ch. 15 maternal nutrition Flashcards
healthy people 2030 goal for maternal nutrition
increase the proportion of women delivering a live birth who had a healthy weight/BMI prior to pregnancy
- increase the proportion of women of childbearing potential with intake of atleast 400 mg of folic acid from fortified foods and dietary supplements
maternal weight (3)
- pre pregnancy weight (BMI going INTO the pregnancy)
- maternal weight gain
- factors that influence weight gain: age, parity, nutritional status
formula for BMI
(weight (Ibs)/height (in))^2 x 703^12
underweight pre pregnancy (1)
higher risk of:
- low birth weight (or growth restricted) babies
overweight/obese pre pregnancy (4)
higher risk of:
- gestational diabetes
- HTN
- preeclampisa
- complications during labor and birth
babies of obese women (6)
higher risk of:
- PTB
- cesarean birth
- macrosomia
- stillbirth
- congenital anomalies
- childhood obesity
maternal weight gain (underweight) (BMI, total weight gain, rates of weight gain)
BMI: <18
total weight gain: 28-40 Ibs
rates of weight gain in 2/3 trimester (Ib/week): 1 (1-1.3)
maternal weight gain (normal) (underweight) (BMI, total weight gain, rates of weight gain)
BMI: 18.5 - 24.9
total weight gain: 25-35
rates of weigh gain in 2nd/3rd trimester (Ib/week): 1 (0.8-1)
maternal weight gain (overweight) (underweight) (BMI, total weight gain, rates of weight gain)
BMI: 25.0 - 29.9
total weight gain: 15-25
rates of weight gain in 2nd/3rd trimester (Ib/week): 0.6 (0.5-0.7)
maternal weight gain (obese) (underweight) (BMI, total weight gain, rates of weight gain)
BMI: >30
total weight gain: 11-20
rates of weight gain in 2nd/3rd trimester (Ib/week): 0.5 (0.4-0.6)
average maternal weight gain distribution (5)
1) fetus, placenta, amniotic fluid: 11 Ibs/ 5 kg
2) uterus: 2 Ibs/0.9 kg
3) increase blood volume: 4 Ibs/1.8 kg
4) breast tissue: 3 Ibs/1.4 kg
5) maternal stores: 5-10 Ibs./ 2.3-4.5 kg
macronutrients needed during pregnancy (3)
protein
fats
carbohydrates
micronutrients needed during pregnancy (2)
- fat soluble vitamins (A,D,E,K)
- water soluble vitamins (folate/folic acid, vitamin B6, vitamin B12, vitamin C)
minerals needed during pregnancy (6)
- iron
- calcium
- magnesium
- zinc
- choline
- iodine
fluids/electrolytes needed during pregnancy (3)
- fluids
- sodium
- potassium
protein during pregnancy (6)
- provides amino acids for fetal development, blood volume expansion, and growth of breasts & uterus
- contributes to body’s overall energy metabolism
- pregnant women: need 71g daily (1.5x)
- non pregnant women: 46g daily
- animal products, dairy, lentils, nuts
- soy, rice, or almond milk good for vegetarians or lactose intolerant women
fat during pregnancy (6)
- more completely absorbed in pregnancy
- results in marked increase in serum lipids, lipoproteins, cholesterol, & decreased elimination in the bowel
- pregnant women: 20-35% of daily calorie intake (ONLY 10% SATURATED FATS)
- essential fatty acids needed for development of fetal CNS
- fish (salmon, hallibet, tuna), soybean/canola oil, flaxweeds, walnuts good
- AVOID MERCURY IN FISH (toxic to babies)
carbohydrates during pregnancy (5)
- body’s primary source of energy
- provides fiber necessary for proper bowel function
- if not adequate, body uses protein instead of carbs for energy
- needs for pregnant women increase, esp in 2nd/3rd trimester
- breads, cereals, pastas, brown rice, dairy, fruits & veggies are good sources
minerals during pregnancy (ca/phos (3), iodine (3), Na (3), Zinc (4), Mg (3), Iron (4))
1) calcium/phosphorus: 700-1250 mg/day
- both involved in fetal bone/teeth development, energy & cell production
- MILK, eggs, meat
2) iodine: essential part of thyroid hormone: thyroxine
- 220 mcg/day with iodized salt/seafood good
- impaired brain development in fetus if low (lower IQs)
3) sodium: 2-3g
- metabolism & regulation of fluid balance
- AVOID CHIPS, HAM, SAUSAGE, SEASONINGS
4) zinc: 11 mg/day
- protein metabolism & synthesis of DNA and RNA
- needed for normal fetal growth and breast milk production
- shellfish (crab meat, shrimp lobster), meats, poultry good
5) magnesium: 350 mg/day
- cellular metabolism & structural growth
- dark leafy greens, fish, beans, seeds, nuts, yogurts, grains
6) iron: 27mg/day (supplements)
- growth of fetus, placenta, expansion of maternal BV
- animal products, dark green veggies
- deficiency anemia: decrease in O2 carrying capacity of blood, can have negative affect on fetal brain development, can cause CONSTIPATION (increase fluids)
fat soluble vitamins: A,D,E,K (3)
- toxicity possible (if w/prenatal or too much)
- stored in liver
- not excreted in urine -> can build up + utilize throughout the body
water soluble: C/B vitamins (4)
- must be ingested daily
- folic acid (risk of spina bifida if NOT)
- need to prevent neural tube defects
- ingestion of folic acid has essentially eliminated neural tube defects in fants (work of MARCH OF DIMES)
vegetarianism (4)
1) lacto-ovo vegetarians
- include milk, dairy products, eggs
2) lacto-vegetarian
- dairy products, no eggs
3) vegans
- no food from any animal sources
- how would you teach a vegan or vegetarian how to get protein in their diet?
4) need meal planning to ensure obtaining necessary nutrients
- table 15.4
factors influencing nutrition (7)
- common discomforts of pregnancy
- must educate patients to be careful with: complementary/alternative therapies, nonnutritive sweeteners, energy drinks, mercury in fish
- food borne illnesses: salmonella, listeria (maintain refrigerator temp at 40F and freezer 0F, refrigerate leftovers within 2 hours, no hot dogs/meat unless steaming hot, avoid feta/brie/camembert/blue-veined/queso fresco/queso blanco, no meat spreads/raw milk, avoid smoked seafood (high salt)
- lactase deficiency (lactose intolerant)
- cultural/ethic/religious influences: symbolic significance, raw meat risk for worms
- psychosocial factors: sharing of food symbol of friendliness, warmth, eating disorders (anorexia - fear of weight gain, bulimia - binging/purging)
- PICA eaters: persistent cravings (dirt, corn starch, ice, soap, paint, burned matches, only during pregnancy, iron deficiency anemia is a MAJOR PROBLEM, poor weight gain and fetal impaction also potential issue)
TIP: EVERYTHING CROSSES THE PLACENTA
nutritional care of pregnant adolescent (5)
- adolescents considered physiologically mature 4 years after menarche (16 years old if started at 12)
- iron, calcium, folic acid, zinc
- vitamins A,D,E,B6
- dietary patterns
- counseling issues - who preps food?
