Promoting Nutritional Health During Pregnancy

Nutritional Health

n Nutritional state before and during pregnancy have a direct bearing on the her health and on fetal growth and development.

n Hyperplasia-early in pregnancy, fetal growth occurs by an increase in the number of cells formed.

n Hypertrophy-late in pregnancy, occurs by enlargement of existing cells.

n Nurses must educate their patients on the importance of good nutrition.

n Recommended Weight Gain:

n adequate nutrients to the fetus and her own nutrition.

n adequate protein

n weight gain of 11.2 to 16 kg (25 to 40 lbs)

n 1 lb / month during the 1st trimester

n 1 lb/ week during the last 2 trimesters (3-12-12)

n excessive is > 6.6 lbs in the last 2 trimesters or < 2.2 lbs/ month

n underweight women should gain 30 to 40 lbs

n obese women should gain less 15 lbs

n multiple pregnancy- 1 lb / wk for total of 40 to 45 lbs

n sudden gains suggest fluid retention

n Components of Health Nutrition:

n Caloric Needs:

n total 2500 calories/day

n never less than 1500 calories/ day

n Protein Needs:

n 60 g/day

n meat, poultry,fish, yogurt, eggs, milk, beans & rice, legumes & rice, or beans & wheat.

n Fat Needs:

n linoleic acid necessary for new cell growth

n vegetable oils are a good source

n Vitamin Needs:

n folate deficiency>fetal neural tube defect

n vitamin D deficiency>diminished bone density of fetus and mother

n Prenatal Vitamins (Natalins)

n Mineral Needs:

n needed for new cell building

n calcium - 1200 to 1500 mg

n phosphorus - eat foods high in protein

n iodine - 175 ug daily(seafood is best source)

n iron - 30 mg dietary supplement of 30 mg / day

n organ meats, eggs, green leafy vegetables, whole grain, enriched breads, dried fruits (OJ increases absorption)

n black stools and constipation

n may need a stool softener- Colace

n Fluoride:

n aids in formation of teeth

n Sodium:

n maintains fluid balance in body

n to much salt results in retention of fluids

n Zinc:

n synthesis of DNA and RNA

n 15 mg in meats, liver,eggs and seafood.

n Fluid Needs:

n increase water to promote kidney function

n 2 glasses daily plus 1 quart of milk

n Fiber Needs:

n increase fiber-broccoli, asparagus, fruits and green leafy vegetables

n Foods to Avoid:

n caffeine

n artificial sweeteners

n weight loss diets

n Ask for a 24 hour nutrition recall

n Areas of assessment

n Monitor H&H and UA

n Promoting Nutritional Health

n Set nutritional outcomes by looking at the woman’s lifestyle.

n Family considerations

n Financial considerations

n Cultural considerations

n Managing Common Problems:

n Nausea and vomiting

n once a day is common

n acupressure, antimotion sickness wrist bands, avoiding fluids with meals, increasing carbohydrates, eat dry crackers or sourball candies

n disappears by 4th month

n Cravings

n strange desires for foods

n Pica

n Pyrosis (heartburn) burning sensation along esophagus caused by regurgitation of gastric contents into lower esophagus.

n due to decreased gastric motility that slows gastric emptying

n relieved by small frequent meals and do not lie down immediately after eating

n Maalox or Amphojel

n Hypercholesterolemia:

n elevated cholesterol

n may be due to increased progesterone

n gallstone formation and cardiovascular disease

n eat moderate amounts of fat, oat bran, fish, butter substitutes, broil meats, minimum use of salad oils, exercise daily

n Special Needs:

n Adolescent:

n they are continuing to grow also

n high caloric intake (2500 calories / day); need calcium, iron, folic acid.

n avoid foods that their parents see as important (milk, fruit, vegetables)

n meal-cheese and sausage pizza, milk and apple

n snack frequently need good snacks

n Woman Over Age 40:

n not studied a lot - decreased kidney function

n high fluid intake

n packed or fast-foods

n Decreased Nutritional Stores:

n high parity, short intervals between pregnancies or dieting depletes reserves

n may have anemia, decreased K, folate, iron, thiamine

n Underweight Women:

n defined as 10% to 15% less than ideal body weight for her height or BMI < 19.8

n low birth weight infants

n poverty, stress, depression, eating disorders

n major reason - insufficient intake of food due to chronic poor nutritional habits

n 24 hour nutrition recall

n need 3500 calories; 500 calorie increase = additional 1 lb/week

n Overweight Women:

n 20% above her ideal body weight or BMI over 26.1

n risks - diabetes, hypertension, excessive fetal growth, prolonged pregnancies, ambulating is difficult

n dieting not recommended during pregnancy not below 1500 to 1800 calories/day

n walk daily and decrease carbohydrates

n Vegetarian Woman:

n different types

n lack of vitamin B12 (from meats), calcium (dark leafy vegetables), vitamin D (milk and sunlight)

n need a prenatal supplement

n Phenylketonuria PKU:

n inherited disorder-cannot convert amino acid phenylalanine into tyrosine; used for cell growth

n Fetus can develop microcephaly, intrauterine growth restrictions, neurological damage.

n Foods low in phenylalanine- OJ, bananas, squash, spinach, peas.

n Proteins contain high levels

n Begin low phenylalanine diet 3 months prior to pregnancy

n Multiple Pregnancy:

n gain more weight with greater speed

n Smoking, Drugs or Alcohol:

n general nutrition problems

n Many Fast Food Meals:

n 90% women work outside the home

n prepare a good lunch the night before

n Lactose Intolerance:

n sugar in milk is lactose and people have difficulty digesting lactose

n nausea, diarrhea, cramps, gas, bloatedness

n can eat cheese, yogurt, soy milk

n Hyperemesis Gravidarum:

n nausea and vomiting prolonged past week 12 or so severe that dehydration, ketonuria, weight loss

n may need to be hospitalized for IV RL