1. Maternal and Fetal Nutrition
Chapter 15
Maternal and Fetal Nutrition
Copyright © 2016 by Elsevier Inc. All rights reserved.

2. Learning Objectives
Discuss recommendations for maternal weight gain during pregnancy.
Compare the recommended level of intake of energy sources, protein, and key vitamins and minerals during pregnancy and lactation.
Give examples of the food sources that provide the nutrients required for optimal maternal nutrition during pregnancy and lactation.
Examine the role of nutritional supplements during pregnancy.
List nutritional risk factors during pregnancy.
Analyze examples of eating patterns of women from two different ethnic or cultural backgrounds, and identify potential dietary concerns. Assess nutritional status during pregnancy.
Discuss nutritional considerations for pregnant women who are obese and those who have had bariatric surgery.
Describe food safety precautions for pregnant women.

3. Key Components of Preconception and Prenatal Nutritional Care
Nutrition assessment, including appropriate weight for height, dietary intake and habits, and preexisting issues that can affect nutritional status
Diagnosis of nutrition-related problems or risk factors such as diabetes and obesity
Interventions to promote appropriate weight gain, ingestion of a variety of foods, appropriate use of dietary supplements, and physical activity
Evaluation as an integral part of the nursing care provided to women during the preconception period and pregnancy, with referral to a nutritionist or dietitian as necessary

5. Nutrient Needs Before Conception
Healthy diet ensures adequate nutrients for developing fetus
First trimester critical in terms of embryonic and fetal development
Folic acid intake
0.4 mg in fortified foods recommended
Neural tube defects can occur with poor intake
Desirable body weight reduces maternal and fetal risks

6. Nutrient Needs During Pregnancy
Dietary reference intakes (DRIs)
Energy needs
Body mass index
Weight gain
Pattern of weight gain
Hazards of restricting adequate weight gain
Excessive weight gain
Protein
Fluids

8. Weight Gain During Pregnancy
Determined by PRE-Pregnancy wt for height
Underweight BMI- gain kg (28-40#)
Normal BMI- gain kg (25-35#)
Overweight BMI- gain kg(15 -25#)
Obese gain 5-9.1kg (11-20#)
Hazards of restricting adequate weight gain
Pregnancy is not a time for weight reduction
Quality of weight gain is important –eat nutrient rich foods
Risk of PTL

9. Nutrient Needs During Pregnancy (Cont.)
Omega-3 fatty acids
Minerals and vitamins
Iron
Physiologic anemia
Plasma volume increases more than RBC mass
Excessive plasma causes a modest decrease in H/H

10. Nutrient Needs During Pregnancy (Cont.)
Calcium
Magnesium
Sodium
Potassium
Zinc

11. Nutrient Needs During Pregnancy (Cont.)
Minerals and vitamins (Cont.)
Fat-soluble vitamins
Water-soluble vitamins
Folate and folic acid
Vitamin C
Vitamin B6
Vitamin B12
Multivitamin-multimineral supplements during pregnancy

12. Other Nutritional Issues During Pregnancy
Alcohol
There is no safe amount or type of alcohol during pregnancy, and there is no time during pregnancy when alcohol consumption is without risk.
Caffeine
Data unclear
General recommendation of no more than 200 mg of caffeine a day
Artificial sweeteners
Pica and food cravings

14. Other Nutritional Issues During Pregnancy (Cont.)
Adolescent pregnancy needs focus on improving
Nutrition knowledge
Meal planning
Food preparation
Access to prenatal care
Nutritional interventions
Educational programs
Physical activity during pregnancy
Factors to consider prior to exercise
Dehydration
Calorie intake

15. Care Management Assessment
Obstetric and gynecologic effects on nutrition
Diet history
Health history
Usual maternal diet
Physical examination
Anthropometric (body) measurements
Laboratory testing
Anemia

16. Nutritional Care and Teaching
Programs for women with limited financial resources
SNAP
WIC
Daily food guide and menu planning
MyPlate program
Food safety
Medical nutrition therapy

17. Nutritional Care and Teaching (Cont.)
Nutrition-related concerns during pregnancy
Iron supplementation
Nutrition-related discomforts of pregnancy
Nausea and vomiting
Constipation
Heartburn (pyrosis)

18. Nutritional Care and Teaching (Cont.)
Vegetarian diets
Consuming a variety of different plant proteins—grains, dried beans and peas, nuts, and seeds—on a daily basis can provide all of the essential amino acids.
Cultural influences
Nurse should be aware of what constitutes a typical diet for each cultural or ethnic group.

19. Postpartum Nutrition Lose the weight gained during pregnancy.
Appropriate weight loss goals
Nonlactating women—0.5 to 0.9 kg per week
Lactating women—1 kg per month
Attain a healthy weight.
Weight loss and breastfeeding

20. Nutrient Needs During Lactation
Similar to those during pregnancy
Needs for energy, protein, vitamins, minerals are greater than nonpregnant needs
The recommended energy intake for the first 6 months PP is 330 kcal more than nonpregnant intake.
The AAP recommends that breastfeeding women who are well nourished should add 450 to 500 kcal/day to a balanced diet.
Adequate fluid intake
Avoid smoking, alcohol, and excessive caffeine

21. Key Points
A woman’s nutritional status before, during, and after pregnancy contributes, to a significant degree, to her well-being and that of her developing fetus and newborn.
Many physiologic changes occurring during pregnancy influence the need for additional nutrients and the efficiency with which the body uses them.
Both the total maternal weight gain and the pattern of weight gain are important determinants of the outcome of pregnancy.

22. Key Points (Cont.)
The appropriateness of the woman’s prepregnancy weight for height (BMI) is a major determinant of her recommended weight gain during pregnancy.
Nutritional risk factors include adolescent pregnancy; abuse of nicotine, alcohol, or drugs; bizarre or faddish food habits; a low or high weight for height; and frequent pregnancies.
Iron supplementation is usually routinely recommended during pregnancy. Other supplements may be warranted when nutritional risk factors are present.

23. Key Points (Cont.)
Food safety is important for pregnant women to prevent adverse maternal and fetal effects.
Women who are pregnant should consume seafood that is low in methylmercury.
The nurse and the pregnant woman are influenced by cultural and personal values and beliefs during nutrition counseling.

24. Key Points (Cont.)
Pregnancy complications that can be nutrition-related include anemia, gestational hypertension, gestational diabetes, and IUGR.
Dietary modifications can be effective interventions for some of the common discomforts of pregnancy, including nausea and vomiting, constipation, and heartburn.

25. Question
A woman in week 34 of gestation reports that she is very uncomfortable because of heartburn. The nurse suggests that the woman:
Substitute other calcium sources for milk in her diet
Lie down after each meal
Reduce the amount of fiber she consumes
Eat five small meals daily
ANS: D
Feedback
A Incorrect: This suggestion might be appropriate for a client who is lactose intolerant; however, it will not alleviate heartburn.
B Incorrect: Lying down after every meal is likely to increase the amount of heartburn that the woman is experiencing due to the position of the fetus and reflux.
C Incorrect: This is an inappropriate dietary suggestion for all pregnant women, and will not alleviate heartburn.
D Correct: Eating small, frequent meals may help with heartburn, nausea, and vomiting.