Promoting Nutritional Health During Pregnancy

Nutritional Health

 Nutritional state before and during pregnancy have a direct bearing on the her health and on fetal growth and development.

 Hyperplasia-early in pregnancy, fetal growth occurs by an increase in the number of cells formed.

 Hypertrophy-late in pregnancy, occurs by enlargement of existing cells.

 Nurses must educate their patients on the importance of good nutrition.

 Recommended Weight Gain:

 adequate nutrients to the fetus and her own nutrition.

 adequate protein

 weight gain of 11.2 to 16 kg (25 to 40 lbs)

 1 lb / month during the 1st trimester

 1 lb/ week during the last 2 trimesters (3-12-12)

 excessive is > 6.6 lbs in the last 2 trimesters or < 2.2 lbs/ month

 underweight women should gain 30 to 40 lbs

 obese women should gain less 15 lbs

 multiple pregnancy- 1 lb / wk for total of 40 to 45 lbs

 sudden gains suggest fluid retention

 Components of Health Nutrition:

 Caloric Needs:

 total 2500 calories/day  never less than 1500 calories/ day

 Protein Needs:

 60 g/day

 meat, poultry,fish, yogurt, eggs, milk, beans & rice, legumes & rice, or beans & wheat.

 Fat Needs:

 linoleic acid necessary for new cell growth

 vegetable oils are a good source

 Vitamin Needs:

 folate deficiency>fetal neural tube defect

 vitamin D deficiency>diminished bone density of fetus and mother

 Prenatal Vitamins (Natalins)

 Mineral Needs:

 needed for new cell building

 calcium - 1200 to 1500 mg

 phosphorus - eat foods high in protein

 iodine - 175 ug daily(seafood is best source)

 iron - 30 mg dietary supplement of 30 mg / day

 organ meats, eggs, green leafy vegetables, whole grain, enriched breads, dried fruits (OJ increases absorption)

 black stools and constipation

 may need a stool softener- Colace  Fluoride:

 aids in formation of teeth

 Sodium:

 maintains fluid balance in body

 to much salt results in retention of fluids

 Zinc:

 synthesis of DNA and RNA

 15 mg in meats, liver,eggs and seafood.

 Fluid Needs:

 increase water to promote kidney function

 2 glasses daily plus 1 quart of milk

 Fiber Needs:

 increase fiber-broccoli, asparagus, fruits and green leafy vegetables

 Foods to Avoid:

 caffeine

 artificial sweeteners

 weight loss diets

 Ask for a 24 hour nutrition recall

 Areas of assessment

 Monitor H&H and UA

 Promoting Nutritional Health

 Set nutritional outcomes by looking at the woman’s lifestyle.  Family considerations

 Financial considerations

 Cultural considerations

 Managing Common Problems:

 Nausea and vomiting

 once a day is common

 acupressure, antimotion sickness wrist bands, avoiding fluids with meals, increasing carbohydrates, eat dry crackers or sourball candies

 disappears by 4th month

 Cravings

 strange desires for foods

 Pica

 Pyrosis (heartburn) burning sensation along esophagus caused by regurgitation of gastric contents into lower esophagus.

 due to decreased gastric motility that slows gastric emptying

 relieved by small frequent meals and do not lie down immediately after eating

 Maalox or Amphojel

 Hypercholesterolemia:

 elevated cholesterol

 may be due to increased progesterone

 gallstone formation and cardiovascular disease  eat moderate amounts of fat, oat bran, fish, butter substitutes, broil meats, minimum use of salad oils, exercise daily

 Special Needs:

 Adolescent:

 they are continuing to grow also

 high caloric intake (2500 calories / day); need calcium, iron, folic acid.

 avoid foods that their parents see as important (milk, fruit, vegetables)

 meal-cheese and sausage pizza, milk and apple

 snack frequently need good snacks

 Woman Over Age 40:

 not studied a lot - decreased kidney function

 high fluid intake

 packed or fast-foods

 Decreased Nutritional Stores:

 high parity, short intervals between pregnancies or dieting depletes reserves

 may have anemia, decreased K, folate, iron, thiamine

 Underweight Women:

 defined as 10% to 15% less than ideal body weight for her height or BMI

< 19.8

 low birth weight infants

 poverty, stress, depression, eating disorders  major reason - insufficient intake of food due to chronic poor nutritional habits

 24 hour nutrition recall

 need 3500 calories; 500 calorie increase = additional 1 lb/week

 Overweight Women:

 20% above her ideal body weight or BMI over 26.1

 risks - diabetes, hypertension, excessive fetal growth, prolonged pregnancies, ambulating is difficult

 dieting not recommended during pregnancy not below 1500 to 1800 calories/day

 walk daily and decrease carbohydrates

 Vegetarian Woman:

 different types

 lack of vitamin B12 (from meats), calcium (dark leafy vegetables), vitamin

D (milk and sunlight)

 need a prenatal supplement

 Phenylketonuria PKU:

 inherited disorder-cannot convert amino acid phenylalanine into tyrosine; used for cell growth

 Fetus can develop microcephaly, intrauterine growth restrictions, neurological damage.

 Foods low in phenylalanine- OJ, bananas, squash, spinach, peas.  Proteins contain high levels

 Begin low phenylalanine diet 3 months prior to pregnancy

 Multiple Pregnancy:

 gain more weight with greater speed

 Smoking, Drugs or Alcohol:

 general nutrition problems

 Many Fast Food Meals:

 90% women work outside the home

 prepare a good lunch the night before

 Lactose Intolerance:

 sugar in milk is lactose and people have difficulty digesting lactose

 nausea, diarrhea, cramps, gas, bloatedness

 can eat cheese, yogurt, soy milk

 Hyperemesis Gravidarum:

 nausea and vomiting prolonged past week 12 or so severe that dehydration, ketonuria, weight loss

 may need to be hospitalized for IV RL