1. Maternal and Fetal Nutrition
Chapter 9
Maternal and Fetal Nutrition
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2. 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
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4. 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
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5. 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
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6. 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
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7. 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.
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8. 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.
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9. 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.
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11. Nutrient Needs During Pregnancy (Cont.)
Minerals and vitamins
Iron
Calcium
Other minerals and electrolytes
Magnesium
Sodium
Potassium
Zinc
Fluoride
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12. 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
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13. 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
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15. 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
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16. 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
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17. 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
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18. 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
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19. 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
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20. Care Management Diet history
Obstetric and gynecologic effects on nutrition
Health history
Usual maternal diet
Physical examination
Anthropometric measurements
Laboratory testing
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21. Care Management (Cont.)
Collaborative care
Adequate dietary intake
Pregnancy
Postpartum
Daily food guide and menu planning
Medical nutrition therapy
Counseling about iron supplementation
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22. Care Management (Cont.)
Collaborative care
Coping with nutrition-related discomforts of pregnancy
Nausea and vomiting
Constipation
Pyrosis (heartburn)
Cultural influences
Vegetarian diets
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23. 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
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