Nutrition 526 - 2012

Framing Maternal & Infant Nutrition

Healthy People 2020 Maternal, Infant and Child Health

• Why do we care about maternal and infant nutritional health?

• What are the determinants of maternal and infant health?

• What are some key indicators of maternal and infant nutritional health: preconceptionally,in the fetus & infant, during pregnancy?

A Life Course Framework: T2 – E2

• Timeline: today’s exposures influence tomorrow’s health

• Timing: health trajectories are particularly affected during critical periods

• Environment: the broader community environment strongly affects the capacity to be healthy

• Equity: inequality in health reflects more than genetics and personal choice

A Public Health Approach to Maternal and Infant Health

• Assessment

• Policy Development

• Assurance: Surveillance and monitoring progress towards goals

Assessment

• Pregnancy population characteristics

• Maternal health indicators

• Infant health indicators

In 2008 births and birth rate were ~ 2% less than 2007; in 2009 they were ~ 3% less than 2008. http://www.cdc.gov/nchs/products/nvsr.htm

http://www.cdc.gov/nchs/products/nvsr.htm

America's Children in Brief: Key National Indicators of Well-Being, 2012: Http://childstats.gov/americaschildren/fam_fig.asp#fam2a

Birth rates for females ages 15–17 by race and Hispanic origin, 1980–2010

America's Children in Brief: Key National Indicators of Well-Being, 2012: Http://childstats.gov/americaschildren/fam_fig.asp#fam2a

Percentage of all births to unmarried women by age of mother, 1980 and 2010

Population Indicators & Trends for Maternal Health

• Pre-conceptual indicators

• Weight gain

• Diabetes in pregnancy

• Pre-eclampsia

• Cesarean delivery

• Maternal death

Weight Gain During Pregnancy: Reexamining the Guidelines, IOM. 2009

Per birth certificate – includes all diabetes in pregnancy

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.

Population Indicators of Infant Health

• Infant mortality

• Birthweight

• Gestational age

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.

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

America's Children in Brief: Key National Indicators of Well-Being, 2012: Http://childstats.gov/americaschildren/fam_fig.asp#fam2a

Death rates among infants by race and Hispanic origin of mother, 1983–1991 and

1995–2010

QuickStats: Infant Mortality Rates, by Mother's Place of Birth and Race/Ethnicity --- United States,* 2007MMWR July 8, 2011 / 60(26);891

Muntaner, C et al. ECONOMIC INEQUALITY, WORKING-CLASS POWER,SOCIAL CAPITAL, AND CAUSE-SPECIFICMORTALITY IN WEALTHY COUNTRIES. International Journal of Health Services, Volume 32, Number 4, Pages 629–656, 2002

• “In summary, the rates of low birth weight and infant deaths from all causes were lower in those countries with more voter turnout, more left votes, more left members of parliament, more years of social democratic government, more women in government, a stronger social pact and various aspects of the welfare state, and low income inequality, as measured in a variety of ways.”

Birthweight & Gestational Age

Birthweight Definitions• LBW = low birthweight (less than 2,500

grams)• VLBW = Very low birthweight (less than

1,500 g• ELBW = Extremely low birthweight (less

than 1,000 g)• LGA = Large for gestational age

(macrosomia); > 90th %; 4,000 (ICD9) or 4,500 g

Defining Small for Gestational Age (SGA) and Large for Gestational Age (LGA)

America's Children in Brief: Key National Indicators of Well-Being, 2012: Http://childstats.gov/americaschildren/fam_fig.asp#fam2a

Percentage of infants born preterm and percentage of infants born with low

birthweight, 1990–2010

America's Children in Brief: Key National Indicators of Well-Being, 2012: Http://childstats.gov/americaschildren/fam_fig.asp#fam2a

Percentage of infants born with low birthweight by race and Hispanic origin of

mother, 1990, 2006, and 2010

Social Determinants

America's Children in Brief: Key National Indicators of Well-Being, 2012: Http://childstats.gov/americaschildren/fam_fig.asp#fam2a

Percentage of children ages 0–17 living in poverty by race, Hispanic origin and

family type, 1980–2010

Structures, Policies, SystemsLocal, state, federal policies and laws

InstitutionsRules, regulations, policies &

informal structures

CommunitySocial Networks, Norms, Standards

InterpersonalFamily, peers, social networks,

associations

IndividualKnowledge, attitudes,

beliefs

Social-Ecological Model for Determinants of Access to Resources & Nutrition Behaviors

Individual - Pregnancy• Physiology and Psychology of Pregnancy• Maternal Preconceptional 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, Hypertensive

disorders of pregnancy

Intrapersonal/Community

• Social and cultural environments

• Support from friends and family

• Health and nutrition care providers

Institutional

• Hospital breastfeeding & formula policies

• Child Care policies

• School policies for pregnant and parenting teens

• Worksite lactation policies

Policy & Environment

• Nutrition Assistance Programs for pregnancy, lactation and early childhood.

• Insurance policies for lactation support

• Parental leave policies