Ch.9 - Maternal and Fetal Nutrition

Question 1

Is one of those many factors that influence the outcome of pregnancy good nutrition is super important before and during pregnancy and serves as an important preventive measure for a variety of problems to include low birth weight and preterm infants

Answer 1

nutrition

Question 2

Key components of nutrition care during the preconception period and pregnancy include the following
Key components of nutrition care

Answer 2

Maternal and fetal nutrition

Question 3

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

Answer 3

Key components of nutrition care

Question 4

first would be a nutrition assessment which would include height and weight adequacy quality of dietary intake and habits so we’re going to ask Mom what have her do a 24-hour recall as far as her diet give us an idea of how often she eats out so that we can help formulate a plan nutrition is one of those modifiable risk factors
we’re going to do our best to help guide her into hopefully not gaining too much weight during pregnancy so we can have the best outcome for her

Answer 4

Nutrition assessment

Question 5

Such as obesity diabetes and such so people who are in the obese spectrum of the BMI we need to talk to them pretty significantly about weight control during pregnancy not weight loss weight control how we do that is by the nutrients that they’re taking in

Answer 5

Diagnosis of nutritional related problems or risk factors

Question 6

Dietary goals to promote appropriate weight gain including ingesting a variety of foods appropriate use of dietary supplements and physical activity you guys have done a case study about exercise exercise is important unless there are some significant risk factors that would preclude a woman from exercising we want all women to exercise 150 min a week and that’s low impact
I wanted a variety of foods now first trimester is tough because you’ve got morning sickness and you know your body’s starting to change and don’t feel it don’t have the energy at first and so women tend to gravitate towards comfort food: being almost the time carbohydrates; eval nutrient intake is at that time and see what kind of interventions we need to do based on that information

Answer 6

Intervention based on an individual’s dietary goals and plan for appropriate weight gain

Question 7

Lastly evaluate have a nutritionist or dietitian do an evaluation women who are diabetic or obese will set up a session with one of these two professions to help manage their glucose control

Answer 7

Evaluation with referral to a nutritionist or dietitian as necessary

Question 8

At least half of all pregnancies were unplanned in other words there were no ovulation predictor kits and following cervical fluids and trying to figure out exactly when the right time is to get pregnant this is a woman who’s walking around and doesn’t even realize it if you’re not getting a positive pregnancy test - may realize six weeks pregnant and halfway through that first trimester
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 preconceptual period

Answer 8

Nutrient needs before conception

Question 9

that first trimester where embryonic and Fetal organ development is occurring that critical crucial time of development
prior to conception good habits that that precede conception are very very important

Answer 9

First trimester crucial for embryonic and fetal organ development

Question 10

one of those minerals would be folic acid - peri-conception period - all women of childbearing age should be consuming folic acid whether they intend to get pregnant or not because half of them are unintended so these neural tube defects are the more common and infants of women that had poor folic acid intake whether they were not taking a multivitamin or ate foods that had low folic acid content
the neural tube begins to close within the first month of gestation often before the woman realize that she is pregnant
should take at least 400 micrograms of folic acid every day
Fetal risks in pregnancy are increased when the mother is significantly underweight or overweight when pregnancy begins
Neural tube defects are more common in infants of women with poor folic acid intake

Answer 10

Folate or folic acid intake important in the preconceptual period

Question 11

So nutrient needs are determined at least in part by the stage of gestation the amount of fetal growth berries during the different stages of pregnancy as in the first trimester the synthesis of fetal tissues places relatively few demands on maternal nutrition during that first trimester when the embryo or fetus is very small the needs are only slightly increased over those before pregnancy and contrast the last trimesters accelerated fetal growth when most fetal stores energy stores are deposited
four factors that contribute to the increase in nutrient need for pregnant woman
Factors that contribute to the increase in nutrient needs
Energy needs
Protein
Fluids
Minerals and vitamins
Other minerals and electrolytes
Minerals and vitamins
Water-soluble vitamins
Other nutrition issues during pregnancy
Other nutrition issues during pregnancy
Physical activity during pregnancy

Answer 11

Nutrient needs during pregnancy

Question 12

The uterine-placental-fetal unit
Maternal blood volume and constituents
Maternal mammary development
Metabolic needs

Answer 12

Factors that contribute to the increase in nutrient needs

Question 13

Development and growth of that uterine placental fetal unit so the uterus is getting larger he now have a new organ called the placenta and the placenta needs to be healthy because it’s it’s what’s going to help diffuse oxygen to the baby and carry away waste through the away from the baby into the maternal bloodstream this is how baby is being nourished and oxygenated and then we have a baby if we have that and so how that all ties in together circulation through the uterus to get to the placenta to get to the fetus and then back in that same route so increase nutrient needs

Answer 13

The uterine-placental-fetal unit

Question 14

We already know that it increases significantly during pregnancy end up with an extra leader to 2 L of blood that you create during pregnancy increases rapidly and Peaks at about 28 to 34 weeks so end of that third trimester where it stabilizes and may actually decrease slightly so the increase blood is a protective mechanism it’s essential for me the blood volume needs of the hypertrophied vascular system so we need extra nutrients for that to happen

Answer 14

Maternal blood volume and constituents

Question 15

And then next to maternal mammary development the breast are enlarging the the breasts the acid the city sells are preparing to make milk so we need extra nutrients for that

Answer 15

Maternal mammary development

Question 16

20% increase in the metabolic rate during pregnancy so if you are expending 20% more energy because of all of these body processes and these adaptations that are occurring need 20% more nutrients to satisfy that need

Answer 16

Metabolic needs

Question 17

no specific recommendations exist for the amount of carbohydrates and fats in the diet of a pregnant woman however the intake of these nutrients should be adequate to support the recommended weight gain
weight gain maternal and Fetal risks and pregnancy are increased when the mother is significantly underweight or overweight before pregnancy
Weight gain
Pattern of weight gain
Hazards of restricting adequate weight gain
Excessive weight gain

Answer 17

Energy needs

Question 18

Body mass index (BMI) = weight/height2
we determine this is based on the BMI of the woman pre-pregnant so we’re going to ask her what is your normal body weight this could be tricky because we all tend to lie so we’re going to get we’re going to get her on the scale early and typically during that first prenatal appointment that first trimester get her on the scale and get a number we ask her is that kind of what your average weight is before pregnant
typically in that first trimester there’s only about a 2 to 4 lb weight gain in those first 12 weeks
anything less than 18.5 BMI is too low 18.5 to 24.9 is just where we want people to be 25 to 29.9 is overweight and then greater than 30 would be considered obese and then you’ve got another unfortunate category that is actually morbidly obese and that would be I think it’s greater than 40

Answer 18

Weight gain

Question 19

first and second trimesters is most the weight gain that a woman is seeing is mostly due to maternal tissues the uterus is getting larger the blood volume is increasing the breasts are getting larger to put down some fat stores - all of this occurring for mom so this is where that weight gain is coming from the first two trimesters
third trimester is a time of rapid fetal growth that’s where babies putting on the weight
women will tend to complain of not being as hungry - stomach is being pushed up you know closer to the heart they tend to have more heartburn they will eat a meal at breakfast and not feel hungry by lunch

Answer 19

Pattern of weight gain

Question 20

And then we also concern ourselves a little bit with with women who you know there are women who exercise entire pregnancy do very well to gain minimal the minimal amount of weight that’s healthy for their BMI but we have to be very careful how we approach this for some women that’s part of going back and doing your nutritional assessment and and looking at patterns for the woman pre-pregnant if she has got a a self image where she’s concerned about gaining weight we want to make sure that she understands that we don’t want her to restrict her weight gain if you restrict your weight gain your potentially restricting very important nutrients that the baby needs

Answer 20

Hazards of restricting adequate weight gain

Question 21

women who gain excessive weight are putting themselves not only at risk of C-sections and prolonged labor but cardiac conditions and diabetes later on in life
60% of women who give birth are overweight or obese
only 30% of those women actually follow the recommended weight gain and pregnancy
most women gain excessive amounts of weight during pregnancy

Answer 21

Excessive weight gain

Question 22

essential consistent of protein which is nitrogen is very very important to meet increasing demands and pregnancy this is what’s helping grow these tissues and these demands arise from the growth of the fetus the enlargement of the uterus the the increase in blood volume amniotic fluid protein is all important for those processes
looking for is three servings of milk yogurt or cheese and two servings of meat or fish a day and most women exceed that daily

Answer 22

Protein

Question 23

if our bodies are getting bigger our fluid intake is also increased
includes water milk and decaffeinated tea
food that we eat actually contributes to about half a liter or more of that volume
woman who’s pregnant needs to consume about 3 liters of fluid a day

Answer 23

Fluids

Question 24

nutrient needs can be met through dietary sources if we’re eating the right Foods; we’re getting the minerals and vitamins that we need everyday
it’s important that the pregnant woman understand that the use of a vitamin mineral supplement does not lessen the need to consume a nutritious fruits vegetables, lean meats, dairy products
Iron
Calcium

Answer 24

Minerals and vitamins

Question 25

Allow transfer of adequate iron to the fetus into permit expansion of the maternal red blood cell Mass because the plasma increase is greater than the increase in red blood cell production there is a decrease in normal hemoglobin and hematocrit values this state of hemodilution is referred to as physiologic anemia of pregnancy pregnant woman is considered anemic if the hemoglobin is less than 11 grams per deciliter or the hematocrit is less than 33% during the first or third trimester this is a normal adaptation during pregnancy

Answer 25

Iron

Question 26

No increase in the daily recommended intake of calcium during pregnancy and lactation.
consuming enough calcium in the the dairy product consuming to meet their protein needs

Answer 26

Calcium

Question 27

Magnesium
Sodium
Potassium
Zinc
Fluoride

Answer 27

Other minerals and electrolytes

Question 28

Magnesium diets of women in the childbearing years are likely to be low in mag; adults and low income women are specially at risk so: eat dairy products nuts whole grains green leafy vegetables are all good source of magnesium

Answer 28

Magnesium

Question 29

moderate peripheral edema is normal in pregnancy
occurs as a response to estrogen which is a fluid retaining effect so during pregnancy
need for sodium may increase slightly primarily because the body water is expanding okay however we don’t want to have an excessive intake of sodium because it may contribute to the development of hypertension and salt sensitive individuals

Answer 29

Sodium

Question 30

Potassium diets including adequate intake of potassium or associated with reduced risk for hypertension: bananas

Answer 30

Potassium

Question 31

constituent of numerous enzymes involved in major metabolic pathways
deficiency associated with malformations of the central nervous system and infants when large amounts of iron and folic acid are consume the absorption of zinc
In prenatal vitamins

Answer 31

Zinc

Question 32

no evidence that prenatal fluoride supplementation reduces the child’s likelihood of tooth decay during the preschool year

Answer 32

Fluoride

Question 33

Fat-soluble vitamins
Vitamins A, D, E, and K
stored in the body tissues in the event of prolonged overdoses these vitamins can reach toxic levels
Typically not included in supplements for pregnant women unless they’re advised to take them and then usually just prescribed because toxic levels of these would be detrimental to the fetus
One of the most concern would be vitamin A: needed so that the sufficient amounts of the vitamin can be stored in the fetus a well chosen diet including adequate amounts of deep yellow and deep green vegetables and fruits such as leafy greens broccoli carrots cantaloupe apricots provide sufficient amounts of carotene that can be converted in the body to vitamin A now congenital malformations of occurred in infants of mothers who took excessive amounts of preformed vitamin A during pregnancy the supplements are not recommended routinely for pregnant women
vitamin D plays an important role in absorption and met about a metabolism of calcium the main food sources of this vitamin are enriched or fortified foods such as milk and ready to eat cereals a severe deficiency may lead to neonatal hypocalcemia and tetany as well as hypoplasia of the tooth enamel

Answer 33

Minerals and vitamins

Question 34

Folate or folic acid
Pyridoxine
Vitamin C
Vitamin B12

Answer 34

Water-soluble vitamins

Question 35

B6
essential for carbohydrate protein and fat metabolism and is involved in the synthesis of red blood cells
there is evidence that larger doses are effective for someone in reducing nausea and vomiting so there is a drug that is fairly effective in helping combat the morning sickness

Answer 35

Pyridoxine

Question 36

tissue formation and repair

Answer 36

Vitamin C

Question 37

important for the formation of the rbcs

Answer 37

Vitamin B12

Question 38

Alcohol
Caffeine
Artificial Sweeteners
Pica
Food cravings

Answer 38

Other nutrition issues during pregnancy

Question 39

It’s just contraindicated. no amount of alcohol is considered safe and we know that the there is a fetal anomaly associated with alcohol consumption called fetal alcohol syndrome

Answer 39

Alcohol

Question 40

Now you do not have to cut out your caffeine consumption when you’re pregnant but you do need to keep it less than 200 mg per day ACOG and March of Dimes recommend 200 mg a day keeping in mind that caffeine is found not only in coffee but tea and soft drinks and chocolates

Answer 40

Caffeine

Question 41

Artificial sweeteners as a general rule we usually tell women just to avoid those artificial sweeteners they’ve been found to have adverse effects on the mother of fetus
are approved by the US Food and Drug Administration for you during pregnancy however aspartame should be avoided
if they got to have something sweet to use a natural sweetener like a Stevia honey Agave maple syrup those are all good naturally occurring sugars

Answer 41

Artificial Sweeteners

Question 42

Is the practice of consuming non-food substances
clay dirt Laundry Starch or excessive amounts of food stamps that are low in nutritional value like cornstarch ice baking powder it’s often influenced by a woman’s cultural background so one problem with Pica is that regular and heavy consumption of low nutrient products may cause more nutritious foods to be displaced from the diet
Mexican American women consumption of Tiara includes both soil and pulverized Mexican Pottery what concerns us with this is the potential exposure to high levels of lead so try and assess for this during pregnancy with other cultures
The practice of consuming nonfood substances
May be influenced by the woman’s cultural background

Answer 42

Pica

Question 43

many women experience food cravings during pregnancy the nurse can suggest healthy alternatives for Cravings eating small amounts of the craved foods eating regularly and including healthy snacks to avoid drops in the drops in blood glucose levels and using distraction to curb the 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

Answer 43

Food cravings

Question 44

Adolescent pregnancy needs
Many adolescent females have diets that provide less than the recommended intake of key nutrients including calcium and iron pregnant adolescents and their infants are already increased risk for complications during pregnancy impartuition or postpartum time period growth of the pelvis is delayed and comparison with growth and statue and this helps explain why cephalopelvic disproportion and other mechanical problems associated with labor young adolescents competition for nutrients between the growing Adolescent and the fetus may also contribute to some of the poor outcomes apparent and teen pregnancies recommended weight gain goals are not different however from those of adult women if she’s normal weight we only wanted to gain 25 to 35 pounds we don’t want her to gain more efforts to improve a Nutritional Health of pregnant adolescence focus on improving nutrition knowledge meal planning and selection and food prep promoting access to prenatal care developing nutrition interventions and educational programs that are effective with adolescents and striving to understand the factors that create barriers to change in adolescent population
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

Answer 44

Other nutrition issues during pregnancy

Question 45

Moderate exercise yields many benefits, including improving muscle tone, shortening course of labor, and sense of well-being
All right you guys should be expert on physical activity during pregnancy now if no medical or obstetric problems contraindicate physical activity pregnant women should engage in 20 to 30 minutes of moderate physical exercise on most if not all days of the week two nutritional concepts are especially important for women who chose who choose to exercise during pregnancy first a liberal amount of fluid should be consumed before during and after exercise because dehydration can trigger premature labor second the killer calorie intake should be sufficient to meet the increase needs of pregnancy and the demands of exercise
Liberal amounts of fluid should be consumed before, during, and after exercise
Calorie intake sufficient to meet increased needs of pregnancy and exercise

Answer 45

Physical activity during pregnancy

Question 46

Nutritional needs during lactation or similar in many ways to those during pregnancy needs for energy protein calcium iodine zinc the B vitamins and vitamin C remain greater than non-pregnant needs the recommendations for some of these are slightly to moderately higher than during pregnancy the recommended energy intake for the first six months is an increase of 400 to 500 kilocalories more than the woman’s non-pregnant state it becomes difficult to obtain adequate nutrients for maintenance of lactation of total caloric intake is less than 1800 calories per day because of the deposition of energy stores the women who has gain the optimal amount of weight during pregnancy is heavier after birth than at the beginning of pregnancy as a result of the caloric demands of lactation the lactating mother usually experiences a gradual but steady weight loss and who doesn’t want that most women rapidly lose several kilograms during the first month after birth whether or not they breastfeed after the first month the average loss during lactation is 521 kg a month and a woman who is overweight kilograms without decreasing her milk supply fluid intake must be adequate to maintain milk production but the mother’s level of thirst is the best guide to the right amount there is no need to consume more fluids than those needed to satisfy thirst smoking alcohol intake and excessive caffeine intake should be avoided during lactation smoking not only May impair milk production but also exposes the infant to the risk of passive smoking it is speculated that the infant psychomotor development may be affected by maternal alcohol use and alcohol use May impair the milk ejection reflex caffeine can lead to reduced iron concentration and milk and consequently contribute 1% of the mother’s plasma level breastfed and fence of mothers who drink large amounts of caffeine or coffee maybe unusually active and wakeful
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
Energy intake increase of 400-500 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

Answer 46

Nutrient needs during lactation

Question 47

Optimal nutrition cannot eliminate all problems that may arise during pregnancy but it does establish a good foundation for supporting the needs of the mother and her unborn baby
Assessment
Physical examination
Laboratory testing
Nutrition Care and Teaching
Coping with nutrition-related discomforts of pregnancy

Answer 47

Care management

Question 48

ideally a nutritional assessment is performed before conception so that any recommended changes can be undertaken before the woman becomes pregnant nutrition
reserves may be depleted in the multiparous woman or one who has had frequent pregnancies a history of preterm birth or the birth of a low birth weight or small for gestational age infant May indicate inadequate dietary intake birth of a large for gestational age infant off of indicates the existence of maternal diabetes mellitus
contraceptive methods Also may affect reproductive Health
increase menstrual blood loss often occurs during the first three to six months after placement of an IUD
chronic maternal illnesses such as diabetes renal disease liver disease cystic fibrosis or other malabsorbed of disorder seizure disorders and the use of anti-convulsant Agents hypertension and PKU may affect a woman’s nutritional status and dietary needs the woman’s usual food and beverage intake the adequacy of income and other resources to meet her nutritional needs and a dietary modifications food allergies and intolerances all medications and nutrition supplements being taken as well as cultural dietary requirements should be ascertained in addition and let’s go on to the physical assessment
Obstetric and gynecologic effects on nutrition
Health history
Usual maternal diet

Answer 48

Assessment

Question 49

Minimum: height and weight must be determined at the time of her first prenatal visit and her weight should be measured at each subsequent visit
Anthropometric measurements

Answer 49

Physical examination

Question 50

only nutrition Testing needed is a hematocrat and hemoglobin measurement to screen for the presence of anemia

Answer 50

Laboratory testing

Question 51

Following educating the women about her needs during pregnancy helping her individualize her diet so she achieves those at the adequate intake of nutrients discussing with her strategies for coping with a nutrition related discomforts of pregnancy helping her choose nutrition supplements appropriately and Consulting with and making referrals to other professionals is indicated
Adequate dietary intake

Answer 51

Nutrition Care and Teaching

Question 52

Are many and varied for many women the most common one being morning sickness constipation and pyrosis or heartburn
Nausea and vomiting
Constipation
Pyrosis (heartburn)
Cultural influences
Vegetarian diets

Answer 52

Coping with nutrition-related discomforts of pregnancy

Question 53

Common during the first trimester usually causes only mild to moderate problems nutritionally although it may be a source of substantial discomfort
antiemetic medications vitamin B6 Ginger acupressure may be effective and reducing the severity of nausea although the evidence supporting them is not strong
Hyperemesis gravidera: is a severe and persistent vomiting syndrome it causes weight loss dehydration and electrolyte imbalance and occurs into about 1% of pregnant women this typically requires IV fluid electrolyte replacement and many times a hospital admission

Answer 53

Nausea and vomiting

Question 54

improved bowel function generally results from increasing the intake of fiber fiber fiber fiber recommendation for pregnant women for fibers 25 to 30 g a day and adequate fluid intake of at least 8 to 10 cups

Answer 54

Constipation

Question 55

usually caused by reflex of gastric contents into the esophagus this could be minimized by eating small frequent meals rather than two to three large meals fluids increase the dissension of the stomach they should not be consumed with food so do your drinking after you eat avoid spicy foods and avoid lying down immediately after eating or wearing clothes that are too tight across the abdomen

Answer 55

Pyrosis (heartburn)

Question 56

Need to be cognizant of what women eat based on cultures during pregnancy that’s part of that nutritional assessment to make sure they while they are eating what they’re used to for their culture that they’re still including that the the right amount of nutrients in their diet

Answer 56

Cultural influences

Question 57

can still have a very healthy diet
if their planned well can be nutritionally adequate for pregnant and lactating woman

Answer 57

Vegetarian diets