WIC Nutrition Risk Criteria A Scientific Assessment (1996) / Chapter Skim
Currently Skimming:
5 BIOCHEMICAL AND OTHER MEDICAL RISK CRITERIA
5 BIOCHEMICAL AND OTHER MEDICAL RISK CRITERIA
Pages 149-250
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 149... ...
WIC program regulations define this group of nutrition risks in two categories: · those determined by biochemical measures such as hemoglobin as a measure of Armenia, and · other documented nutritionally related medical conditions, such as clinical signs of nutrition deficiencies, metabolic disorders, preeclampsia in pregnant women, failure to thrive in an infant, chronic infections in ally person, alcohol or drug abuse or mental retardation in women, lead poisoning, history of high-risk pregnancies or factors associated with high-risk pregnancies (such as smoking; conception before 16 months postpartum; history of low birth weight, premature births, or neonatal loss; adolescent pregnancy; or current multiple pregnancy) in pregnant women, or congenital malformations in infants or children or infants born to women with alcohol or drug abuse histories or mental retardation (7 CFR Subpart C, Section 246.7(e)
|
From page 150... ...
A summary of the criteria as predictors of risk and benefit appears in Table 5-2. TABLE 5-1 Summary of Biochemical and Other Medical Risk Criteria in the WIC Program and Use by States States Using Women Infants Children Risk Criterion Criteria Related to Nutrient Deficiencies Anemia Nutrient deficiencies including failure to thrive Malnutrition Nutrition related illness Failure to thrive 54 54 54 8 25 30 8 27 27 Medical Conditions Applicable to the Entire WIC Population Gastrointestinal disorders 13 30 24 Nausea and vomiting of pregnancy 26 Chronic diarrhea - 16 15 Chronic vomiting 15 7 Crohn's disease 7 Liver disease 15 14 Hepatitis 18 14 Intestinal diseases 6 7 Cystic fibrosis 30 32 Endocrine disorders 6 Diabetes mellitus (Types I and II)
|
From page 151... ...
. Medical Conditions Applicable to the Entire WIC Population (ContinuedJ Chronic hypertension 54 19 25 Renal disease 54 35 35 Cancer 20 26 30 Central nervous system disorders 12 10 Epilepsy Cerebral palsy Spina bifida Myelomeningocele Genetic and congenital disorders Cleft lip or palate Down syndrome Pyloric stenosis Thalassemia Sickle cell anemia History of an infant with congenital disorder History of a genetic disorder in infant Nutritionally significant genetic disease Congenital disorder Genetic disorder Inborn errors of metabolism Phenylketonuria Maple syrup urine disease Galactosemia Metabolic disorder Tyrosinemia and homocystinuria Other inborn errors of metabolism Chronic infections Recurrent infections Infectious disorder Nutrition-related infectious disease Respiratory infections Tuberculosis Pneumonia Bronchitis Otitis media Meningitis HIV infection and AIDS Recent surgery or trauma Burns Severe acute infections Other medical conditions Juvenile rheumatoid arthritis Arthritis 6 36 12 21 6 37 13 6 38 39 10 41 16 7 14 6 16 20 21 32 17 37 29 28 12 15 26 13 19 32 24 7 19 52 21 25 28 14 12 25 19 7 21 14 20 22 28 24 18 10 28 20 10 '11 9 19 25 18 12 19 15 20 27 24 Continued
|
From page 152... ...
152 TABLE 5-1 Continued WIC NUTRITION RISK CRITERIA Risk Criterion States Using Women Infants Children Medical Conditions Applicable to the Entire WIC Population (Continued9 Lupus erythematosus 6 _ . Cardiorespiratory disorders 17 37 38 Conditions Related to the Intake of Specific Foods Food allergies 27 29 34 Celiae disease or intolerance 24 24 Food intolerances Lactose intolerance Asthma Conditions Specific to Pregnancy Pregnancy at a young age Pregnancy age older than 35 Closely spaced pregnancies High parity History of pretend delivery History of postterm delivery History of low birth weight History of neonatal loss History of previous birth of an infant with a congenital or birth defect Lack of prenatal care Multifetal gestation Fetal growth restriction Preeelampsia and eelampsia Placental abnormalities Conditions Specific to Infants and/or Children Prematurity Hypoglycemia Fetal alcohol syndrome Potentially Toxic Substances Drug-nutrient interactions Inappropriate use of medication 20 16 6 8 52 43 52 43 42 8 _ 49 43 32 18 51 17 54 15 39 6 12 12 9 9 23 23 Maternal smoking 51 Alcohol and illegal drug use Alcohol use 51 36 23 Illegal drug use 50 36 23 Lead poisoning 19 24 24 NOTE: Dashes indicate risk is not applicable or not reported for that population.
|
From page 153... ...
O Lack of prenatal care ~ ` Multifetal gestation '/ Feta} growth restriction ` Preeclampsia and eclampsia ~ O Placental abnormalities ~ O Maternal smoking ~ ? Alcohol andillegal drug use `/ ~ Continued
|
From page 154... ...
a Within the broad category chronic or recurring infections, there is evidence for nutrition risk and benefit for some specific criteria, such as tuberculosis, but not for other specific criteria, such as upper respiratory infections, bronchitis, and otitis media. The same is true within the broad categories drug-nutrient interactions and food intolerances.
|
From page 155... ...
Anemia as an Indicator of Nutrition and Health Risk Anemia can impair energy metabolism, temperature regulation, immune function, and work performance (IOM, 1993~. Anemia during pregnancy may increase the risk of prematurity, poor maternal weight gain, LBW, and infant mortality (IOM, 1990~.
|
From page 156... ...
are at increased risk for iron deficiency anemia, their potential to benefit through participation in the WIC program is clear. Iron is one of the nutrients targeted in the WIC program food package through the provision of iron-fortified cereals and infant formula.
|
From page 157... ...
. Use of Anemia as a Nutrition Risk Criterion in the WIC Setting Measurement of either hemoglobin or hematocrit concentration is used to detect the presence of anemia or putative iron deficiency because both are easy to use and inexpensive.
|
From page 158... ...
SOURCE: WIC program cutoff values reported in 1992 state plans (USDA, 1994~; CDC guidelines for pregnant women (CDC, 1989~; Report of the Committee on the Prevention, Management, and Treatment of Iron Deficiency Anemia Among U.S. Infants, Children, and Women of Childbearing Age (IOM, 1993~.
|
From page 159... ...
Therefore, the committee recommends use of anemia as a nutrition risk criterion for women, infants, and children in the WIC program, using cutoff values from the CDC (1989)
|
From page 160... ...
160 so o ._ as o C: 3 ._ C)
|
From page 161... ...
161 S ' N~N Cal > o ~ ~k _ ~- C.; Cal C ° C o S hO CJ - - Sot ~ ~ UP Cat C} V: Vat Cat o o Vat o Vat - -- o V)
|
From page 164... ...
Failure to Thrive and Other Nutrient Deficiency Diseases as Indicators of Nutrition and Health Risk The presence of clinical signs and symptoms of PEM or of specific micronutrient deficiencies indicates current nutrition and health risks. Persistent malnutrition may lead to elevated morbidity and mortality rates.
|
From page 165... ...
Data on the benefit of participation in the WIC program for those identified as being at risk of nutrient deficiency diseases were not available to the committee. Use of Failure to Thrive and Other Nutrient Deficiency Diseases as Nutrition Risk Criteria in the WIC Setting The diagnosis of most nutrient deficiency diseases, including failure to thrive, is based on clinical evidence (including laboratory or radiological findings)
|
From page 166... ...
Quality of the water supply, sanitation systems, and household food preparation habits are environmental factors associated with gastrointestinal disorders (Luster et al., 1992~. Prevalence of and Risks Associated with Specif c Gastrointestinal Disorders Nausea and vomiting of pregnancy.
|
From page 167... ...
Gastrointestinal Disorders as Indicators of Nutrition and Health Risk Gastrointestinal disorders increase nutrition risk through any of a variety of mechanisms: impaired food intake, abnormal deglutition, impaired digestion of food in the intestinal lumen, generalized or specific nutrient malabsorption, or excessive gastrointestinal losses of endogenous fluids and nutrients. Nutrient intake may need to be increased to correct existing deficiencies or to counterbalance excessive losses of nutrients or fluid.
|
From page 168... ...
are used as nutrition risk criteria by state WIC agencies. Recommendations for Gastrointestinal Disorders The risk of chronic gastrointestinal disorders is well documented among women, infants, and children, and clinical methods are available to identify these risk criteria.
|
From page 169... ...
Gestational diabetes refers to diabetes mellitus that is diagnosed during pregnancy; in most cases it is non-insulin-dependent. Prevalence of and Factors Associated with Diabetes Mellitus More than 13 million persons in the United States have diabetes mellitus, and 60 percent of newly diagnosed cases occur in women (Tinker, 1994~.
|
From page 170... ...
Use of Diabetes Mellitus as a Nutrition Risk Criterion in the WIC Setting A health care provider reports the diagnosis of diabetes mellitus to WIC program staff. Table 5-1 lists the use of this nutrition risk criterion by state WIC programs.
|
From page 171... ...
Nutrition education and referrals to health care and social services may also assist individuals in managing their condition. Use of Thyroid Disorders as a Risk Criterion in the WIC Setting The diagnosis of hypo- or hyperthyroidism is performed by a health care provider, and the diagnosis is reported to WIC program staff.
|
From page 172... ...
Therefore, the committee recommends that the WIC program use hypo- and hyperthyroidism as nutrition risk criteria for women, infants, and children in the WIC program. Chronic Hypertension Hypertension is defined as elevated arterial blood pressure measured indirectly by an inflatable cuff and pressure manometer (NRC, 1989~.
|
From page 173... ...
See Table 5-1 for the use of hypertension as a nutrition risk criterion in the WIC program.
|
From page 174... ...
Therefore, the committee recommends the use of chronic hypertension as a nutrition risk criterion for women, infants, and children in the WIC program. Renal Disease Either acute or chronic renal disease may complicate pregnancy.
|
From page 175... ...
Use of Renal Disease as a Risk Criterion in the WIC Setting Renal disease is diagnosed by a medical care provider and reported to WIC agency staff. See Table 5-1 for the use of renal disease as a nutrition risk criterion in the WIC program.
|
From page 176... ...
Use of Cancer as a Risk Criterion in the WIC Setting A diagnosis of cancer is made by a health care provider and reported to WIC agency staff. See Table 5-1 for use of this criterion by state WIC programs.
|
From page 177... ...
The prevalence of cerebral palsy is approximately 2 per 1,000 live births, with cases occurring more than twice as often in whites as in blacks. Factors associated with CP are LOW and birth asphyxia.
|
From page 178... ...
Women, infants, and children with epilepsy, cerebral palsy, or NTDs can benefit from participation in the WIC program by the provision of nutritious supplemental food, nutrition education, and referrals to health care and social services. Use of Central Nervous System Disorders as a Risk Criterion in the WIC Setting CNS disorders are diagnosed by a health care provider and reported to WIC agency staff.
|
From page 179... ...
. Prevalence of and Factors Associated with Genetic and Congenital Disorders Approximately 0.5 to 1 percent of infants have a hereditary malformation at birth that causes no physical or metabolic abnormality.
|
From page 180... ...
Genetic and Congenital Disorders as Indicators of Nutrition and Health Benefit For infants and children with these disorders, special attention to nutrition may be essential to achieve adequate growth and development and to maintain their health. The WIC program can provide supplemental food, special formula as appropriate, general nutrition and health education, and improved linkages with health care and social services.
|
From page 181... ...
Therefore, the committee recommends use of genetic or congenital disorders as nutrition risk criteria for women, infants, and children in the WIC program. This includes the use of specific disorders discussed in this section, except for pyloric stenosis.
|
From page 182... ...
Inborn Errors of Metabolism as Indicators of Nutrition and Health Risk Untreated pregnant women with certain inborn errors of metabolism have a higher risk of spontaneous abortion or other health or nutrition risks. Infants born to mothers with untreated PKU may show fetal growth restriction, microcephaly, LBW, and congenital heart disease (Barness, 1993; Rohr et al., 1985~.
|
From page 183... ...
Therefore, the committee recommends use of PKU and other inborn errors of metabolism as nutrition risk criteria for women, infants, and children in the WIC program. Chronic or Recurrent Infections The relationship between nutrition and infection has been appreciated for centuries: tuberculosis was known as "consumption," and HIV/AIDS was categorized as "slim disease" when first discovered in East Africa (Keusch, 1994~.
|
From page 184... ...
The committee recommends use of selected chronic or recurrent infections as a nutrition risk criterion for women,
|
From page 185... ...
The committee recommends discontinuation of chronic upper respiratory infections, bronchitis, otitis media, and chronic urinary tract infection (see earlier section) as nutrition risk criteria in the WIC program because of lack of scientific evidence to support nutrition benefit.
|
From page 186... ...
HI V/AIDS as an Indicator of Nutrition and Health Benefit Some prospective, observational evidence, mainly obtained from studies on homosexual men, indicates that optimizing nutrition among individuals with
|
From page 187... ...
Use of HIV/AIDS as a Nutrition Risk Criterion in the WIC Setting Health care providers report diagnoses of HIV infection or AIDS to WIC program staff. Table 5-1 lists the numbers of states using this diagnosis as a nutrition risk criterion.
|
From page 188... ...
The variability in the metabolic and physiologic responses to major surgery, trauma, burns, and severe acute infections is related in part to the patient's age, previous state of health, preexisting disease, previous stress, and specific pathogens. Prevalence of and Factors Associated with Recent Major Surgery, Trauma, Burns, or Severe Acute Infections Data on the prevalence of recent major surgery, trauma, burns, or severe acute infections among women, infants, and children in the U.S.
|
From page 189... ...
Supplemental food supplied by the WIC program is a source of key nutrients. Use of Recent Major Surger, Trauma, Burns, or Severe Acute Infections as Nutrition Risk Criteria in the WIC Setting Recent major surgery, trauma, burns, or severe acute infections are diagnosed by a health care provider and reported to WIC program staff or are selfreported during the certification process for participation in the WIC program, or at follow-up visits.
|
From page 190... ...
Pregnant women with lupus erythematosus are at increased risk of late pregnancy losses (after 28 weeks gestation) secondary to hypertension and renal failure, of cardiac defects or heart block in the fetus, and spontaneous abortion (Ferris and Reece, 1994~.
|
From page 191... ...
Note that JRA has not been used as a nutrition risk criterion in the WIC by state WIC agencies for infants or children (USDA, 1994~. Recommendations for Other Medical Conditions The risks of juvenile rheumatoid arthritis, lupus erythematosus, and cardiorespiratory disorders are documented in women, infants, and children, and they can be identified by a clinical diagnosis.
|
From page 192... ...
The prevalence of food allergies among the WIC population was not available to the committee. Food Allergies as Indicators of Nutrition and Health Risk Atopic diseases such as asthma, allergic rhinitis, and atopic dermatitis can all be precipitated by antigenic foods.
|
From page 193... ...
Use of Food Intolerances as Nutrition Risk Criteria in the WIC Setting Diagnosis of food intolerance is reported to the WIC agency by a health care provider. Table 5-1 lists use of food intolerance as a nutrition risk criterion by WIC state agencies.
|
From page 194... ...
Use of Pregnancy at a Young Age as a Risk Criterion in the WIC Setting Table S- 1 lists the use of pregnancy at a young age as a nutrition risk criterion by state WIC programs. Cutoff points in use include conception at a specified number of years postmenarche and specific actual ages at conception.
|
From page 195... ...
Use of Risk of Food Allergies as Nutrition Risk Criteria in the WIC Setting Food allergies are diagnosed by a physician and reported to the WIC program. Table 5-1 lists the use of food allergies as a nutrition risk criterion by state WIC agencies.
|
From page 196... ...
Therefore, the committee recommends use offood allergy and celiac disease as nutrition risk criteria for women, infants, and children in the WIC program. Food Intolerances Food intolerances occur through many different mechanisms.
|
From page 197... ...
However, there is no theoretical or empirical basis for benefit from participation in the WIC program. Therefore, the committee recommends discontinuation of use of pregnancy age older than 35 years as a nutrition risk criterion for women in the WIC program.
|
From page 198... ...
Closely Spaced Pregnancies as an Indicator of Nutrition and Health Risk Mothers with closely spaced pregnancies have little time to recover from the physiologic and nutrition demands of the previous pregnancy. If such women are also breastfeeding, any negative effects of lactation on maternal nutritional status may further increase the risks of adverse outcomes of pregnancy, such as prematurity or fetal growth restriction (Cleland and Sathar, 1984; Hobcraft et al., 1985~.
|
From page 199... ...
Closely Spaced Pregnancies as an Indicator of Nutrition and Health Benefit The shorter the time between pregnancies, the shorter the time for repletion of nutrient stores. As reported in Chapter 4, women who received postpartum WIC program benefits for 5 to 7 months delivered infants with higher mean birth weights and birth lengths and a lower risk of low birth weight (Caan et al., 1987)
|
From page 200... ...
Closely spaced pregnancies can be identified using information easily available through self-report and the patient's record. The committee recommends use of closely spaced pregnancies as a nutrition risk criterion for pregnant women, using a 6-month interpregnancy interval as the usual cutoff point, but increasing the cutoff point to a 9-month interpregnancy interval for women who are concurrently pregnant and lactating.
|
From page 201... ...
The rationale typically offered for expecting poorer pregnancy outcomes for women of high parity is maternal depletion (Merchant and Martorell, 1988~. High parity implies frequent, and often closely-spaced, pregnancies, which could result in a deterioration in maternal nutrition status and increased risks of intrauterine growth retardation, low birth weight, and poor lactation performance.
|
From page 202... ...
Many studies find interaction effects of parity and age and parity and short interpregnancy birth interval on birth weight. In particular, multiparity increases the risk of low birth weight for women under age 20, although the independent effects of parity and short interpregnancy intervals for young women are diff~cult to disentangle (Kramer, 1987; MacLeod and Kiely, 1988~.
|
From page 203... ...
Use of High Parity in the WIC Setting State WIC agencies typically define high parity on the basis of the number of previous pregnancies and rely on self-report. Table 5-1 indicates the extent to which state WIC agencies use high parity as a risk criterion.
|
From page 204... ...
Empirical evidence on the interactions of high parity with both age and short interpregnancy interval does suggest significant risks associated with high parity at young ages and high parity with short interpregnancy intervals. The committee recommends that consideration be given to the development of a nutrition risk criterion that reflects the combination of high parity and other nutrition risk criteria, such as age and interpregnancy interval.
|
From page 205... ...
Use of History of Preterm Delivery as a Nutrition Risk Criterion in the WIC Setting Table 5-1 lists the use of history of preterm delivery by state WIC programs. Recommendation for History of Preterm Delivery The risk of history of preterm delivery is well documented in women, and it can be identified from medical records or self-report.
|
From page 206... ...
Therefore, the committee recommends discontinuation of use of history of Postterm delivery as a nutrition risk criterion for women by state WIC programs. History of Low Birth Weight Low birth weight (see section "Low Birth Weight" in Chapter 4)
|
From page 207... ...
There is some basis for anticipating benefit from nutritional intervention in case of preteen birth and fetal growth restriction. Since a history of LBW identifies women at increased risk for either of these two conditions, the committee recommends use of a history of LBW as a nutrition risk criterion.
|
From page 208... ...
The potential to benefit from WIC program participation is uncertain. The committee recommends use of history of a previous birth of an infant with a congenital or birth defect, particularly a neural tube defect, as a nutrition risk criterion for pregnant women.
|
From page 209... ...
Use of Lack of Prenatal Care as a Nutrition Risk Criterion in the WIC Setting According to 1992 state plans, lack of prenatal care or inadequate prenatal care is used as a risk criterion in 18 state WIC agencies (USDA, 1994~. Cutoffs for establishing the presence of this risk criterion in the WIC program are generally based on the interval between conception and initiation of prenatal care or less than a specified number of prenatal care visits at a stated length of gesta tion.
|
From page 210... ...
Therefore, the committee recommends use of lack of prenatal care or inadequate prenatal care as a nutrition risk criterion for women in the WIC program, with a cutoff value of care beginning after the first trimester or long intervals between additional visits (see AAP-ACOG, 1992~. In addition, the committee recommends that its relative priority be reduced to priority level VII.
|
From page 211... ...
Use of Multifetal Gestation in the WIC Setting Multifetal gestation is generally determined via sonography and reported to WIC by the health care provider. Multifetal gestation is used as a nutrition risk criterion in the WIC by 51 state WIC agencies (USDA, 1994~.
|
From page 212... ...
Therefore, the committee recommends use of fetal growth restriction as a nutrition risk criterion for pregnant women in the WIC program.
|
From page 213... ...
As a risk criterion for pregnant women in the WIC program, Preeclampsia or eclampsia is used by all state WIC agencies (USDA, 1994~.
|
From page 214... ...
Therefore, the committee recommends discontinuation of use of preeclampsia or eclampsia as a nutrition risk criterion for pregnant women in the WIC program. Placental Abnormalities Prevalence of and Factors Associated with Placental Abnormalities The placenta normally implants in the uterine fundus and remains attached until after delivery of the infant.
|
From page 215... ...
There is no theoretical basis for benefit from participation in the WIC program. Therefore, the committee recommends discontinuation of use of placental abnormalities as a nutrition risk criterion for women in the WIC program.
|
From page 216... ...
Therefore, the committee recommends the use of prematurity as a nutrition risk criterion for infants, with a cutoff value of 37 weeks; but it recommends discontinuation of prematurity as a nutrition risk criterion for children.
|
From page 217... ...
Hypoglycemia as an Indicator of Nutrition and Health Benefit Nutrition management for infants and children with hypoglycemia must concentrate on frequent feedings and the provision of adequate glucose and nutrients to prevent deficiencies and to support adequate growth. Use of Hypoglycemia as a Risk Criterion in the WIC Setting Table 5-1 lists the number of states that use hypoglycemia as a nutrition risk criterion in the WIC.
|
From page 218... ...
Pathophysiologic interactions include those in which drugs, through their toxicologic effect, cause cellular damage so that nutrients cannot be activated within, used by, stored in, or removed from the body. Prevalence and Factors Associated with Drug-Nutrient Interactions or Misuse of Medications Prescription or over-the-counter drugs are widely used, and are sometimes misused.
|
From page 219... ...
daily from supplements was associated with increased risk of cranial-neural-crest origin birth defects (Rothman et al., 1995~. Use of some prescription or over-the-counter drugs is not advisable when breastteeding because of health risks to the infant, as covered in detail by the Committee on Drugs of the American Academy of Pediatrics (COD-AAP, 1 994~.
|
From page 220... ...
However, the potential to benefit is divided between those drugs for which a clear nutrient interaction is present, and those for which the interaction is weak or unclear. Therefore, the committee recommends use of drug-nutrient interactions or misuse of medications as a nutrition risk criterion for pregnant and lactating women in the WIC program, but only for a predetermined listing of pharmaceutical agents that have a known direct effect on nutrition.
|
From page 221... ...
According to WIC program data, in 1986, approximately 12 percent of pregnant women participating in the WIC program were certified using smoking as a nutrition risk criterion in the WIC program (USDA, 1987) , and 16 percent were certified on the same basis in 1988 (USDA, 1994~.
|
From page 222... ...
Evidence is equivocal that maternal smoking during pregnancy has important long-term negative effects on the growth, development, behavior, and cognition of the infant, in addition to its fetal effects. The most consistent predictors of fetal growth restriction are small maternal size, low maternal weight gain, history of previous low-birth-weight infant, and smoking (Kramer, 1987~.
|
From page 223... ...
Naeye (1978, 1981a, b) reported that, at least among heavy smokers, maternal weight gains are independent of either fetal or placental weight.
|
From page 224... ...
have shown beneficial effects of supplementation on weight gains and birth weights (Adair and Pollitt 1985; Prentice 1991; Smith 1992~. Since nutritional factors could be partially responsible for the low birth weight in the offspring of women who smoke, supplementary feeding of pregnant women who smoke may reduce their risk of delivering a low-birth-weight infant.
|
From page 225... ...
The lack of scientific evidence as to appropriate cutoff points relative to the potential for women who smoke during pregnancy or lactation from to benefit from the WIC program makes setting a cutoff point difficult. Therefore, as an interim approach, the committee recommends maternal smoking as a nutrition risk criterion for pregnant and lactating women in the state WIC program, with a cutoff of"any smoking." However, the committee recommends that this criterion be given lower priority, comparable to that of the predisposing risk category that is currently in use.2 The committee further recommends (l)
|
From page 226... ...
Fetal growth restriction has been noted, although inconsistently, at levels of alcohol ingestion of l to 2 oz/day (Hanson et al., 1978; Little, 1977; Wright et al., 19839. Postnatal growth may be adversely affected in children who do not have full FAS.
|
From page 227... ...
Estimates of the prevalence of marijuana use during pregnancy have ranged from 10 to 27 percent in hospital-based studies (Hatch and Bracken, 1986; Linn et al., 1983; Zuckerman et al., 1989~. Illegal Drug Use as an Indicator of Nutrition and Health Risk There is growing evidence that cocaine use during pregnancy is associated with both preterm delivery and fetal growth restriction as well as spontaneous abortion and abruptio placentae (IOM, 1990~.
|
From page 228... ...
Use of Alcohol and Illegal Drug Use as Risk Indicators in the WIC Setting History of alcohol or drug use through self-reports or written referrals are used to document these risks in the WIC setting. See Table 5-1 for state WIC agencies using these nutrition risk indicators.
|
From page 229... ...
For women and children, pica can include the ingestion of lead-containing toxic substances (see also Chapter 6~. Factors associated with lead poisoning include young age, male gender, low income, non-Hispanic black race/ethnicity, poor housing, homelessness, poor nutrition, limited child supervision, and family history of pica 3 Three committee members (Barbara Abrams, Barbara Devaney, and Roy Pitkin)
|
From page 230... ...
Data on the prevalence of lead poisoning among the WIC program population were not available to the committee. Lead Poisoning as an Indicator of Nutrition and Health Risk Lead ingested by pregnant women crosses the placenta and detrimentally affects the developing fetus.
|
From page 231... ...
Adverse effects of higher blood lead concentrations include damage to the central nervous system, kidneys, and hematopoietic system. Lead Poisoning as an Indicator of Nutrition and Health Benefit Adequate intake of calories, calcium, magnesium, iron, zinc, and various vitamins (e.g., thiamin, ascorbic acid, and vitamin E)
|
From page 232... ...
There is empirical evidence and a theoretical basis that those with high lead concentrations can benefit from participation in the WIC program. Therefore, the committee recommends use of lead poisoning as a nutrition risk criterion for women, infants, and children in the WIC program, with the CDC cutoff value of > 10 ~g/dl.
|
From page 233... ...
1995. The role of prenatal care in preventing low birth weight.
|
From page 234... ...
1987. Short interpregnancy interval: A risk factor for low birthweight.
|
From page 235... ...
1993. Prenatal WIC participation can reduce low birth weight and newborn medical costs: A cost-benef~t analysis of WIC participation in North Carolina.
|
From page 236... ...
1976. CigareKe smoking in pregnancy: Associations with maternal weight gain and fetal growth.
|
From page 237... ...
1979. The risk of low birth weight.
|
From page 238... ...
1978. The effects of moderate alcohol consumption during pregnancy on fetal growth and morphogenesis.
|
From page 239... ...
1988. Dose-response of birth weight to various measures of maternal smoking during pregnancy.
|
From page 240... ...
1987. Determinants of low birth weight: Methodological assessment and meta-analysis.
|
From page 241... ...
1977. Moderate alcohol use during pregnancy and decreased infant birth weight.
|
From page 242... ...
1978. How does maternal smoking affect birth weight and maternal weight gain?
|
From page 243... ...
1995. The problem of low birth weight.
|
From page 244... ...
1995. Prevalence of low birth weight and preterm delivery in relation to the interval between pregnancies among white and black women.
|
From page 245... ...
1974. Examination of the relationship between birth weight, cigarette smoking during pregnancy and maternal weight gain.
|
From page 246... ...
Pp. 153-165 in Advances in the Prevention of Low Birth weight: An International Symposium, H
|
From page 247... ...
Report no. 7 in Technical Papers: Review of WIC Nutrition Risk Criteria.
|
From page 248... ...
1983. Alcohol consumption, pregnancy, and low birth weight.
|
From page 249... ...
1989. Effects of maternal marijuana and cocaine use on fetal growth.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.