Maternal Newborn Antepartum: Nutritional Needs

What are the clients? Nutritional needs during pregnancy and postpartum? Nutrition prior to and during pregnancy is extremely important, as the pregnant woman's food and fluid intake must nourish her own body and that of the growing fetus. The United States Department of Agriculture's food guide pyramid can be used to teach her pregnant client to follow a nutritious diet during pregnancy. Cultural adaptations of the pyramid are available, as is a vegetarian version. But first let's review the basics. Maternal nutrition affects the size and health of her fetus and whether or not the infant has adequate stores of nutrients after birth. Some specific nutrients are especially important during pregnancy. For example, it has been well established that folic acid prevents neural tube defects and iron supplements help prevent anemia, because it is difficult to ingest enough of these nutrients, and food supplements of both folic acid and iron are usually prescribed during pregnancy. As for weight gain, it is recommended that a healthy pregnant woman gained 25 to 35 pounds, that's about 11 to 16 kilograms, during Show more

pregnancy. This allows a weight gain of three and a half pounds- about 1.6 kilograms during the first trimester and just under a pound, which is less than a half a kilogram per week thereafter. For your client to attained recommended weight gain, she should increase her dietary intake by about 300 calories a day during pregnancy. If she breastfeeds, her infant suggests that she had 500 calories a day more than her pre-pregnancy intake. To support lactation during the postpartum period and beyond, as for as long as she is breastfeeding, she should also drink at least three liters of fluid a day. That is almost a leader above the normal Show more

requirement to provide enough fluid for breast milk. If your client is not lactating, she should consume 2202- 2,300 calories a day and drink two liters of fluid per day to support postpartum diuresis and prevent constipation. To promote the return of normal bowel function, her diet should also include adequate fiber. If a pregnant woman gains too little or too much weight, she is at risk for nutrition related complications. In either case, the nutrients taken in might be empty calories and not high quality nutrients when she needs it at this time. With improper nutrition, the pregnant woman can become anemic and fetal development can be compromised, resulting in intrauterine growth restriction or iugr. Infants with iugr are likely to be small for gestational age. Now, in this situation, you must provide information about good nutrition during pregnancy. A client named CJ is at the end of the Show more

first trimester of her pregnancy. Her normal pre pregnant weight is 120 pounds were about fifty four kilograms. She now weighs 125 pounds- that's just under 57 kilograms- and she's concerned that she is getting fat. Her food diary shows she is eating a fairly well balanced diet except for an insufficient intake of dairy products and iron rich foods. What information tells you that CJ understands what has been taught to her? A- I don't drink milk. It gives me Show more

heartburn. Or B: I'm limiting my calories to 800 a day to prevent weight gain. See, I hate spinach. Or D- I've been taking my folic acid supplements as prescribed. The answer is d- I have been taking my folic acid supplements as prescribed. In the above situation, CJ appears to only understand that the folic acid supplement is good for her. This is an important fact to remember when talking further about her diet, because it is always more positive approach to discuss what she has already understood about nutrition. Then direct the discussion towards the diet that contains dairy products and foods high in iron other than the two she considers off-limits for her. Commend CJ at the end of your dietary consultation for gaining five pounds, that is, 2.3 kilograms, in the first trimester. You should reinforce at 125 pounds- or 57 kilograms is a good weight for her at this point- and provide important nutrition for the fetus. Now here's a critical thinking exercise: which dietary choice would be most appropriate for CJ during her pregnancy? A- a tuna sandwich, potato chips and milk? Show more

Or be grilled tofu, pasta salad and frozen yogurt? See- a hamburger, french fries in a milkshake? Or D- fried chicken, mashed potatoes and diet soda? The answer is B- it can't be a because tuna and some other ocean fish should be restricted because of mercury levels, and milk isn't an option because your client doesn't like it. C is too high in fat and she probably wouldn't drink a milkshake if she doesn't like milk. D is high in fat and soda lacks nutritional value. But B has a low-fat protein source and the yogurt contains calcium. Now here's another one which diet more commonly consumed by a Hispanic pregnant woman shows an understanding of the importance of nutrition during pregnancy: a tortillas, beans, rice and cheese, or be Show more

tacos dipped in salsa with water to drink, see a beef, burrito, rice and milk. Or D, a vegetable taco, salad, rice and milk. A is correct answer because it is a meal with a good balance of protein, carbohydrates and dairy. It's lower in fat than B or C and more complete than D. While we're focused on essential nutrients, let's consider a common problem you'll encounter in pregnant clients. That's how iron deficiency anemia. Diet alone cannot meet the normal gestational iron needs. In fact, iron requirements Show more

double to 30 milligrams per day during pregnancy, not only for fetal and placental development, but to supply the expanded maternal red blood cell mass. Since maternal blood volume increases by fifteen hundred milliliters, the need for supplemental iron is clear. Risk factors for anemia during pregnancy include pre-pregnancy anemia, poor nutritional Show more

status, close spacing of pregnancies multiple gestation and excessive vaginal bleeding prior to or as a result of pregnancy. Hemoglobin, hematocrit and serum ferritin levels are the Diagnostics used to confirm iron deficiency anemia. A hemoglobin level below 10 milligrams per liter and a hematocrit below thirty five percent reflect anemia. If your client has anemia, she will be susceptible to infections and show signs of fatigue in pallor Show more

during and after delivery. Your anemic client will be less able to tolerate blood loss. Without sufficient supplies of iron she will have increased risk of postpartum hemorrhage and other infection. Other maternal risk factors are congestive heart failure during labor and poor wound healing. Post-delivery fetal and neonatal problems include increased risk of preterm birth and small for gestational age infants. Your intervention for anemia include education about iron rich foods such as fortified cereals, enriched breads, liver meat, dried fruits, green leafy vegetables and legumes. These food sources are especially important for Show more

women who do not tolerate iron. Supplements very well reinforce that iron is best absorbed on an empty stomach and that is also taken with a rich source of vitamin C, such as orange juice or tomato juice. Make sure your client understands that milk inhibits iron absorption, Show more

so suggests taking iron with other fluids. A common side effect of iron is constipation, so encourage a diet high in fiber and fluids. Iron supplements also turn the stools black and can cause some gastrointestinal upset. Warn your client about these effects so that she will not be alarmed by them and abruptly stopped taking the iron. The usual prescription for anemia is either ferrous sulfate or ferrous gluconate. These medications are taken orally. However, in rare cases when they are not tolerated, iron dextran Show more

complex can be given by injection Show more