Chapter 15 Maternal and Fetal Nutrition Copyright 2016

Learning Objectives • Discuss recommendations for maternal weight gain during pregnancy. • Compare the

Key Components of Preconception and Prenatal Nutritional Care • Nutrition assessment, including appropriate weight

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Nutrient Needs Before Conception • Healthy diet ensures adequate nutrients for developing fetus •

Nutrient Needs During Pregnancy • Dietary reference intakes (DRIs) • Energy needs • Body

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Weight Gain During Pregnancy • Determined by PRE-Pregnancy wt for height • Underweight BMI-

Nutrient Needs During Pregnancy (Cont. ) • Omega-3 fatty acids • Minerals and vitamins

Nutrient Needs During Pregnancy (Cont. ) • • • Calcium Magnesium Sodium Potassium Zinc

Nutrient Needs During Pregnancy (Cont. ) • Minerals and vitamins (Cont. ) • Fat-soluble

Other Nutritional Issues During Pregnancy • Alcohol • There is no safe amount or

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Other Nutritional Issues During Pregnancy (Cont. ) • Adolescent pregnancy needs focus on improving

Care Management • Assessment • • • Obstetric and gynecologic effects on nutrition Diet

Nutritional Care and Teaching • Programs for women with limited financial resources • SNAP

Nutritional Care and Teaching (Cont. ) Nutrition-related concerns during pregnancy Ø Iron supplementation Nutrition-related

Nutritional Care and Teaching (Cont. ) • Vegetarian diets • Consuming a variety of

Postpartum Nutrition • Lose the weight gained during pregnancy. • Appropriate weight loss goals

Nutrient Needs During Lactation • Similar to those during pregnancy • Needs for energy,

Key Points • A woman’s nutritional status before, during, and after pregnancy contributes, to

Key Points (Cont. ) • The appropriateness of the woman’s prepregnancy weight for height

Key Points (Cont. ) • Food safety is important for pregnant women to prevent

Key Points (Cont. ) • Pregnancy complications that can be nutritionrelated include anemia, gestational

Question 1. A woman in week 34 of gestation reports that she is very

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Learning Objectives • Discuss recommendations for maternal weight gain during pregnancy. • Compare the recommended level of intake of energy sources, protein, and key vitamins and minerals during pregnancy and lactation. • Give examples of the food sources that provide the nutrients required for optimal maternal nutrition during pregnancy and lactation. • Examine the role of nutritional supplements during pregnancy. • List nutritional risk factors during pregnancy. • Analyze examples of eating patterns of women from two different ethnic or cultural backgrounds, and identify potential dietary concerns. Assess nutritional status during pregnancy. • Discuss nutritional considerations for pregnant women who are obese and those who have had bariatric surgery. Copyright © 2016 by Elsevier Inc. All rights reserved. 2

Key Components of Preconception and Prenatal Nutritional Care • Nutrition assessment, including appropriate weight for height, dietary intake and habits, and preexisting issues that can affect nutritional status • Diagnosis of nutrition-related problems or risk factors such as diabetes and obesity • Interventions to promote appropriate weight gain, ingestion of a variety of foods, appropriate use of dietary supplements, and physical activity • Evaluation as an integral part of the nursing care provided to women during the preconception period and pregnancy, with referral to a nutritionist or dietitian as necessary Copyright © 2016 by Elsevier Inc. All rights reserved. 3

Nutrient Needs Before Conception • Healthy diet ensures adequate nutrients for developing fetus • First trimester critical in terms of embryonic and fetal development • Folic acid intake • 0. 4 mg in fortified foods recommended • Neural tube defects can occur with poor intake • Desirable body weight reduces maternal and fetal risks Copyright © 2016 by Elsevier Inc. All rights reserved. 5

Nutrient Needs During Pregnancy • Dietary reference intakes (DRIs) • Energy needs • Body mass index • Weight gain • Pattern of weight gain • Hazards of restricting adequate weight gain • Excessive weight gain • Protein • Fluids Copyright © 2016 by Elsevier Inc. All rights reserved. 6

Weight Gain During Pregnancy • Determined by PRE-Pregnancy wt for height • Underweight BMI- gain 12. 7 -18. 1 kg (28 -40#) • Normal BMI- gain 11. 3 - 15. 9 kg (25 -35#) • Overweight BMI- gain 6. 8 -11. 3 kg(15 -25#) • Obese gain 5 -9. 1 kg (11 -20#) • Hazards of restricting adequate weight gain • Pregnancy is not a time for weight reduction • Quality of weight gain is important –eat nutrient rich foods • Risk of PTL Copyright © 2016 by Elsevier Inc. All rights reserved. 8

Nutrient Needs During Pregnancy (Cont. ) • Omega-3 fatty acids • Minerals and vitamins • Iron • Physiologic anemia Plasma volume increases more than RBC mass • Excessive plasma causes a modest decrease in H/H Copyright © 2016 by Elsevier Inc. All rights reserved. 9

Nutrient Needs During Pregnancy (Cont. ) • Minerals and vitamins (Cont. ) • Fat-soluble vitamins • Water-soluble vitamins • • Folate and folic acid Vitamin C Vitamin B 6 Vitamin B 12 • Multivitamin-multimineral supplements during pregnancy Copyright © 2016 by Elsevier Inc. All rights reserved. 11

Other Nutritional Issues During Pregnancy • Alcohol • There is no safe amount or type of alcohol during pregnancy, and there is no time during pregnancy when alcohol consumption is without risk. • Caffeine • Data unclear • General recommendation of no more than 200 mg of caffeine a day • Artificial sweeteners • Pica and food cravings Copyright © 2016 by Elsevier Inc. All rights reserved. 12

Other Nutritional Issues During Pregnancy (Cont. ) • Adolescent pregnancy needs focus on improving • Nutrition knowledge • Meal planning • Food preparation • Access to prenatal care • Nutritional interventions • Educational programs • Physical activity during pregnancy • Factors to consider prior to exercise • • Dehydration Calorie intake Copyright © 2016 by Elsevier Inc. All rights reserved. 14

Care Management • Assessment • • • Obstetric and gynecologic effects on nutrition Diet history Health history Usual maternal diet Physical examination • Anthropometric (body) measurements • Laboratory testing • Anemia Copyright © 2016 by Elsevier Inc. All rights reserved. 15

Nutritional Care and Teaching • Programs for women with limited financial resources • SNAP • WIC • Daily food guide and menu planning • My. Plate program • Food safety • Medical nutrition therapy Copyright © 2016 by Elsevier Inc. All rights reserved. 16

Nutritional Care and Teaching (Cont. ) Nutrition-related concerns during pregnancy Ø Iron supplementation Nutrition-related discomforts of pregnancy Ø Nausea and vomiting Ø Constipation Ø Heartburn (pyrosis) Copyright © 2016 by Elsevier Inc. All rights reserved. 17

Nutritional Care and Teaching (Cont. ) • Vegetarian diets • Consuming a variety of different plant proteins— grains, dried beans and peas, nuts, and seeds—on a daily basis can provide all of the essential amino acids. • Cultural influences • Nurse should be aware of what constitutes a typical diet for each cultural or ethnic group. Copyright © 2016 by Elsevier Inc. All rights reserved. 18

Postpartum Nutrition • Lose the weight gained during pregnancy. • Appropriate weight loss goals • Nonlactating women— 0. 5 to 0. 9 kg per week • Lactating women— 1 kg per month • Attain a healthy weight. • Weight loss and breastfeeding Copyright © 2016 by Elsevier Inc. All rights reserved. 19

Nutrient Needs During Lactation • Similar to those during pregnancy • Needs for energy, protein, vitamins, minerals are greater than nonpregnant needs • The recommended energy intake for the first 6 months PP is 330 kcal more than nonpregnant intake. • The AAP recommends that breastfeeding women who are well nourished should add 450 to 500 kcal/day to a balanced diet. • Adequate fluid intake • Avoid smoking, alcohol, and excessive caffeine Copyright © 2016 by Elsevier Inc. All rights reserved. 20

Key Points • A woman’s nutritional status before, during, and after pregnancy contributes, to a significant degree, to her well-being and that of her developing fetus and newborn. • Many physiologic changes occurring during pregnancy influence the need for additional nutrients and the efficiency with which the body uses them. • Both the total maternal weight gain and the pattern of weight gain are important determinants of the outcome of pregnancy. Copyright © 2016 by Elsevier Inc. All rights reserved. 21

Key Points (Cont. ) • The appropriateness of the woman’s prepregnancy weight for height (BMI) is a major determinant of her recommended weight gain during pregnancy. • Nutritional risk factors include adolescent pregnancy; abuse of nicotine, alcohol, or drugs; bizarre or faddish food habits; a low or high weight for height; and frequent pregnancies. • Iron supplementation is usually routinely recommended during pregnancy. Other supplements may be warranted when nutritional risk factors are present. Copyright © 2016 by Elsevier Inc. All rights reserved. 22

Key Points (Cont. ) • Food safety is important for pregnant women to prevent adverse maternal and fetal effects. • Women who are pregnant should consume seafood that is low in methylmercury. • The nurse and the pregnant woman are influenced by cultural and personal values and beliefs during nutrition counseling. Copyright © 2016 by Elsevier Inc. All rights reserved. 23

Key Points (Cont. ) • Pregnancy complications that can be nutritionrelated include anemia, gestational hypertension, gestational diabetes, and IUGR. • Dietary modifications can be effective interventions for some of the common discomforts of pregnancy, including nausea and vomiting, constipation, and heartburn. Copyright © 2016 by Elsevier Inc. All rights reserved. 24

Question 1. A woman in week 34 of gestation reports that she is very uncomfortable because of heartburn. The nurse suggests that the woman: a. Substitute other calcium sources for milk in her diet b. Lie down after each meal c. Reduce the amount of fiber she consumes d. Eat five small meals daily Copyright © 2016 by Elsevier Inc. All rights reserved. 25