2. Objectives
Explain the importance of adequate nutrition and weight gain during pregnancy.
Calculate if weight gain is within recommended guidelines.
Determine food sources for recommended nutrients.
Explain nutritional risk factors as they relate to pregnancy and fetal growth and development.
Recognize the role cultural differences/preferences influence nutrition during pregnancy.

3. Good nutritional status prior to pregnancy is important to conception and healthy fetal development.
Weight gain is an important determinant of fetal growth
Insufficient weight gain- low birth weight, preterm labor, increased fetal mortality and morbidity
Excessive weight gain- macrosomia, prolonged labor, birth trauma-mom and baby, cesarean birth
Weight gain from empty calories is not as beneficial as weight gain from a balanced diet.

4. Effects of maternal nutrition on fetus
Deficiencies can interfere with cell and organ growth
If deficiencies occur during cell division - permanent consequences
If deficiencies occur during cell enlargement - reversible

5. Recommended weight gain for normal weight pre-pregnant = 25-35 lbs
1st trimester- 1-4 lbs total weight gain
2nd and 3rd trimester- 1 lb. per week
Underweight= lbs.
Overweight= lbs.
Obese=11-20 lbs.
Weight distribution:
Fetus, Placenta, Amniotic fluid = 11 lbs
Uterus= 2
Breasts= 3
Increased blood volume= 4
Extravascular fluids= 5
Maternal reserves= 5-10

6. Practice
Patient at 34 weeks gestation weighed 135 pre-pregnant now weighs 162. Is her weight gain within normal limits, to much or not enough. 34 weeks -13 weeks (1st trimester) = (1st trimester gain)=25 pounds suggested weight gain = 27 pounds actual weight gain (+/- 5 Pounds)

7. For each patient, determine if the weight gain is within normal limits, to much or not enough.
1) Your patient is at 32 weeks gestation. Her current weight is 164. Her pre-pregnant weight was 145.
2) Your client is at 36 weeks gestation. Her current weight is 175. Her pre-pregnant weight was 143.
3) Your client is at 28 weeks gestation. Her current weight is 137. Her pre-pregnant weight was 125.

8. Weight gain answers 1. 32 weeks- 13 weeks= 19 weeks
19 lbs (1 lb/wk) + 4 lbs (1st trimester) = 23 lbs Recommended
164 lbs-145 lbs= 19 lbs actual
Good weight gain
2. 36 weeks-13weeks= 23 weeks at 1 pound /week
23 lbs+ 4 lbs= 27 lbs recommended
175 lbs -143 lbs =32 lbs actual
Only 3 pounds from target 35 and has 4 weeks to go. No diet but watch intake
3. 28 weeks -13 weeks =15 weeks
15 lbs+ 4 lbs = 19 lbs recommended
137 lbs-125 lbs= 12 lbs actual
Not enough

9. Calories 1,800-2,200 daily for non-pregnant
1st trimester = no additional calories
2nd & 3rd trimester = +300 calories/day
Twins calories/day

10. Carbohydrates- 4 calories/gram, essential for energy and fiber
Protein- 4 calories/gram, essential for metabolism, tissue synthesis and repair; normally get gm/day, need 60 g/day
Fats- 9 calories/gram, essential for placenta formation, fetal brain development and fetal visual function

11. Vitamins True deficiency states are rare in U.S.
Fat-soluble- stored in liver, excess can cause fetal defects. (A,D,E & K)
Water soluble- are not stored as readily so need to be consumed daily; excreted in urine so less likely to have toxicity. (C & B vitamins)
Fat soluble vitamins-
Water soluble vitamins-

12. Folic Acid Decreases chance of neural tube defect by 50-70%
Thought to decrease incidence of PTL
Needs to be taken prior to conception and during first trimester
0.4 mg daily unless history of neural tube defect then take 4mg daily
B12 assists folate in manufacture of new cells
Best food sources- green leafy vegetables, legumes, peanuts, liver, whole grains, orange juice, fortified cereal

13. Protein
Needed for fetal development, blood volume expansion, maternal growth of uterus and breast tissue
Energy metabolism maternal and fetal
Animal protein is of a higher quality than plant protein
Best sources- lean meats, fish, poultry, eggs, dairy, soy, legumes, nuts and grains

14. Iron Two types: Heme – Non-heme-
Iron from heme is more readily absorbed and is less affected by other foods
Absorption increased if eaten in same meal as ascorbic acid (vitamin C).
Foods cooked in cast iron pans have a higher iron content
Best food sources:
Red meat, legumes (lentils &peas), grains (bran flakes), broccoli, raisins, apricots, cooked spinach, tofu

15. Iron is important in hemoglobin formation
Will be transferred to fetus even if maternal intake is inadequate causing depletion of mother’s stores.
Need 30 mg/day unable to get in diet alone so iron supplements are often prescribed starting in 2nd trimester

16. Nursing Education
avoid taking with milk (calcium), coffee (binds it) and tea (tannins).
Take with Orange juice to increase absorption
Take at night because of nausea
Increase roughage

17. Zinc Necessary for tissue growth Increases immunity
Deficiencies can contribute to preterm birth
Need supplement if take large doses of iron
Best Food Sources- beef, poultry, seafood, nuts, seeds, legumes, whole grains and yogurt

18. Calcium Necessary for: fetal bone and teeth formation
maintenance of cell membrane permeability
coagulation
neuromuscular function
Need 1,000-1,300 mg/day (4 cups of milk)
Calcium will be drawn from bones if woman’s calcium intake is inadequate- easily restored after pregnancy

19. Caffeine increases excretion of calcium and decreases intestinal absorption
Vitamin D increases absorption
Better absorbed when taken with meals but separately from iron supplement
Best sources: dairy products, legumes, nuts, broccoli, dried fruits, dark green leafy vegetables (except spinach), sardines (fish with bones left in), fortified orange juice

20. Iodine- needed for brain development
Sodium
needs are increased to provide for an expanded blood volume and needs of the fetus.
does not have to be restricted but high salt food should be limited
Iodine- needed for brain development
American Academy of Pediatrics recommends supplement in Pregnancy and while breastfeeding
Food Sources- iodized salt and seafood

21. Supplements
Food is the best source of nutrients and often only need folic acid and iron supplements.
Vitamins are not food substitutes and do not contain all the nutrients needed during pregnancy.
Each woman needs to be assessed for her needs

22. Water Important for expanded blood volume
Minimum of eight 8 oz glasses of fluid each day with water being the majority
Limit carbonated beverages, coffee, tea, or juice drinks that are high sugar and little real juice.

23. Complex vs Simple Carbs
Simple carbs are digested quickly
Contain refined sugar and few essential vitamins and minerals
Fruits, fruit juice, milk, yoghurt, honey, molasses and sugar
Complex Carbs take longer to digest
Packed with fiber, vitamins and minerals
Vegetables, breads, cereals, legumes and pasta
Are high fiber foods which improve digestion, stabilize blood sugar, maintain energy levels.
Cause weight gain in most people and can cause withdrawal symptoms.

25. Vegetarians
Protein sources: peanut butter, tofu, legumes, nuts, oatmeal
Iron sources: legumes, grains, fruits, vegetables, tofu
Calcium sources: fortified juices, black strap molasses, fortified tofu
May need vitamin supplement
Vegans-
Lacto-vegetarians-
Ovo-vegetarioans-
Lacto-ovovegetarians-

28. Daily servings 7 whole grains- provide complex carbs
4 fruits- vitamins, minerals, and fiber
5 vegetables- vitamins, minerals, and fiber
1-2 dairy- same nutrient value whole, low-fat and skim
7oz protein- in addition to meat, poultry, fish and eggs- legumes, nuts and soybeans
Oils, fats and concentrated sugars- sparingly
2 tablespoons of unsaturated fats

29. Limit/Avoid
Limit fish to 6-12 oz/week- mercury- damages fetal CNS. Light tuna less mercury than albacore. Never swordfish, shark, king mackerel
No raw eggs- salmonella.
Avoid saturated fats and trans fats
Avoid raw fish
Avoid cold cuts, deli meats, hot dogs unless heated thoroughly.
soft cheeses (brie, feta, blue cheese) unless pasteurized.
no refrigerated potted meats and pate, raw or undercooked meats and poultry- listeria .Canned pates and potted meat OK

30. Risk Factors Be aware of cultural differences Nutrition Knowledge
Patient age
Vegetarians
Substance abuse-
-alcohol- FAS
-drugs
-caffeine
-smoking
Assess for eating disorders
Strenuous exercise

31. Risk Factors (cont.) Multifetal pregnancy- higher calorie needs
Lactose intolerant
Multiparity
-5 or more closely
spaced pregnancies
-may have nutritional
deficits
Socioeconomic status

32. WIC Women, Infants and Children:
U.S. government program to ensure proper adequate nutrition to women and newborns til 5 years of age.

33. PICA

34. Nursing role in Nutrition
Education
Monitor weight every visit
Nutrition/dietitian referral
WIC, social services

35. High Risk Pregnancy Preeclampsia- lose protein
Diabetics- watch glucose