Chapter 9 Maternal and Fetal Nutrition All Elsevier items and derived items © 2014, 2010, 2006,...
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Transcript of Chapter 9 Maternal and Fetal Nutrition All Elsevier items and derived items © 2014, 2010, 2006,...
Chapter 9
Maternal and Fetal Nutrition
All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Key components of nutrition care Nutrition assessment Diagnosis of nutritional related problems or risk
factors Intervention based on an individual’s dietary goals
and plan for appropriate weight gain Evaluation with referral to a nutritionist or dietitian as
necessary
Maternal and Fetal Nutrition
2All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
3All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
First trimester crucial for embryonic and fetal organ development
Healthful diet before conception ensures that adequate nutrients are available for developing fetus
Folate or folic acid intake important in the periconceptual period Neural tube defects are more common in infants of
women with poor folic acid intake
Nutrient Needs Before Conception
4All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Factors that contribute to the increase in nutrient needs The uterine-placental-fetal unit Maternal blood volume and constituents Maternal mammary development Metabolic needs
Nutrient Needs During Pregnancy
5All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Energy needs Weight gain
• Body mass index (BMI) = weight/height2
Pattern of weight gain Hazards of restricting adequate weight gain Excessive weight gain
Protein Fluids
Nutrient Needs During Pregnancy (Cont.)
6All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
You are the nurse working with prenatal patients at the health department. You meet Ms. Brooks, a 29-year-old G1P1 at 28 weeks of gestation. Ms. Brooks began prenatal care at 12 weeks. Her fetal screening ultrasound at 18 weeks revealed normal anatomy, and all of her prenatal laboratory results have been normal or negative. The pregnancy was not planned, but she and her partner are “delighted” and plan to be married in 2 weeks.
Case Study
7All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Ms. Brooks had a prepregnancy BMI of 32 and has a history of borderline chronic hypertension. She has been counseled by the physician to gain no more than 15 lbs during her pregnancy. As you check her in for her visit, you note that her total weight gain during pregnancy is 12 lbs. Her blood pressure is 138/86. Her urine is negative for protein and glucose. When Ms. Brooks looks at the scale, she says, “What am I going to do? I have 3 more months to go.” She begins to cry.
Case Study (Cont.)
8All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
What should you do and say? What risk factors are associated with obesity in
pregnancy? Why was the urine checked for protein and
glucose at the visit?
Case Study (Cont.)
9All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
10All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Minerals and vitamins Iron Calcium
Other minerals and electrolytes Magnesium Sodium Potassium Zinc Fluoride
Nutrient Needs During Pregnancy (Cont.)
11All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Minerals and vitamins Fat-soluble vitamins
• Vitamins A, D, E, and K
Water-soluble vitamins• Folate or folic acid• Pyridoxine• Vitamin C
• Vitamin B12
Nutrient Needs During Pregnancy (Cont.)
12All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Other nutrition issues during pregnancy Pica
• The practice of consuming nonfood substances• May be influenced by the woman’s cultural background
Food cravings• Proposed that food cravings during pregnancy are caused by
an innate drive to consume nutrients missing from the diet• This has not been supported by research
Nutrient Needs During Pregnancy (Cont.)
13All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
14All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Other nutrition issues during pregnancy Adolescent pregnancy needs
• Improve nutritional health of pregnant adolescents by focusing on knowledge and planning of meals
• Nutrition interventions and educational programs effective with adolescents
• Understanding factors that create barriers to change in adolescent population
• Promote access to prenatal care
Nutrient Needs During Pregnancy (Cont.)
15All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Other nutritional issues during pregnancy Preeclampsia
• The cause is still unknown• Speculation that poor intake of specific nutrients may be a
contributing factor• An adequate diet remains the best means of prevention
Nutrient Needs During Pregnancy (Cont.)
16All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Physical activity during pregnancy Moderate exercise yields many benefits, including
improving muscle tone, shortening course of labor, and sense of well-being
• Liberal amounts of fluid should be consumed before, during, and after exercise
• Calorie intake sufficient to meet increased needs of pregnancy and exercise
Nutrient Needs During Pregnancy (Cont.)
17All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Nutrition needs during lactation similar to those during pregnancy
Needs for energy (calories), protein, calcium, iodine, zinc, the B vitamins, and vitamin C remain greater than nonpregnant needs
Nutrient Needs During Lactation
18All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Energy intake increase of 330 kcal more than woman’s nonpregnant intake recommended
Increased maternal weight loss during lactation Smoking, alcohol intake, and excessive caffeine
intake should be avoided during lactation
Nutrient Needs During Lactation (Cont.)
19All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Diet history Obstetric and gynecologic effects on nutrition Health history Usual maternal diet Physical examination Anthropometric measurements Laboratory testing
Care Management
20All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Collaborative care Adequate dietary intake
• Pregnancy• Postpartum• Daily food guide and menu planning• Medical nutrition therapy• Counseling about iron supplementation
• www.choosemyplate.gov
Care Management (Cont.)
21All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Collaborative care Coping with nutrition-related discomforts
of pregnancy• Nausea and vomiting• Constipation• Pyrosis (heartburn) • Cultural influences• Vegetarian diets
Care Management (Cont.)
22All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.
Assessment of a woman’s nutritional status includes a diet history, medication regimen, physical examination, and relevant laboratory tests. A maternity nurse performing such an assessment should be aware that:
oral contraceptive use may interfere with the absorption of iron. illnesses that have created nutritional deficits such as
phenylketonuria may require nutritional care before conception. the woman’s socioeconomic status and educational level are not
relevant to her examination; they are the province of the social worker, if anybody.
the only nutrition-related laboratory test most pregnant women need is testing for diabetes.
Question
23All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.