Exam 2 Study Guide
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This 25 page Study Guide was uploaded by Bridget Ochuko on Sunday September 13, 2015. The Study Guide belongs to FDNS 4050 at University of Georgia taught by Alex K. Anderson in Fall 2015. Since its upload, it has received 95 views.
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Date Created: 09/13/15
FDNS Exam 2 Study Guide 09142015 Nutrition Management for Preconception Conditions Folic acid most important prenatal vitamin for women Premenstrual syndrome could interfere with fertility Characterized by lifedisrupting physiological and psychological changes that begin in the luteal phase and end with menses Symptoms occur in 1525 of menstruating women If you know you have this you can seek treatment previous to conceonn Some studies suggest that reducing caffeine intake could reduce PMS also Vitamin D and Magnesium but there is not much evidence for this Cause of PMS not yet clear 0 Thought to be related to abnormal serotonin activity following ovulation Treatments 0 Antidepressants containing serotonin uptake inhibitors 0 Calcium B6 chaste berry supplements Premenstrual Dysphoric Disorder 0 Severe form of PMS o Characterized by marked mood swings depressed mood irritability and anxiety 0 Symptoms breast tenderness headache joint and muscle pain Obesity Body Fat Distribution and Fertility Central obesity interferes with reproduction in women and men 0 Treatment of rst choice for obese people should be weight loss this can reduce or eliminate fertility problems Weight reduction methods 0000 Focus on lifestyle changes Decrease calorie intake Increase physical activity levels Weight loss surgery if efforts fail bariatric surgery Fertility may return after surgery Increases the risk for multiple de ciencies Pregnancy not recommended during rst year after surgery Metabolic syndrome can be well managed by diet and physical activity Characterized by a cluster of abnormal metabolic and health indicators o If not well managed it can lead to CVD and diabetes Prevalent in about 32 of US adults 0 Therapy dietary modi cation weight reduction exercise Eating Disorders 0 Women with eating disorders particularly anorexia will hardly get pregnant because O 0000 They don t have enough body fat Lower energy levels Less nutrient support They are not menstruating lf pregnancy occurs There tends to be complications with the babies It is easier for a bulimic to become pregnant rather than an anorexic Female Athletic Triad o Triad o Amenorrhea o Disordered eating negatively affects bone development 0 Osteoporosis o Triggered when energy intake in 30 less than requirement 0 Low hormone levels lead to reduction in bone density Supplements are important to help with pregnancy 0 Management 0 Correction of negative energy balance 0 Correction of eating disorders 0 Vitamin D and calcium supplements to facilitate bone development Diabetes 0 Diabetes mellitus intolerance to carbohydrate with fasting glucose gt 126 mgdL 0 Prior to pregnancy High blood glucose levels during the rst 2 months of pregnancy are teratogenic Associated with a 23 fold increase in congenital abnormalities n newborns n Malformations of pelvis CNS and heart seen in newborns higher rates of miscarriage Types 0 Gestational diabetes only seen in females during pregnancy If it is well managed it can go away If not it could lead to Type 2 diabetes 0 73pe 1 diabetes autoimmune the patient is not secreting insulin previously called juvenile diabetes Results from destruction of insulin producing cells 10 of cases Management a Main goals blood glucose control resolution of coexisting health problems health maintenance a Diets controlled in carbohydrate content carbohydrate control 0 Replace sugars with reasonable amounts of arti cial sweeteners Choose food low in glycemic index and high in ber 0 Encourage brightly colored fruits and vegetables 0 Low fat meat and dairy products sh dried beans and nuts and seed U Need insulin shots to enhance transport of glucose in blood to the cells a Physical activity 73pe 2 diabetes the body may be secreting adequate or excess insulin but the problem is that the insulin is insensitive 0 Body unable to use insulin normally to produce enough insulin or both 90 of cases 0 Without insulin the sugar is unable to move from the blood to the cells 0 Need medication to sensitize the insulin to transport the sugar into the mitochondria for energy metformin Can enhance weight loss 0 Management Diet and exercise and oral medication to increase insulin production and insulin sensitivity Polycystic Ovary Syndrome lnsulin is not sensitive enough for glucose transport 510 of women of childbearing age Leading cause of female infertility Tends to be in women who are overweight who have fatty ovaries Cause is uncertain o lnsulin o Genetics could play a part in this Management 0 Primary goal to increase insulin sensitivity 0 Weight loss and exercise improve prognosis 0 Important to limit fat in the diet to help with this weight loss recommended Phenylketonuria Elevated blood phenylalanine due to lack of phenylalanine hydroxylase If this accumulates in the blood it could affect the mental state of the fetus intellectual disability Monitor the amount of phenylalanine make sure it is able to be synthesized Celiac Disease Autoimmune disease characterized by chronic in ammation of small intestine o lnherited sensitivity to gluten in wheat rye barley which causes malabsorption and attening of intestinal lining 133 in the US have this Linked to infertility in some women and men Management 0 Important to avoid gluten in diet 0 Correction of vitamin and mineral de ciencies Nutrition Needs and In uences During Pregnancv When pregnant you cannot eat and drink all you want because you have to think about the nutrient value for the baby 0 Everything the mother eats goes to the baby and determines the health and progression of the pregnancy 0 The child develops taste buds for the foods the mother eats The fetus is never a parasite because whatever the mother eats she must satisfy her own needs rst then the placenta and lastly the fetus bene ts from what the mother eats o A parasite takes from the host whether the host likes it or not the fetus does not do this Terms 0 We estimate conception based on the last menstrual cycle Periconceptional one month before pregnancy Conceptus when the sperm fuses with the egg 0 Zygote between conception and 2 weeks 0 Embryo between two weeks and 8 weeks 0 Fetus between 8 weeks and delivery 0 Very preterm anything before 34 weeks 0 Premature babies Infant mortality is a great indication of a nation s health 0 Decreases in mortality related to improvements in social circumstances safe and nutritious food availability and infectious disease control 0 Strong correlation between infant mortality and life expectancy 0 Infant mortality higher in males male fetus much more vulnerable 0 There is a lot of focus on the rst 1000 days of life pregnancy2 years if the child is healthy the child will grow up and go on to be healthy throughout their lives 0 Low birth weight or preterm infants at higher risk of dying in 1st year of life 0 Reducing infant mortality 0 Improve birth weight of newborns desirable birth weight 7 lb 12 oz 10 lb 0 Infants born with desirable weight less likely to develop heart and lung diseases diabetes and hypertension Health Objectives for 2020 o The Health Objectives for 2020 in relation to pregnant women and newborns focus on o The reduction of low birth weight 0 Preterm delivery 0 Infant mortality 0 A number of the objectives are related to improvements in nutritional status 0 Reducing teenage pregnancy is important 0 Teenagers are still growing themselves so they need more of every source she gets normally give birth to preterm babies because when eating they consume most of the nutrients they absorb leaving little for the baby 0 Tend to hide the pregnancy in the beginning which is the most important time of pregnancy early prenatal care Physiology of Pregnancy Gestational age assessed from date of conception average pregnancy is 38 weeks Menstrual age assessed from onset of last menstrual period average pregnancy is 40 weeks 0 A lot of dilution in the rst weeks of pregnancy 0 Hemodilution Most weight gain occurs between 35 and 40 weeks 0 Two phases of changes o Anabolic phase rst 20 weeks Blood volume expansion increased cardiac output buildup of fat nutrient and lover glycogen stores Growth of some maternal organs increased appetite and food intake Decreased exercise tolerance increased levels of anabolic hormones o Cataboic phase last 20 weeks Mobilization of fat and nutrient stores increased production and blood levels of glucose triglycerides and fatty acids decreased liver glycogen stores Accelerated fat metabolism Increased appetite and food intake decline somewhat near term increased levels of anabolic hormones Glucose provides an energy source for the baby through glycogen and fat Body Water Changes 0 Body water increases from 7 L to 10L results from increased blood and body tissues and extracellular volume and amniotic uid Edema swelling due to accumulation of extracellular uid Metabolism Carbohydrate Metabolism O O O Glucose is preferred fuel for fetus Early pregnancy high estrogen and progesterone stimulate insulin which increases glucose and consequently glycogen and fat Late pregnancy human chronic somatotropin hCS and prolactin inhibit conversion of glucose to glycogen and fat 0 Protein Metabolism 0 About 92 g of protein accumulate during pregnancy 0 Protein and amino acids conserved during pregnancy 0 Needs must be met by mother s intake of protein 0 Fat Metabolism 0 Fat stores accumulated in rst half of pregnancy enhanced fat mobilization in last half 0 Blood lipid levels increase 0 Increased cholesterol is substrate for steroid hormone synthesis 0 Mineral Metabolism 0 Calcium increased bone turnover and reformation 0 Sodium accumulation in mother placenta and fetus restriction of sodium potentially harmful The Placenta 0 Nutrient factors 0 Size and charge of molecules 0 Small molecules pass through most easily 0 Lipid solubility of particles 0 Concentration of nutrients in maternal and fetal blood 0 The fetus is not a parasite Nutrients rst used for maternal needs then for placenta and last for fetal need 0 The fetus is harmed more than the mother by poor maternal nutrition 0 Types of transport Passive diffusion Facilitated diffusion Active transport Endocytosis 0 OOO Embryonic and Fetal Growth and Development 0 Growth and development is at the highest level during the 9 months of gestation o If weight gain continued at this level at 1 years old the infant would be 160 lbs 0 Critical Periods o Differentiation cellular acquisition of one or more characteristics or functions different from that of the original cell 0 Critical Periods preprogrammed time periods during embryonic and fetal development when speci c cells organs and tissues are formed and integrated or functional levels established Fetal Body Composition 0 In the second half of pregnancy body fat composition occurs where nutrients are extremely critical 0 Small for gestational age 0 Disproportional the baby s body is disproportional the legs arms and head are of normal range but the weight is extremely low less than 10th The malnutrition within the mother occurs at the end of the pregnancy 0 Proportional the child is all around small each part of the baby is small Side effect of chronic malnutrition in the mother There is a de cit in the babies cells because the mother doesn t eat enough nutrients 0 Variations in fetal growth if the mother eats too much protein it results in a high risk for the baby to be overweight later on in life 0 Linked to Energy nutrient and oxygen availability Genetically programmed growth and development Insulinlike growth factor lGF1 is main fetal growth stimulator 0 Nutrition Miscarriages and Preterm delivery 0 Miscarriages thought to be caused by chromosome abnormalities thyroid disorders hormone imbalances infections Underweight increases risk Elevated blood cholesterol or triglycerides increase risk Multivitamin use reduces risk 0 Preterm Delivery infants born preterm are at risk for death Neurological problems congenital malformations and chronic health problems Developmental Programming of Later Disease Risk every chronic disease has the origin from the mother s womb Process by which exposures to adverse nutritional and other conditions during critical periods of growth and development modify gene function fetal origins hypothesis Changes may predispose individuals to chronic diseases As long as there is weight gain in the child periodically the child is ok not every child will gain weight at the same rate Many chronic diseases begin in the womb with whatever the mother is eating during pregnancy could relate to changes in genes 0 Related to genes and environmental exposure through the uterus Environmental exposures epigenetic alterations in gene activity that do not change the structure of DNA but only affected by environmental factors Pregnancy Weight Gain It is important for all expecting mothers to gain weight Even if they are obese Weight gain during pregnancy is related to the weight and health status of the newborn infant o The fetus is only about 13 of the total weight gain 0 The balance of the weight gain is related to body fat changes placenta amniotic uid increase of extracellular uids and blood supply of the mother As long as the mother is continually gaining weight it shows a healthy intake of macronutrients Even though there is a baby in the womb the mother isn t actually eating for two she just must increase her nutrient intake When a mother breastfeeds she tends to lose the weight faster Undernutrition puts the mother as well as the baby at risk Normal amount of calories needed a day 1650 0 Energy requirements in pregnancy require a gradual increase of caloric intake Energy and Nutrient Needs During Pregnancy 0 Energy requirements 300 additional calday 34day in 2nCI trimester 452 calday in 3rel trimester Calorie intake assessed by pregnancy weight gain Carbohydrates Arti cial Sweeteners and Alcohol Carb intake 4565 minimum of 175 g 0 Basic foods such as vegetables fruits and whole grains with bers 0 Arti cial sweeteners are ok Strongly advised to avoid alcohol ingestion during pregnancy Fiber 0 Very important of pregnancy diet although fetus development does not depend on it Adequate ber intake increases the comfort of pregnant women helps reduce constipation 28 glday Protein 0 Requirement 25 gday or 71 g 0 Average intake of typical female 78 g Fat 0 Pregnant women consume 33 of total calories from fat 0 Fat consumed in food is used as an energy source for fetal growth and development 0 Fat serves as a source of fatsoluble vitamins Fat provides essential fatty acids 0 Adequate intake liked to higher intelligence optimal development better vision and more mature CNS 0 Do not exceed 3 gdays Vitamins Folate associated with anemia and reduced fetal growth 0 Increase in folate extensive organ and tissue growth 0 Functions metabolic reaction de ciencies lead to abnormal cell division and tissue formation 0 Congenital abnormalities Neural Tube Defects Malformations of spinal cord and brain spinal bi da anencephaly encephalocele 0 Status has improved with forti ed cereals and supplements 0 Recommended intake 600 mcg o Choline fetal brain growth intellectual development 0 Vitamin A needed for cell differentiation growth of fetus protein synthesis 0 In US more concerned with toxicity 0 Vitamin D supports fetal growth and bonesskeleton supports immune system prevents autoimmune diseases and other chronic diseases 0 812 also very important when pregnant Minerals 0 Calcium needed for fetal skeletal mineralization and maintain maternal bones 0 Needs can be met with 3 cups of milk or calcium forti ed soy rice and almond milk 0 Fluoride teeth begin to develop in utero limited amount transferred from mother supplementation not recommended 0 Iron 0 Iron de ciency a condition marked by depleted iron stores with weakness fatigue short attention span poor appetite increased susceptibility to infection and irritability 0 Iron de ciency anemia a condition marked by low hemoglobin with signs of iron de ciency plus paleness exhaustion and rapid heart rate Risk of preterm delivery lf late in pregnancy associated with lower intelligence 0 Iron supplementation Absorbed better from supplements containing iron only than when mixed with other minerals Excess intake can create other problems it can impair the absorption of zinc a Make sure not to exceed the amount of zinc needed as well 0 Magnesium only occurs if not eating healthy 0 De ciencies associated with increased risk of miscarriage fetal growth retardation and preterm delivery 0 Some studies show de ciencies can create gestational diabetes 0 Zinc extremely important during the rst trimester when organs are formed and may play a role in assisting in immune system development 0 lodine required for thyroid function and energy production and for fetal brain development 0 Absence can lead to many deformities in the baby still birth premature delivery Cretinism affects the intellectual ability of the individual Abundant in seafood Need minute amounts of iodine Sodium plays a critical role in maintaining body s water balance restriction not indicated in normal pregnancy or for control of edema or high blood pressure Bioactive food components that s have health bene ts besides nutritional bene ts 0 Include phytochemicals and antioxidant pigments Are not considered essential nutrients but in uence health Water helps with amniotic uid in mother s womb protects the baby from serious trauma while in the stomach Met by increased levels of thirst Diet During Pregnancy Effect of taste and smell changes during pregnancy on intake This will in uence the baby s taste preferences Pica eating disorder where pregnant women eat nonfood substance Dietary supplements during pregnancy 0 Pregnant women do not need supplements as long as they are eating healthy except for iron Food Safety Issues 0 Foodborne illness 0 Avoid foods with mercury in them Exercise No evidence that moderate or vigorous exercise undertaken by healthy women is harmful Studies show women who exercise during pregnancy have an easier time during labor Recommendation 35 times each week for 2030 minutes at 60 70 V02 max Common Health Problems During Pregnancy Nausea and vomiting 0 Separating uids from food will give the food sometime to settle in your stomach reducing the frequency of vomiting 0 Eating dry foods helps reduce 0 Certain dietary supplements 0 Ginger Heartburn o Ingest small meals frequently do not go to bed with a full stomach avoid foods that make heartburn worse Constipation o Consume daily ber drink water along with ber laxatives are not recommended Model Nutrition Programs 0 The Montreal Diet Dispensary MDD 0 Results in fewer low birth weight infants lower rates of perinatal mortality 0 WIC help pregnant women who are at nutritional risks 0 Saves Medicaid a lot of money because there are fewer sick newborns Nutrition Needs and In uences during Lactation Bene ts of breastfeeding Reduced infant morbidity Cost savings to the Medicaid program 0 Higher levels of immune function Primary function of the breasts is to feed 0 The more we breastfeed the more milk we produce 0 Milk composition changes over time o If breastfeeding hurts that means the mother is doing something wrong 0 Diet variety and balanced meals Physiology o Mammary gland source of milk for offspring the breast o Alveoli functional units 0 Rounded or oblong shaped cavity present in breast o Composed of secretory cell with a duct in the center Secretory cells cells in acinus that are responsible for secreting milk components in ducts Myoepithelial cells line the alveoli and can contract to cause milk to be secreted into ducts o The most important thing when breastfeeding is the nipple and areola o The baby must have the entire areola in their mouth with the nipple center of the mouth 0 If the baby latches on to only the nipple it will be painful for the mother Mammary Gland Development Estrogen progesterone and human growth hormone help with the development of the breasts 0 Levels of both hormones increase dramatically to prepare mammary glands for actaio o If progesterone levels do not decrease after pregnancy it will affect prolactin 0 Primary hormones contributing to breast development 0 Human placental actogen is released during pregnancy to prepare the breasts for lactation o Prolactin synthesizes the milk Secreted towards the end of pregnancy 0 Oxytocin is the enzyme that enables the milk to ow Also known as the Letdown Hormone Secreted after birth when there is any type of stimulation to the breasts Without oxytocin the mother can become engorged Helps with contraction of the uterus Stages of Lactogenisis Stage 1 birth to 25 days the mother does not need stimulation of the breasts 0 Milk colostrum Helps the babies immune system mature faster yellowish in color 0 Stage 2 begins 25 days after birth 0 Stimulation needed 0 Milk transitional milk Much lighter milk 0 Stage 3 begins 10 days after birth 0 Stimulation needed 0 Milk mature milk coming in Slightly thicker than transitional milk but lighter than colostrum For each breastfeeding episode the baby gets foremilk and hindmilk o Foremilk lighter very high in lactose o Hindmilk much thicker very high in fat and protein and nutrients o The mother must empty one breast completely before going to the next breast so the baby gets the foremilk and hindmilk If the baby only gets foremilk the baby will get diarrhea Only foremilk also can result in the baby not gaining weight 0 As the baby suckles on the breasts it sends signals to the brain to release prolactin and oxytocin 0 Both hormones cause inhibition of ovulation 98 protection from pregnancy during the period of breastfeeding FDNS Exam 2 Study Guide cont 09152015 Exclusive breastfeeding all of the baby s nourishment is coming from breastfeeding absolutely no other food not even water 0 Up to 6 months 0 After 2 months the baby should be supplemented Vitamin D because the mother isn t producing enough Vitamin D Optimal breastfeeding breastfeeding 80 of the time formula or other foods here and there Partial breastfeeding 5050between breastfeeding and formula Token breastfeeding when the baby uses the breasts as more of a snack seen in older children 0 Ultimately it is up to the mother and the baby on how long they breastfeed Milk composition 0 Human milk is the only food needed by the majority of healthy infants for 6 months 0 The composition changes over a single feeding over a day based on the age of the infant presence of infection in the breasts with menses and maternal nutritional status 0 The fat content in the morning is lower than in the evening because the baby is sleeping 0 At each feeding the foremilk has more water than the feeding before The carb and protein composition remain the same throughout the day Protein in Human Milk 0 At the beginning of breastfeeding 90 whey 10 casein o Whey a soluble protein that contains some minerals hormones and vitamin binding proteins includes lactoferrin which is an iron carrier 0 Casein main protein in mature human milk which facilitates calcium absorption 0 After 6 months 50 whey 50 casein The protein content in human milk decreases as the baby gets older 0 Formula is an indication of childhood obesity because it has a high protein concentration the entire time the baby drinks it DHA Trans Fatty Acids and Cholesterol in Human Milk DHA essential for retinal development associated with higher IQ scores Trans fatty acids present in human milk from maternal diet Cholesterol higher in human milk than human milk substitute early consumption of cholesterol through breast milk appears to be related to lower blood cholesterol levels later in life Minerals in Human Milk Minerals contribute to osmolality 0 Content related to growth of infant 0 Concentration decreases over rst 4 months except for magnesium Bioavailability most have high bioavailability Exclusively breastfed infants have very low risk of anemia despite low iron content of human milk Zinc bound to protein and highly available rare defect in mammary gland uptake of zinc may cause zinc de ciency that appears as diaper rash Trace minerals copper selenium chromium manganese molybdenum nickel uoride 0 Not altered by mother s diet Importance of Breastfeeding Species speci c Nutritional advantages Infection protection Allergy protection Psychological bene ts Brain development Bene ts of Breastfeeding Breastfeeding worldwide is known universally as the method of feeding the baby o No formula can be an exact replacement of breast milk because it contains active compounds 0 Hormonal bene ts increased oxytocin stimulates uterus to return to prepregnancy status 0 Physical bene ts delay in monthly ovulation resulting in longer intervals between pregnancies Psychological bene ts increased selfcon dence and bonding with infant Bene ts for mother 0 Reduced risk of cancer breast and ovarian 0 Reduced risk of diabetes 0 Reduced risk of postpartum depression 0 Bene ts for infants 0 Many nutritional bene ts 0 Immunological bene ts lower infant mortality in developing countries and fewer acute illnesses 0 Reduced risk of SIDS Sudden Infant Death Syndrome infants dying for no apparent reason Normally suffocation Reduces risk because when breastfeeding mothers wake up more often to feed the baby and consequently are able to check on the baby and make sure he is still breathing Babies that drink formula won t wake up as often and therefore the mother won t wake up as much 0 Reduction in chronic illness 0 Reduction in possibility of baby being overweight Weight wise babies at 1 year are leaner than formula fed babies I They have more body fat which assists in brain development and growth spurts Signi cant cognitive difference in premature babies Analgesic effects reduction of infant pain signi cantly milder when it comes to circumcision in breast fed babies Socioeconomic bene ts decreased need for medical care 0 Countries save on formula exchange 0 Employers bene t because parents don t need to stay home and take care of sick children Breast Milk Supply and Demand 0 Milk synthesis is related to o How vigorously an infant nurses 0 How much time the infant is at the breast o How many times per day the infant nurses 0 Having larger breasts doesn t mean you make more milk but it means it contains more fat 0 Baby milk demand 0 Nutritive feeding if the child is feeding and removing nutrients from the breasts You can hear a faint noise indicating that the baby is still feeding o Nonnutritive feeding if the child is sucking on the breasts as a paci er Feeding frequency depending on how much the baby feeds the breasts will send a signal to the brain to either inhibit or enhance milk production 0 One breast always produces more than the other 0 There are several different methods for pumping or expressing milk manual and electric The type of breast reductionaugmentation determines the ability to breastfeed but it is possible 0 There is no evidence that silicone from breast implants produces toxicities in breast milk Positions for Breastfeeding Lay back hold 0 Football or clutch hold Crosscuddle hold The Breastfeeding Infant 0 Identifying hunger and satiety o Hunger is signaled by infant bringing hands to mouth sucking on them and moving head from side to side 0 Crying is a late sign of hunger 0 Allow infant to nurse on one breast as long as they want to ensure they get hindmilk with its high fat content that provides satiety Identifying Breastfeeding Malnutrition Losing 7 in the rst week is normal because the baby is full of uids when born some babies also have stool that they will pass 0 Weight loss of 10 needs evaluation by lactation consultant Malnourished infants become sleepy nonresponsive have a weak cry and wet few diapers o By day 5 to 7 infants should have 6 wet diapers and 34 soiled diapers Energy and Nutrient Needs for Lactation 0 RDA for macronutrients during lactation is similar to that for pregnant women 0 Energy needs vary by activity level DRI is 500 kcalday for the rst 6 months and 400 kcalday afterward The additional energy needs is to come from increase in intake and fat stores Exercise Water and Breastfeeding Modest energy restriction combined with increased activity may help women lose weight and body fat 0 Exercise does not inhibit milk production or infant growth Lactating mothers should consume 38 liters or 128 ounces of water perday Micronutrients o The RDA for micronutrients remain the same as those set for pregnancy except iron 0 Water soluble vitamins dependent on mother s intake because they are not stored in the body as well as zinc selenium and iodine 0 During breastfeeding iron RDA moves from 27 during pregnancy back to 18 0 Vitamin and mineral supplements not needed in wellnourished women 0 Functional foods show no adverse effects Factors in uencing Breastfeeding Initiation and Duration Obese women tend to have difficulty with breastfeeding due to higher levels of estrogen and progesterone Lowincome and more af uent mothers need breastfeeding support due to socioeconomic status Barriers to Breastfeeding Initiation o Embarrassment Time and social constraints 0 Lack of support from family and friends 0 Lack of con dence Concerns about diet and health 0 Fear of pain Healthy People 2020 Objectives 0 Increase proportion of infants breastfed lncrease duration of breastfeeding 0 Increase worksite lactation programs 0 Reduce formula supplementation in rst 2 days of life 0 Increase births in facilities providing recommended care for breastfeeding mothers Breastfeeding Promotion Facilitation and Support The healthcare system plays an in uential role in breastfeeding Lactation support in hospitals and birthing centers Lactation support after discharge essential in the rst few weeks after delivery 0 Any knowledgeable healthcare practitioner should see all breastfed infants at 24 days of age 0 Breastfeeding Peer Counseling 0 Le Leche League The work place provides barriers making it difficult for mothers to breast feed The community must establish a multidisciplinary breastfeeding task force with representatives from the healthcare system and others knowledgeable in the eld 0 Community attitudes and obstacles to breastfeeding need to be assessed Model Breastfeeding Promotion Programs 0 WIC national Breastfeeding Promotion Project 0 Office of Women s Health 0 Wellstart International
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