Chapter 8

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Maternal and Fetal Nutrition

nutrition before and during pregnancy an important preventive measure

Low-birth-weight (LBW) infants < 2500 g
10-90th percentile of birth weight AGA (Average for gestational age)
SGA- small for gestational age
>4000g = LGA large for gestational age
Preterm infants < 37 weeks
Neonatal death rates for near term babies is three times higher than for term babies
The 2% of infants born very preterm account for 50% of infant deaths in the U.S.

Nutrient Needs Before Conception:

First trimester crucial for embryonic and fetal organ development
Healthful diet before conception ensures that adequate nutrients are available for developing fetus
Folic acid intake important in periconceptional period
o Neural tube defects more common in infants of women with poor folic acid intake
Nutrient Needs During Pregnancy
Energy needs
o Weight gain
Body mass index (BMI) = weight/height2
18.5-24.9 normal BMI. Normal weight gain 25-35 lbs
o Pattern for weight gain
o Hazards of restricting adequate weight gain
Infants with IUGR
Protein
Fluids
Nutrient Needs During Pregnancy contd
Minerals and vitamins
o Iron
Dark leafy greens. Liver. Meats. Whole grain or enriched breads/cereals
Take with citrus. Do not take with milk (calcium)
o Calcium
Other minerals and electrolytes
o Magnesium
o Sodium
o Potassium
o Zinc
o Fluoride
Fat-soluble vitamins
o Vitamins A, D, E, and K
Water-soluble vitamins
o Folate or folic acid
o Pyridoxine
o Vitamin C
Multivitamin-multimineral supplements
Other Nutritional Issues During Pregnancy
Pica and food cravings
o Takes away from normal nutrients
o Council- risk of anemia
Adolescent pregnancy needs

Improve nutritional health of pregnant adolescents by focusing on knowledge and planning

of meals
o Nutrition interventions and educational programs effective with adolescents
o Understanding factors that create barriers to change in adolescent population
Preeclampsia
o Cause is still unknown
o Speculation that poor intake of specific nutrients may be a contributing factor
o Adequate diet remains the best means of prevention
Physical activity during pregnancy
o Moderate exercise yields many benefits, including improved muscle tone, shortened course
of labor, and sense of well-being
Liberal amounts of fluid should be consumed before, during, and after exercise
Calorie intake should be sufficient to meet increased needs of pregnancy and
exercise

Nutrient Needs During Lactation

Nutrition needs during lactation similar to those during pregnancy
Needs for energy (calories), protein, calcium, iodine, zinc, the B vitamins, and vitamin C greater
than nonpregnant needs
Energy intake increase of 330 kcal more than womans nonpregnant intake recommended
Smoking, alcohol intake, and excessive caffeine intake should be avoided during lactation
Care Management
Diet history
o Obstetric and gynecologic effects on nutrition
Medical history
Usual maternal diet
Physical examination
Laboratory testing
Adequate dietary intake
o Pregnancy
o Postpartum
o Daily food guide and menu planning
o Medical nutrition therapy
o Counseling about iron supplementation
o Coping with nutrition-related discomforts
of pregnancy
o Nausea and vomiting
o Constipation
o Pyrosis (heartburn)
o Cultural influences
o Vegetarian diets
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Key Points
Womans nutritional status before, during, and after pregnancy contributes to her well-being
and that of her infant
Physiologic changes during pregnancy influence need for additional nutrients and efficiency with
which the body uses them
Total maternal weight gain and pattern of weight gain are important determinants of outcome of
pregnancy
Appropriateness of mothers prepregnancy weight for height (BMI) is major determinant of
recommended weight gain during pregnancy

 Nutritional risk factors include adolescent pregnancy; bizarre or faddish food habits; abuse of
nicotine, alcohol, or drugs; low weight for height; and frequent pregnancies
Iron supplementation is recommended routinely during pregnancy
Other supplements recommended when nutritional risk factors present
Both nurse and pregnant woman influenced by cultural and personal values and beliefs during
nutrition counseling
Pregnancy complications that may be nutrition related include:
Anemia
Gestational hypertension
Gestational diabetes
Intrauterine growth restriction
Dietary adaptations can be effective interventions for some common discomforts of pregnancy,
including nausea and vomiting, constipation, and heartburn