Nutrition

Question 1

Weight Gain
1st-3rd trimester

underweight vs. overweight

Calories

Answer 1

1st Trimester: 2 - 4 pounds
2nd Trimester: 12 pounds
3rd Trimester: 12 pounds
Total wt gain: 25 – 35 pounds

Underweight woman: 25 - 35 pounds
Overweight woman: 15 – 25 pounds

    Calories: 340 extra per day in 2nd trimester
                      450 extra per day in 3rd trimester

       range of 2200 – 2900 calories per day

Question 2

Protein

Answer 2

Protein
Increased to 70 grams/day (from 45 g)
Sources: meat, poultry, fish, seafood, eggs, beans & peas, milk, cheese, soy, nuts, seeds, quinoa, wheat germ

Question 3

Calcium

Answer 3

Calcium
Needs equivalent of calcium in 32 oz. milk

Sources: milk, yogurt, cheese, OJ with Ca

Lactose intolerant: collards, kale, broccoli, sardines, salmon, edamame, almonds

Question 4

Iron

Answer 4

Iron deficiency anemia is the #1 problem of pregnancy

Physiologic Anemia: perceived drop in hgb/hct begins at 8 weeks and continues to 32 weeks because plasma volume increases while RBC production remains unchanged until the third trimester.
Fetus stores iron during the last trimester.

Iron supplements often started at 1st prenatal visit

Stool may turn dark or black colored due to iron
Iron is constipating, causes nausea
Suggest taking before bed to avoid nausea
Absorption best with Vitamin C
Not absorbed well with calcium, coffee, tea, red wine, antacids

Question 5

Folic Acid

Answer 5

Folic acid needs double in pregnancy - difficult to get enough by diet
Low intake at conception and first weeks linked to neural tube defects (encephalocele, spina bifida)
Prenatal vitamins supply folic acid
Federal law requires all commercially sold flour,
grains, and cereals to be fortified with folic acid

Best dietary sources: liver, green leafy vegetables, whole grain breads and cereals

Question 6

Iodine

Answer 6

Iodine deficiency associated with decreased cognitive performance of children
in US, iodine deficiency is less common due to the addition of iodine to table salt
Assessment: Is standard table salt being used?
Perceptions: Added salt is “bad”
Sea Salt, gourmet salt is “better”
Note: sea salt and gourmet salts do not provide iodine supplementation

Question 7

Factors That Affect Nutrition

Answer 7

Eating disorders
PICA
Anorexia nervosa, bulimia nervosa
Cultural factors
What is the meaning of food in global cultures?
How does this relate to pregnancy?

Vegetarian diets
Food cravings and food aversions

Question 8

PICA

Answer 8

Persistent eating of nonnutritive substances not usually considered edible
Common items: clay, dirt, laundry or corn starch, freezer frost, ice, ashes
Socioeconomic, cultural and familial influences …resulting in poor nutrition
May be associated with iron deficiency anemia so screening should be considered when PICA is
reported.

Question 9

Foods to Avoid

Answer 9

Potential salmonella contamination: foods with raw or undercooked eggs.
Potential listeria contamination: unpasteurized meats and dairy products.
Mercury contaminated fish such as shark, swordfish, tilefish and mackerel

Question 10

Foods to Limit

Answer 10

Limit fish with lower mercury levels to 12 ounces per week: i.e. shrimp, salmon, catfish, pollack and canned light tuna
Canned white albacore tuna contains higher levels of mercury and should be limited to 6 ounces per week