dhf w12/13

Healthy Pregnancy Factors

• nutr status before conception

• approp weight gain

• rate of mortality among infants born b4 37weeks

Unusual Dietary Patterns

• PICA = abnorm consump specific foods/non-food subs) = paint chips, dirt, clay, ice

• can wear down teeth quickly

PICA risk factors

• lower socioeconomic groups

• less than a high school education

• poor nutritional health

• behavioral/environ factors, such as subs abuse

• nutr deficiencies (esp iron) may occur

• may be cultural/regional, & may result in poor nutr

Healthcare access

• inadeq prenatal care leads to probs for mom/fetus

• prenatal care important to protect embryo from fx of chronic health probs in later life (diabetes & hypertension)

Age

adolscent preg > inc risk for low birth weight infants

• majority have inadeq intake Ca, Fe, vit A&D, niacin, kcals

• 1 in 3 teen mom show sign of signif bone loss

preg after 35

• maternal risks = diabetes, hypertension, & CV disease

• inc # myocardial infarction (heart attack)

Weight gain

• for women in normal BMI range total weight gain around 25-35 lbs

• inadeq weight gain assoc w LBW

• child more likely to be overweight at age 3 if mom gained escess weight

know %

Oral Health

• 22-34% of women receive dental care during preg

• attitudes & behaviors abt dental care during preg influenced by fear/harm to fetus

• routine dental care during 2nd trim (gest wks 13-21) was not assoc w inc risk of serious medical events, preterm deliveries, spont aborts, or fetal deaths/anomalies

• best trim to do it?

hormonal changes (estrogen & progesterone)

• contrib to inc suscept > gingivitis & periodontitis

• studies indic perio during preg is signif risk factor for preeclampsia and/or delivering premature or LBW infant

• nausea, vomiting, & gastroesophageal reflux disease (GERD) are common (strong assoc betw GERD & dental erosion)

GERD

• common during preg due to normal physiologic changes affecting lower esophageal sphincter (LES)

• acid from vomit should be neutralized using baking soda (rub n rinse after 30 sec)

• brush after 30 min

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Artificial Sweeteners

• nonnutritive ones gen recog as safe & can use

• acesulfame potassium

Food Safety

• women at high risk for food-borne illness

• listeriosis (serious infect) can cause miscarriage, premature birth, still birth, or acute illness in the newborn

• Avoid unpasteurized juices, milk, and milk products

and certain soft cheeses; raw sprouts; and raw or

undercooked meat, poultry, eggs, fish(Sushi), and

shellfish(watch levels of mercury)

Severe nutr defs can result in malformations (cleft palate/lip/shortened mand)

• nutr availability affect whether teeth achieve optimum genetic potential

E/kcals

• 1st trim = needs dont inc

• 2nd trim = +340 kcal

• 
  

B-vits

• several B-vit reqs based on E or cal intake, & intake usually inc w additional intake of cals

• 
  

• olate = B-vit found in many foods

Cleft Lip

• tissue making up lip doesnt joing completelt before birth

• result in opeing in upper lip

• opening can be small slit/large opening going into nose

Spina Bifida

• birth defect when spine & spinal cord don’t form properly

• type of neural tube defect

Iron

• deficiency common problem among women

• many begin preg w/ diminished iron stores

• inc iron during gestation needed for prod of RBC & placenta

Zinc

• crucial early in preg during form of fetal orgs

• reqs highest in late preg (for fetal grow & dev)

• 
  

from slide i missed this

nut sup during preg

Vit C = 50 mg rec

vit b6 - 2mg

folate 300ug (microgram)

iron = 30 mg

zinc 15 mg

copper 2mg

supplementation should be based on an identified nutritional need, evidence of a benefit & lack of hharmful effects (only part need know)

DH considerations

• be familiar w cultural beliefs

• refer to HC provided if concerns identified

• encourage nutr-dense food rich in folate, iron, Ca

• encourage oral-selfcare & preventative dental care

Lactation

• exclusive breastfeed for 4-6mo. w/ addition of complementary foods beginning at least by 6 months until 12 months is ideal method of feeding infant

• breast milk is all infant need for first 6 month for optimal growth/dev (rare exceptions)

Nutr reqs

• approx

Dietary Patterns

• repletion of iron stores may be nec

• continued avoid of meds, OTC drugs & herbals rec

• many subs consumed by mom have been though to affect breast milk

• certain foods, (esp strong flav ones like raw onion, garlic, curry, chilli, choco) may cause GI distress, rash, irritability in infant (only omit if affected

Nutr Reqs: Oral Contraceptives

Nutr absorp negatively affected by OCAs

• vits B6, B12, & folate

• low body B6 reserves may put womena at risk for Vit b6 inadequacy during preg upon cessation of OCAs

• inc amts of B6 (pyridoxine) may be indicated (bc strogen inc prod of tryptophan which uses b6 in its metabolism)

• low b6 lvls also indep assoc w the risk for thromboembolism (blood clot that break lose) so supplement may be indicted

OCAs

Since nutr intake of many o