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Objectives PowerPoint PPT Presentation


Objectives. To produce a healthy, normal weight infant while minimizing the short and long term health risks to the mother To determine the appropriate weight gain during pregnancy for the normal weight, underweight, overweight and adolescent pregnant woman. Objectives (cont.).

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Objectives

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Objectives

  • To produce a healthy, normal weight infant while minimizing the short and long term health risks to the mother

  • To determine the appropriate weight gain during pregnancy for the normal weight, underweight, overweight and adolescent pregnant woman


Objectives (cont.)

  • To recognize the additional energy, vitamin and mineral requirements during pregnancy and lactation

  • To recommend dietary modifications to help alleviate nausea, heartburn and constipation during pregnancy

  • To develop skills to help promote and maintain breast-feeding


Prenatal Nutrition


Questions with nutritional implications for the obstetric history and physical exam


Present illness

  • General: recent weight change, poor weight gain, edema, dehydration

  • G.I. complaints: Diarrhea, nausea, vomiting, heartburn, constipation


Medical History

  • Prenatal vitamins, nutritional supplements, herbs, remedies?

  • Iron supplements

  • Food allergies

  • Non-food cravings

  • Obstetric history


Social History

  • Alcohol?

  • Special Diet?

  • How many meals and snacks daily?

  • Avoid any specific foods?

  • Milk: how much, type?

  • Lactose intolerance


Family History

  • Familial occurrence of dx

  • History of children with fetal anomalies


Review of symptoms

  • General: Fatigue, weight change

  • Month: teeth, gums, lips, tongue

  • GI/abdomen: Appetite, food intolerance, nausea, constipation, diarrhea


Physical Exam: Anthropometric data

  • Height

  • Current weight

  • Prepregnancy weight

  • Prepregnancy BMI = {[wt (kg)] / ht2 (m2)}

  • Weight gain during pregnancy so far


Laboratory Evaluation

  • Glucose

  • Hematocrit

  • Hemoglobin


Maternal weight gain


Underweight

  • BMI < 19.8

  • Total weight gain 28 - 40 lbs.

  • 5 lbs./ 4 weeks


Normal

  • BMI = 19.8 - 26

  • Total weight gain 25 - 35 lbs.

  • 4 lbs./ 4 weeks


Overweight

  • BMI = 26.1 - 29

  • Total weight gain 15 - 25 lbs

  • 2.6 lbs./ 4 weeks


Adolescent

  • Pounds to bring weight near normal for height

  • Pounds for 9 month interval of growth

  • Pounds recommended for pregnancy


Nutritional requirements

  • Energy: + 300 kcal/day in 2nd and 3rd trimester

  • Protein: RDA = 60 g

  • Calcium

  • Folate

  • Iron


Nutritional Problems

  • Nausea and vomiting (hCG)

  • Constipation (progesterone)

  • Heartburn


Lactation Management


Benefits of Breast-feeding


Infant

  • Decreased incidence of infection

  • Protection against autoimmune diseases

  • Good jaw and tooth development

  • Mother - Infant bonding


Mother

  • Accelerated weight loss

  • Delayed return of ovulation

  • Improved bone remineralization

  • Reduced ovarian and premenopausal breast cancer risk

  • Easy, clean, economical


Maternal nutritional requirements

  • Energy: + 500 kcal/day, progressive weight loss not to exceed 4.5 lb/month

  • Protein: RDA = 65 g

  • Calcium: 1200 mg (same as prenatal)

  • Iron requirement is decreased

  • Prenatal supplements

  • Fluids 2-3 quarts/day


Contraindications

  • Maternal infections: TB, typhoid, rubella, mumps, HIV and CMV

  • Maternal medications: most chemotherapeutic agents, illegal substances. "If you wouldn't prescribe it for the baby, think carefully about giving it to the mother.”

  • Infant: galactosemia, some congenital deformities of the palate


Breast-feeding promotion and support

  • Education of mother and family

  • Provision for early and frequent mother infant contact

  • Concept of "demand and supply”

  • Solutions for work related concerns: pumping and storage

  • Proper feeding technique and breast care


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