CH 8 Nutrition for childbearing

Weight gain during pregnancy

- Recommended for total weight gain, based on the woman's pregnancy body mass index.

- Recommended weight gain is 11.5 to 16kg which is 25 to 25 Ib for women who begin pregnancy at normal BMI.

- Higher pre-pregnancy BMIs should not gain as much.

All women with childbearing potential should be taking a prenatal vitamin or multivitamin with _____

Folic acid

Why is folic acid essential to take during pregnancy?

- Decreases the incidence of neural tube defects and possibly reduces cleft lip and palate

- Taking 600 mcg during pregnancy

Pattern of weight gain

- The general recommendation is an increment of 0.5 to 1 Ib a week during the second and third trimesters. No weight gain or minimal in the first trimester.

- Maternal and fetal distribution

- Factors that influence weight gain

First trimester weight gain

The mom doesn't really gain any weight during the first trimester, may be less 0.5 a pound a week.

How much is "baby weight"?

1. Products of conception include the placenta, amniotic fluid, and fetus, which equal 1/3 of gestational weight gain (GWG).

2. Maternal tissue includes blood, uterus, mammary gland, and fluid. Water gain is highly variable, usually 7-8 liters.

3. Fat deposition occurs mostly in the first 20 weeks, mostly over the abdomen, back, and upper thighs.

- The amount of fat gained depends on pre-pregnancy BMI, and obese women gain less fat.

Underweight Rates of GWG

- Pre-pregnancy BMI: Less than 18.5

- TGWG: 28-40 pounds

- Rates of Mean GWG in the 2nd & 3rd trimesters: 1 (1-1.3)

Normal Rates of GWG

- Pre-pregnancy BMI: 18.5-24.9

- TGWG: 25-35 pounds

- Rates of Mean GWG in the 2nd & 3rd trimesters: 1 (0.8-1)

Overweight Rates of GWG

- Pre-pregnancy BMI: 25.0-29.9

- TGWG: 15-25 pounds

- Rates of Mean GWG in the 2nd & 3rd trimesters: 0.6 (0.5-0.7)

Obese Rates of GWG

- Pre-pregnancy BMI: Greater than 30.0

- TGWG: 11-20

- Rates of Mean GWG in the 2nd & 3rd trimesters: 0.5 (0.4-0.6)

Dietary reference intakes (DRIs)

Used to estimate nutrient needs

Recommended dietary allowance (RDA)

The amount of a nutrient that is sufficient to meet the needs of almost all healthy people in an age group.

Nutritional requirements: energy

- Measured in kilocalories (calories)

- Carbohydrates: simple or complex

- Fats: provide energy and fat-soluble vitamins

- Calories: most pregnant women need 2200 to 2900 calories daily

- Nutrient density: the quantity and quality of various nutrients in every 100 calories of food.

Nutritional Requirements: Protein

- Necessary for metabolism, tissue synthesis, and tissue repair

- Daily protein RDA is 46 g for nonpregnant females

- Daily recommended protein intake of 71 g during pregnancy

- Expansion of blood volume

- Growth of maternal and fetal tissues

Nutritional Requirements: Vitamins

- Fat-soluble

- Water-soluble

- Folic acid (folate)

Fat-soluble vitamins

- A, D, E, K

- Stored in the liver

- Excessive intake of these vitamins can be toxic, causing fetal defects; ask about maternal vitamins.

Water-soluble vitamins that should be included in daily diet

- B6

- B12

- C

- Folic acid

- Thiamine

- Riboflavin

- Niacin

Folic acid

Decreases the occurrence of neural tube defects.

Nutritional requirements: Minerals

- Iron

- Calcium

- Sodium

Iron

- Important in the formation of hemoglobin.

- During pregnancy, approximately 1,000 mg of absorbed iron above maternal iron stores are needed.

Calcium

- Important for the mineralization of fetal bones and teeth.

- Calcium absorption and retention increase during pregnancy

Sodium

Sodium needs are increased during pregnancy to provide for an expanded blood volume and the needs of the fetus.

Nutritional supplementation

- Food is the best source of nutrients

- Healthcare providers usually prescribe prenatal vitamin-mineral supplements.

- Women with adequate diets may not need supplements except for iron and folic acid.

- Assessment of each woman's individualized needs determines whether supplementation is appropriate.

The disadvantages and dangers of nutritional supplementation

- No standardization of the regulation of ingredient amounts.

- Excessive amounts of some vitamins and minerals may be toxic to the fetus.

- Supplements are not food substitutes and do not contain all the nutrients needed during pregnancy

Nutritional requirements: water

- Water is important during pregnancy

- For expanded blood volume

- As part of the increased maternal and fetal tissues

- Women should drink approximately 8 to 10 cups of water each day

Food plan: USDA MyPlate provides a guide for healthy

Whole grains, vegetables, fruits, dairy groups, protein groups, and other elements.

Factors that influence nutrition

- Age

- Nutritional Knowledge

- Exercise

- Culture:

(Southeast Asian dietary practices & Effect of culture on diet during childbearing)

(Increasing nutrients with traditional foods and Hispanic dietary practices)

Nutritional Risk Factors

- Socioeconomic status, such as poverty

- Lactose intolerance

- Nausea and vomiting from pregnancy

- Anemia

- Abnormal prepregnancy weight

- Eating disorders such as anorexia and bulimia

- Food cravings and aversions such as pica

- Multiparity and multifetal pregnancy

PICA

An abnormal craving or appetite for nonfood substances, such as dirt, paint, or clay, that lasts for at least 1 month.

Nutritional risk factors in vegetarianism

Ensuring that the nutritional requirements for the pregnant vegetarian are met: energy, protein, calcium, iron, zinc, vitamin B12, and vitamin A.

Severe nutritional risk factors

- Substance abuse, smoking, caffeine, alcohol

- Adolescence, nutrient needs, common problems, and teaching adolescents

Food safety during pregnancy & lactation

- Do not eat shark, swordfish, mackerel, and tilefish.

- Do not eat raw or undercooked fish, meats, poultry, or eggs.

- Avoid luncheon meats and hot dogs unless reheated until steaming hot.

- Avoid soft cheeses that are made with unpasteurized milk.

- Do not consume pâté or meat spreads or raw (unpasteurized) milk products.

Nutrition after birth

- Lactating mothers require more energy.

- In the first 6 months of lactation, the estimated energy requirement (EER) is an additional 330 calories.

- The second 6 months require 400 additional calories

- Including more of protein, fats, vitamins, and minerals

Nutrition After Birth: Specific Concerns

- Dieting

- Adolescence

- Vegan diet

- Avoidance of dairy products

- Inadequate diet

- Alcohol

- Caffeine

Non-lactating mother

- Can return to her pre-pregnancy diet

- Nurse assesses the mother's understanding of the amount of food she needs from each food group

- Weight loss

Application of the Nursing Process: Nutrition for Childbearing

Assessment: Interview, diet history, physical assessment, laboratory tests, ongoing nutritional status.

- Identification of patient problems

- Planning

- Interventions: Identifying problems, explaining nutrient needs, providing reinforcement, evaluating weight gain, encouraging supplement intake, making referrals

- Evaluation