Chapter 9 Maternal and Fetal Nutrition All Elsevier items and derived items © 2014, 2010, 2006,...

Chapter 9

Maternal and Fetal Nutrition

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Key components of nutrition care Nutrition assessment Diagnosis of nutritional related problems or risk

factors Intervention based on an individual’s dietary goals

and plan for appropriate weight gain Evaluation with referral to a nutritionist or dietitian as

necessary

Maternal and Fetal Nutrition

2All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

First trimester crucial for embryonic and fetal organ development

Healthful diet before conception ensures that adequate nutrients are available for developing fetus

Folate or folic acid intake important in the periconceptual period Neural tube defects are more common in infants of

women with poor folic acid intake

Nutrient Needs Before Conception


Factors that contribute to the increase in nutrient needs The uterine-placental-fetal unit Maternal blood volume and constituents Maternal mammary development Metabolic needs

Nutrient Needs During Pregnancy


Energy needs Weight gain

• Body mass index (BMI) = weight/height2

Pattern of weight gain Hazards of restricting adequate weight gain Excessive weight gain

Protein Fluids

Nutrient Needs During Pregnancy (Cont.)


You are the nurse working with prenatal patients at the health department. You meet Ms. Brooks, a 29-year-old G1P1 at 28 weeks of gestation. Ms. Brooks began prenatal care at 12 weeks. Her fetal screening ultrasound at 18 weeks revealed normal anatomy, and all of her prenatal laboratory results have been normal or negative. The pregnancy was not planned, but she and her partner are “delighted” and plan to be married in 2 weeks.

Case Study


Ms. Brooks had a prepregnancy BMI of 32 and has a history of borderline chronic hypertension. She has been counseled by the physician to gain no more than 15 lbs during her pregnancy. As you check her in for her visit, you note that her total weight gain during pregnancy is 12 lbs. Her blood pressure is 138/86. Her urine is negative for protein and glucose. When Ms. Brooks looks at the scale, she says, “What am I going to do? I have 3 more months to go.” She begins to cry.

Case Study (Cont.)


What should you do and say? What risk factors are associated with obesity in

pregnancy? Why was the urine checked for protein and

glucose at the visit?

Case Study (Cont.)


Minerals and vitamins Iron Calcium

Other minerals and electrolytes Magnesium Sodium Potassium Zinc Fluoride



Minerals and vitamins Fat-soluble vitamins

• Vitamins A, D, E, and K

Water-soluble vitamins• Folate or folic acid• Pyridoxine• Vitamin C

• Vitamin B12



Other nutrition issues during pregnancy Pica

• The practice of consuming nonfood substances• May be influenced by the woman’s cultural background

Food cravings• Proposed that food cravings during pregnancy are caused by

an innate drive to consume nutrients missing from the diet• This has not been supported by research



Other nutrition issues during pregnancy Adolescent pregnancy needs

• Improve nutritional health of pregnant adolescents by focusing on knowledge and planning of meals

• Nutrition interventions and educational programs effective with adolescents

• Understanding factors that create barriers to change in adolescent population

• Promote access to prenatal care



Other nutritional issues during pregnancy Preeclampsia

• The cause is still unknown• Speculation that poor intake of specific nutrients may be a

contributing factor• An adequate diet remains the best means of prevention



Physical activity during pregnancy Moderate exercise yields many benefits, including

improving muscle tone, shortening course of labor, and sense of well-being

• Liberal amounts of fluid should be consumed before, during, and after exercise

• Calorie intake sufficient to meet increased needs of pregnancy and exercise



Nutrition needs during lactation similar to those during pregnancy

Needs for energy (calories), protein, calcium, iodine, zinc, the B vitamins, and vitamin C remain greater than nonpregnant needs

Nutrient Needs During Lactation


Energy intake increase of 330 kcal more than woman’s nonpregnant intake recommended

Increased maternal weight loss during lactation Smoking, alcohol intake, and excessive caffeine

intake should be avoided during lactation

Nutrient Needs During Lactation (Cont.)


Diet history Obstetric and gynecologic effects on nutrition Health history Usual maternal diet Physical examination Anthropometric measurements Laboratory testing

Care Management


Collaborative care Adequate dietary intake

• Pregnancy• Postpartum• Daily food guide and menu planning• Medical nutrition therapy• Counseling about iron supplementation

• www.choosemyplate.gov

Care Management (Cont.)


http://www.choose/myplate.gov

Collaborative care Coping with nutrition-related discomforts

of pregnancy• Nausea and vomiting• Constipation• Pyrosis (heartburn) • Cultural influences• Vegetarian diets

Care Management (Cont.)


Assessment of a woman’s nutritional status includes a diet history, medication regimen, physical examination, and relevant laboratory tests. A maternity nurse performing such an assessment should be aware that:

oral contraceptive use may interfere with the absorption of iron. illnesses that have created nutritional deficits such as

phenylketonuria may require nutritional care before conception. the woman’s socioeconomic status and educational level are not

relevant to her examination; they are the province of the social worker, if anybody.

the only nutrition-related laboratory test most pregnant women need is testing for diabetes.

Question


Chapter 9 Maternal and Fetal Nutrition All Elsevier items and derived items © 2014, 2010, 2006,...

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