WEIGHT GAIN DURING PREGNANCY
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Recommended Maternal Weight Gain During Single Fetus Pregnancy
Underweight (BMI < 18.5): 28-40 lbs
Normal (BMI 18.5-24.9): 25-35 lbs
Overweight (BMI 25-29.9): 15-25 lbs
Obese (BMI = to or >30): 11-20 lbs
*General recommendation is an increment of about 1.1-4.4 lbs during the first trimester. During the rest of the pr
Formula to Determine BMI
[Weight (lbs)/height (inches)^2] x 704.5
Quiz Me: A 27-year old pregnant woman had a preconceptual BMI of 18. The nurse would be aware that this woman's total recommended weight gain during pregnancy should be-
Woman is underweight. She should gain 28-40 lbs.
Adolescent Maternal Weight Gain
BMI should be calculated using adult categories, which may put them in a lighter weight group, thus supporting more weight gain. Additional weight gain in younger adolescents often improves birth outcomes.
Risk Factors for Inadequate Weight Gain
Low income, unmarried, poorly educated, insufficient prenatal care, physical and emotional immaturity/imbalances, lack of available resources
Obesity During Pregnancy
-Associated with increased morbidity and mortality such as fetal demise, spontaneous abortion, and congenital defects.
-Higher risk of maternal gestational diabetes, cesarean birth, thromboembolic disorders, and postpartum complications.
-Obese women who
NUTRITIONAL REQUIREMENTS
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Recommended Daily Allowance (RDA)
The amount of a nutrient that is sufficient to meet the needs of almost all healthy people in an age group.
Adequate Intake (AI)
The nutrient intake assumed to be adequate when an RDA cannot be determined.
Tolerable Upper Intake Level (UL)
The highest amount of a nutrient that be ne taken without probably adverse health effects by most people.
Estimated Average Requirement (EAR)
The amount of a nutrient estimated to meet the needs of half the healthy people in an age group.
Energy: Carbohydrates
-4 cals/gram
-Most common simple carb: sucrose
-Complex carbs: starches (cereals, vitamins, minerals, and fiber). Should be the major source of carbs in the diet.
Energy: Fats
-9 cals/gram
-Often restricted to prevent weight gain, however essential fatty acids help in the formation of fetal nerve, brain, and visual development and function.
-Essential fatty acids: omega-3 (alpha-linolenic acid), omega-6 (linoleic acid), and DHA
Energy: Calories
-Recommended daily calorie intake for pregnant women: 2200-2900 cals depending on age, activity level, and prepregnancy BMI.
-First trimester: 1800-2400 cals/day; no added calories are needed.
-Second trimester: increase by 340 cals/day (2140-2740 cals/da
Protein
-4 cals/gram
-First half of pregnancy: 46g/day to support metabolism for increased tissue synthesis and tissue repair
-Second half of pregnancy: 71 g/day to support increased metabolic demands of pregnancy, expansion of maternal blood volume and growth of
Vitamins
-Fat-soluble vitamins: ADEK; stored in liver and deficiency states not likely to occur because excessive intake can be toxic (ex: Accutane contains high levels of Vitamin A and is a known teratogen). Limit Vitamin A to 770 mcg/day
-Water-soluble vitamins:
Vitamins: Folic Acid
-Necessary for cell division, DNA synthesis, and is the most important vitamin during pregnancy
-Can decrease the occurrence of neural tube defects, cleft lip, and cleft palate
-Adequate intake important even before conception and during first trimester a
Minerals: Iron
-Iron deficiency anemia can become a serious condition during pregnancy due to the increase in RBCs (25-33% increase) needed to supply fetus.
-Care providers often prescribe supplements of 27-30mg/day beginning the second trimester. Should be taken betwee
Minerals: Calcium
-Necessary for fetal bone and tooth development and for maintaining maternal bone mass. Fetal calcium needs are nighest during third trimester.
-Absorption and retention is increased during pregnancy. No increase in calcium is recommended as long as dieta
Quiz Me: Spinach is a good source of calcium. True or false?
False. Spinach and chard contain oxalates that decrease calcium availability, making spinach a poor source.
Minerals: Zinc
-Crucial for tissue growth and development of the central nervous system
-RDA for pregnancy: 11mg/day
-Found in same foods as iron and calcium (i.e. meat and dairy products)
-Plant sources: wheat germ, whole grains, nuts, and dried beans
Sodium
-Needs increased during pregnancy to provide for expanded blood volume and needs of fetus, however excessive amounts should be avoided.
-Salting foods to taste is accepted, but intake of high-sodium food should be limited.
-Examples of high-sodium foods:
Fluids
8-10 8oz. glasses/day maintains hydration and promotes exchange of nutrients
Vegetarianism
-Vegans have the most difficulty meeting nutrient needs as they avoid all animal products
-Vegetarians may be lacking in adequate calcium, iron, zinc, riboflavin, and vitamins D and B12 if their diet does not include eggs or milk.
Dietary Risks: Mercury
-Avoid these fish: shark, swordfish, king mackerel, tilefish, marlin, albacore or white tuna
-Pregnant women are advised to restrict fish intake to 12oz per week.
Dietary Risks: Listeriosis
-Found in unpasteurized milk and milk products: soft cheese such as brie, feta, blue cheese
-Found in contaminated deli meats, hot dogs, raw or undercooked meats, fish, and poultry
-May cause spontaneous abortion, stillbirth, or severe newborn illness.
Dietary Risks: Caffeine
-Recommended that caffeine be limited to 300 mg/day during pregnancy. This amounts to about one 8oz. cup of drip method or percolated coffee.
-Decaffeinated coffee contains 2-5 mg per five ounce cup.
-Tea contains 9-50 mg of caffeine in a 5oz. cup, depend
Dietary Risks: Drugs
-Medications: benefits must be weighed against the risks to both mother and fetus
-Marijuana: increased appetite usually satisfied with poor nutritional choices
-Heroin: alters metabolism
-Cocaine: appetite suppressant; causes vasoconstriction which reduc
Pregnant Adolescent: Care Concerns
-Nutritional needs different than pregnant adult.
-Pregnancies at higher risk for complications because adolescents still growing and nutrients may not be available to fetus
-Peer pressure and poor body image often lead to skipped meals and restricted cal
Pregnant Adolescent: Care Solutions
-Establish an open, accepting relationship through active listening
-Encourage the adolescent's input; consider her likes and dislikes.
-Suggest alternative sources to fast food or the best choices of the fast food available (do not eliminate all her favo
Quiz Me: Coffee and tea labeled "caffeine free" contain no caffeine. True or false?
False
Quiz Me: Frequent snacking of potato chips and pickles would significantly increase sodium intake. True or false?
True
Quiz Me: Match the items
1. Foods that are high in sodium- canned soups and condiments such as mustard and ketchup
2. Good source of protein and dietary fiber- whole grains and beans
3. Source of calcium if lactose intolerant- soymilk
Case Study: Jennifer, a 27 yo, is 5 wks pregnant. Her BMI is 23. Based on this info, what should the nurse recommend to Jennifer in terms of an overall weight gain and the specific weight gain pattern for each trimester?
A 25-35 lbs total weight gain; may gain 1.1-4.4 in first trimester.
NEWBORN NUTRITION
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Nutrient Needs: Fluids
-Require 40-60 mL/kg of fluids during the first two days of life. This fluid is supplied through breast milk or infant formula. Additional fluids are required by the end of the first weeks.
Nutrient Needs: Calories
-3 to 6 mos: 100-110kcal/kg/day
-6 to 9 mos: 95 kcal/kg/day
-9 to 12 mos: 100 kcal/kg/day
-Breast milk and formula contain 20 kcal/oz. Nutrients found in breast milk and formula consist of carbs, proteins, fats, vitamins, minerals, and water.
Nutrient Needs: Expected Newborn Weight Loss
May lose up to 10% of their birth weight during the first few days following birth but usually regain that weight within two weeks.
Nutrient Needs: Carbs
40-45% of the infant's total calories are supplied by carbs and the primary carbohydrate in breast milk and most formula is lactose.
Nutrient Needs: Protein
-Needs are greatest during the newborn period a 2.2 gm/kg
-Casein and whey are proteins found in milk. Casein forms a large, insoluble curd that is more difficult to digest than the curd formed by whey.
-Breast milk is more easily digested than formula be
Nutrient Needs: Fat
-Provides approximately 50% of the total cals found in breast milk.
-Beginning of feeding: foremilk; "thirst quenching" part of feeding that is lower in fat and higher in fluids to hydrate the infant
-Progression of feeding: hindmilk; high in fat and cals
Nutrient Needs: Minerals
Calcium, phosphorus, fluoride, and iron (iron is found less in breast milk but is more easily digested than the iron found in formula; considered more "bioavailable").
Nutrient Needs: Vitamins
A, B complex, C, D, E, and K.
Infants not exposed to sun and/or are dark skinned may require vitamin D supplementation.
BREASTFEEDING
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What is the nurse's role in breastfeeding?
Provide accurate information to women so that they can then make the decision that is best for her and her family. The nurse ensures informed decision-making and respects whatever decision is made. Determine the mother's cultural attitude toward breast fe
What does "breastfeeding exclusively mean?
The infant receives no food or liquid other than breast milk. This is recommended by the AAP for at least 6 months with continuation of breastfeeding for 12 months or longer if desired. If breastfeeding is discontinued, the infant should be placed on an i
Breastfeeding Advantages
-For mom: convenience, cost, hormonal elevation, reduction of cancer risk, reduction of maternal weight and osteoporosis protection.
-For baby: nutrient bioavailability, optimal caloric utilization, colonization of the GI tract, reduction in infection, de
Antibodies and Immune Qualities
-Secretory IgA: provides immunological protection to the digestive tract; acts upon viruses and bacteria that cause respiratory and GI illnesses.
-Lactoferrin: iron-binding protein not found in cow's milk or formula; prevents pathogenic organisms from obt
Contraindications to Breastfeeding
-HIV
-Human T cell leukemia virus type I and II (HTLV-I and HTLV-II): greatly increase the risk for developing T cell leukemia
-Galactosemia: interferes with the infant's ability to metabolize lactose, the primary carb in breast milk; infant will need to
Hormones and Lactation
-Prolactin: milk production; stimulated by suckling and the removal of colostrum or milk cause a continued increase in levels
Oxytocin: milk ejection or release; aka "Let down;" mother may also feel abdominal cramping
Changing Composition of Breast Milk
1. Colostrum- "early milk;" present in the breasts toward the end of pregnancy and during the first 7-10 days following birth; thick in consistency and is usually yellow or clear in color; higher content of many of the essential nutrients and is rich in i
Nurses Role Prior to Breastfeeding
-For mom: encourage her to avoid using soap on her nipples as this can be very drying and can lead to skin breakdown. Overall nutrition status should be assessed and she should be encouraged to consume and additional 200-500 kcals more than her pre-pregna
Nursing Actions
Assist with first feeding, positioning of the infant at the breast, latching on, observation of suckling pattern, removal of the infant from the breast, monitoring the frequency and length of feedings, and demonstrating burping techniques will assist the
Position and Latch
-Baby should be supported at the level of the mother's breast
-Bring baby to breast, not breast to baby
-Position baby tummy-to-tummy with the mother (turn baby toward mom)
-Baby's ear, shoulder, and hip should be aligned
-The mother supports the baby's h
Commonly Used Breastfeeding Positions
-Football: infant clutched under the arm
-Cross-cradle: infant laid across the lap
-Cradle hold: infant cradled in arms
-Side-lying: infant and mom laying down
Interventions That Support Successful Breastfeeding
-Early feeding (don't wait until baby cries)
-Feed often (q2-3hrs)
-Unlimited mother/baby contact (rooming-in)
-Skin-to-skin mother/baby contact (kangaroo care)
Nurse Should Encourage Mother To-
-Offer both breasts at each feeding
-Allow infant to finish feeding on first breast before moving
-Do not limit the length or frequency of feedings (this can contribute to the risk for jaundice)
-Avoid artificial nipples and supplemental feedings for the
Signs of Adequate Intake
-Breastfeeding q2-3hr on demand
-6 to 8 wet diapers per day (after mother's milk comes in around day 3-4)
-3 to 4 stools per day (after milk comes in)
-Infant should appear content after feeding
-Should be evidence of swallowing at the breast
-Baby should
Normal Appearance of the Breastfed Infant's Stools
-First stool: meconium; black and sticky
-Day 3 or 4: green
-Day 5+: yellow
Red Flags
-Inadequate output
-Greater than 7% of body weight lost (newer research suggests not to wait until 10% lost)
-Infant appears fretful after feeding or is very lethargic
-Maternal nipple pain that is not resolving and unrelieved breast fullness/ engorgement
FORMULA FEEDING
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Formula Preparations
Ready-to-feed, concentrate (to dilute with water), powder (most common).
Bottle Preparation
-Sterilization of bottle and equipment isn't necessary if water source is safe.
-When choosing a formula, always remember to follow all instructions for preparation. If boiling the water is required, boil for 1 minute and allow to cool to 70C.
-Can store
Feeding Patterns
-Infants demonstrate same feeding cues as the breastfed infant.
-1oz for the first 24-48 hours and then gradually increasing to 2-3oz. per feeding during the first week. The newborn will eat every 3-4 hours.
-Remember to burp after every ounce.
Introduction of Solid Foods
-Recommended that all infants receive only breast milk or formula for the first 6 months.
-After 6 months, iron-fortified cereals can be given in addition to breast milk or formula.
-Introduce foods slowly and one at a time.
-At 1 year, cow's milk may be