Chapter 9

Nutrition for Childbearing

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

Weight Gain During Pregnancy

Recommendation for total weight gain

Weight gain recommendations based on the womans

prepregnancy body mass index (BMI)

Recommended weight gain is 11.5 to 16 kg (25

to 35 lb) for women who begin pregnancy at
normal BMI.

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

Weight Gain During Pregnancy (Cont.)

Pattern of weight gain

The general recommendation is an increment of

about 0.5 to 2 kg (1.1 to 4.4 lb) during the first
trimester.

Maternal and fetal distribution

Factors that influence weight gain

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

Weight Gain for Pregnancy

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

Case Study
You are the nurse working with prenatal patients at
the health department. You meet Ms. Brooks, a 29year-old G1P1 at 28 weeks of gestation. Ms.
Brooks began prenatal care at 12 weeks. Her fetal
screening ultrasound at 18 weeks revealed normal
anatomy, and all of her prenatal labs have been
normal or negative. The pregnancy was not
planned, but she and her partner are delighted
and plan to be married in 2 weeks.

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

Case Study (Cont.)

Ms. Brooks had a prepregnancy BMI of 32 and has
a history of borderline chronic hypertension. She
has been counseled by the physician to gain no
more than 15 pounds during her pregnancy. As
you check her in for her visit, you note that her
total weight gain during pregnancy is 12 pounds.
Her blood pressure is 138/86. Her urine is negative
for protein and glucose. When Ms. Brooks looks at
the scale, she says, What am I going to do? I
have three more months to go. She begins to cry.
Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

Case Study (Cont.)

What should you do and say?

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

Nutritional Requirements

Dietary reference intakes (DRIs)

Used to estimate nutrient needs

Recommended dietary allowance (RDA)

The amount of a nutrient that is sufficient to meet the

needs of almost all healthy people in an age group

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

Nutritional Requirements: Energy

Measured in kilocalories (calories)

Carbohydrates

Fats

Provide energy and fat-soluble vitamins

Calories

Simple or complex

Most pregnant women need 2200 to 2900

calories daily.

Nutrient density

The quantity and quality of the various nutrients in each 100

calories of food.
Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

10

Nutritional Requirements: Protein

Necessary for metabolism, tissue synthesis, and

tissue repair
Daily protein RDA is 46 g for nonpregnant
females.
Daily recommended protein intake of 71 g during
pregnancy

Expansion of blood volume

Growth of maternal and fetal tissues

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

11

Nutritional Requirements: Vitamins

Fat-soluble

Water-soluble

A, D, E, and K
Stored in liver
Excessive intake of these vitamins can be toxic.
B6, B12, and C; folic acid; thiamin; riboflavin; and
niacin
Should be included in the daily diet

Folic acid (also called folate)

Can decrease the occurrence of neural tube defects

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

12

Nutritional Requirements: Minerals

Iron
Important in the formation of hemoglobin
During pregnancy approximately 1000 mg of absorbed iron
above maternal iron stores are needed.

Calcium
Important for mineralization of fetal bones and teeth
Calcium absorption and retention increase during
pregnancy.

Sodium

Sodium needs are increased during pregnancy to provide

for an expanded blood volume and the needs of the fetus.
Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

13

Nutritional Requirements: Nutritional

Supplementation

Food is the best source of nutrients.

Health care providers usually prescribe prenatal
vitamin-mineral supplements.
Women with adequate diets may not need
supplements except for iron and folic acid.
Assessment of each womans individualized
needs determines whether supplementation is
appropriate.

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

14

Nutritional Requirements:
Nutritional Supplementation (Cont.)

Disadvantages and dangers

No standardization or regulation of the amounts of

ingredients.
Excessive amounts of some vitamins and minerals
may be toxic to the fetus.
Supplements are not food substitutes and do not
contain all the nutrients needed during pregnancy.

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

15

Nutritional Requirements: Water

Water is important during pregnancy.

For the expanded blood volume

As part of the increased maternal and fetal tissues

Women should drink approximately 8 to 10 cups

of fluids that are mostly water each day.

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

16

Nutritional Requirements: Food Plan

USDA MyPlate provides a guide for healthy

eating.

Whole grains
Vegetables and fruits
Dairy foods
Protein group
Other elements

Food precautions

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

17

Factors That Influence Nutrition

Age
Nutritional knowledge
Exercise
Culture

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

18

Nutritional Risk Factors

Socioeconomic status

Vegetarianism

Poverty
Food supplement programs; www.fns.usda.gov/wic
Meeting the nutritional requirements for the
pregnant vegetarian

Lactose intolerance
Nausea and vomiting of pregnancy
Anemia
Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

19

Nutritional Risk Factors (Cont.)

Abnormal prepregnancy weight

Eating disorders
Food cravings and aversions

Pica

Multiparity and multifetal pregnancy

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

20

Nutritional Risk Factors (Cont.)

Substance abuse

Adolescence

Smoking
Caffeine
Alcohol
Drugs
Nutrient needs
Common problems
Teaching the adolescent

Other risk factors

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

21

Nutrition After Birth

Lactating mother

Energy
First 6 months of lactation, the estimated energy requirement
(EER) is 330 additional calories.
Second 6 months require 400 additional calories.

Protein
Fats
Vitamins and minerals

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

22

Nutrition After Birth (Cont.)

Specific concerns

Dieting
Adolescence
Vegan diet
Avoidance of dairy products
Inadequate diet
Alcohol
Caffeine
Fluids
Food to avoid
Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

23

Nutrition After Birth (Cont.)

Nonlactating mother

Can return to her prepregnancy diet

The nurse should assess the mothers understanding
of the amount of food she needs from each food
group.
Weight loss

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

24

Application of the Nursing Process:

Nutrition for Childbearing

Assessment

Interview
Diet history
Physical assessment
Laboratory tests
Ongoing nutritional status

Analysis
Planning

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

25

Application of the Nursing Process:

Nutrition for Childbearing (Cont.)

Intervention

Identifying problems
Explaining nutrient needs
Providing reinforcement
Evaluating weight gain
Encouraging supplement intake
Making referrals

Evaluation

Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

26

Question
A pregnant woman with a BMI of 22 asks the
nurse how she should be gaining weight during
pregnancy. The nurse's best response would be
to tell the woman that she should gain
approximately:
a.1 pound per week throughout the pregnancy.
b.3.5 pounds during the first trimester, then 1 pound each
week until the end of the pregnancy.
c.1 pound a week during the first two trimesters, then 2
pounds per week during the third trimester.
d.A total of 25 to 35 pounds.
Copyright 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc.

27