1. 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

2. 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

3. Prenatal Nutrition

4. Questions with nutritional implications for the obstetric history and physical exam

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

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

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

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

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

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

11. Laboratory Evaluation Glucose Hematocrit Hemoglobin

12. Maternal weight gain

13. Underweight BMI < 19.8 Total weight gain 28 - 40 lbs. 5 lbs./ 4 weeks

14. Normal BMI = 19.8 - 26 Total weight gain 25 - 35 lbs. 4 lbs./ 4 weeks

15. Overweight BMI = 26.1 - 29 Total weight gain 15 - 25 lbs 2.6 lbs./ 4 weeks

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

17. Nutritional requirements Energy: + 300 kcal/day in 2 nd and 3 rd trimester Protein: RDA = 60 g Calcium Folate Iron

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

19. Lactation Management

20. Benefits of Breast-feeding

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

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

23. Maternal nutritional requirements Energy: + 500 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

24. 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

25. 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