A S S O C I A T I O N OAFS SSOT C

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Role of Nutrition in Infant Mortality
– A Public Health Perspective

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Nutrition and Infant Mortality

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
✔Summarizes the impact of nutrition on infant
mortality
✔Identifies areas where nutrition interventions
can make a difference
✔Describes the critical role that public health
nutritionists play in preventing infant mortality

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Infant Mortality

Infant mortality is a multi-factorial phenomenon,

with rates reflecting a society’s commitment to the
provision of high quality health care, adequate food
and good nutrition, safe and stable housing, a healthy
psychosocial and physical environment, and
sufficient income to prevent impoverishment.

Recommendations for HHS Action and Framework for a National Strategy; 2013

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Nutrition and Infant Mortality
✔Is part of a complex whole of interventions
necessary to make a sustained difference.

✔A focus on nutrition is not a new approach

to reducing infant mortality.

✔Nutrition is often inadequately addressed

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Infant Mortality
✔Infant mortality is defined as the
probability of dying between birth and one
year of age.
✔Reported as rate per 1000 live births
✔In 2010, US ranked 26th in the world for
infant mortality
✔Ranking of US has decreased in past decades
✔In 1960, the US ranked 13th
✔In 2004, the US ranked 29th
A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Source: Adapted by CRS from Ariadi M. Minino, et al., National Vital Statics Reports: Deaths: Final Data for 2008,
National Center for Health Statistics, Vol. 59, No. 10, Hyattsville, MD, December 7, 2011.

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Nutrition’s Role in Infant Mortality
“Every single cell, organ, and system inside a
newborn baby comes mostly from her mother’s
food intake before or during pregnancy.

Maternal nutrition is a critical determinant of

infant health; thus, it is not hard to see that
poor maternal nutrition can contribute, directly
or indirectly, to infant mortality.”

Lu 2005

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Causes of Infant Mortality

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Nutrition and Infant Mortality
✔Good evidence of maternal nutrition role:
✔Birth defects
✔Preterm birth / Fetal growth restriction
✔Maternal complications of pregnancy
✔Breastfeeding is associated with:
✔Sudden unexpected infant death reduction
✔Reduced rates of post neonatal deaths

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Nutrition and Birth Defects
✔Folic Acid
✔Certain nutrition deficiencies
✔Certain nutritional excesses
✔Maternal obesity
✔Maternal diabetes
✔Maternal phenylketonuria (PKU)

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
How Public Health Nutrition Can Make a
Difference
✔Campaigns and interventions that address:
✔healthy weight maintenance
✔folic acid consumption
✔Medical nutrition therapy:
✔For women entering pregnancy with:
✔PKU or other metabolic conditions
✔Diabetes
✔Hypertension
✔When gestational diabetes is identified
A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Nutrition and Low Birth Weight
✔Preterm delivery is not fully understood
✔Underweight
✔Inadequate pregnancy weight gain
✔Maternal hypertension
✔Maternal diabetes
✔Nutrition deficiencies

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
How Public Health Nutrition Can Make a
Difference
✔Preconception and prenatal care with a
strong nutrition component
✔Efforts to promote making healthy eating
as the easy choice
✔Medical nutrition therapy:
✔women who are gaining inappropriately
✔medical conditions with a nutritional
component.

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Nutrition and Maternal Complications

✔Micronutrients may influence maternal infection

rates
✔Anemia
✔Diabetes
✔Maternal obesity
✔Excessive weight gain
✔Nutrition can mediate or modulate pathways
leading to spontaneous preterm birth
✔Periconception nutrition may be important in
preeclampsia
A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Nutrition and Sudden Unexpected Infant Death
✔Breastfeeding
✔SUID/SIDS risk is 56 % higher among infants
who never breastfed
✔Reduction in risk for postneonatal death.
✔Reduces infant mortality from common
childhood illnesses
✔Associated with the development of a preterm
infant’s immature host defense

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
How Public Health Nutrition Can Make a
Difference
✔Partner in breastfeeding promotion and
support efforts
✔Collaboration with:
✔Breastfeeding promotion campaigns
✔Workplace lactation accommodation efforts
✔Implementation of maternity care practices
✔Innovative efforts such as state programs
that pay for donor breast milk.

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Nutrition’s Role in Infant Mortality
Nutrition plays a key role in preventing
several leading causes of infant mortality,
but only as part of a long-term and
integrated strategy for improving maternal
and family health

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Clinical and Public Health
Nutrition Efforts are Needed
✔ Clinical interventions include working as part of the health
care team to assist a woman.

✔ Some efforts such as supporting use of folic acid prior to

conception may be accomplished in both settings.

✔ Public health nutrition efforts such as community and

environmental change strategies, campaigns to educate
professionals and women about the IOM weight gain
guidelines or creating environments where healthy eating is
the easy choice are all important.

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Use a Systems Approach
Removes critical barriers to women receiving adequate
nutrition, such as:

✔Access to health care

✔Access to healthy foods and nutrition education

✔Stronger referral and care coordination systems

✔An overall integration of nutrition into a life course

perspective within health and public health systems.
A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
4 Ways to Integrate Nutrition into
Infant Mortality Efforts
1. Public health nutrition professionals are included in all levels of
infant mortality prevention efforts.

2. Environments exist that support breastfeeding and where healthy

eating is the easy choice for woman, especially those who are or are
contemplating becoming pregnant.

3. Life course and preconception care address maintaining or achieving

a healthy weight and eating well.

4. Prenatal care addresses appropriate weight gain, healthy eating,

medical nutrition therapy as needed and referrals to WIC, if
appropriate.

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Reducing Infant Mortality through Nutrition
✔Encouraging women to reach and maintain healthy
body weight and waist circumference prior to
pregnancy
✔Supporting healthy eating patterns for women and
families
✔Encouraging appropriate weight gain during
pregnancy
✔Offering preconception care for women considering
pregnancy
✔healthy weight
✔addressing chronic conditions and risk factors
A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Reducing Infant Mortality through Nutrition
✔Supporting breastfeeding initiation and
continuation
✔Monitoring and evaluating nutritional risk
among women
✔Engaging in program development, policy,
systems and environmental change
activities to support the health of women
of reproductive age

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Call to Action
 Ensure that nutrition is an integral component of all
federal, state and community infant mortality prevention
interventions.

 Engage in program development, policy, systems and

environmental change activities that support the health of
women.

 Support access to healthy foods for girls and women during

the life course and education on eating well and
maintaining a healthy weight.

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Call to Action
✔Provide preconception care that specifically addresses healthy
weight, eating well, chronic conditions and nutrition related risk
factors.

✔Address appropriate weight gain during pregnancy, provide any

necessary medical nutrition therapy, refer eligible women to
WIC, and support breastfeeding initiation.

✔Encourage the development of positive feeding behaviors for

infants and children throughout the life course.

✔Seek solutions to hunger, food insecurity and other factors that

reduce women’s ability to eat well.

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Nutrition Topics to Address
✔Dietary Quality
✔Nutrition through the Life Course
✔Hunger and food insecurity
✔WIC
✔Preconception Care and Pregnancy
✔Breastfeeding
✔Medical nutrition therapy for chronic
conditions
A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Dietary Quality
✔Diet matters
✔Women eat food not nutrients
✔Policies that support a healthy eating
environment, healthy eating campaigns
and individual nutrition counseling all
help to improve dietary quality
✔Nutrition through the life course

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Nutrition through the Life Course
✔For life, not just 9 months
✔Healthy eating behaviors require the
ability to access, select and prepare food
and beverages
✔Healthy eating patterns for women and
families
✔Community environments need to support
active living and healthy eating behaviors

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Hunger and Food Insecurity
✔Assess hunger, food insecurity and other
factors that reduce women’s ability to eat
well.
✔Be aware of and make referrals to
programs within the community that
assist families with limited resources.
✔WIC

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Special Supplemental Nutrition Program for
Women, Infants and Children (WIC)
✔The recognition that nutrition impacts
infant mortality led to the development
WIC.
✔WIC does reduce conditions associated
with infant mortality such as low
birthweight.
✔Infants born to mothers enrolled in WIC
are also less likely to die from genetic
conditions or delivery complications.
A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Preconception Care and Pregnancy
✔Educating on the importance of folic acid
✔Addressing hunger and food insecurity
✔Encouraging women to reach and maintain
healthy body weight prior to pregnancy
✔Encouraging appropriate weight gain
during pregnancy
✔Educating on importance of breastfeeding
and baby behavior.

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Summary
✔Nutrition is an essential component of efforts to reduce infant
mortality and should be integrated into activities directed at
reducing infant mortality.

✔While a focus on nutrition alone is insufficient to eliminate infant

mortality, efforts to reduce infant mortality will only be effective if
nutrition is part of a comprehensive effort.

✔Available data and current practice reinforces the importance of

nutrition prior to and during pregnancy.

✔However, evidence also indicates that supporting healthy eating and

appropriate weight gain during pregnancy is not being done
consistently.

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Nutrition and Infant Mortality Resources
✔ The Role of Nutrition in Infant Mortality: A Public
Health Perspective
✔Association of State Public Health Nutritionists MCH
Council, Winter 2013
✔Available at www.asphn.org/resource_read.php?
resource_id=577

✔National Maternal and Infant Nutrition Intensive

Course
✔On-site and distance education options
✔http://sph.umn.edu/ce/mnic/

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S
Suggested Readings
✔Maternal Nutrition and Infant Mortality in the Context of Relationality by Michael
C. Lu and Jessica S. Lu (2007) Joint Center for Political and Economic Studies
✔The US Infant Mortality Rate: International Comparisons, Underlying Factors, and
Federal Programs by Elayne J. Heisler (April 4, 2012) Congressional Research
Service
✔MacDorman MF. Race and ethnic disparities in fetal mortality, preterm birth, and
infant mortality in the United States: an overview. Smein Perinatol. 2011;35:200-
208
✔Slavig JD, Lamont RF. Evidence regarding and effect of marine n-3 fatty acids on
preterm birth: a systematic review and meta-analysis. Acta Obst Gynec.
2011;90:825-838
✔Savitz DA, et al. Behavioral influences on preterm birth: Integrated analysis of the
Pregnancy, Infection and Nutrition Study. Matern Child Health J. 2012;16:1151-
1163.
✔Dunlop AL, et al. Racial disparities in preterm birth: an overview of the potential
role of nutrient deficiencies. Acta Obst Gynec Scand. 2011; 90:1332-1341.

A S S O C I AT I O N O F S TAT E P U B L I C H E A LT H N U T R I T I O N I S T S