Maternal and Child Nursing NUR 362

Lecture 4

Why is nutrition so important?Why is nutrition so important?

Meet increased nutrient demandsMeet increased nutrient demands

Provide needed energyProvide needed energy

Prevent or minimize common pregnancy-Prevent or minimize common pregnancy-related problemsrelated problems

Reduce risk of birth defectsReduce risk of birth defects

Supply needed nutrients for baby’s growthSupply needed nutrients for baby’s growth

Ensure healthy birth weightEnsure healthy birth weight

Maintain a healthy weightMaintain a healthy weight

Key Components of a Healthy Key Components of a Healthy PregnancyPregnancy

Appropriate weight gainAppropriate weight gain

Consumption of a variety of foodsConsumption of a variety of foods

Vitamin and mineral supplementationVitamin and mineral supplementation

Avoidance of alcohol, tobacco and Avoidance of alcohol, tobacco and other harmful substancesother harmful substances

Safe food handlingSafe food handling

Recommended Weight GainRecommended Weight Gain

UnderweightUnderweight 28-40 lbs28-40 lbs

Normal weightNormal weight 25-35 lbs25-35 lbs

OverweightOverweight 15-25 lbs15-25 lbs

ObeseObese ~~ 15 lbs 15 lbs

TwinsTwins 35-45 lbs35-45 lbs

TripletsTriplets 50 lbs50 lbs

1 pound = about 0.45 kilograms

Normal Pregnancy Weight Normal Pregnancy Weight GainGain

BreastBreast 1-1.5 lbs1-1.5 lbs

BloodBlood 3-4.5 lbs3-4.5 lbs

Extra waterExtra water 4-6 lbs4-6 lbs

UterusUterus 2.5-3.0 lbs2.5-3.0 lbs

Placenta/amniotic Placenta/amniotic fluidfluid 3.5-5.5 lbs3.5-5.5 lbs

BabyBaby 7-8 lbs7-8 lbs

Fat storesFat stores 4-6.5 lbs4-6.5 lbs

TotalTotal 25-35 lbs25-35 lbs

Risks of Low Weight GainRisks of Low Weight Gain

Low weight gain in second or third Low weight gain in second or third trimester increases risk of trimester increases risk of intrauterine growth retardationintrauterine growth retardation

Low weight gain in third trimester Low weight gain in third trimester increases risk of preterm deliveryincreases risk of preterm delivery

Guidelines for teenagersGuidelines for teenagers

Higher weight gains and greater Higher weight gains and greater postpartum weight retention is postpartum weight retention is common if mother is still growingcommon if mother is still growing

Maternal growth in multiparous Maternal growth in multiparous teenagers is associated with lower teenagers is associated with lower birth weightsbirth weights

Proper nutritionProper nutrition

Major NutrientsMajor Nutrients

CarbohydratesCarbohydrates

ProteinProtein

FatFat

VitaminsVitamins

MineralsMinerals

WaterWater

Special Interest Special Interest NutrientsNutrients

Vitamin BVitamin B1212

Generally adequate amounts are obtained Generally adequate amounts are obtained through animal productsthrough animal products

Fish, eggs, milk, meats, etc. Fish, eggs, milk, meats, etc.

Vegans that do not have any animal products in Vegans that do not have any animal products in their diet need supplementationtheir diet need supplementation

Works with folic acid in cell growth and is Works with folic acid in cell growth and is essential to the normal development of the infantessential to the normal development of the infant

Folic AcidFolic Acid

A supplement taken 1-3 months prior to conception A supplement taken 1-3 months prior to conception and during first 6 weeks gestation reduces the risk of and during first 6 weeks gestation reduces the risk of neural tube defects, cleft palate/lipneural tube defects, cleft palate/lip

400 micrograms per day of synthetic folic acid 400 micrograms per day of synthetic folic acid needed per day (pregnant women and those of needed per day (pregnant women and those of childbearing age)childbearing age)

Needed for rapidly dividing cells, protein metabolism, Needed for rapidly dividing cells, protein metabolism, and formation of red blood cellsand formation of red blood cells

IronIron

Needed for the formation of red blood cellsNeeded for the formation of red blood cells

15 milligrams a day for woman during 15 milligrams a day for woman during childbearing years recommendedchildbearing years recommended

Iron supplement (30 mg/d) recommended for Iron supplement (30 mg/d) recommended for pregnant womenpregnant women

CalciumCalcium

Calcium absorption doubles early in Calcium absorption doubles early in pregnancypregnancyIs used in the formation of fetal bonesIs used in the formation of fetal bonesWill be absorbed from maternal bones if Will be absorbed from maternal bones if not enough calcium in dietnot enough calcium in dietCalcium absorption increases with Calcium absorption increases with Vitamin DVitamin DCalcium and vitamin D supplements Calcium and vitamin D supplements sometimes neededsometimes neededRecommended amounts of calcium during Recommended amounts of calcium during Pregnancy 1200-1500 mg per dayPregnancy 1200-1500 mg per day

Multivitamin and Mineral Multivitamin and Mineral SupplementsSupplements

Recommended for:Recommended for:

Women who smokeWomen who smoke

Women with iron deficiency anemia or poor Women with iron deficiency anemia or poor quality dietsquality diets

Women who eat animal products rarely or not Women who eat animal products rarely or not at all (such as vegans)at all (such as vegans)

Vitamin B 12 supplement important for vegansVitamin B 12 supplement important for vegans

Foods to AvoidFoods to Avoid

Fish containing high levels of mercury Fish containing high levels of mercury

Undercooked fishUndercooked fish

Partially cooked eggsPartially cooked eggs

undercooked meat and poultryundercooked meat and poultry

Things to Avoid During Things to Avoid During PregnancyPregnancy

CigarettesCigarettes

Over-The-Counter Medications or Over-The-Counter Medications or Herbal SupplementsHerbal Supplements

Consult health care providerConsult health care provider

CaffeineCaffeine

Consult health care providerConsult health care provider

Smoking during PregnancySmoking during PregnancyLimits oxygen supplied to the fetusLimits oxygen supplied to the fetus

Reduces birth weight of the infantReduces birth weight of the infant

Increases the risk of pre-term deliveryIncreases the risk of pre-term delivery

Increases the risk of perinatal mortalityIncreases the risk of perinatal mortality

Passive exposure to tobacco smoke may also reduce infant Passive exposure to tobacco smoke may also reduce infant growthgrowth

Associated with mental retardation and nicotine addiction Associated with mental retardation and nicotine addiction in the fetusin the fetus

Common Pregnancy Common Pregnancy ProblemsProblems

Nausea and VomitingNausea and VomitingAvoid strong odorsAvoid strong odors

Eat before getting out of bed Eat before getting out of bed

Avoid an empty stomachAvoid an empty stomach

Eat easy-to-digest foodsEat easy-to-digest foods

Eat slowlyEat slowly

Snack before bedSnack before bed

ConstipationConstipation

Hormonal changes slow down the Hormonal changes slow down the intestineintestine

Drink 8-12 glasses of water everydayDrink 8-12 glasses of water everyday

Eat high-fiber foodsEat high-fiber foods

Be as physically active as possibleBe as physically active as possible

Do not use laxatives unless Do not use laxatives unless prescribed by health care providerprescribed by health care provider

HeartburnHeartburnEat small meals frequentlyEat small meals frequently

Cut down on caffeinated and carbonated Cut down on caffeinated and carbonated beveragesbeverages

Eat slowly in a relaxed environmentEat slowly in a relaxed environment

Do not lie down after eatingDo not lie down after eating

Prop head of bed upProp head of bed up

Wear loose-fitting comfortable clothesWear loose-fitting comfortable clothes

Avoid gaining too much weightAvoid gaining too much weight

Talk to doctor before taking antacids Talk to doctor before taking antacids

SwellingSwelling

As blood supply increases, legs, feet, As blood supply increases, legs, feet, and arms may swelland arms may swell

Drink plenty of fluids, especially waterDrink plenty of fluids, especially water

Avoid diuretics, unless prescribed by Avoid diuretics, unless prescribed by health care providerhealth care provider

Elevate your feet whenever possibleElevate your feet whenever possible

Wear loose-fitting shoes and clothesWear loose-fitting shoes and clothes

Pica (nonfood cravings)Pica (nonfood cravings)

Some pregnant women develop cravings for Some pregnant women develop cravings for nonfood substances like clay, dirt, or icenonfood substances like clay, dirt, or ice

This does not reflect a physiological need for This does not reflect a physiological need for a particular nutrienta particular nutrient

Pica is especially common in African Pica is especially common in African American womenAmerican women

Pica may lead to iron-deficiency anemia, Pica may lead to iron-deficiency anemia, malnutrition and lead exposure (brain damage)malnutrition and lead exposure (brain damage)

Respiratory distressRespiratory distress

In many women respiratory distress In many women respiratory distress occurs because of the growing uterus occurs because of the growing uterus as the pregnancy advances. as the pregnancy advances.

Fatigue and insomniaFatigue and insomnia

Fatigue is very common in early pregnancy and Fatigue is very common in early pregnancy and reaches a peak at the end of the first trimester. reaches a peak at the end of the first trimester.

Rest, lifestyle adjustment and reassurance are Rest, lifestyle adjustment and reassurance are usually all that is required. usually all that is required.

Fatigue also occurs in late pregnancy, when Fatigue also occurs in late pregnancy, when anemia should be excluded. anemia should be excluded.

Insomnia is also very common and due to a Insomnia is also very common and due to a combination of anxiety, hormonal changes and combination of anxiety, hormonal changes and physical discomfort. physical discomfort.

Varicose veinsVaricose veins

Feet and ankles can also become Feet and ankles can also become swollen. swollen.

Treatment is by elevation of legs when Treatment is by elevation of legs when sitting, support, encourage walking sitting, support, encourage walking and avoid standing still. and avoid standing still.

BackacheBackache

Many women develop backache during Many women develop backache during pregnancy and it often first develops during pregnancy and it often first develops during the 5th to 7th months of pregnancy. the 5th to 7th months of pregnancy.

Encourage light exercise and simple Encourage light exercise and simple analgesia, and consider physiotherapy analgesia, and consider physiotherapy referral. referral.

Exercising in water, massage therapy and Exercising in water, massage therapy and group or individual back care classes have group or individual back care classes have been shown to be effective interventions. been shown to be effective interventions.