PREGNANCY

BY: RHODEVA JOY BRAGA, RN

What is the difference between
growth and development?
Increase in BMR by 25%
Tendency to retain water
Constipation- 3rd tri
Hormonal changes
Weight gain
Inc plasma volume
Production of simple
glycosuria
RECOMMENDED WEIGHT GAIN
DURING PREGNANCY
• A weight gain of 11.2 to 15.9 kg (25 to 35 lb) is recommended as an
average weight gain in pregnancy
PRE-PREGNANT WEIGHT RECOMMENDED
WEIGHT GAIN
UNDERWEIGHT BMI <18.5 28-40 lbs
HEALTHY BMI <18.5-24.9 25-35 lbs
OVERWEIGHT BMI <25-29.9 15-25 lbs
OBESE BMI >30 15 lbs
WEIGHT GAIN
• 0.4 kg (1 lb) per month during the first trimester
• 0.4 kg (1 lb) per week during the last two trimesters (3-12-12)
• As a general rule, in the average woman, weight gain is considered
excessive if it is more than 3 kg (6.6 lb) a month during the second
and third trimesters; it is less than usual if it is less than 1 kg (2.2 lb)
per month during the second and third trimesters.
• You can encourage women pregnant with multiple fetuses to gain at
least 1 lb per week for a total of 40 to 45 lb
ENERGY (CALORIE)
NEEDS
CARBOHYDRATES
• An inadequate intake of carbohydrates can lead to protein breakdown
for energy, depriving a fetus of essential protein, and possibly
resulting in ketoacidosis, a possible cause of fetal and neurologic
disorders.
• The DRI of calories for women of childbearing age is 2200.
• An additional 300 calories, or a total caloric intake of 2500
calories, is recommended to meet the increased needs of pregnancy.
• In addition to supplying energy for a fetus, this increase provides
calories to sustain an elevated metabolic rate in the woman from
increased thyroid function and an increased workload from the extra
weight she must carry.
• obese women should never consume fewer than 1500 calories
per day.
Advise women to obtain calories from complex
carbohydrates (cereals and grains) rather than simple
carbohydrates (sugar and fruits).
Do not recommend sugar substitutes for women during
pregnancy, because a pregnant woman needs sugar to
maintain glucose levels
When helping a woman plan an increased caloric intake,
consider her lifestyle.
EXAMPLE: many women commonly skip meals, have erratic
eating patterns, or rely on fast and convenience foods. For
pregnancy, a woman needs to add calories by eating foods
rich in protein, iron, and other essential nutrients rather than
eating more fast-food, empty-calorie foods such as pretzels
and doughnuts.
SUGGESTION: prepare snacks such as carrot sticks or cheese
and crackers early in the day when fatigue is usually less.
The easiest method for determining if a
woman’s caloric intake is adequate is assessing
the weight she is gaining.
PROTEIN NEEDS
ADEQUATE PROTEIN INTAKE
to build a body framework
also help prevent complications of pregnancy such as pregnancy-
induced hypertension or preterm birth
NOTE:
Be careful when nutrition counseling not to make general statements
such as, “Eat high-protein foods.” Food in the supermarket, after all, is
not labeled “high-protein.” Instead, provide advice in more specific
terms: “Eat three servings of some type of meat or fish every day.”
• The DRI for protein in women is 46 g/d.
• During pregnancy, the need for protein increases to 71
g daily.
• If protein needs are met, overall nutritional needs are
likely to be met as well(with the possible exceptions of
vitamins C, A, and D) because of the high
incorporation of other nutrients with protein foods.
• A woman with a family history of high cholesterol levels
(hypercholesterolemia) probably should not eat more than
two or three eggs per week because of the high cholesterol
content of eggs.
• Encourage such women to eat lean meat, to cook with olive
oil instead of lard or butter, and to remove the skin from
poultry to reduce its fat content.
• She also should not eat lunch meats such as bologna or
salami as food staples, because their protein content may
not be high and their fat content is invariably exceptionally
high.
Milk is a rich source of protein.
Nonfat milk supplies the same protein and half the calories
as regular milk and is very low in fat.
Yogurt or cheese may also be substituted for milk, or milk
may be incorporated into custards, eggnogs, or cream soups.
Women who are lactose intolerant can add a lactase
supplement, buy lactose-free milk, or take a calcium
supplement.
FAT NEEDS
• Only linoleic acid, an essential fatty acid necessary for new cell
growth, cannot be manufactured in the body from other sources.
• Using vegetable oils (e.g., safflower, corn, olive, peanut, and
cottonseed) that have a low cholesterol content rather than
animal oils (butter) is recommended for all adults as a means of
preventing hypercholesterolemia and coronary heart disease.
• Women should also try and ingest omega-3 oils, found primarily in
fish, omega-3–fortified eggs, and the newer omega-3–fortified
spreads.
VITAMIN NEEDS
VITAMIN DEFICIENCY
VITAMIN D-can begin to diminish both fetal and maternal mineral
bone density.
Lack of vitamin A results in tender gums and poor night vision.
Women who were taking oral contraceptives before they became
pregnant should be certain to include good sources of vitamins A and
B and folic acid in early pregnancy.
VITAMIN DEFICIENCY

Counsel women not to use mineral oil as a laxative.

If a woman is housebound, be certain that she is taking a prenatal
vitamin containing vitamin D because she is probably not receiving
as much sun exposure as normally
Megadoses of vitamin C may cause withdrawal scurvy in the infant at
birth.
excessive vitamin A intake and fetal malformation. It is well
documented that the intake of excessive vitamin A in the form of
isotretinoin (Accutane), a medication prescribed for acne, causes
congenital anomalies
VITAMIN DEFICIENCY
FOLIC ACID- Found predominantly in fresh fruits and vegetables.
Necessary for red blood cell formation.
Without adequate folic acid, a megaloblastic anemia (large but
ineffective red blood cells) may develop.
important in preventing neural tube defects.
Take prenatal vitamins that contains a folic acid supplement of 0.4 to
1.0 mg
MINERAL NEEDS
CALCIUM AND PHOSPHORUS
• 8th week- Tooth formation begins
• 12th week- Bones begin to calcify
• The recommended amount of calcium during
pregnancy is 1300 mg
• Most foods high in protein are also high in
phosphorus, so by eating high-protein foods, women
receive enough phosphorus, also important for bone
growth.
IODINE
• Iodine is essential for the formation of thyroxine and,
therefore, for the proper functioning of the thyroid gland.
• If iodine deficiency occurs, it can cause hypothyroidism and
thyroid enlargement (goiter) in a woman.
• Thyroid enlargement in a fetus at birth is serious because the
increased pressure of the enlarged gland on the airway. If
not discovered at birth, hypothyroidism may lead to the
infant’s being cognitively challenged.
IODINE
• The DRI for iodine is 220 g daily during pregnancy.
Seafood is the best source of iodine. In areas where the
water and soil are known to be deficient in iodine, it is
suggested that women use iodized salt rather than plain salt
to ensure a healthy iodine intake.
IRON
• A fetus at term has a hemoglobin level of 17 to 21 g per
100 mL of blood
• Iron is needed to build this high level of hemoglobin.
• After week 20 of pregnancy fetus begins to store iron in
the liver to last through the first 3 months of life
• A woman needs iron to build an increased red cell volume
for herself and to protect against iron lost in blood at birth.
IRON
• The DRI for iron for pregnant women is 27 mg.
• An average diet supplies about 6 mg of iron per 1000
calories.
• If a woman eats a 2500-calorie diet daily, her daily intake,
therefore, is about 15 mg iron. Because only 10% to 20% of
dietary iron is absorbed, she is actually taking in less than
this amount (closer to 1.5 to 3 mg).
• Therefore, dietary supplementation with 15 mg iron per day
helps ensure that adequate iron is ingested and absorbed.
IRON
• Oral iron compounds turn stools black or blackish green.
• The compounds can be irritating to the stomach or cause
constipation in some women.
INTERVENTION:
increase fluid intake or fiber to relieve the constipation.
Some may need a prescribed stool softener such as
docusate sodium (Colace)
FLUORIDE
Because fluoride aids in the formation of sound
teeth, a pregnant woman should drink fluoridated
water.
 Fluoride in large amounts causes brown-stained
teeth, so a woman should not take the supplement
more often than prescribed or if tap water in her area
is already fluoridated.
SODIUM
Sodium is the major electrolyte that acts to maintain fluid in the body
Retaining enough fluid during pregnancy in the maternal circulation is
important to ensure a pressure gradient to allow optimal exchange of
nutrients across the placenta.
Too much salt could result in retention of excessive amounts of fluid,
putting a strain on the heart as blood volume doubles.
ZINC
Zinc is necessary for the synthesis of DNA and RNA.
Although not proved, zinc deficiency may be associated with preterm
birth.
The DRI for zinc during pregnancy is 12 mg, or an increase of 3 mg
over pre-pregnancy needs.
 Most people who take in adequate protein also take in adequate zinc
because zinc is contained in foods such as meat, liver, eggs, and
seafood. It is also a component of prenatal vitamins to help ensure an
adequate intake.
FLUID NEEDS
Two or three glasses of fluid daily over and above the
three servings of milk recommended by the food
pyramid is a common recommendation during
pregnancy (a total of six to eight glasses daily).
FIBER NEEDS
Eating fiber-rich foods, foods consisting of parts of
the plant cell wall resistant to normal digestive
enzymes such as broccoli and asparagus, are a natural
way of preventing constipation, because the bulk of
the fiber left in the intestine aids evacuation.
Fiber also has the advantage of lowering cholesterol
levels and may remove carcinogenic contaminants
from the intestine.
 Dietary Reference Intakes for
Pregnant and Nonpregnant Women
FOODS TO AVOID OR LIMIT IN
PREGNANCY
EXCESS SEAFOODS
• Women should eat up to 12 ounces (2 to 3 meals) of seafood or shellfish a
week for their omega-3 and iodine content.
• Fish such as shark, swordfish, king mackerel or tilefish are high in mercury
contamination, however, so should be avoided.
• Five types of fish that are low in mercury:
1. Shrimp
2. canned light tuna
3. Salmon
4. Pollock
5. catfish.
FOODS WITH CAFFEINE
• Caffeine a central nervous system stimulant capable of increasing
heart rate, urine production in the kidney, and secretion of acid in the
stomach.
• A daily intake of caffeine of two or three cups of coffee has not been
associated with low birth weight, but drinking over three cups is
associated with an increased rate of early miscarriage (Applebee,
2008).
• To limit their caffeine intake, women may need to limit not only the
amount of coffee they drink but also other sources of caffeine such as
chocolate, soft drinks, and tea.
FOODS WITH CAFFEINE
• Decaffeinated coffee, as the name implies, contains almost no caffeine. The
longer tea brews, the greater is the caffeine content.
• Green tea has less caffeine than black tea. Both herbal teas and
decaffeinated tea are readily available.
• The cocoa bean that is used to make chocolate and cocoa is yet another
natural source of caffeine.
• Chocolate sources tend to be low in caffeine, however, compared with
coffee. A cup of coffee contains approximately 120 mg of caffeine, whereas a
cup of hot chocolate contains only 10 mg.
• Baking chocolate, used for cake frostings and glazes, is proportionately higher,
containing about 35 mg of caffeine per ounce.
• Soft drinks do not naturally contain caffeine; it is added to improve their
flavor. To limit the amount of caffeine consumed, encourage pregnant women
to choose caffeine free types
What if...
Tori Alarino states, “I love coffee. There’s always a pot
brewing where I work. And I love a cup of cappuccino
for lunch.” What suggestions could you make to help
her reduce her caffeine intake?
WEIGHT LOSS DIETS
• As a rule, weight reduction is not healthy during pregnancy. Liquid
reducing diets and/or diets that are combined with weight-reducing
drugs are particularly contraindicated during pregnancy because they
may lead to fetal ketoacidosis and poor growth. If women have been
following such diets before becoming pregnant, they may have few
nutritional stores, and additional vitamin supplementation may be
necessary
NUTRITIONAL RISK FACTORS
DURING PREGNANCY
AREAS TO BE ASSESSED FOR A
TOTAL NUTRITION HISTORY
PHYSICAL SIGNS AND SYMPTOMS
OF ADEQUATE PREGNANCY
NUTRITION
 MANAGING COMMON PROBLEMS
AFFECTING NUTRITIONAL HEALTH
Nausea and Vomiting
CAUSES:
Sensitivity to the high level of chorionic gonadotropin hormone
produced by the trophoblast cells
High estrogen or progesterone levels
Lowered maternal blood sugar caused by the needs of the developing
embryo
Lack of pyridoxine
Diminished gastric motility
Nausea is aggravated by fatigue and may be aggravated by emotional
disturbance.
Nausea and Vomiting
Methods such as acupressure or avoiding fluid with meals are
effective for some women.
Mild-flavored ginger tea may be helpful
Increasing carbohydrate intake seems to relieve nausea better than
any other nutrition remedy.
The traditional solution is for women to keep dry crackers/saltines,
such as Saltines, by their bedside and eat a few before rising; sourball
candies may serve the same purpose.
 A woman can then eat a light breakfast or delay breakfast until 10
or 11 AM, past the time her nausea seems to persist.
CRAVINGS
• During pregnancy, some women report an abnormal craving for nonfood
substances (termed pica from the Latin word for “magpie,” a bird that
is an indiscriminate eater).
• The most common form of pica in the past was a craving for laundry
starch.
Always ask women at prenatal visits if they crave any nonfood items, as
most women do not supply this information unless asked directly.
Encouraging a woman to stop eating the nonfood substance may not be
effective because the habit may be deeply ingrained. Because pica is a
symptom that often accompanies iron deficiency anemia, correcting this
underlying problem with an iron supplement may correct the pica.
 At subsequent visits, be certain to assess if a woman’s hemoglobin is
increasing and ask if she notices any difference in her cravings.
 HEARTBURN (PYROSIS)
Common suggestions to help prevent reflux into the esophagus are:
 Eat small meals frequently rather than large meals.
Sleep on the left side with two pillows to elevate the upper torso.
Do not lie down immediately after eating; try and wait at least 2
hours.
 Avoid fatty and fried foods, coffee, carbonated beverages, tomato
products, and citrus juices
Aluminum hydroxide (Amphojel, Alternagel) or a combination of
aluminum and magnesium hydroxide (Maalox) may be prescribed for
relief.
HYPERCHOLESTEROLEMIA
A woman who has had difficulty with hypercholesterolemia before
pregnancy may need to continue to eat only moderate amounts of fat during
pregnancy to prevent any increase in cholesterol. Helpful ways to reduce
cholesterol include:
• Exercising daily
• Eating oat cereal
• Broiling meat rather than frying it
• Using a minimum of salad oils
• Substituting new omega-3 products in place of butter
• Eating fish high in omega-3 oil, such as salmon or trout