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Breakout Session IV—Nutrition and Physical
Activity Issues for Women of Reproductive Age
Moderator: Barbara A.
Underwood
Speakers: Richard C.
Deckelbaum, Lindsey H. Allen, Marshall W. Carpenter, Nancy F. Butte,
Kathleen M. Rasmussen
Recorders: Brenda Lisi,
Burnese Walker-Dix
Purpose: Meeting the
energy and nutrient needs of women who are about to become pregnant,
who are pregnant, or who are lactating represents a considerable
challenge. There is now convincing evidence that maternal nutrition
can have a lasting impact on fetal and infant growth and development.
At the same time, there is a growing awareness that the nutritional
needs of women prior to and during reproduction are not always being
met. What are the obstacles and how can they be remedied?
Topics—Summary and Recommendations
Getting ready for pregnancy.
Identification of social, cultural, racial, etc., factors that need
to be addressed to insure healthy pregnancy outcomes.
Richard C. Deckelbaum, Columbia University
The United States ranks 25th among industrialized
nations in the world in infant mortality rate. In addition, there
are major differences in rates of infant mortality between whites
and specific racial and ethnic groups. For example, the rate of
infant mortality in African-Americans is more than twice that of
whites. Among the leading causes of infant mortality that are related
to maternal nutrition are birth defects, premature delivery, low
birth weight, and maternal complications. Maternal nutritional factors
identified for educational programs and targeted interventions were
maintenance of ideal weight during childbearing years, appropriate
weight gain during pregnancy, appropriate weight loss during lactation,
the insurance of adequate micronutrient intakes prior to and during
pregnancy and lactation, and timely access to health care professionals.
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Nutrients are likely to be
limiting in diets of pregnant and lactating women. What types of
action need to be taken to insure adequate nutrient transfer to
the developing fetus and infant and to maintain maternal nutritional
adequacy?
Lindsay H. Allen, University of California
at Davis
There is no nationally representative data for pregnant
and lactating women, so it is difficult to assess the extent of
nutritional adequacy and/or inadequacy of reproducing women. There
are, however, indications that pregnant and lactating women are
at risk for several micronutrient deficiencies. For example, national
pregnancy surveillance data indicate that about 29 percent of low-income
pregnant women have anemia, a good predictor of iron deficiency
in this segment of the population. Other nutrients likely to be
limiting in the diets of reproducing women are calcium, zinc, folate,
vitamin A, vitamin B-6, vitamin B-12, and the long-chain polyunsaturated
fatty acids. Research is needed for the development of specific
assessment and outcome measures that are sensitive to interventions
targeted to this segment of the population.
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What recommendations can be
made concerning a safe and appropriate level of exercise during
pregnancy and lactation?
Marshall W. Carpenter, Women and Infants
Hospital of Rhode Island
The concept that pregnancy and lactation are fragile
circumstances with respect to exercise is not well substantiated
by scientific evidence. Moderate exercise during reproduction may
play a protective role in reducing risk for gestational diabetes,
excessive gestational weight gain, and postpartum weight retention.
Research, using noninvasive techniques, is needed to examine the
health impact of moderate and vigorous exercise during reproduction.
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Can weight gain recommendations
during pregnancy be tailored both to achieve optimal infant birth
weight and prevent the growing incidence of maternal obesity?
Nancy F. Butte, Baylor College of Medicine
Weight gain during pregnancy is positively associated
with infant birth weight. Low weight gain increases the risks for
intrauterine growth retardation, low birth weight, and infant death.
On the other hand, high gestational weight gain increases the risks
for large birth weight infants and enhances the likelihood of above-average
weight retention well beyond the immediate postpartum period. There
is a need to identify maternal characteristics associated with excessive
postpartum weight retention and risk for long-term obesity as well
as effective interventions for weight management following pregnancy
and lactation.
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What are the maternal consequences
of extended lactation as is currently recommended? Should success
of lactation include measures of maternal health and nutrition as
well as infant outcomes?
Kathleen M. Rasmussen, Cornell University
The nutritional impact of lactation is in large part
dependent on maternal nutritional status prior to and during pregnancy
and the extent and duration of lactation. During lactation there
is a period of maternal depletion followed by repletion upon infant
weaning. The extent of the depletion relative to the rate of repletion
has not been studied in extended lactation (>3 months). There is
evidence that lactation can favorably influence maternal health
(i.e., there is a decreased risk for premenopausal breast cancer
associated with duration of lactation). There is a need for research
to assess both the nutritional and health impact of lactation on
the mother and her subsequent reproductive performance risk.
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Final Overall Issues and Questions
- There is growing recognition that women should
prepare for pregnancy. There also is a need to focus specifically
on women who enter pregnancy underweight, overweight, or with
diabetes because of the specialized interventions required for
these women to decrease risk for adverse outcomes.
In the development of educational programs and targeted
interventions, the following factors were identified as key concerns:
- Emphasis should be placed on both maternal and
infant health.
- Educational programs should target high-risk
groups beginning in junior high school.
- Obstetricians, gynecologists, and family physicians
should be encouraged to use health visits for addressing nutrition
issues of women prior to conception.
- The national government is urged to invest in survey
research that specifically examines the nutritional status of
pregnant and lactating women. There is a strong need for longitudinal
data, particularly from subgroups at risk for poor reproductive
performance. With this information, targeted interventions may
be directed to those segments bearing the greatest burden of reproductive
causality. In addition, there also is a need to establish a national
task force to evaluate findings and suggest strategies for appropriate
followup programs.
- There are a number of important health messages
that can impact maternal health behaviors. In delivering specialized
health messages to women of childbearing years, the following
should be considered:
- Health messages have to be culturally appropriate,
with input from the target audience.
- Need to help women lose weight before they become
pregnant.
- Use an interdisciplinary approach to develop
health messages.
- There is an opportunity to form partnerships between
the public and private sectors to give important public health
messages to women during their reproductive age. A program that
may serve as a model is the March of Dimes' "Folic Acid Campaign."
- There is a need to remove structural barriers to
extended lactation, such as extended maternity leave and quality
infant care, and a need to address how will it be made available
to all women. Other measures that may enhance the prevalence of
extended lactation include the following:
- Educating pediatricians about lactation and its
medical support,
- Initiating legislation for maternity leave to
permit the establishment and maintenance of lactation, and
- Developing a mandatory postpartum home visit
for both the mother and child as part of routine healthcare.
- Research is needed to assess potential benefits
and/or risks from nutrient supplements for pregnant and lactating
women. This research must be evaluated in the context of baseline
dietary intakes and maternal nutritional status.
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