Maternal and Child Nursing During this presentation we will discuss how good nutrition during pregnancy makes a positive contribution to the health and well-being of both the developing baby and the mother. We will discuss the following topics: Why nutrition is so important during this critical stage of the life cycle Recommended weight gain during pregnancy The recommended diet for the pregnant mother Nutrients of special concern during pregnancy Foods and non-food substances to avoid during pregnancy Common problems during pregnancy Maternal and Child Nursing NUR 362 Lecture 4 Lecture 5

Why is nutrition so important? Meet increased nutrient demands Provide needed energy Prevent or minimize common pregnancy-related problems Reduce risk of birth defects Supply needed nutrients for baby’s growth Ensure healthy birth weight Maintain a healthy weight Nutrition prior to, during, and immediately following pregnancy is more important than at any other time in life. There is a definite relationship between a baby’s development during pregnancy and his/her lifelong health and the quality of the mother’s diet during pregnancy. Women who eat a nutritious diet during pregnancy usually deliver babies who are in good to excellent health. On the other hand, women who are malnourished prior to pregnancy and/or consume a poor diet during pregnancy increase their chances of delivering a baby who is stillborn, functionally immature, premature, or that has a low birth weight or congenital defect. There is an increased demand for several nutrients during pregnancy. For example, the mother needs to ensure she gets sufficient iron in her diet to prevent anemia. We will discuss other key nutrients that are in higher demand during pregnancy later in the presentation. Lecture 5

Key Components of a Healthy Pregnancy Appropriate weight gain Consumption of a variety of foods Vitamin and mineral supplementation Avoidance of alcohol, tobacco and other harmful substances Safe food handling To ensure a healthy pregnancy, it is important for the expectant mother to: - gain sufficient weight to support the demands of the pregnancy - consume a variety of nutritious foods - take a daily multivitamin/multi-mineral as prescribed by her healthcare provider - abstain from alcohol, tobacco, and other harmful substances - handle foods safely Ask question: What is a healthy weight gain during pregnancy?......Go to next slide. Lecture 5

Recommended Weight Gain Underweight 28-40 lbs Normal weight 25-35 lbs Overweight 15-25 lbs Obese ~ 15 lbs Twins 35-45 lbs Triplets 50 lbs Prenatal weight gain within these ranges from the Institute of Medicine is associated with better pregnancy outcomes. Women with a BMI of <19.8 are at high risk of delivering a low birth weight infant if their weight gain is inadequate. Women who lose weight or gain less than 6 kg are more likely to deliver an infant that is small for gestational age. Excessive weight gain in women with a BMI > 26 also places the child at risk of being large-for-gestational age, which in turn, has been associated with excess body fat during childhood. Excessive weight gain contributes more to postpartum weight retention and less to fetal growth in normal weight and overweight women. Being overweight or underweight prior to pregnancy is associated with a greater risk of complications. Overweight and/or obese women are at a higher risk for medical complications like premature births, pregnancy-induced hypertension, gestational diabetes, and complications during labor. The recommended weight gain from conception to 20 weeks is only about 2-5 pounds total weight gain. From 20 weeks to delivery the average weight gain is 1 pound per week. Following these recommendations is associated with better pregnancy outcomes. Low weight gain in either the second or third trimester increases the risk of intrauterine growth retardation. Low weight gain in the third trimester is also associated with preterm delivery. Ask question: Where do those extra pounds go?.......Go to next slide 1 pound = about 0.45 kilograms Lecture 5

Normal Pregnancy Weight Gain Breast 1-1.5 lbs Blood 3-4.5 lbs Extra water 4-6 lbs Uterus 2.5-3.0 lbs Placenta/amniotic fluid 3.5-5.5 lbs Baby 7-8 lbs Fat stores 4-6.5 lbs Total 25-35 lbs Normal weight gain is important to the development of the baby. Impaired intrauterine growth and development of the infant may result in cardiovascular, metabolic, or endocrine disease in adult life. Maternal obesity increases the risk of gestational diabetes, cesarean deliveries, complications during delivery, congenital defects, and childhood obesity. Women who gain excessive amounts of weight are more likely to be overweight or obese after the baby is born. Lecture 5

Risks of Low Weight Gain Low weight gain in second or third trimester increases risk of intrauterine growth retardation Low weight gain in third trimester increases risk of preterm delivery The timing of weight gain during pregnancy is also important. Regardless of pre-pregnancy weight, women with low weight gain in the second or third trimester increases the risk of growth retardation of the fetus. Low weight gain in the third trimester is also associated with an increased risk of a preterm delivery. Lecture 5

Guidelines for teenagers Higher weight gains and greater postpartum weight retention is common if mother is still growing Maternal growth in multiparous teenagers is associated with lower birth weights Healthcare providers should avoid advising pregnant teens to limit excessive weight gains during pregnancy. Instead focus effort on helping teens return to normal weight after delivery and preventing subsequent teenage pregnancies. Pregnant teenagers who have previously delivered one or more babies are more likely to deliver a low birth weight baby. Lecture 5

Proper nutrition Major Nutrients Carbohydrates Protein Fat Vitamins Minerals Water These nutrients, consumed in the correct amounts, help make a healthy baby. Eating nutritious foods from MyPyramid supplies these nutrients. Your doctor may prescribe a multi-vitamin and mineral supplement during pregnancy which you will need to take as directed in addition to eating a nutritious diet. Supplements are not a substitute for a healthful diet. However, they may be especially beneficial for teenagers, women who smoke or abuse alcohol or drugs, and strict vegetarians. Lecture 5

Special Interest Nutrients Special interest nutrients include: Vitamin B12 Folic Acid Iron Calcium Lecture 5

Vitamin B12 Generally adequate amounts are obtained through animal products Fish, eggs, milk, meats, etc. Vegans that do not have any animal products in their diet need supplementation Works with folic acid in cell growth and is essential to the normal development of the infant In most cases, even modest amounts of fish, meat, eggs, or milk products, along with body stores, easily meet Vitamin B12 needs. A deficiency is rare in women who consume these foods. Strict vegetarians who don’t eat any foods of animal origin may need daily Vitamin B12 supplements to prevent a deficiency. A deficiency of vitamin B12 increases the risk of having a stillborn baby. Lecture 5

Folic Acid A supplement taken 1-3 months prior to conception and during first 6 weeks gestation reduces the risk of neural tube defects, cleft palate/lip 400 micrograms per day of synthetic folic acid needed per day (pregnant women and those of childbearing age) Needed for rapidly dividing cells, protein metabolism, and formation of red blood cells RDA Non-pregnant 400 micrograms per day Pregnant 600 micrograms per day (400 micrograms should be in synthetic form) Pregnant smoker up to 3-4 times more is required to reach the same blood levels The Public Health Service recommends that all women of childbearing age who are capable of becoming pregnant take 0.4 milligrams (400 micrograms) of folic acid daily. Lecture 5

Iron Needed for the formation of red blood cells 15 milligrams a day for woman during childbearing years recommended Iron supplement (30 mg/d) recommended for pregnant women Pregnant women who make wise food choices can meet most of their nutrient needs, except for iron. Iron supplements are recommended during the second and third trimesters of pregnancy. Low iron stores increase the risk for anemia. Lecture 5

Calcium Calcium absorption doubles early in pregnancy Is used in the formation of fetal bones Will be absorbed from maternal bones if not enough calcium in diet Calcium absorption increases with Vitamin D Calcium and vitamin D supplements sometimes needed Recommended amounts of calcium during Pregnancy 1200-1500 mg per day Due to increased absorption of calcium during pregnancy, calcium requirements during pregnancy are similar to the non-pregnant state for most pregnant women. However, pregnant adolescents and women at risk of pregnancy-induced hypertension might benefit from higher calcium intakes. Milk and some soy milks are fortified with vitamin D. Vitamin D is produced by exposure of the skin to sunlight. Women who do not consume milk products or calcium-fortified foods may need to take a calcium and vitamin D supplement. The inclusion of vitamin D in the supplement is especially important in northern locations during the winter, because exposure to sunlight may not be enough to maintain levels of vitamin D in the body. Lecture 5

Multivitamin and Mineral Supplements Recommended for: Women who smoke Women with iron deficiency anemia or poor quality diets Women who eat animal products rarely or not at all (such as vegans) Vitamin B 12 supplement important for vegans Including a daily multivitamin and mineral supplement is especially important for these women. Lecture 5

Foods to Avoid Fish containing high levels of mercury Undercooked fish Partially cooked eggs undercooked meat and poultry Eating fish that contains high levels of mercury can cause nerve damage. Eating foods containing raw or undercooked eggs increases the risk of salmonella poisoning. Lecture 5

Things to Avoid During Pregnancy Cigarettes Over-The-Counter Medications or Herbal Supplements Consult health care provider Caffeine Consuming alcohol during pregnancy can cause irreversible physical and mental retardation of the fetus – fetal alcohol syndrome (FAS). FAS is totally preventable by merely avoiding alcohol. Pregnancy dramatically increases the harmful effects of smoking cigarettes. Smoking restricts the blood supply to the growing fetus. This limits oxygen and nutrient delivery and waste removal. Women who smoke usually eat less nutritious foods during pregnancy than nonsmokers. A mother who smokes is more likely to have a complicated birth and a low-birth weight infant. There is a positive relationship between Sudden Infant Death Syndrome (SIDS) and cigarette smoking during pregnancy. Marijuana, cocaine and other illegal drugs should be avoided. Research has not shown that caffeine causes birth defects in human infants. Moderate-to-heavy intake of caffeine may lower infant birth weight. Heavy caffeine use is the equivalent of 2-3 cups of coffee per day. Lecture 5

Smoking during Pregnancy Limits oxygen supplied to the fetus Reduces birth weight of the infant Increases the risk of pre-term delivery Increases the risk of perinatal mortality Passive exposure to tobacco smoke may also reduce infant growth Associated with mental retardation and nicotine addiction in the fetus Pregnant women should not smoke. The risk to the baby and the expectant mother is not worth it! Lecture 5

Common Pregnancy Problems Common problems experienced during pregnancy include: Nausea and Vomiting Constipation Heartburn Swelling Pica (nonfood cravings) Lecture 5

Nausea and Vomiting Avoid strong odors Eat before getting out of bed Avoid an empty stomach Eat easy-to-digest foods Eat slowly Snack before bed Nausea and vomiting may be due to food-borne illness. Be sure to wash hands often, store food properly and cook food thoroughly. Odors: Pregnant women have a better sense of smell. Avoid spicy foods. Stay out of the kitchen if necessary and let someone else prepare meals. Eat every 2-3 hours Easy to digest: pasta, rice, crackers, potatoes, lean meats, eggs Before bed: Peanut butter crackers, glass of milk, or small bowl of cereal Lecture 5

Constipation Hormonal changes slow down the intestine Drink 8-12 glasses of water everyday Eat high-fiber foods Be as physically active as possible Do not use laxatives unless prescribed by health care provider High fiber: Whole-grain foods, bran, vegetables, fruits, and legumes (dried beans and peas) Regular exercise also helps alleviate constipation. Be sure to talk to your doctor before starting any exercise program. Lecture 5

Heartburn Eat small meals frequently Cut down on caffeinated and carbonated beverages Eat slowly in a relaxed environment Do not lie down after eating Prop head of bed up Wear loose-fitting comfortable clothes Avoid gaining too much weight Talk to doctor before taking antacids Many pregnant women experience heartburn during some point in their pregnancy. These suggestions are effective ways to avoid heartburn most of the time. Lecture 5

Swelling As blood supply increases, legs, feet, and arms may swell Drink plenty of fluids, especially water Avoid diuretics, unless prescribed by health care provider Elevate your feet whenever possible Wear loose-fitting shoes and clothes Mild edema (swelling) during pregnancy is related to the normal and necessary increase in body fluids. Water actually helps to decrease swelling. Avoid salt and salty foods. If your hands and/or face begin to swell, or if the swelling persist for more than 24 hours at one time, notify your doctor. This may be a sign of eclampsia (pregnancy-induced hypertension) if also accompanied by a rise in blood pressure, protein in the urine and a rapid weight gain. Lecture 5

Pica (nonfood cravings) Some pregnant women develop cravings for nonfood substances like clay, dirt, or ice This does not reflect a physiological need for a particular nutrient Pica is especially common in African American women Pica may lead to iron-deficiency anemia, malnutrition and lead exposure (brain damage) Food cravings and aversions are common during pregnancy due to hormonal changes. They are usually harmless unless you avoid an entire food group. However, consuming nonfood items during pregnancy can be dangerous to both the mother and the baby and should be avoided. Lecture 5

Respiratory distress In many women respiratory distress occurs because of the growing uterus as the pregnancy advances. Lecture 5

Fatigue and insomnia Fatigue is very common in early pregnancy and reaches a peak at the end of the first trimester. Rest, lifestyle adjustment and reassurance are usually all that is required. Fatigue also occurs in late pregnancy, when anemia should be excluded. Insomnia is also very common and due to a combination of anxiety, hormonal changes and physical discomfort. Lecture 5

Varicose veins Feet and ankles can also become swollen. Treatment is by elevation of legs when sitting, support, encourage walking and avoid standing still. Lecture 5

Backache Many women develop backache during pregnancy and it often first develops during the 5th to 7th months of pregnancy. Encourage light exercise and simple analgesia, and consider physiotherapy referral. Exercising in water, massage therapy and group or individual back care classes have been shown to be effective interventions. Lecture 5