Chapter 9: Nutrition for Childbearing Flashcards Preview

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Flashcards in Chapter 9: Nutrition for Childbearing Deck (37)
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1

what is low weight gain associated with?

what is excessive weight gain associated with?

  • 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

2

what does maternal weight gain predict?

fetal growth

3

recommendations for weight gain during pregnancy

  • 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

4

risks for obese women who become pregnant

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

5

pattern of weight gain

  • 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

6

serving specifics for pregnant women

  • 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)

7

calories during pregnancy

  • 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

8

carbohydrates during pregnancy

  • 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

9

fats during pregnancy

  • 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

10

protein during pregnancy

  • 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

11

vitamins during pregnancy

  • 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

12

iron during pregnancy

  • 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

13

calcium during pregnancy

  • 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

14

sodium during pregnancy

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

 

15

iodine during pregnancy

  • met by iodized salt

16

zinc and magnesium during pregnancy

  • met by PNV

17

food precautions during pregnancy

  • listeria
  • seafood
  • toxoplasmosis
  • salmonella

18

listeria during pregnancy

  • 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

19

seafood during prengnacy

  • 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

20

toxoplasmosis during pregnancy

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

21

salmonella during pregnancy

  • found in chicken and eggs

22

PICA

  • 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

 

23

nausea and vomiting of pregnancy

  • 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

24

anemia during pregnancy

  • 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

25

nutrition for the lactating mother

  • 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

26

nutrition for non-lactating mother

  • 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

27

nursing considerations for nutrition

  • 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

28

lactose intolerance during pregnancy

  • 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

29

vegetarian diet during pregnancy

  • 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

30

eating disorders

  • 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