Maternal and Fetal Nutrition Chapter 9 Maternal and Fetal Nutrition All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Maternal and Fetal Nutrition Key components of nutrition care Nutrition assessment Diagnosis of nutritional related problems or risk factors Intervention based on an individual’s dietary goals and plan for appropriate weight gain Evaluation with referral to a nutritionist or dietitian as necessary All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Nutrient Needs Before Conception First trimester crucial for embryonic and fetal organ development Healthful diet before conception ensures that adequate nutrients are available for developing fetus Folate or folic acid intake important in the periconceptual period Neural tube defects are more common in infants of women with poor folic acid intake All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Nutrient Needs During Pregnancy Factors that contribute to the increase in nutrient needs The uterine-placental-fetal unit Maternal blood volume and constituents Maternal mammary development Metabolic needs All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Nutrient Needs During Pregnancy (Cont.) Energy needs Weight gain Body mass index (BMI) = weight/height2 Pattern of weight gain Hazards of restricting adequate weight gain Excessive weight gain Protein Fluids All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Case Study You are the nurse working with prenatal patients at the health department. You meet Ms. Brooks, a 29-year-old G1P1 at 28 weeks of gestation. Ms. Brooks began prenatal care at 12 weeks. Her fetal screening ultrasound at 18 weeks revealed normal anatomy, and all of her prenatal laboratory results have been normal or negative. The pregnancy was not planned, but she and her partner are “delighted” and plan to be married in 2 weeks. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Case Study (Cont.) Ms. Brooks had a prepregnancy BMI of 32 and has a history of borderline chronic hypertension. She has been counseled by the physician to gain no more than 15 lbs during her pregnancy. As you check her in for her visit, you note that her total weight gain during pregnancy is 12 lbs. Her blood pressure is 138/86. Her urine is negative for protein and glucose. When Ms. Brooks looks at the scale, she says, “What am I going to do? I have 3 more months to go.” She begins to cry. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Case Study (Cont.) What should you do and say? What risk factors are associated with obesity in pregnancy? Why was the urine checked for protein and glucose at the visit? What should you do and say? Get a 24-hour recHelp calm the patient. Take her to an examination room for privacy. Sit down and offer her your attention. Acknowledge her disappointment and recognize that it may be hard to limit weight gain. Once she is calm, let her know that you can offer her some help with meal planning. all of her diet and begin with basic suggestions. Identify foods that Ms. Brooks likes and help with alternatives that may be lower in fat, carbohydrates, and sodium. Ask about level of activity and discuss appropriate, nonstrenuous ways to increase activity. Ask about her partner’s eating habits and his level of support of her diet. Offer to include her partner in your teaching and recommendations. Help her set a reasonable weight goal for her next visit in two weeks. Consider scheduling an additional nurse visit sooner than 2 weeks to check on diet and weight goals. Gently remind her of her risk for increasing blood pressure during the 3rd trimester and the importance of adhering to her goal for herself and her baby. Congratulate her on all of the positive things she is doing to grow a healthy baby. Encourage her to bring a 3-day diet history to her next visit so that you can review it fully with her. Offer to help explore support groups for weight issues in the community.   What risk factors are associated with obesity in pregnancy? Gestational diabetes, preeclampsia, neural tube defects, macrosomia, cesarean birth, and postpartum complications. Why was the urine checked for protein and glucose at the visit? Proteinuria may indicate early signs of pregnancy-induced hypertension or preeclampsia. Glucose could indicate signs of diabetes. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Nutrient Needs During Pregnancy (Cont.) Minerals and vitamins Iron Calcium Other minerals and electrolytes Magnesium Sodium Potassium Zinc Fluoride All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Nutrient Needs During Pregnancy (Cont.) Minerals and vitamins Fat-soluble vitamins Vitamins A, D, E, and K Water-soluble vitamins Folate or folic acid Pyridoxine Vitamin C Vitamin B12 All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Nutrient Needs During Pregnancy (Cont.) Other nutrition issues during pregnancy Pica The practice of consuming nonfood substances May be influenced by the woman’s cultural background Food cravings Proposed that food cravings during pregnancy are caused by an innate drive to consume nutrients missing from the diet This has not been supported by research All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Nutrient Needs During Pregnancy (Cont.) Other nutrition issues during pregnancy Adolescent pregnancy needs Improve nutritional health of pregnant adolescents by focusing on knowledge and planning of meals Nutrition interventions and educational programs effective with adolescents Understanding factors that create barriers to change in adolescent population Promote access to prenatal care All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Nutrient Needs During Pregnancy (Cont.) Other nutritional issues during pregnancy Preeclampsia The cause is still unknown Speculation that poor intake of specific nutrients may be a contributing factor An adequate diet remains the best means of prevention All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Nutrient Needs During Pregnancy (Cont.) Physical activity during pregnancy Moderate exercise yields many benefits, including improving muscle tone, shortening course of labor, and sense of well-being Liberal amounts of fluid should be consumed before, during, and after exercise Calorie intake sufficient to meet increased needs of pregnancy and exercise All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Nutrient Needs During Lactation Nutrition needs during lactation similar to those during pregnancy Needs for energy (calories), protein, calcium, iodine, zinc, the B vitamins, and vitamin C remain greater than nonpregnant needs All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Nutrient Needs During Lactation (Cont.) Energy intake increase of 330 kcal more than woman’s nonpregnant intake recommended Increased maternal weight loss during lactation Smoking, alcohol intake, and excessive caffeine intake should be avoided during lactation All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Care Management Diet history Obstetric and gynecologic effects on nutrition Health history Usual maternal diet Physical examination Anthropometric measurements Laboratory testing All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Care Management (Cont.) Collaborative care Adequate dietary intake Pregnancy Postpartum Daily food guide and menu planning Medical nutrition therapy Counseling about iron supplementation www.choosemyplate.gov All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Care Management (Cont.) Collaborative care Coping with nutrition-related discomforts of pregnancy Nausea and vomiting Constipation Pyrosis (heartburn) Cultural influences Vegetarian diets All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Question Assessment of a woman’s nutritional status includes a diet history, medication regimen, physical examination, and relevant laboratory tests. A maternity nurse performing such an assessment should be aware that: oral contraceptive use may interfere with the absorption of iron. illnesses that have created nutritional deficits such as phenylketonuria may require nutritional care before conception. the woman’s socioeconomic status and educational level are not relevant to her examination; they are the province of the social worker, if anybody. the only nutrition-related laboratory test most pregnant women need is testing for diabetes. ANS: B Feedback A Incorrect: Oral contraceptive use may interfere with the absorption of folic acid. Iron deficiency can appear if placement of an intrauterine device resulted in blood loss. B Correct: A registered dietician can help with therapeutic diets. C Incorrect: A woman’s finances affect her access to good nutrition; her education (or lack thereof) can influence the nurse’s teaching decisions. D Incorrect: The nutrition-related laboratory test that pregnant women usually need is a screen for anemia. DIF: Cognitive Level: Comprehension OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.