Maternal and Infant Nutrition Ann Rucinski, MA, RD 208 Alison Hall  Department of Nutrition and Dietetics  Telephone: 831-2079  Rucinski@UDEL.EDU

    Class meeting time:      Monday 6:00 - 9:00 pm

    Office Hours:              Monday 1:00 - 4:00 pm
                                            Other hours by appointment

    Textbook:

Worthington-Roberts, B.S. and Williams, SR.  Nutrition in Pregnancy and Lactation, 6th edition.  Brown and Bechmark, 1997.

 

    Course Description:

Maternal physiological adjustments in pregnancy and their relationship to nutritional needs; effect of maternal nutrition on fetal growth and development; physiology of lactation and maternal nutrient needs; and neonatal nutritional needs and current infant feeding practices.

 

 

Course Objectives:

Upon Completion of the course, the student will be able to:

 2.   define indices of maternal and infant health.

 3.   identify the nutritional needs during pregnancy and lactation.

 4.    describe the physiological changes that occur during pregnancy and lactation.

 5.   describe maternal/environmental factors affecting maternal outcome.

 6.   discuss the impact of preconceptive interventions on improving pregnancy
       outcome.

 7.  become familiar with the WIC program and the impact on maternal and
      infant and infant health.

8.   practice evaluating nutritional status and implementing a care plan for
      pregnant women and infants.

  9.  discuss what is known about mineral deficiencies on pregnancy outcome.

 10. become familiar with the management of high risk pregnancies; including
        risk factors in pregnancy-induced complications and preexisting chronic
        conditions in the mother.

 11.  discuss nutritional concerns related to pregnant adolescents and concerns
         related to infants born to teenagers.

 12.  compare the benefits of beastfeeding verses infant formulas.

 13. become familiar with the breastfeeding promotion efforts by the WIC program.

 14.  discuss infant nutrition recommendations and practices.

 15.  practice utilizing growth charts.
 
 

Grading, Evaluation Policies and Procedures

Grading:  The following examinations and assignments are required.  The course grade will be compiled according to the following point schedule.  There are no regularly scheduled make-up exams.  If you miss an exam, you must have a valid documented excuse.

NTDT 420	NTDT 620
3  exams - 50 %	3 exams - 45%
Term Paper - 20%	Term Paper - 20%
Presentation - 5 %	Presentation - 5%
Attendance - 10%	Attendance - 5%
Final Exam - 15%	Graduate practicum – 10%
	Final exam - 15%

The final course grade will be calculated as follows:

 Grade            %

     A        92.5 - 100%`
     A-       89.5 - 92.4
     B+      86.5 - 89.4
     B        82.5 - 86.4
     B-      79.5 - 82.4
     C+     76.5 - 79.4
     C       72.5 - 76.4
     C-      69.5 - 72.4
     D+     66.5 - 69.4
     D       62.5 - 66.4
     D-      59.5 - 62.4

Policy on Attendance:
Attendance at the lectures will be part of the students grade.

All assignements are avaialable on the world wide web.  Web-links to the assignments can be accessed from the home  page for the NTDT 420 syllabus.  Students are expected to access the assignements and complete prior to coming to class.  The instructor will announce ahead of time as to when a particular assignment will be reviewed in class.

Assignments:

Term Paper Guidelines:

An in-depth review of a topic related to maternal and infant nutrition is the goal of this paper.  The instructor will provide a list of topics, however students are free to select their own.  The instructor must approve a topic other than what is listed.  Topics must be selected by March 6, 2000.

Technical Aspects:

1. Before starting this paper, review the “Guidelines for Authors” in the most recent
 January issue of the Journal of the American Dietetics Association (JADA). You
can also find a copy of this from the home page of the American Dietetic Association; http://www.eatright.org.  Pay attention to the use of abbreviations, numbers, preparation of tables and presentation of laboratory values.

2. The paper must by typed double spaced with appropriate margins and pagination.
 Use proper spelling, word selection, and sentence construction.  Do not use
 contractions.

3. Reverences must follow JADA guidelines and should include but not limited to:
 four journal articles published within the last five years.  Citations from books
 should include page number(s) used.  (See JADA guidelines).  In addition,
 please feel free to cite current nutrition texts.

4. Do not plagiarize material (books, articles, charts).

5. The typed report should be at least five pages, but not more than ten.  In addition,
 your report should have a title page, abstract, reference page, and appendices
 (as appropriate).  Please note, the latter is in addition to the five to ten page text.

Outline:

1. Abstract (100 words or less on a separate page).  Describe the highlights of your
 main findings and conclusions.

2. A general theoretical discussion of the topic based on current research.  You
 should draw a conclusion and indicate implications for practice from your findings.

3.  References

4. Appendix (if appropriate)
 
 
 

Presentation Guidelines:

1. You must sign up for a presentation time when your topic is selected.

2. Your presentation should be 10-15 minutes.  You may use overheads, charts etc.
To highlight your main points.

3. A 250-300 word abstract in addition to your bibliography is due the night of your
presentation.

Graduate Practicum: (NTDT 620)

1. Graduate students must complete a graduate practicum which is 5% of your grade.

2. The idea is to obtain a “real-life” practical experience in the area of maternal and infant health.   Examples include spending a half day with a registered dietitian or
Other health professional specializing in this area.   Other examples include teaching a class or talking with an expert in this area about the need for services
For this target group.

3. The above descriptions are examples.  Graduate students can determine their type of experience.  The instructor prior to spring break, must approve the practicum.  The instructor will help you with ideas and contacts for your particular area of interest.

4. Write a brief summary of your experience to be submitted by the last class.
 
 
 

The course is designed to enhance active learning by working on case   studies     for "hands-on" practice.  Links to other web sites are listed under various topics.

Study Tips/Learning Resources

Students are highly encouraged to complete all assingments given in class. Students who complete homework assignments appear to be most successful in the course. In addition, articles are  on reserve in the library, selected to enhance course material.  The instructor will make note of any article covered in class.

Student feedback on instruction

All homework assignments will be reviewed in class.  Tests will be given back within one week of taking the exam.  Exams will be held in the instructor's office.  Students can make an appointment to review an exam at any time.

 
Reserve Readings

1.    Hurley - Chapter 4:  Differentiation and morphogenesis
        Chapter 17: Principles of Developmental Nutrition

2.    Maternal Morbidity
       Bennet, T.A. et.al. Pregnancy-associated hospitalizations in the United States in
       1991 and 1992: A comprehensive view of maternal morbidity.  Am J Obstet Gynecol.
       1998;346-354.

3.     Maternal Weight
        Johnson, W.C. et. al. Excessive maternal weight and pregnancy outcome.
        Am J Obstet Gynecol. 1992;353 - 371.

        Mitchel, M.C. et. al.  Weight gain and pregnancy outcome in underweight and
        normal weight women.  J Am Diet Assoc. 1989;89:634 - 641.

4.     Gestational Diabetes
         Jones, M.W. et. al. Management of the Woman with Gestational Diabetes
         Mellitus.  J of Pernatal and Neonatal Nursing/March.  1998;13 - 24.

         Fagen, C. et.al.  Nutrition Management in women with gestational diabetes
         mellitus:  A review by ADA’s Diabetes Care and Education dietetic practice group.
         J Am Diet Assoc.  1995;95:460 - 467.

5.     Pica
        Rainville, A.J. Pica practices of pregnant women are associated with lower maternal
        hemoglobin level at delivery. J Am Diet Assoc.  1998;98:293-296.

6.     Birth Defects
        Worthington-Robert, B. The role of maternal nutrition in the prevention of birth
        defects.  J Am Diet Assoc.  1997;97(S10)S184-S185.

7.     Drug/Alcohol
        Mattson, S.N. et. al.  Heavy prenatal alcohol exposure with or without physical
        features of fetal alcohol syndrome leads to IQ deficits.  J of Pediatrics. 1997;
        718-721.

       Ostrea, E.M. et. al. Mortality Within the First 2 Years in Infants Exposed to Cocaine,
       Opiate, or Cannabinoid During Gestation.  Pediatrics.  1997;100:79-83.

       Bateman, D.A. et. al. The Effects of Intrauterine Cocaine Exposure in Newborns.
       Am J of Public Health.  1993;83:190-193.
 

       Harsham, J. et. al. Growth patterns of infants exposed to cocaine and other drugs
       in   utero.  J Am Diet Assoc. 1994;94:999-1006.

8.    Folate
       Gaul. G. E.  Fortifying Policy with Science - The Case of Folate. J Nutr. 1996;
       126:749S-759S.

9.    Adolescent Pregnancy
       Story, M. et. al.  Nutrition Issues and Adolescent Pregnancy.  Nutr. Today.
       1995;30:142-151.

       Dubois, S. et. al.  Ability of the Higgins Nutrition Intervention Program to improve
       adolescent pregnancy outcome.  J Am Diet Assoc.  1997;97:871-878.

10.  Maternal Phenylketonuria
        Koch, R. et. al.  The North American Collaborative Study of Maternal
        Phenylketonuria.  AJDC;1993:1224-1230.

11.   Breastfeeding
        Frequently Asked Questions About Breastfeeding.  La Leche League.

        American Academy of Pediatrics.  Policy Statement March 1980.  Encouraging
        Breastfeeding.

        Position of The American Dietetic Association: Promotion of breast-feeding.
        J Am Diet Assoc.  1997;97:662-666.

        Montgomery, D. L.  et. al.  Economic benefit of breast-feeding infants enrolled in
        WIC.  J Am Diet Assoc.  1997;97:379-385.

        Mackey. A. D.  Self-selected diets of lactating women often fail to meet dietary
        recommendation.  J Am Diet Assoc.  1998;98:297-302.

        Black. R. F.  Transmission of HIV-1 in the breast-feeding process.  J Am Diet
        Assoc.  1996;96:267-274.

12.   Infant Nutrition
        Darby, M. K.  et. al.  Neonatal Nutritional Requirements and Formula Composition:
        A Review.  JOGNN;March/April.1996:209-217.

        Gerber Products Company.  Current Practices in Infant Feeding. 1995.

        Into the Mouths of Babes.  Consumer Reports. September 1996:56-58.
 

Case Study Assingments

 

Select the appropriate topic and "link" to the case study.
Preconception Counseling
Pregnancy Worksheet

Adolescent Pregnancy
Failure to Thrive
Gestational Diabetes

    Substance Abuse During Pregnancy

Infant Feeding

Breastfeeding Promotion

 

Tentative Class Schedule

February 7  Chapters 1 & 2	Course Introduction     Terminology in maternal and child         nutrition    Discussion of term paper topics    Promotion of Maternal and Infant Health    Nutrition and Family Planning
February 14  Hurley, Chap. 4,17 (reserve)	Fetal Origin Hypothesis (video)     Conception and nutrition interrelationships    Brief review of female reproductive physiology;           Embryonic development     Preconception care - Speaker
February 21 Chapter 3& 4	Physiology of Pregnancy Prenatal Nutrition General issues in maternal nutrition and pregnancy outcome
February 28	No Class, Case Studies Assigned
March 6 Chapter 5& 6 Reserve Readings	Energy and vitamin and mineral needs Public Health Nutritionist - Speaker Submit topic for term paper
March 13	March of Dimes - Speaker Exam 1
March 20 Chapter 7&9 Reserve Readings	Lifestyle concerns during pregnancy  Maternal Disease Conditions WIC program - Speaker
March 27	Spring Break
April 3 Chapter 10 Reserve Readings	Special Concerns of the Pregnant Adolescent
April 10 Chapter 11 &12 Reserve Readings	Anatomy and physiology of lactation  Human Milk Compostion
April 17	Breast feeding promotion  Exam 2
April 24 Reserve Readings	Infant nutrition; grotwth charts, infant feeding practices; infant readiness and nueromoter development; gastrointesital development Term Papers Due Speaker: Delaware Division of Public Health
May 1 Reserve Readings	Infant Feeding, cont'd Seminar Reports
May 8	Exam 3 Speaker: Nutritional needs of the premature infant
May 15	Seminar reports Review for the final
Final Exam	TBA

* For Academic Honesty and Dishonesty Policy Information and Information About Learning Disabilities Services see On-Line Official Student Handbook: http://udel.edu/studhb/