4.1c Other Nutritional Issues During Pregnancy, Nutritional Care, Teaching

Question 1

Alcohol

Answer 1

• No safe amount at any point in pregnancy
• Teratogen causes the below
  Birth defects
  Impaired cognitive and psychomotor development
  Emotional and behavioral problems
  Growth restriction
  CNS abnormalities
  Facial dysmorphia

Question 2

Caffeine

Answer 2

• Less than 200 mg daily has been shown to be safe

Question 3

Artificial Sweeteners

Answer 3

• Aspartame should be avoided in patients with PKU
• PKU (Amino acid phenylalanine build up in body which results in health problems)
• DO NOT TAKE STEVIA (plant based sweetener)
• Nutrasweet, Sunett, Splenda are okay to take

Question 4

PICA

Answer 4

• Consuming non-food substances or excessive amount of low nutrition food
• Often influenced by cultural background
• Screening during first prenatal visit, every trimester, and if anemia is present

Question 5

Food Cravings

Answer 5

• Generally not harmful to satisfy cravings

Question 6

Types of vegetarianism

Answer 6

Lacto-Vegetarian - Consumes milk products
Lacto-Ovo Vegetarians - Consumes egg, dairy, plants
Vegans - Consumes only plant products

Vegetarians can obtain adequate nutrition for pregnancy
Vegans should be referred to nutritional counseling

Question 7

Gluten Free Diets

Answer 7

• Little to no evidence of gluten free benefits

Question 8

Nutritional Assessment

Answer 8

• Preformed before conception to recommend diet, lifestyle, weight changes before pregnancy
• Completed at first prenatal visit

Question 9

Health History

Answer 9

• Completed at first prenatal visit and provides nutrition needs and concerns
• Nutrition can be affected by DM, liver disease, cystic fibrosis, crohns disorder
• Adolescents and multiple gestations should be referred to nutrition counseling
• Bariatric surgery also has serious implications for nutritional health

Question 10

How to preform Nutrition Health Assessment

Answer 10

• Bariatric surgery has serious implications for nutritional health during pregnancy
• Information about medication, alcohol, tobacco, drugs
• Review of OB and gynecologic history may reveal nutritional concerns
• Important to note if pregnant woman is an adolescent
• Adolescent and multiple gestations are both important to note

Question 11

Nutritional Assessment Components

Answer 11

• Adequate income to support nutritional needs
• Dietary modifications
• Food allergies/intolerances
• All medication and supplements
• Unusual cravings, PICA, cultural dietary practices
• Presence of n/v, constipation, pyrosis (heartburn)
• Evidence of eating disorders (anorexia, bulimia, rigorous dieting)

Question 12

Anthropometric (Body) Measures

Answer 12

• Physical Assessment
• Height and weight during first prenatal visit
• Weight measured at each subsequent prenatal visit
• BMI determines how much weight should be gained

Question 13

Laboratory Testing

Answer 13

ONLY IMPORTANT ONES

- Hematocrit & hemoglobin

Question 14

Education

Answer 14

• Nutritional needs during pregnancy
• Appropriate weight gain throughout pregnancy
• Dietary planning
• Coping methods for nutrition related discomforts
• Appropriate use of supplements
• Avoid alcohol/tobacco/drugs
• Safe food preparation and handling

Question 15

Financial Programs

Answer 15

• Supplement Nutrition Assistance Program (SNAP)

- Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Question 16

Nutrition Risks

Answer 16

• LBW
• Preterm Birth
• First trimester crucial for neural tube defect

Question 17

Weight Gain during Pregnancy

Answer 17

First Trimester
- Total weight gain 1-2 kg

Second & Third Trimester
Underweight - 0.5kg per week
Normal - 0.4kg per week 
Overweight - 0.3kg per week
Obese - 0.2kg per week

Question 18

Helpful Teaching Strategies of Diet Planning

Answer 18

• Daily food guide is good education for most cultures and vegetarians
• Helpful strategy is to help patients plan daily menus that are affordable and have realistic preparation times

Question 19

Food Safety

Answer 19

• Impacts fetus possibly due to
• Ecoli
• Salmonella
• Listeriosis
• Toxoplasmosis
• Brucellosis

Question 20

HOW TO COPE

Question 21

Nausea and Vomiting

Answer 21

• Antiemetic Medications
• Vitamin B6
• Ginger
• Acupuncture
  HYPERMESIS GRAVIDARUM (EXTREME VOMITING)
• Causes weight loss, dehydration, electrolyte abnormalities
• Cure includes IV fluid replacement, electrolyte replacement, enteral tube feeding, TPN

Question 22

Constipation

Answer 22

• Increased fiber
• Adequate fluid intake 8-10 cups a day
• Regular Physical Activity

Question 23

Pyrosis

Answer 23

• Caused by reflux of gastric contents
• Eat small more frequent meals
• Do not consume fluid with food (drink in between meals)
• Avoid spicy foods
• Avoid lying down directly after eating
• Avoid wearing tight clothes around abdomen

Question 24

Adolescent Pregnancy

Answer 24

• Cephalopelvic disproportion (baby head too big for moms pelvis) is common
• Competition for nutrients from baby and mother
• Mom generally needs more nutrients in adolescent pregnancy

Question 25

Bariatric Pregnancy

Answer 25

Common Deficiencies
- Folate
- B12
- Iron (Iron deficiency long term effect after bariatric surgery) 
- Calcium 
- Vitamin D
Screen for nutrient deficiencies, appropriate weight gain, provide supplemental nutrition 
Risks
- Prematurity
- Small for gestational age
- NICU admission