The future of neonatal nutrition: Further research and investment, new products

Introduction

The paradigm of a healthy mother with good nutrition and her healthy term infant who breastfeeds for at least the first year after birth with minimal exposure to adverse environmental conditions is ideal. Mother’s milk is personalized for her infant. Its composition undergoes dynamic fluxes over time and under various conditions, thus adjusting to the infant’s needs. Unfortunately, this ideal is not met by a large portion of the world’s population. Pregnant women and their fetuses are subject to their prepregnancy and intrapregnancy environments, which include nutrition, toxin exposure, genetic and epigenetic factors, and social influences. Many infants are born preterm and lack normal suck-swallow coordination and a fully developed intestine, negating the ability to directly feed from the breast. Various birth factors, as well as the mother’s individual and social limitations, such as the need to work, influence ideal maternal–infant interactions, including breastfeeding; hence the ideal is not often achieved.

This chapter discusses how the challenges to meet this ideal are currently being addressed and the pathways for taking steps toward the ideal. A complete discussion of all these factors is beyond the scope of a single chapter; hence the chapter includes brief overviews on optimization of nutrition during pregnancy and lactation, nutrition for preterm infants, and enhancing the composition of commercial formulas toward that of breast milk.

Nutrition during pregnancy and lactation: Where are we now?

Nutrition plays a vital role during a woman’s reproductive period and establishes the potential for health and risks for chronic diseases in their offspring throughout their lifetime. Most women in the United States do not meet the recommendations for healthful nutrition and weight before and during pregnancy. Ways to overcome these problems have been addressed in a recent report that provides background information on the physiologic rationale for dietary recommendations during pregnancy and lactation. Following is a summary of some of the major issues and recommendations in the report:

• 1.

  It is critical that women’s health status and nutrition is optimized not only during but also before pregnancy. This will contribute to optimal fetal growth, obstetrical outcomes, and long-term health in both mother and offspring.

• 2.

  Abnormal fetal growth patterns that include being small for gestational age (fetal growth restriction and macrosomia) are associated with maternal nutrition and increase the risk of later disease.

• 3.

  Diets that restrict any macronutrient should be avoided during pregnancy.

• 4.

  The optimal time to improve maternal body weight and nutrition-related lifestyle is well before conception occurs, but interventions may be more achievable during pregnancy.

• 5.

  Human milk consumption during infancy for term infants is associated with lower risks of chronic disease in later life. Many factors affect the composition of human milk including maternal adiposity and maternal diet. Exclusive breast feeding in women with gestational diabetes may mitigate the development of type 2 diabetes in the mother and childhood obesity in her offspring.

• 6.

  All reproductive age women should have their balanced diet supplemented with optimal amounts of folic acid among other micronutrients at least 2 to 3 months before conception. This should be continued during pregnancy and at least the first 4-6 weeks after delivery.

Strategies to address some of the major concerns related to nutrition in pregnancy and lactation were recommended in the same expert panel report. These include:

• Evidence-based educational approaches that focus on nutrition across academic clinical programs that emphasize multidisciplinary team approaches to management.

• Use of rapidly evolving technology to disseminate appropriate nutrition education that creates connections between scientists, policymakers, and the general population.

• Development of improved measures of maternal glucose concentration throughout pregnancy to establish glycemic patterns. Similarly, implementation of better methods to assess lipid availability and use by the fetus and, likewise, determine how to maintain maternal lipid concentrations in the “normal” range and at relatively constant concentrations with appropriate and successful maternal diets.

• Development of a better understanding of amino acid and protein needs of both fetus and mother during pregnancy.

• Development of methods to best feed the mother who is showing signs of fetal growth restriction or increased fetal fat mass .