Chapter 12

Maternal and Fetal Nutrition

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Maternal and Fetal Nutrition

Good nutrition before and during pregnancy an important preventive measure

Low-birth-weight (LBW) infants Preterm infants Neonatal death rates for moderate LBW are five times higher than babies >2500 g The risk for VLBW is 100 times higher

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Nutrient Needs Before Conception

First trimester crucial for embryonic and fetal organ development Healthful diet before conception ensures that adequate nutrients are available for developing fetus Folic acid intake important in periconceptual period

Neural tube defects are more common in infants of women with poor folic acid intake

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Fig. 12-1. Factors that influence the outcome of pregnancy.

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Nutrient Needs During Pregnancy

Energy needs

Weight gain Body mass index (BMI) = weight/height2 Pattern for weight gain Hazards of restricting adequate weight gain

Protein Fluids

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Nutrient Needs During Pregnancy contd

Minerals and vitamins

Iron Calcium

Other minerals and electrolytes

Magnesium Sodium Potassium Zinc Fluoride

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Nutrient Needs During Pregnancy contd

Minerals and vitamins

Fat-soluble vitamins Vitamins A, D, E, and K Water-soluble vitamins Folate or folic acid Pyridoxine Vitamin C Multivitamin-multimineral supplements

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Nutrient Needs During Pregnancy contd

Other nutrition issues during pregnancy

Pica and food cravings 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

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Nutrient Needs During Pregnancy contd

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

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Nutrient Needs During Pregnancy contd

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

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Nutrient Needs During Lactation

Nutrition needs during lactation similar to those during pregnancy Needs for energy (calories), protein, calcium, iodine, zinc, the B vitamins, and vitamin C greater than nonpregnant needs

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Nutrient Needs During Lactation contd

Energy intake increase of 500 kcal more than womans nonpregnant intake recommended Smoking, alcohol intake, and excessive caffeine intake should be avoided during lactation

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Nursing Care Management

Assessment

Diet history Obstetric and gynecologic effects on nutrition Medical history Usual maternal diet Physical examination Laboratory testing

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Nursing Care Managementcontd

Plan of care and implementation

Adequate dietary intake Pregnancy Postpartum Daily food guide and menu planning Medical nutrition therapy Counseling about iron supplementation

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Nursing Care Managementcontd

Plan of care and implementation

Adequate dietary intake Coping with nutrition-related discomforts

of pregnancy

Nausea and vomiting Constipation Pyrosis (heartburn) Cultural influences Vegetarian diets

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Key Points

Womans nutritional status before, during, and after pregnancy contributes to her wellbeing and that of her infant Physiologic changes during pregnancy influence need for additional nutrients and efficiency with which the body uses them Total maternal weight gain and pattern of weight gain are important determinants of outcome of pregnancy
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Key Pointscontd

Appropriateness of mothers prepregnancy weight for height (BMI) is major determinant of recommended weight gain during pregnancy Nutritional risk factors include adolescent pregnancy; bizarre or faddish food habits; abuse of nicotine, alcohol, or drugs; low weight for height; and frequent pregnancies

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Key Pointscontd

Iron supplementation is recommended routinely during pregnancy Other supplements recommended when nutritional risk factors present Nurse and woman influenced by cultural and personal values and beliefs during nutrition counseling

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Key Pointscontd

Pregnancy complications that may be nutrition related include:

Anemia Gestational hypertension Gestational diabetes Intrauterine growth restriction

Dietary adaptations can be effective interventions for some common discomforts of pregnancy, including nausea and vomiting, constipation, and heartburn
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