ch 12 pregnancy/babies

Cultural and Religious Influences on Food and Nutrition

Nutritional deficiencies during the __________ increase the risk of certain chronic diseases later in the infant’s life

first trimester

pre-pregnancy overweight and obesity

• need a longer time to conceive due to higher risk of infertility

• increases the risk for:

  • maternal complications

  • maternal postpartum weight retention

  • poor fetal outcomes

  • childhood obesity in the infant

  • large-for-gestational-age (LGA) births

  • HTN/preecclampsia

  • Gestational DM (GDM)

  • C-section delivery

Pre-pregnancy underweight

• increased risk for small-for-gestational-age births (LBW)

• Multiple micronutrient supplementation appears to be “too little, too late” to fundamentally improve child health outcomes

  • Need to focus on preconception maternal health

Pre-pregnancy nutrition

• Limit solid fats, added sugars, sodium, and refined grains

  • solid fats and added sugars = less than 10% of total daily calories

  • sodium = less than 2300mg per day

• get nutrients through food & beverages, not supplements

• Include the Healthy U.S.-Style Eating Pattern and Mediterranean-Style Eating Pattern

  • Vegetarian Eating Pattern can also be used with careful attention to certain nutrients (B12, calcium, iron)

folic acid taken prior to pregnancy decreases the risk of ____________, which obese women are more at risk too

neural tube defects

synthetic folic acid

• recommended amount: 400 mcg - 800 mcg daily

  • obese women need closer to 800 mcg

  • mostly from supplements

• consume by supplements and fortified foods

• More readily absorbed in our bodies than the natural version

• The critical supplementation period starts 1 month before conception and continues through the first 2–3 months of pregnancy

Risk factors for neural tube defects

• Obesity, maternal diabetes, and mutations in folate-related enzymes

  • may benefit from a supplement containing 800 mcg of folic acid

Recommended amount of weight gain ________ is based on ________ BMI

prepregnancy

Recommended amount of weight gain - Underweight

28 to 40 pounds

Recommended amount of weight gain - Normal/healthy BMI

25 to 35 pounds

Recommended amount of weight gain - Overweight BMI

15 to 25 pounds

Recommended amount of weight gain - Obese

11 to 20 pounds

BMI - Obesity Class I

30–34.9

BMI - Obesity Class II

35–39.9

BMI - Obesity Class III

≥40

weight gain during pregnancy

• All women gain 1-4 pounds in the first trimester

• Normal-weight women are urged to gain ~1 pound per week during the second & third trimesters

Increased Calorie Needs - 1st trimester

no extra calories

Increased Calorie Needs - 2nd trimester

+ 340 cal/day

Increased Calorie Needs - 3rd trimester

+ 452 cal/day

Calories range from ________ from before pregnancy through the 3rd trimester

2000 to 2400

calorie levels

1800, 2000, 2200, 2400, 2600, and 2800

important nutrients for pregnancy

• Folic Acid

• Iron → recommendation is increased to 27 mg/day

• Iodine → not all prenatal supplements contain iodine

  • Main dietary source is iodized salt

• Calcium → 1000 mg daily; 3 servings of milk

• Vitamin D → 600 IU per day; sunlight and fortified dairy

what is folic acid necessary for?

• DNA synthesis

• Synthesis of new cells

• Transmission of inherited characteristics

folic acid foods

• beans, lentils, leafy greens (broccoli, spinach)

• Fortified in grains/breads

what is iron necessary for?

• Increase in maternal blood volume

• Support fetal storage

iron - heme foods

meat, fish, poultry, some fish

iron - non-heme foods

beans, lentils, leafy greens, fortified grains/cereals

what is iodine necessary for?

• Supports fetal neurocognitive development

• Insufficient intake = stillbirth, miscarriage, cretinism (severe hypothyroidism in kids), neurodevelopmental deficits

• prenatal supplements should contain this (not all of them do!)

Alcohol

• can cause physical and neurodevelopmental problems

• small amounts may not be harmful to the fetus

• Potent teratogen, a “safe” level of consumption is not known but women are advised to completely avoid before and during pregnancy

• Fetal ______ syndrome

Caffeine

• Should limit intake to less than 300 mg/day (~ 3 cups)

  • 80-100 mg per 8 ounces is the usual amount

• Data do not suggest an increased risk of adverse effects on pregnancy, fertility, or fetal neurodevelopment with caffeine intake of 300 mg/day or less

• Not known if higher caffeine intake is correlated to miscarriage

Non-nutritive sweeteners

• FDA has approved 6 nonnutritive sweeteners as food additives and 2 as Generally Recognized as Safe (GRAS)

• Data regarding the use of saccharin are conflicting

• controversy exists

Seafood

• omega-3 fatty acids, especially docosahexaenoic acid (DHA) → improved infant visual and cognitive development

  • no clear evidence that omega-3 supplements improve outcomes in children

• 8-12 oz. of low mercury fish per week recommended

  • mercury can cause fetal neurologic damage in high doses

• possible that mercury in fish is offset by DHA intake

Good seafood choices

anchovies, salmon, herring, mackerel, sardines, light tuna, trout

Seafood choices to avoid

shark, king mackerel, swordfish

Listeriosis/listeria

• Usually a mild illness for pregnant women but causes severe disease in the fetus or newborn

• increased risk for pregnant women due to hormonal changes that decrease cell-mediated immune function

• Can result in miscarriage, stillbirth, preterm birth

Listeriosis/listeria - foods to avoid

• Raw milk, unpasteurized juices

• Soft and/or unpasteurized cheeses

• Deli meats

Toxoplasma gondii (parasite)

• Healthy people → asymptomatic or flu-like symptoms

• increased risk for pregnant women due to hormonal changes that decrease cell-mediated immune function

• can cause fetal mental disability, blindness, and hearing loss, which may not develop until later in life

• Avoid undercooked meat/poultry and changing cat litter

During pregnancy, a goal of ___________ of moderate exercise is recommended

150 minutes per week

possible causes of N/V

• Hypoglycemia

• decreased gastric motility

• relaxation of the cardiac sphincter

• anxiety

N/V nursing interventions

• Eat easily digested carb foods before getting out of bed in the morning

  • dry crackers, melba toast, dry cereal, hard candy

• Eat frequent, small snacks of dry carbs to prevent hypoglycemia

  • crackers, hard candy

• Eat small frequent meals.

• Avoid liquids with meals.

• Limit high-fat foods bc they delay gastric emptying.

• Eliminate individual intolerances and foods with a strong odor.

possible causes of constipation

• increased progesterone levels may cause relaxed GI muscles and motility

• Increasing pressure on the GI tract by the fetus

• Decrease in physical activity

• Inadequate fiber and fluid intake

• Use of iron supplements

constipation nursing interventions

• Increase fiber intake, especially intake of whole-grain breads and cereals

  • Look for breads that provide at least 2g fiber/slice and cereals with at least 5g fiber/serving.

• Drink at least eight 8-oz glasses of liquid daily.

• hot water with lemon or prune juice upon waking to help stimulate peristalsis.

• regular exercise.

possible causes of heartburn

• Decreased GI motility

• relaxed cardiac sphincter

• Pressure of the uterus on the stomach

heartburn nursing interventions

• Eat small, frequent meals

• eliminate liquids immediately before and after meals to avoid gastric distention.

• Avoid coffee, high-fat foods, and spices.

• Eliminate individual intolerances.

• Avoid lying down or bending over after eating.

Pica

• craving for nonfood items such as laundry starch, clay, or ice

• associated with micronutrient deficiencies, such as iron deficiency anemia

• Rates of anemia higher in these cases

• ____ may cause deficiencies but it’s also possible that micronutrient deficiencies cause ____

Excessive Gestational Weight Gain (GWG)

• Women who are obese may not need to increase calories

• Maternal increased risk of the following:

  • C-section delivering a LGA neonate

  • Post-partum weight retention

  • Type 2 diabetes

  • CVD

  • Metabolic syndrome

• Risks to the infant include macrosomia and childhood overweight or obesity

Macrosomia

a condition where a newborn baby is significantly larger than average for their gestational age

Fetal risk of maternal preexisting DM

• premature or still birth, birth defects

• hypoglycemia

• jaundice

• Hydraminos (extra amniotic fluid in the sac) leading to preterm delivery

• Macrosomia leading to c-section birth

Maternal risk of preexisting DM during pregnancy

Complications such as retinal and kidney disease, hypertension or pre-eclampsia

Hydramnios/polyhydramnios

Extra amniotic fluid in the sac

fetal risk of maternal gestational diabetes

• c-section delivery, shoulder dystocia, birth trauma, neonatal hypoglycemia, and neonatal hyperbilirubinemia

• macrosomia

• Increased risk of obesity and type 2 diabetes during childhood or adolescence

maternal risk from gestational diabetes

Type 2 diabetes

gestational diabetes usually develops in the ______________ trimester

second or third

Complications of Hypertensive Disorders during Pregnancy

• preeclampsia

• fetal growth restriction, preterm birth, and increased likelihood of cesarean delivery

• placental abruption

Gestational HTN

• Systolic BP of at least 140 mmHg OR a diastolic BP of at least 90 mmHg

• Onset after 20 weeks of gestation and without proteinuria

  • Often does not occur until 30 weeks or later

• greater chance of this in those who begin pregnancy obese

Preeclampsia

• gestational HTN

• proteinuria, although it can occur in the absence of proteinuria but with certain other symptoms

• Treatment of high BP = giving magnesium sulfate to prevent eclampsia and inducing delivery

Maternal Phenylketonuria (PKU)

• inborn error of phenylalanine (an essential amino acid) metabolism

• causes severe neurologic damage when left untreated

• interventions = a very low protein diet and supplements with low or phenylalanine-free medical foods are used to meet protein and calorie needs

  • Aspartame must be avoided as it contains phenylalanine

• Most infants born to mothers with this don’t inherit it

Foods high in Phenylalanine

• meat, poultry, seafood

• dairy, eggs

• beans, nuts, and soy

Adolescent Pregnancy

• Increases health risks to both infant and mother

• Infants at higher risk of low birth weight (LBW) and preterm delivery

  • Especially in mothers < 15 years old

• Mothers tend to:

  • be physically, emotionally, financially, and socially immature

  • seek prenatal care later and have fewer total visits

  • smoke

  • misunderstand need for weight gain

low birth weight (LBW) is under _____ lbs

5.5

In the US, both the American Academy of Pediatrics and the Academy of Nutrition and Dietetics recommend the following:

• Infants be exclusively breastfed for the first 6 months of life

• Breastfeeding continues with complementary foods until at least 1 year of age

mom’s breastfeeding benefits

• reduced risk of postpartum hemorrhage and depression

• delays ovulation

• possibly also:

  • Postpartum weight loss

  • Improved infant bonding

  • reduces risk of:

    • HTN

    • postmenopausal breast and ovarian cancer

    • premenopausal breast cancer

    • comorbidities of excess weight (ex: type 2 diabetes)

infant breastfeeding benefits

• reduces the risk of:

  • Nonspecific GI infections

  • Upper and lower respiratory tract infections

  • Otitis media

  • Sudden infant death syndrome

  • Necrotizing enterocolitis among premature and low-birth-weight infants

    • enterocolitis = inflammation of all of intestines

• possibly also:

  • promotes cognitive development

  • decreases risks of:

    • atopic dermatitis (eczema)

    • autoimmune disorders

    • asthma

    • overweight/obesity later in life

    • comorbidities related to excess weight (ex: type 2 diabetes, heart disease)

Contraindications to breastfeeding

Mother with HIV, Ebola, TB, drug use, certain medications

calorie needs for lactation

• Exclusive breastfeeding = ~500 cal/day above nonpregnant calorie needs

  • An extra 330 cal/day for the first 6 months

  • An extra 400 cal/day for the 2nd 6 months

• Breastfeeding supplemented with formula requires a smaller increase in calorie intake

• Not enough calories = less breast milk

  • mom should not eat less than 1500-1800 cals/day

fluid needs for lactation

• Drink a glass of fluid at each nursing, with all meals, or about twelve 8oz caffeine-free glasses daily

• Thirst is a good indicator of need except among women who live in a dry climate or who exercise in hot weather

• more fluid does NOT increase milk production

recommended iron during pregnancy

27 mg/day

recommended calcium during pregnancy

1000 mg daily

recommended Vitamin D during pregnancy

600 IU per day