Download Ch 15 Maternal and Fetal Nutrition.2016e

Chapter 15
Maternal and Fetal Nutrition
Copyright © 2016 by Elsevier Inc. All rights reserved.
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.
• Describe food safety precautions for pregnant women.
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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
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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
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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
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Weight Gain During
Pregnancy
• Determined by PRE-Pregnancy wt for height
• Underweight BMI- gain 12.7-18.1kg (28-40#)
• Normal BMI- gain 11.3- 15.9kg (25-35#)
• Overweight BMI- gain 6.8-11.3 kg(15 -25#)
• Obese gain 5-9.1kg (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
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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
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Nutrient Needs During Pregnancy
(Cont.)
•
•
•
•
•
Calcium
Magnesium
Sodium
Potassium
Zinc
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Nutrient Needs During Pregnancy
(Cont.)
• Minerals and vitamins (Cont.)
• Fat-soluble vitamins
• Water-soluble vitamins
• Folate and folic acid
• Vitamin C
• Vitamin B6
• Vitamin B12
• Multivitamin-multimineral supplements during pregnancy
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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
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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
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Care Management
• Assessment
•
•
•
•
•
Obstetric and gynecologic effects on nutrition
Diet history
Health history
Usual maternal diet
Physical examination
• Anthropometric (body) measurements
• Laboratory testing
• Anemia
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Nutritional Care and Teaching
• Programs for women with limited financial resources
• SNAP
• WIC
• Daily food guide and menu planning
• MyPlate program
• Food safety
• Medical nutrition therapy
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Nutritional Care and Teaching
(Cont.)
Nutrition-related concerns during pregnancy
 Iron supplementation
Nutrition-related discomforts of pregnancy
 Nausea and vomiting
 Constipation
 Heartburn (pyrosis)
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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.
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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
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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
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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.
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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.
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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.
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Key Points (Cont.)
• Pregnancy complications that can be nutrition-related
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.
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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
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