Week 1: Nutrition for Childbearing Study Notes

CHAPTER 8: Nutrition for Childbearing

Weight Gain During Pregnancy

  • Normal BMI:

    • Recommended weight gain is between 11.5 to 16 kg (25 to 35 lb).

  • Overweight:

    • Recommended weight gain is between 6.8 to 11.3 kg (15 to 25 lb).

  • Obese:

    • Recommended weight gain is between 5 to 9.1 kg (11 to 20 lb).

Pattern of Weight Gain

  • First Trimester:

    • Recommended weight gain is 0.5 to 2 kg (1.1 to 4.4 lb).

Case Study: Ms. Brooks

  • Patient Profile:

    • 29-year-old G1P1 at 28 weeks of gestation.

    • Began prenatal care at 12 weeks.

    • Fetal screening ultrasound at 18 weeks revealed normal anatomy.

    • All prenatal labs have been normal or negative.

    • Unplanned pregnancy; patient and partner delighted and planning marriage in 2 weeks.

  • Medical History:

    • Prepregnancy BMI: 32 (Obese).

    • History of borderline chronic hypertension.

    • Physician counselled to gain no more than 15 lb during pregnancy.

  • Clinical Assessment:

    • Current total weight gain: 12 lb.

    • Blood pressure: 138/86.

    • Urine: Negative for protein and glucose.

  • Patient's Emotional Response:

    • Expressed concern about weight gain saying, “What am I going to do? I have three more months to go.”

    • Began to cry.

  • Recommended Actions:

    • Nurse's responsibilities include providing support, reassurance, and guidance regarding healthy weight gain strategies.

Nutritional Requirements: Energy

  • Energy Measurement:

    • Measured in kilocalories (calories).

  • Carbohydrates:

    • Include both simple and complex carbohydrates.

  • Fats:

    • Provide energy and are carriers of fat-soluble vitamins.

  • Daily Caloric Needs:

    • Most pregnant women require between 2200 to 2900 calories daily.

  • Nutrient Density:

    • Refers to the quantity and quality of various nutrients in each 100 calories of food.

Nutritional Requirements: Protein

  • Need for Protein:

    • Essential for metabolism, tissue synthesis, and tissue repair.

  • Recommended Dietary Allowance (RDA):

    • Nonpregnant females: 46 g per day.

    • During pregnancy: 71 g per day.

    • Required for:

    • Expansion of blood volume.

    • Growth of maternal and fetal tissues.

Nutritional Requirements: Vitamins

  • Fat-soluble Vitamins:

    • Include A, D, E, and K.

    • Stored in the liver and can be toxic in excessive amounts.

  • Water-soluble Vitamins:

    • Include B6, B12, C, folic acid, thiamine, riboflavin, and niacin.

    • Should be included in the daily diet.

  • Folic Acid (Folate):

    • Important for decreasing the occurrence of neural tube defects.

Nutritional Requirements: Minerals

  • Iron:

    • Crucial for hemoglobin formation; approximately 1000 mg of absorbed iron needed above maternal stores during pregnancy.

  • Calcium:

    • Important for mineralization of fetal bones and teeth.

    • Increased absorption and retention of calcium during pregnancy.

  • Sodium:

    • Increased needs during pregnancy to support expanded blood volume and fetal needs.

Nutritional Requirements: Nutritional Supplementation

  • Purpose of Supplementation:

    • Food is the best source of nutrients; supplementation is prescribed typically by healthcare providers.

    • Women with adequate diets may not need supplements other than for iron and folic acid.

  • Assessment of Nutritional Needs:

    • Each woman's individualized needs must be assessed to determine if supplementation is necessary.

  • Disadvantages and Dangers of Supplements:

    • No standardization or regulation of ingredient amounts.

    • Excessive intake of some vitamins/minerals can be toxic to the fetus.

    • Supplements are not food substitutes and may lack some essential nutrients required during pregnancy.

Nutritional Requirements: Water

  • Importance of Water:

    • Essential for increased blood volume and maternal/fetal tissue expansion.

  • Recommended Water Intake:

    • Approximately 8 to 10 cups of fluids, primarily water, daily.

Factors Influencing Nutrition

  • Factors:

    • Age

    • Nutritional knowledge

    • Exercise

    • Cultural practices

      • Southeast Asian dietary practices, effect of culture on diet

      • Hispanic dietary practices

  • Potential Impact:

    • Increasing nutrients with traditional foods.

Nutritional Risk Factors

  • Socioeconomic Status:

    • Issues related to poverty.

    • Food supplement programs (e.g., WIC - Women, Infants, and Children) at www.fns.usda.gov/wic.

  • Vegetarianism:

    • Meeting nutritional requirements is challenging for pregnant vegetarians concerning energy, protein, calcium, iron, zinc, vitamin B12, and vitamin A.

  • Bariatric Surgery Considerations:

  • Pregnancy-related Issues:

    • Nausea and vomiting of pregnancy.

    • Anemia.

  • Abnormal Prepregnancy Weight:

    • Eating disorders: Anorexia and Bulimia.

    • Food cravings and aversions: PICA.

    • Multiparity and multifetal pregnancy.

Nutritional Risk Factors: Substance Use

  • Smoking:

  • Caffeine:

  • Alcohol:

  • Drugs and Substance Abuse:

    • Nutrient needs

    • Common problems, specifically in adolescents.

  • Other Risk Factors:

    • Include various psychosocial influences.

Nutrition After Birth

  • Lactation:

    • Energy:

    • During the first 6 months: Estimated energy requirement (EER) is an additional 330 calories.

    • During the second 6 months: Requires an additional 400 calories.

  • Nutritional Needs:

    • Includes protein, fats, vitamins, and minerals.

  • Fluid Needs:

    • Importance of fluid intake during lactation.

  • Other Considerations:

    • Avoid fish with high mercury levels.

    • Avoid herbal teas and remedies.

    • Avoid illicit drugs and tobacco.

Specific Nutritional Concerns After Birth

  • Dieting:

    • Implications for post-lactation weight loss.

  • Adolescents:

  • Vegan Diet Considerations:

    • Implications and nutritional adequacy.

  • Avoidance of Dairy Products:

    • Impacts calcium and vitamin D levels.

  • Bariatric Surgery Implications:

    • Potential for inadequate diet during recovery.

  • Overall Inadequate Diet Concerns:

Nutrition for the Non-lactating Mother

  • Return to Prepregnancy Diet:

    • Return to previous nutritional patterns post-birth.

  • Nursing Responsibilities:

    • Assess understanding of nutritional needs from food groups.

    • Guidance on weight loss strategies post-pregnancy.

Application of the Nursing Process: Nutrition for Childbearing

  • Assessment:

    • Includes interviews regarding appetite, eating habits, and food preferences.

    • Identification of potential problems stemming from psychosocial influences.

    • Diet history and food intake records.

  • Identification of Potential Problems:

    • Food frequency questionnaires, physical assessments, and signs of nutrient deficiency.

    • Laboratory tests for ongoing nutritional status and client problem identification.

  • Planning: Expected Outcomes:

    • Establish expected outcomes based on nutritional assessments.

    • Interventions include:

    • Identifying problems.

    • Explaining nutrient needs.

    • Providing reinforcement for healthy practices.

    • Evaluating weight gain.

    • Encouraging supplements where necessary.

    • Referral to specialists if needed.

Example Case: Weight Gain Guidelines

  • A pregnant woman with a BMI of 22 inquires about weight gain recommendations during pregnancy:

    • Possible responses include:

    • Weight gain of 1 lb per week throughout pregnancy.

    • Weight gain of 3.5 lb during the first trimester, then 1 lb each week until the end of pregnancy.

    • Weight gain of 1 lb a week during the first two trimesters, then 2 lb per week during the third trimester.

    • A total weight gain recommendation of 25 to 35 lb.