Nutrition During Pregnancy and Lactation Exploring New Evidence: Proceedings of a Workshop (2020) / Chapter Skim
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9 The Role of Systems and Policies in Providing Solutions to Nutrition Access and Equity During Pregnancy and Lactation
9 The Role of Systems and Policies in Providing Solutions to Nutrition Access and Equity During Pregnancy and Lactation
Pages 119-134
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From page 119... ...
Consideration of social determinants of dietary intakes can help inform interventions at the individual, systems, and population levels. Session 8 of the workshop, moderated by Angela Odoms-Young, associate professor in the Department of Kinesiology and Nutrition and associate director of research, education, and training in the Office of Community Engagement and Neighborhood Health Partnerships at the University of Illinois at Chicago, explored the role of systems and policies in improving nutrition access and equity during pregnancy and lactation.
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. • Fetal exposure to high maternal glucocorticoid concentrations is thought to be a key mechanism for how prenatal stress influences a child's stress architec ture (Keenan)
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Appropriate Frameworks to Guide Research "Addressing inequities in maternal nutrition during pregnancy and lactation requires first an in-depth understanding of the social, economic, physical, and health care systems surrounding pregnant and lactating women and their families across the life course," said Pérez-Escamilla. He added that addressing inequities would also require consideration of the different layers or levels of the social ecological model.
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Examples included breastfeeding, specific healthy food and physical activity policies, and modeling food system improvements. Breastfeeding Over the past several years, breastfeeding rates have continued to improve in the United States (Li et al., 2019)
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(2019) found that implementation of the Baby-Friendly Hospital Initiative in hospitals in Louisiana, Mississippi, Tennessee, and Texas increased breastfeeding initiation, increased exclusive breastfeeding, and decreased the breastfeeding initiation disparities between African American and white infants.
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First, he believed a need exists to determine optimal dietary and physical activity patterns for pregnant and lactating women. Second, he thought further exploration into how different systems can facilitate and support optimal nutrition during these key life stages was needed.
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As such, Keenan's group has taken a prenatal programming perspective in considering the long-term health ramifications of maternal stress during pregnancy. Fetal exposure to high maternal glucocorticoid concentrations is thought to be a key mechanism for how prenatal stress influences a child's stress architecture, noted Keenan.
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FOOD INSECURITY AND STRESS AS COMMON CHALLENGES TO OPTIMAL NUTRITION DURING PREGNANCY Optimal nutrition is critical for maternal well-being, mental health, and physical health, as well as for fetal development, said Barbara Laraia, professor of public health nutrition in the Division of Community Health Sciences at the University of California, Berkeley. Nutrition is strongly influenced by food security and stress, she added to provide context for her remarks.
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. Although all participants gained weight over the course of pregnancy, the intervention group was at greater odds of gaining weight below the Institute of Medicine pregnancy weight gain guidelines.
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Finally, she said that new organizational models facilitating food security during pregnancy would be valuable. HOW WIC SUPPORTS PREGNANCY AND LACTATION In her presentation, Darlena Birch, senior public health nutritionist at the National WIC Association (NWA)
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The organization "defines health equity as the ability of all individuals and families to achieve optimal health, irrespective of their identity, race, ability, or class," she said. Two examples of how WIC addresses health equity are the Breast feeding Peer-Counseling Program and the nutrition support it provides.
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for Families Act seeks to further extend the referral networks by creating partnerships to link community and clinics. Third, the Supporting Healthy Mothers and Infants Act creates federal nutrition education materials for opioid use and neonatal abstinence syndrome.
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While the government had hoped to show that improvements in socioeconomic inequities were a result of program, policies, or universal health care, the analysis revealed that 75 percent could be attributed to economic growth and more equitable distribution of wealth. He said: In the long term, if we don't address the social determinants of health through an equity lens, we are not going to be able to solve this very seri ous public health problem related to the lack of access to healthy dietary, physical activity, and mental health state for many, many low-income women and families in our country.
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QUESTIONS FROM THE AUDIENCE After the panel discussion, session speakers took questions from the audience. Topics covered included international models for nutrition and breastfeeding counseling, WIC eligibility, and community-based participatory research.
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She added that the WIC Act would help to alleviate some of the burden by extending the infant certification period. There have also been suggestions to link databases with Medicaid and SNAP, as these programs require similar paperwork, but Birch indicated that bringing this to fruition has proved challenging.
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