1. Chapter 12 Maternal and Fetal Nutrition Debbie Hogan RN

2. Maternal and Fetal Nutrition Good nutrition before and during pregnancy an important preventive measure –Low-birth-weight (LBW) infants –Preterm infants –Neonatal death rates for moderate LBW are five times higher than babies >2500 g –The risk for VLBW is 100 times higher

3. Nutrient Needs Before Conception First trimester crucial for embryonic and fetal organ development Healthful diet before conception ensures that adequate nutrients are available for developing fetus Folic acid intake important in periconceptual period –Neural tube defects are more common in infants of women with poor folic acid intake

4. Fig. 12-1. Factors that influence the outcome of pregnancy.

5. Nutrient Needs During Pregnancy Energy needs –Weight gain Body mass index (BMI) = weight/height 2 –Pattern for weight gain –Hazards of restricting adequate weight gain Protein Fluids

6. Nutrient Needs During Pregnancy—cont’d Minerals and vitamins –Iron –Calcium Other minerals and electrolytes –Magnesium –Sodium –Potassium –Zinc –Fluoride

7. Nutrient Needs During Pregnancy—cont’d Minerals and vitamins –Fat-soluble vitamins Vitamins A, D, E, and K –Water-soluble vitamins Folate or folic acid Pyridoxine Vitamin C –Multivitamin-multimineral supplements

8. Nutrient Needs During Pregnancy—cont’d Other nutrition issues during pregnancy –Pica and food cravings –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

9. Nutrient Needs During Pregnancy—cont’d 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

10. Nutrient Needs During Lactation Nutrition needs during lactation similar to those during pregnancy Needs for energy (calories), protein, calcium, iodine, zinc, the B vitamins, and vitamin C greater than nonpregnant needs

11. Nutrient Needs During Lactation— cont’d Energy intake increase of 500 kcal more than woman’s nonpregnant intake recommended Smoking, alcohol intake, and excessive caffeine intake should be avoided during lactation

12. Nursing Care Management Assessment –Diet history Obstetric and gynecologic effects on nutrition –Medical history –Usual maternal diet –Physical examination –Laboratory testing

13. Nursing Care Management—cont’d Plan of care and implementation –Adequate dietary intake Pregnancy Postpartum Daily food guide and menu planning Medical nutrition therapy Counseling about iron supplementation

14. Nursing Care Management—cont’d Plan of care and implementation –Adequate dietary intake Coping with nutrition-related discomforts of pregnancy –Nausea and vomiting –Constipation –Pyrosis (heartburn) –Cultural influences –Vegetarian diets

15. Nutrition & Adolescent Pregnancy Adolescent attempting to meet needs of her growing body Now needs nutrients for fetus Weight restriction/mask the pregnancy Insufficient dietary intake=SGA

16. Key Points Woman’s nutritional status before, during, and after pregnancy contributes to her well-being and that of her infant Physiologic changes during pregnancy influence need for additional nutrients and efficiency with which the body uses them Total maternal weight gain and pattern of weight gain are important determinants of outcome of pregnancy

17. Key Points—cont’d Appropriateness of mother’s prepregnancy weight for height (BMI) is major determinant of recommended weight gain during pregnancy Nutritional risk factors include adolescent pregnancy; bizarre or faddish food habits; abuse of nicotine, alcohol, or drugs; low weight for height; and frequent pregnancies

18. Key Points—cont’d Iron supplementation is recommended routinely during pregnancy Other supplements recommended when nutritional risk factors present Nurse and woman influenced by cultural and personal values and beliefs during nutrition counseling

19. Key Points—cont’d Pregnancy complications that may be nutrition related include: –Anemia –Gestational hypertension –Gestational diabetes –Intrauterine growth restriction Dietary adaptations can be effective interventions for some common discomforts of pregnancy, including nausea and vomiting, constipation, and heartburn