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Maternal and Child Nursing NUR 362 Lecture 4 Why is nutrition so important? Meet increased nutrient demands Provide needed energy Prevent or minimize common pregnancy-related problems Reduce risk of birth defects Supply needed nutrients for baby’s growth Ensure healthy birth weight Maintain a healthy weight Key Components of a Healthy Pregnancy Appropriate weight gain Consumption of a variety of foods Vitamin and mineral supplementation Avoidance of alcohol, tobacco and other harmful substances Safe food handling Recommended Weight Gain Underweight 28-40 lbs Normal weight 25-35 lbs Overweight 15-25 lbs Obese ~ 15 lbs Twins 35-45 lbs Triplets 50 lbs 1 pound = about 0.45 kilograms Normal Pregnancy Weight Gain Breast Blood Extra water Uterus Placenta/amniotic fluid Baby Fat stores Total 1-1.5 lbs 3-4.5 lbs 4-6 lbs 2.5-3.0 lbs 3.5-5.5 lbs 7-8 lbs 4-6.5 lbs 25-35 lbs Risks of Low Weight Gain Low weight gain in second or third trimester increases risk of intrauterine growth retardation Low weight gain in third trimester increases risk of preterm delivery Guidelines for teenagers Higher weight gains and greater postpartum weight retention is common if mother is still growing Maternal growth in multiparous teenagers is associated with lower birth weights Proper nutrition Major Nutrients Carbohydrates Protein Fat Vitamins Minerals Water Special Interest Nutrients Vitamin B12 Generally adequate amounts are obtained through animal products Fish, eggs, milk, meats, etc. Vegans that do not have any animal products in their diet need supplementation Works with folic acid in cell growth and is essential to the normal development of the infant Folic Acid A supplement taken 1-3 months prior to conception and during first 6 weeks gestation reduces the risk of neural tube defects, cleft palate/lip 400 micrograms per day of synthetic folic acid needed per day (pregnant women and those of childbearing age) Needed for rapidly dividing cells, protein metabolism, and formation of red blood cells Iron Needed for the formation of red blood cells 15 milligrams a day for woman during childbearing years recommended Iron supplement (30 mg/d) recommended for pregnant women Calcium Calcium absorption doubles early in pregnancy Is used in the formation of fetal bones Will be absorbed from maternal bones if not enough calcium in diet Calcium absorption increases with Vitamin D Calcium and vitamin D supplements sometimes needed Recommended amounts of calcium during Pregnancy 1200-1500 mg per day Multivitamin and Mineral Supplements Recommended for: Women who smoke Women with iron deficiency anemia or poor quality diets Women who eat animal products rarely or not at all (such as vegans) Vitamin B 12 supplement important for vegans Foods to Avoid Fish containing high levels of mercury Undercooked fish Partially cooked eggs undercooked meat and poultry Things to Avoid During Pregnancy Cigarettes Over-The-Counter Medications or Herbal Supplements Consult health care provider Caffeine Consult health care provider Smoking during Pregnancy Limits oxygen supplied to the fetus Reduces birth weight of the infant Increases the risk of pre-term delivery Increases the risk of perinatal mortality Passive exposure to tobacco smoke may also reduce infant growth Associated with mental retardation and nicotine addiction in the fetus Common Pregnancy Problems Nausea and Vomiting Avoid strong odors Eat before getting out of bed Avoid an empty stomach Eat easy-to-digest foods Eat slowly Snack before bed Constipation Hormonal changes slow down the intestine Drink 8-12 glasses of water everyday Eat high-fiber foods Be as physically active as possible Do not use laxatives unless prescribed by health care provider Heartburn Eat small meals frequently Cut down on caffeinated and carbonated beverages Eat slowly in a relaxed environment Do not lie down after eating Prop head of bed up Wear loose-fitting comfortable clothes Avoid gaining too much weight Talk to doctor before taking antacids Swelling As blood supply increases, legs, feet, and arms may swell Drink plenty of fluids, especially water Avoid diuretics, unless prescribed by health care provider Elevate your feet whenever possible Wear loose-fitting shoes and clothes Pica (nonfood cravings) Some pregnant women develop cravings for nonfood substances like clay, dirt, or ice This does not reflect a physiological need for a particular nutrient Pica is especially common in African American women Pica may lead to iron-deficiency anemia, malnutrition and lead exposure (brain damage) Respiratory distress In many women respiratory distress occurs because of the growing uterus as the pregnancy advances . Fatigue and insomnia Fatigue is very common in early pregnancy and reaches a peak at the end of the first trimester . Rest, lifestyle adjustment and reassurance are usually all that is required . Fatigue also occurs in late pregnancy, when anemia should be excluded . Insomnia is also very common and due to a combination of anxiety, hormonal changes and physical discomfort . Varicose veins Feet and ankles can also become swollen . Treatment is by elevation of legs when sitting, support, encourage walking and avoid standing still . Backache Many women develop backache during pregnancy and it often first develops during the 5th to 7th months of pregnancy . Encourage light exercise and simple analgesia, and consider physiotherapy referral . Exercising in water, massage therapy and group or individual back care classes have been shown to be effective interventions .