S Nurses Study Infant born 5 lbs has 15x risk of heart disease 23x risk of

S nurses study infant born 5 lbs has 15x risk of

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U.S. Nurses Study: Infant born < 5 lbs has 1.5x risk of heart disease, 2.3x risk of stroke compared to 7-10 lbs infant (10+ pound has lower risk) Mechanisms underlying developmental programming High maternal glucose and fatty acid levels may result in permanent changes in appetite control, and energy metabolism in the fetus Limitations of the fetal-origins hypothesis Unanswered questions What levels are related to changes? What exposures (Types of fat)?
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GESTATIONAL WEIGHT GAIN (GWG) GWG is related to the weight and health status of the newborn infant Inadequate GWG can lead to SGA Excessive GWG can lead to LGA Weight gain during pregnancy is an indicator of plasma volume expansion and positive calorie balance, and provides a rough index of dietary adequacy Only 31% of women gain within their recommendations GWG recommendation is based on pre-pregnancy BMI
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GWG RECOMMENDATIONS PRE-PREGNANCY BODY MASS INDEX RECOMMENDED WEIGHT GAIN Underweight, < 18.5 kg/m 2 28-40 lb (12.7-18.2 kg) Normal weight, 18.5-24.9 kg/m 2 25-35 lb (11.4-15.9 kg) Overweight, 25-29.9 kg/m 2 15-25 lb (6.8-11.4 kg) Obese, 30 kg/m 2 or higher 11-20 lb (5.0-9.1 kg) Twin pregnancy 25-54 lb (11.4-24.5 kg)
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WHERE DOES THE WEIGHT GO? GWG is NOT usually linear
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POSTPARTUM WEIGHT RETENTION Much concern over pregnancy weight gain and long-term obesity Vicious cycle: Excessive GWG leads to increased postpartum weight retention which leads to higher weight at subsequent pregnancy, etc. ~14 pounds lost at delivery Weight loss difficult in women who gained >44 pounds Women with recommended weight gain in pregnancy are ~2 pounds heavier at 1 year postpartum Lactating women lose slightly more
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NUTRITION AND OUTCOME OF PREGNANCY Famine and pregnancy outcome The Dutch Hunger Winter, 1943-1944 Decline in pregnancy rates Lower birth weights The siege of Leningrad, 1942 Increase in infertility & low birth weights Infant death rates increased Food shortages in Japan Similar to the outcomes found in Holland and Leningrad above
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ENERGY AND NUTRIENT NEEDS DURING PREGNANCY Nutrient needs vary during the course of the pregnancy Energy intake: increased need Carbohydrate intake: 45-65 percent Alcohol and pregnancy outcome: no known safe level Protein intake: increased need Need for fat: 33 percent Omega-3 fatty acids, EPA, and DHA Follow intake recommendations
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ENERGY AND NUTRIENT NEEDS DURING PREGNANCY Energy requirements in pregnancy Range – 300-450 extra calories a day Needs are not greater in 1 st trimester +340/d in 2nd trimester +452/d in 3rd trimester Assessment of caloric intake Most easily assessed by GWG as long as there is no major noticeable edema
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CARBOHYDRATE INTAKE Carbohydrate intake (45-65%) Minimum of 175 grams for fetal brain Vegetables, fruits, and whole grains with fibers = best choice Artificial sweeteners Foods with artificial sweeteners usually poor source of nutrients Can modify microbiome
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  • Spring '14
  • Wilson,JX

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