Maternal

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Maternal Child Nursing CareSecond Edition
Marcia L. London Patricia W. Ladewig Jane W.
Ball Ruth C. Bindler
Lecture NotesChapter 12Maternal Nutrition
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Weight Gain Recommendations

• Optimal weight gain
• Depends on the womans weight for height
• Prepregnant nutritional state
• Underweight 28 to 40 lb
• Normal weight 25 to 35 lb
• Overweight 15 to 25 lb
• Obese Approximately 15 lb

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Weight Gain Recommendations

• Pattern of weight gain is important
• First trimester 3.5 to 5 lb
• Second and third trimester About 1lb weekly
• Twins Second and third trimesters 1.5 lbs per
  week
• Dieting during pregnancy can result in maternal
  ketosis

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Weight Gain
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Role of Nutrients

• Carbohydrates
• Main source of energy as well as fiber
• Promotes maternal, fetal, and placenta weight
  gain
• Protein Supplies needed amino acids for growth
  of uterus and breast tissue
• Magnesium Promotes cellular metabolism
• Iron Prevents maternal anemia
• Maintains fetal and infant stores of iron

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Role of Nutrients

• Fat Promotes fetal fat deposits
• Calcium and phosphorus Promotes mineralization
  of fetal bones and teeth
• Iodine Promotes fetal thyroid gland function
• Sodium Regulates fluid balance and metabolism in
  the mother

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Role of Nutrients

• Zinc Promotes growth of fetus and sufficient
  lactation
• Vitamins Maintain good maternal health
• Folic acid May prevent neural tube defects in
  the fetus

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Folate Supplementation in Pregnancy
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Nutritional Requirements

• Calories in second and third trimester
• Increase by 300 kcal/day
• During lactation Increase by another 200
  kcal/day
• Protein increases by 14 mg to 60 mg/day

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Nutritional Requirements

• Calcium increases to 1000 to 1300 mg/day
• Magnesium increases to 350 mg/day
• Iron increases to 27 mg/day
• Iodine increases to 220 mcg/day

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Nutritional Requirements

• Zinc increases to 11 mg/day during pregnancy and
  12 mg/day during lactation
• Vitamin A increases to 770 mcg/day
• Vitamin D increases to 5 mcg/day
• Vitamin C increases from 75 to 85 mg/day
• Thiamine increases from 1.1 to 1.4 mg/day
• Riboflavin increases from 1.1 to 1.4 mg/day

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Nutritional Requirements

• Niacin increases from 14 to 18 mg/day
• Pantothenic acid increases to 5 mg/day
• Vitamin B12 increases from 2.4 to 2.6 mcg/day
• Fluid needs increase to 8 to 10 glasses of
  noncaffeinated beverages/day
• For nonnursing mothers, during postpartum period
  nutritional requirements return to prepregnancy
  levels

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FIGURE 121 MyPyramid Steps to a Healthier
You identifies the basic food groups and
provides guidance about healthful eating. Grains,
vegetables, fruits, and dairy products are
emphasized, with slightly less emphasis on
protein. The narrow yellow bar is designated for
fats, sugar, and salt. People are encouraged to
have most of their fat intake come from fish,
nuts, and vegetable oils while limiting solid
fats like butter, margarine, shortening, and
lard. The emphasis is also placed on limiting
added sugars, which contribute calories but few,
if any, nutrients. Courtesy of the U.S.
Department of Health and Human Services.
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FIGURE 121 (continued) MyPyramid Steps to
a Healthier You identifies the basic food groups
and provides guidance about healthful eating.
Grains, vegetables, fruits, and dairy products
are emphasized, with slightly less emphasis on
protein. The narrow yellow bar is designated for
fats, sugar, and salt. People are encouraged to
have most of their fat intake come from fish,
nuts, and vegetable oils while limiting solid
fats like butter, margarine, shortening, and
lard. The emphasis is also placed on limiting
added sugars, which contribute calories but few,
if any, nutrients. Courtesy of the U.S.
Department of Health and Human Services.
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Vegetarian Diets During Pregnancy

• There are different types of vegetarian diets
• Lacto-ovovegetarians Dairy and egg products
• Lactovegetarians Dairy products but no eggs
• Vegans No foods from animal sources
• Most vegans need additional supplementation -
  vitamins B12, D, and calcium

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Vegetarian Diets During Pregnancy

• Vegetarians daily food requirements are
• 6 to 11 servings of whole grains, cereal, pasta,
  and rice
• 2 to 4 servings of fruit
• 3 to 5 servings of vegetables
• 2 to 3 servings of legumes, nuts, seeds, and meat
  alternatives
• 2 to 3 servings of milk products (unless vegan)

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FIGURE 122 The vegetarian food pyramid.
Adapted with permission from the Health
Connection, 55 West Oak Ridge Drive, Hagerstown,
MD 21740-7390
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Vegetarian Food Groups
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Factors Affecting Nutritional Intake

• Nausea, vomiting, and heartburn
• Lactose intolerance may cause diarrhea or
  bloating after dietary intake
• Cultural, ethnic, and religious influences may
  prohibit use of foods needed for adequate
  nutrition

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Factors Affecting Nutritional Intake

• Socioeconomic level may limit availability of
  nutritious foods
• Lack of knowledge about proper nutrition may
  limit womans ability to prepare nutritional
  foods
• Clients with eating disorders may have
  nutritional and electrolyte imbalances
• Pica may result in iron deficiency anemia

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FIGURE 123 Food preferences and habits are
affected by cultural factors.
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Developing Cultural Competence
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Factors to Assess

• Factors to assess in pregnant adolescents
• Low prepregnant weight and anemia
• Low weight gain during pregnancy and eating
  disorders
• Young age at menarche
• Unhealthy lifestyle Smoking, alcohol, and
  illicit drug use
• Excessive prepregnant weight
• Chronic disease

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Weight Gain and Nutrient Intake

• Weight gain Recommended weight gain of the adult
  pregnancy plus the expected gain of the
  adolescent
• Nutrient needs - adolescent needs more iron,
  calcium, and folic acid than adult pregnant woman
• Caloric needs
• Vary widely
• Figures as high as 50 kcal/kg have been suggested
• Satisfactory weight gain usually confirms an
  adequate caloric intake

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Nutritional Counseling

• Basic factors to consider
• Number of years since adolescent reached menarche
• Whether growth has been completed
• Most adolescents have irregular eating patterns
• Adolescent may not be the one who regularly
  prepares meals
• Individual who prepares meals should be included
  in nutritional counseling
• Teens are present, not future, oriented, which
  impacts nutritional counseling

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Nutritional Counseling

• May be helpful to involve the expectant father
• Clinics and schools often offer classes
• Provides focused activities designed to address
  this topic
• Pregnant teenager will soon become a parent - her
  understanding of nutrition may influence her
  well-being but also that of her child
• Counseling may be individualized
• May involve other teens
• May provide a combination of both approaches

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Formula-Feeding Mothers

• Eat a well-balanced diet
• Dietary requirements are the same as before
  pregnancy
• Weight loss of 1 to 2 pounds/week is acceptable
• Advise her to reduce her daily caloric intake by
  about 300 kcal
• Excessive weight gain Refer to dietician
• The dietitian can design healthy weight-reduction
  diets

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Breastfeeding Mothers

• Calorie requirements increase by 200 kcal/day
  over needs during pregnancy
• Need 2500 to 2700 kcal/day
• Need 65 g/day of protein.
• Need 1000 mg/day of calcium
• Should avoid foods that irritate the infant