Anticipatory Guidance During Pregnancy By Catherine Ramos Marin, MSN/Ed(c), WHCNP, RN

First Trimester (1-13 weeks) Discomforts of pregnancy (N/V, frequent urination) Increase sleep needs (8 hrs./day) Exercise (fine as long as the client is able to converse easily whle exercising) Work: no exposure to hazardous chemicals or toxins Ingest no medication, no alcohol/drugs and to stop smoking

Second Trimester (14-26 weeks) Sexual needs and desire: encourage communication b/w husband and wife Regular dental check-up: maintain dental hygiene, delay radiographs and major dental work if possible (gum hypertrophy is common)

Third Trimester (27 weeks to 40 weeks) Schedule childbirth classes Increase urinary frequency and dyspnea Review interventions on leg cramps, nasal stuffiness, varicose veins, and constipation Breastfeeding teachings Choosing pediatrician and clinic Nutritional needs: period of rapid fetal growth Teach s/s of preterm labor Teach danger signs of pre-eclampsia and eclampsia

Nutritional Teachings Increase intake by 300 calories above basal and activity needs Increase protein by 30 gm/day Increase intake of Iron (30+ mg) and folic acid (800 to 1000 mcg) through diet and supplements Increase intake of Vitamin A, Vit. C and calcium through diet

Weight Gain 2-4 lbs. in the 1st trimester is considered normal 0.9 lb./week thereafter Is normal (> 2 lbs/week may be related to pre-eclampsia: edema Total weight gain during pregnancy: 25-35 lbs.

Substance Abuse During Pregnancy Smoking: low birth weight infant Alcohol: fetal alcohol syndrome Cocaine: preterm labor and abruptio placenta Teach that teratogenic fetal effects are highest in the first trimester

Anemia during Pregnancy A decrease in the oxygen carrying capacity of blood Often related to Iron deficiency and reduced dietary intake Occurs in 20% of pregnant women Associated with increase incidence of abortion, PTL, pre-eclampsia

Anemia Hgb < 11 g/dl, Hct < 37 % during 1st trimester Hgb <10.5 g/dl, Hct < 35% during 2nd trimester Hgb <10 g/dl, Hct < 32% during 3rd trimester

Nursing Interventions 24 hr. dietary recall Oral administration of Iron Teach nutritional requirements

Oral Administration of Iron Best absorbed on an empty stomach Taken with Vit. C such as OJ to increase absorption Take in the evening if problem exist w/ morning sickness Stools will turn dark green to black Lab values should be checked for increased reticulocytes and rising Hgb and Hct

Teenage Adolescent Pregnancy Pregnancy at age 19 or younger Highly associated with anemia, pre-eclampsia, CPD, STDs, IUGR, and ineffective parenting Assess: Nutritional status (24 hr. diet recall), attitude toward pregnancy and becoming a mother, social support system (family, spouse, BF, friends), domestic violence, peer activities (smoking, drugs, alcohol), economic status, educational status, access to prenatal care