percent.
  • Baseline 8 percent of low-income children under
    age 5 years were growth retarded in 1997 (defined
    as height-for-age below the fifth percentile in
    the age-gender appropriate population using the
    1977 NCHS/CDC growth charts31 preliminary data
    not age adjusted).

79
Reduce iron deficiency among young children and
females of childbearing age.
80
Reduce anemia among low-income pregnant females
in their third trimester
  • Target 20 percent.
  • Baseline 29 percent of low-income pregnant
    females in their third trimester were anemic
    (defined as hemoglobin

81
Anemia Rates - 1996
  • African American, non-Hispanic 44
  • American Indian/Alaska Native 31
  • Asian/Pacific Islander 26
  • Hispanic 25
  • White, non-Hispanic 24

82
Population v.s. individual
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