Maternal and Fetal Nutrition 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.

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

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

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

Nutrient Needs During Pregnancy (Cont.) Omega-3 fatty acids Fluids Minerals and vitamins Iron Physiologic anemia Calcium Magnesium Sodium Potassium Zinc

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

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

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

Care Management Assessment Obstetric and gynecologic effects on nutrition Diet history Health history Usual maternal diet Physical examination Anthropometric (body) measurements Laboratory testing Anemia

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

Nutritional Care and Teaching (Cont.) Nutrition-related concerns during pregnancy Iron supplementation Nutrition-related discomforts of pregnancy Nausea and vomiting Constipation Heartburn (pyrosis)

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.

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

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

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.

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.

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.

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.

Question A woman in week 34 of gestation reports that she is very uncomfortable because of heartburn. The nurse suggests that the woman: Substitute other calcium sources for milk in her diet Lie down after each meal Reduce the amount of fiber she consumes Eat five small meals daily ANS: D Feedback A Incorrect: This suggestion might be appropriate for a client who is lactose intolerant; however, it will not alleviate heartburn. B Incorrect: Lying down after every meal is likely to increase the amount of heartburn that the woman is experiencing due to the position of the fetus and reflux. C Incorrect: This is an inappropriate dietary suggestion for all pregnant women, and will not alleviate heartburn. D Correct: Eating small, frequent meals may help with heartburn, nausea, and vomiting.