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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.).

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Objectives l.jpg
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


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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




Present illness l.jpg
Present illness history and physical exam

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

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


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Medical History history and physical exam

  • Prenatal vitamins, nutritional supplements, herbs, remedies?

  • Iron supplements

  • Food allergies

  • Non-food cravings

  • Obstetric history


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Social History history and physical exam

  • Alcohol?

  • Special Diet?

  • How many meals and snacks daily?

  • Avoid any specific foods?

  • Milk: how much, type?

  • Lactose intolerance


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Family History history and physical exam

  • Familial occurrence of dx

  • History of children with fetal anomalies


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Review of symptoms history and physical exam

  • General: Fatigue, weight change

  • Month: teeth, gums, lips, tongue

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


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Physical Exam: Anthropometric data history and physical exam

  • Height

  • Current weight

  • Prepregnancy weight

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

  • Weight gain during pregnancy so far


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Laboratory Evaluation history and physical exam

  • Glucose

  • Hematocrit

  • Hemoglobin


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Maternal weight gain history and physical exam


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Underweight history and physical exam

  • BMI < 19.8

  • Total weight gain 28 - 40 lbs.

  • 5 lbs./ 4 weeks


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Normal history and physical exam

  • BMI = 19.8 - 26

  • Total weight gain 25 - 35 lbs.

  • 4 lbs./ 4 weeks


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Overweight history and physical exam

  • BMI = 26.1 - 29

  • Total weight gain 15 - 25 lbs

  • 2.6 lbs./ 4 weeks


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Adolescent history and physical exam

  • Pounds to bring weight near normal for height

  • Pounds for 9 month interval of growth

  • Pounds recommended for pregnancy


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Nutritional requirements history and physical exam

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

  • Protein: RDA = 60 g

  • Calcium

  • Folate

  • Iron


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Nutritional Problems history and physical exam

  • Nausea and vomiting (hCG)

  • Constipation (progesterone)

  • Heartburn


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Lactation Management history and physical exam


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Benefits of Breast-feeding history and physical exam


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Infant history and physical exam

  • Decreased incidence of infection

  • Protection against autoimmune diseases

  • Good jaw and tooth development

  • Mother - Infant bonding


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Mother history and physical exam

  • Accelerated weight loss

  • Delayed return of ovulation

  • Improved bone remineralization

  • Reduced ovarian and premenopausal breast cancer risk

  • Easy, clean, economical


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Maternal nutritional requirements history and physical exam

  • 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


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Contraindications history and physical exam

  • 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


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Breast-feeding promotion and support history and physical exam

  • 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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