OB ATI Chapter 5 - Nutrition During Pregnancy

OB ATI Chapter 5 - Nutrition During Pregnancy Recommended weight gain during pregnancy is usually - 11.2 to 15.9 kg (25 to 35 lb). - The general rule is that clients should gain 1 to 2 kg (2.2 to 4.4 lb) during the first trimester and after that, a weight gain of approximately 0.4 kg (1 lb) per week for the last two trimesters. - Underweight woman are advised to gain 28 to 40 lb; overweight women, 15 to 25 lb. ● It is important for the nurse to evaluate the pregnant client's nutritional choices, possible risk factors, and diet history. The nurse also should review specific nutritional guidelines for at-risk clients. Assistance is given to clients to develop a postpartum nutritional plan. Obtain subjective and objective dietary information: - ◯ Journal of client's food habits, eating pattern, and cravings ◯ Nutrition-related questionnaires ◯ Client's weight on first prenatal visit and follow-up visits ◯ Laboratory findings, such as Hgb and iron levels Instruct the client to adhere to and maintain the following during pregnancy: - ◯ An increase of 340 calories/day is recommended during the second trimester. An increase of 452 calories/day is recommended during the third trimester. ◯ If the client is breastfeeding during the postpartum period, an additional intake of 330 calories/day is recommended during the first 6 months, and an additional intake of 400 calories/day is recommended during the second 6 months. ◯ Increasing protein intake is essential to basic growth. Also, the intake of foods high in folic acid is crucial for neurological development and the prevention of fetal neural tube defects. Foods high in folic acid include leafy vegetables, dried peas and beans, seeds, and orange juice. Breads, cereals, and other grains are fortified with folic acid. Increased intake of folic acid is encouraged for clients who wish to become pregnant and clients of childbearing age. It is recommended that 600 mcg of folic acid should be taken during pregnancy. Current recommendations for clients who are lactating include consuming 500 mcg of folic acid. ◯ Iron supplements are often added to the prenatal plan to facilitate an increase of the maternal RBC mass. Iron is best absorbed between meals and when given with a source of vitamin C. Milk and caffeine interfere with the absorption of iron supplements. Food sources of iron include beef liver, red meats, fish, poultry, dried peas and beans, and fortified cereals and breads. A stool softener may need to be added to decrease constipation experienced with iron supplements. ◯ Calcium, which is important to a developing fetus, is involved in bone and teeth formation. ■ Sources of calcium include milk, calcium-fortified soy milk, fortified orange juice, nuts, legumes, and dark green leafy vegetables. Daily recommendation is 1,000 mg/day for pregnant and nonpregnant women over the age of 19, and 1,300 mg/day for those under 19 years of age. ◯ 2 to 3 L of fluids is recommended daily. Preferred fluids are water, fruit juice, and milk. ◯ Caffeine intake should be limited to 300 mg/day. The equivalent of 500 to 750 mL/day of coffee may increase the risk of a spontaneous abortion or fetal intrauterine growth restriction. ◯ It is recommended that women abstain from alcohol consumption during pregnancy. Risk Factors to ensuring adequate Nutrition during Pregnancy: - ● Age, culture, education, and socioeconomic issues may affect adequate nutrition during pregnancy. Also, certain conditions specific to each client may inhibit adequate caloric intake. ◯ Adolescents may have poor nutritional habits (a diet low in vitamins and protein, not taking prescribed iron supplements). ◯ Vegetarians may have low protein, calcium, iron, zinc, and vitamin B12. ◯ Nausea and vomiting during pregnancy. ◯ Anemia. ◯ Eating disorders such as anorexia nervosa or bulimia nervosa. ◯ Pregnant clients diagnosed with the appetite disorder pica (craving to eat nonfood substances such as dirt or red clay). This disorder may diminish the amount of nutritional foods ingested. ◯ Excessive weight gain can lead to macrosomia and labor complications. ◯ Inability to gain weight may result in low birth weight of the newborn. ◯ Financially unable to purchase/access food. Therefore, the nurse should advise the client about the Women, Infants and Children (WIC) programs, which are federally funded state programs for pregnant women and their children (up to 5 years old). ....................