Objectives

• To produce a healthy, normal weight infant while minimizing the short and long term health risks to the mother

• To determine the appropriate weight gain during pregnancy for the normal weight, underweight, overweight and adolescent pregnant woman

Objectives (cont.)

• To recognize the additional energy, vitamin and mineral requirements during pregnancy and lactation

• To recommend dietary modifications to help alleviate nausea, heartburn and constipation during pregnancy

• To develop skills to help promote and maintain breast-feeding

Prenatal Nutrition

Questions with nutritional implications for the obstetric history and physical exam

Present illness

• General: recent weight change, poor weight gain, edema, dehydration

• G.I. complaints: Diarrhea, nausea, vomiting, heartburn, constipation

Medical History

• Prenatal vitamins, nutritional supplements, herbs, remedies?

• Iron supplements

• Food allergies

• Non-food cravings

• Obstetric history

Social History

• Alcohol?

• Special Diet?

• How many meals and snacks daily?

• Avoid any specific foods?

• Milk: how much, type?

• Lactose intolerance

Family History

• Familial occurrence of dx

• History of children with fetal anomalies

Review of symptoms

• General: Fatigue, weight change

• Month: teeth, gums, lips, tongue

• GI/abdomen: Appetite, food intolerance, nausea, constipation, diarrhea

Physical Exam: Anthropometric data

• Height

• Current weight

• Prepregnancy weight

• Prepregnancy BMI = {[wt (kg)] / ht2 (m2)}

• Weight gain during pregnancy so far

Laboratory Evaluation

• Glucose

• Hematocrit

• Hemoglobin

Maternal weight gain

Underweight

• BMI < 19.8

• Total weight gain 28 - 40 lbs.

• 5 lbs./ 4 weeks

Normal

• BMI = 19.8 - 26

• Total weight gain 25 - 35 lbs.

• 4 lbs./ 4 weeks

Overweight

• BMI = 26.1 - 29

• Total weight gain 15 - 25 lbs

• 2.6 lbs./ 4 weeks

Adolescent

• Pounds to bring weight near normal for height

• Pounds for 9 month interval of growth

• Pounds recommended for pregnancy

Nutritional requirements

• Energy: + 300 kcal/day in 2nd and 3rd trimester

• Protein: RDA = 60 g

• Calcium

• Folate

• Iron

Nutritional Problems

• Nausea and vomiting (hCG)

• Constipation (progesterone)

• Heartburn

Lactation Management

Benefits of Breast-feeding

Infant

• Decreased incidence of infection

• Protection against autoimmune diseases

• Good jaw and tooth development

• Mother - Infant bonding

Mother

• Accelerated weight loss

• Delayed return of ovulation

• Improved bone remineralization

• Reduced ovarian and premenopausal breast cancer risk

• Easy, clean, economical

Maternal nutritional requirements

• Energy: + 500 kcal/day, progressive weight loss not to exceed 4.5 lb/month

• Protein: RDA = 65 g

• Calcium: 1200 mg (same as prenatal)

• Iron requirement is decreased

• Prenatal supplements

• Fluids 2-3 quarts/day

Contraindications

• Maternal infections: TB, typhoid, rubella, mumps, HIV and CMV

• Maternal medications: most chemotherapeutic agents, illegal substances. "If you wouldn't prescribe it for the baby, think carefully about giving it to the mother.”

• Infant: galactosemia, some congenital deformities of the palate

Breast-feeding promotion and support

• Education of mother and family

• Provision for early and frequent mother infant contact

• Concept of "demand and supply”

• Solutions for work related concerns: pumping and storage

• Proper feeding technique and breast care