Objectives To produce a healthy, normal weight infant while minimizing the short and long term health risks to the mother To determine the appropriate weight gain during pregnancy for the normal weight, underweight, overweight and adolescent pregnant woman

Objectives (cont.) To recognize the additional energy, vitamin and mineral requirements during pregnancy and lactation To recommend dietary modifications to help alleviate nausea, heartburn and constipation during pregnancy To develop skills to help promote and maintain breast-feeding

Prenatal Nutrition

Questions with nutritional implications for the obstetric history and physical exam

Present illness General: recent weight change, poor weight gain, edema, dehydration G.I. complaints: Diarrhea, nausea, vomiting, heartburn, constipation

Medical History Prenatal vitamins, nutritional supplements, herbs, remedies? Iron supplements Food allergies Non-food cravings Obstetric history

Social History Alcohol? Special Diet? How many meals and snacks daily? Avoid any specific foods? Milk: how much, type? Lactose intolerance

Family History Familial occurrence of dx History of children with fetal anomalies

Review of symptoms General: Fatigue, weight change Month: teeth, gums, lips, tongue GI/abdomen: Appetite, food intolerance, nausea, constipation, diarrhea

Physical Exam: Anthropometric data Height Current weight Prepregnancy weight Prepregnancy BMI = {[wt (kg)] / ht 2 (m 2 )} Weight gain during pregnancy so far

Laboratory Evaluation Glucose Hematocrit Hemoglobin

Maternal weight gain

Underweight BMI < 19.8 Total weight gain lbs. 5 lbs./ 4 weeks

Normal BMI = Total weight gain lbs. 4 lbs./ 4 weeks

Overweight BMI = Total weight gain lbs 2.6 lbs./ 4 weeks

Adolescent Pounds to bring weight near normal for height Pounds for 9 month interval of growth Pounds recommended for pregnancy

Nutritional requirements Energy: kcal/day in 2 nd and 3 rd trimester Protein: RDA = 60 g Calcium Folate Iron

Nutritional Problems Nausea and vomiting (hCG) Constipation (progesterone) Heartburn

Lactation Management

Benefits of Breast-feeding

Infant Decreased incidence of infection Protection against autoimmune diseases Good jaw and tooth development Mother - Infant bonding

Mother Accelerated weight loss Delayed return of ovulation Improved bone remineralization Reduced ovarian and premenopausal breast cancer risk Easy, clean, economical

Maternal nutritional requirements Energy: kcal/day, progressive weight loss not to exceed 4.5 lb/month Protein: RDA = 65 g Calcium: 1200 mg (same as prenatal) Iron requirement is decreased Prenatal supplements Fluids 2-3 quarts/day

Contraindications Maternal infections: TB, typhoid, rubella, mumps, HIV and CMV Maternal medications: most chemotherapeutic agents, illegal substances. "If you wouldn't prescribe it for the baby, think carefully about giving it to the mother.” Infant: galactosemia, some congenital deformities of the palate

Breast-feeding promotion and support Education of mother and family Provision for early and frequent mother infant contact Concept of "demand and supply” Solutions for work related concerns: pumping and storage Proper feeding technique and breast care