Chapter 9: Nutrition for Childbearing

Question 1

what is low weight gain associated with?

what is excessive weight gain associated with?

Answer 1

• low weight gain causes:
  
  • low birth weight
  • SGA
  • preterm birth
  • failure to initiate breastfeeding
• excessive weight gain causes:
  
  • inc birth weight
  • gestational diabetes
  • prolonged labor
  • birth trauma
  • asphyxia
  • cesarean birth
  • low Apgar scores
  • hypoglycemia
  • overweight children
  • postpartum weight retention

Question 2

what does maternal weight gain predict?

Answer 2

fetal growth

Question 3

recommendations for weight gain during pregnancy

Answer 3

• based on the woman’s prepregnancy BMI: calc by dividing weight in kg by height in meters squared
  
  • if underweight (<18.5 BMI): gain 28-40 lbs
  • if normal weight (18.5-24.9 BMI): gain 25-35 lbs
  • if overweight (25-29.9 BMI): gain 15-25 lbs
  • if obese (BMI >30): gain 11-20 lbs
• recommendations for adolescents are to gain weight according to their prepregnancy BMI using adult categories
• multifetal gestation: if normal BMI prepregnancy, gain 37-54 lbs

Question 4

risks for obese women who become pregnant

Answer 4

• spontaneous abortion
• gestational diabetes
• gestational HTN
• preeclampsia
• prolonged labor
• cesarean birth
• congenital anomalies
• macrosomia
• postpartum hemorrhage
• wound complications
• thromboembolic disorders

Question 5

pattern of weight gain

Answer 5

• 1st trimester: 1.1-4.4 lb
  
  • no inc in calories
• 2nd trimester: 0.8-1 lb/week
  
  • inc calories by 340/day
• 3rd trimester: 0.8-1 lb/week
  
  • inc calories by 452/day

Question 6

serving specifics for pregnant women

Answer 6

• daily/milk: 3 servings
• fruits: 4 servings
  
  • 1 should include vitamin C
• meat/beans: 7 oz (2-3 servings)
• vegetables: 5 servings
• whole grains: 7 servings
• oils/fats: 2 tbsp
• water/fluid: 10 cups fluid (2400 mL)

Question 7

calories during pregnancy

Answer 7

• need extra calories to furnish energy for production and maintenance of fetus, placenta, added maternal tissues, and inc BMR
• need a daily intake of 2200-2900 calories–>depends on age, activity level, and prepregnancy BMI

Question 8

carbohydrates during pregnancy

Answer 8

• should eat about 175 g
• may be simple or complex
  
  • fruits and veggies are simple carbs
  • starches (cereal, pasta, potatoes) are complex carbs that supply vitamins, minerals, and fiber
    
    • should eat more complex carbs
• fiber is another nutrient moms should eat
  
  • help stimulate peristalsis, prevent constipation, slow gastric emptying

Question 9

fats during pregnancy

Answer 9

• provide energy and fat soluble vitamins
• need certain fats like alpha linolenic acid and linoleic acid to help with fetal neurologic and visual development
• DHA is also important for fetal visual and cognitive development

Question 10

protein during pregnancy

Answer 10

• need to consume at least 71 g per day during second half of pregnancy
• should eat protein rich foods rather than protein powders or drinks

Question 11

vitamins during pregnancy

Answer 11

• fat soluble vits (ADEK) are stored in the liver, and deficiency is not likely
  
  • too much vit A can cause fetal defects
• water soluble vits are not stored in the body, so they need to be included in the daily diet
  
  • includes vitamins B6, B12, C, folic acid, thiamin, riboflavin, niacin
• folic acid: can dec occurrence of neural tube defects, and help prevent cleft lip/palate and heart defects
  
  • important before conception and during 1st trimester
  • all women of childbearing age should consume 400 mcg/day, and when pregnant, they should consume 600 mcg/day
  • it is added to breads, cereals, and other foods with enriched flour
  • in PNV

Question 12

iron during pregnancy

Answer 12

• helps form some enzymes necessary for metabolism and important in Hgb formation
• unable to get from diet alone
• important to get enough in order to allow their to be a storage of it in the fetus
• HCP often prescribe iron supplements of 30 mg/day
  
  • supplementation may begin during 2nd pregnancy when morning sickness has ended
• easier to tolerate if taken at bedtime, taken with vitamin C, take b/w meals
• SEs: n/v, heartburn, epigastric pain, constipation, diarrhea, black stools

Question 13

calcium during pregnancy

Answer 13

• necessary for bone formation, maintenance of cell membrane permeability, coagulation, and neuromuscular function
• important for fetal mineralization of bones and teeth
• need inc during 2nd and 3rd trimester
• best source of calcium is dairy products: whole, low fat, and non fat milk all contain same amount of calcium
  
  • also present in legumes, nuts, dried fruits, broccoli, green veggies
• need at least 1200 mg per day
  
  • caffeine inc calcium excretion
  • fiber can interfere with calcium absorption
  • too much phosphorus leads to calcium absorption

Question 14

sodium during pregnancy

Answer 14

• Na needs are inc to provide for expanded blood volume and for the fetus
• should have moderate intake of 2-3 g/day

Question 15

iodine during pregnancy

Answer 15

• met by iodized salt

Question 16

zinc and magnesium during pregnancy

Answer 16

• met by PNV

Question 17

food precautions during pregnancy

Answer 17

• listeria
• seafood
• toxoplasmosis
• salmonella

Question 18

listeria during pregnancy

Answer 18

• found in unpasteurized dairy products and refridgerated/ready to eat foods like meat poultry and seafood
• can cause listeriosis which can result in stillbirth, abortion, or severe illness in the newborn
• avoid luncheon meats or hot dogs

Question 19

seafood during prengnacy

Answer 19

• swordfish, shark, king mackerel, tilefish
• safe limits: up to 12 oz per week of lower mercury seafood like shrimp, salmon, polluck, catfish, and canned light tuna

Question 20

toxoplasmosis during pregnancy

Answer 20

• spread thru cat feces or undercooked beef, pork, or lamb
• careful not to contaminate other foods such as lettuce or vegetables

Question 21

salmonella during pregnancy

Answer 21

• found in chicken and eggs

Question 22

PICA

Answer 22

• practice of eating substances not usually considered part of the normal diet
• ice, clay, or dirt, and laundry starch or cornstarch are the most common
  
  • can also include chalk, baking soda, antacid tablets, coffee grounds, freezer frost, toothpaste, burnt matches, or ashes
• more common in inner cities, rural areas, and southeastern US; African Americans; women who live in poverty
• iron deficiency is associated with PICA and woman should be tested for needing iron supplementation

Question 23

nausea and vomiting of pregnancy

Answer 23

• morning sickness usually disappears after 1st trimester
• helps to eat frequent small meals
• protein and complex carbs are tolerated best, but fatty foods inc nausea
• drinking liquids b/w meals instead of w/ meals helps
• carbohydrate snack like dry toast or crackers eaten before getting out of bed often helps

Question 24

anemia during pregnancy

Answer 24

• common concern as hemoglobin often dec during 2nd trimester due to inc volume of blood
  
  • this is normal
• during 3rd trimester, Hgb levels rise to prepregnant levels due to inc absorption of iron
• considered anemic if hemoglobin less than 11 g or HCT less than 33% during 1st/3rd trimesters and less than 10.5 g or less than 32% during 2nd trimester
• anemic women should be given iron supplements and help choosing foods high in iron

Question 25

nutrition for the lactating mother

Answer 25

• for first 6 mos: need an additional 330 calories each day in food, then the body also uses about 170 calories each day from the fat stores which helps burn weight
• for 2nd 6 mos: need an additional 400 calories perday
• protein should be kept at 71 g/day
• mother should drink milk to consume omega 3 and 6 fatty acids
• need more vitamins than pregnancy levels
• often recommended to continue taking PNV while lactating

Question 26

nutrition for non-lactating mother

Answer 26

• return to prepregnancy diet
  
  • should contain enough protein and vit C to promote healing
  • should continue to take PNV until the supply is gone
• weight loss:
  
  • most occurs during first 3 months
  • will be able to lose almost all weight by 1 year

Question 27

nursing considerations for nutrition

Answer 27

• interview about habits and food intake
• ask preferences and eating habits
• have mom keep food intake records or keep a 24 hour diet history
• encourage supplement intake

Question 28

lactose intolerance during pregnancy

Answer 28

• common
• results in a lack of calcium if other sources are not present
• lactose intolerance is caused by deficiency of the small intestine enzyme lactase necessary for absorption of lactose
• symptoms: nausea, bloating, flatulence, diarrhea, abdominal cramping
• should inc their intake of other foods with calcium
• can use soy milk, low lactose milk, and milk treated with lactase
• may need calcium supplements

Question 29

vegetarian diet during pregnancy

Answer 29

• vegetarians eat only or mostly plant foods
• vegans avoid all animal products and may have difficulty meeting nutrient needs
  
  • diets may be lacking in calcium, iron, zinc, riboflavin, vits D, B6, B12
• make sure to educate vegetarians b/c they may not meet all of their nutrient requirements
  
  • may be low in calories and fat
  • combine incomplete plant proteins with other plant foods with complementary amino acids to allow intake of all essential amino acids
  • iron supplements are important in these women, b/c iron from plant sources is not well absorbed
  • zinc supplements are needed b/c best source is from meat and fish

Question 30

eating disorders

Answer 30

• anorexia and bulimia can threaten pregnancy and fetal development
• they are assoc with miscarriage, low birth weight, preterm birth, congenital anomalies, and postpartum depression
• women with anorexia often have amenorrhea and have trouble conceiving
• need a great deal of counseling

Question 31

multiparity and multifetal pregnancy and nutrition

Answer 31

• number and spacing of pregnancies and presence of more than one fetus influence nutrition
• pregnancies spaced 18 to 23 months apart are healthier for the mother and fetus
  
  • if less than 6 mos apart it inc the risk of preterm and low birthweight infants as well as maternal morbidity and motality
  • closely spaced pregnancies don’t allow a women to remedy nutritional deficits from a previous pregnancy
• if multifetal pregnancy, she will need more calories

Question 32

exercise in pregnant women

Answer 32

• moderate exertion
  
  • walk, swim, stationary bike, yoga
  • avoid raising core temp
  • use talk gauge
• think safety:
  
  • balance, falls, no contact sports
• may need to adjust calories if burning some thru exercise

Question 33

Examples of a serving of Dairy

Answer 33

• 8 oz of milk
• 1 1/2 oz cheese
• 1 3/4 cups ice cream
• 2 cups cottage cheese
• 1 cup yogurt

Question 34

Examples of a serving of Protein

Answer 34

• 1 oz meat, poultry, fish
• 1 egg
• 1 oz nuts
• 1 tbsp peanut butter

Question 35

Examples of a serving of whole grains

Answer 35

• 1 slice bread
• 1/2 bun
• 1 cup cereal
• 1/2 cup pasta, rice

Question 36

Examples of a serving of Fruit

Answer 36

• 1 medium fruit
• 1/2 cup juice (120 mL)
• 1 cup raw fruit
• 1/2 cup cooked fruit

Question 37

Examples of a serving of Vegetables

Answer 37

• 1 cup raw
• 1/2 cup cooked
• 2 tomatoes
• 1 medium potato