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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
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
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
Present illness
  • General: recent weight change, poor weight gain, edema, dehydration
  • G.I. complaints: Diarrhea, nausea, vomiting, heartburn, constipation
medical history
Medical History
  • Prenatal vitamins, nutritional supplements, herbs, remedies?
  • Iron supplements
  • Food allergies
  • Non-food cravings
  • Obstetric history
social history
Social History
  • Alcohol?
  • Special Diet?
  • How many meals and snacks daily?
  • Avoid any specific foods?
  • Milk: how much, type?
  • Lactose intolerance
family history
Family History
  • Familial occurrence of dx
  • History of children with fetal anomalies
review of symptoms
Review of symptoms
  • General: Fatigue, weight change
  • Month: teeth, gums, lips, tongue
  • GI/abdomen: Appetite, food intolerance, nausea, constipation, diarrhea
physical exam anthropometric data
Physical Exam: Anthropometric data
  • Height
  • Current weight
  • Prepregnancy weight
  • Prepregnancy BMI = {[wt (kg)] / ht2 (m2)}
  • Weight gain during pregnancy so far
laboratory evaluation
Laboratory Evaluation
  • Glucose
  • Hematocrit
  • Hemoglobin
underweight
Underweight
  • BMI < 19.8
  • Total weight gain 28 - 40 lbs.
  • 5 lbs./ 4 weeks
normal
Normal
  • BMI = 19.8 - 26
  • Total weight gain 25 - 35 lbs.
  • 4 lbs./ 4 weeks
overweight
Overweight
  • BMI = 26.1 - 29
  • Total weight gain 15 - 25 lbs
  • 2.6 lbs./ 4 weeks
adolescent
Adolescent
  • Pounds to bring weight near normal for height
  • Pounds for 9 month interval of growth
  • Pounds recommended for pregnancy
nutritional requirements
Nutritional requirements
  • Energy: + 300 kcal/day in 2nd and 3rd trimester
  • Protein: RDA = 60 g
  • Calcium
  • Folate
  • Iron
nutritional problems
Nutritional Problems
  • Nausea and vomiting (hCG)
  • Constipation (progesterone)
  • Heartburn
infant
Infant
  • Decreased incidence of infection
  • Protection against autoimmune diseases
  • Good jaw and tooth development
  • Mother - Infant bonding
mother
Mother
  • Accelerated weight loss
  • Delayed return of ovulation
  • Improved bone remineralization
  • Reduced ovarian and premenopausal breast cancer risk
  • Easy, clean, economical
maternal nutritional requirements
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
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
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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