Ch 9 Nutrition for child bearing

Ch 9 Nutrition for child bearing


Chapter 9 Nutrition for Childbearing
Weight gain during pregnancy- typically they are looking at about 23-35 pounds for woman
who begin pregnancy at normal BMI. I think I said in one of the other podcast
it really does depend on where she starts pre-pregnancy to decide how much she should
be gaining. Recommendation for total weight gain
Pattern of weight gain is the usual recommendation is she should gain about 0.5-2 kg or that
equals t o1.1 to 4.4 lb during the first trimester. So really that is not a lot for the first
trimester. Some woman end up gaining more in that beginining
and that just makes it hard because as that baby grows you don’t have as much control
over how much weight that you gain. There is a photo in your book about weight
distribution you should gain that you should look at that shows what should go to the baby,
what goes to the placenta, how much they gain in their breasts and things like that. Some factors that will influence weight gain
truly has to deal with what that previous BMI was, has she had a lot of nausea and vomiting? What is her diet like? Those are some various factors that can influence
what the weight gain pattern is like. Some nutritional requirements energy, they
definitely need energy during pregnancy. We talked about this in nutrition a little
bit .It is measured in kilocalories. So you have your carbohydrates which you can
have simple or complex. Your fats provide energy and that is where
you are going get some of those fat-soluable vitamins that we will talk about in a minute. As far as calories, most pregnant woman need
about 2200-2900 calories a day. Once again this is going to fluctuate a little
bit with where their BMI is at. Protein, we definitely need that for metabolism,
tissue synthesis and tissue repair. In pregnancy, it is recommended the intake
is 71 grams. You need that for the expansion of blood volume
and just because of the growth that happens between the mom and baby and their tissues. You definitely need to have that extra protein
intake. Some of the vitamins are the fat- soluable:A,D,E,
and K. These are stored in the liver and if you get
too many of them, they can be toxic. This is not something we encourage woman to
take excess with. Usually what they get in their diet is what
they are going to get. Some of the water soluble vitamins are B6,
B12,C, folic acid, thiamin, riboflavin and niacin . They should be included in the daily
diet. It is anytime with supplements it is always
better if you can take them in with your diet than taking a supplement. Your body utilizes them much better from the
foods you take in than a supplement of pill form. Folic acid also called folate can decrease
the occurance of neural tube defects which is like your spina bifida and stuff so it
is very important we recommend that woman start taking folic acid before they are even
thinking about conceiving to have a baby. Iron it is important for our hemoglobin of
course. During pregnancy approximately 1000mg of absorbed
iron above the maternal iron stores are needed. It is hard sometimes because your iron-enriched
foods are sometimes things people don’t always like. Your red meat has some but things like liver
will have more, dried fruits have more so sometimes woman do have to have an iron supplement
in order to get that amount that they need. Calcium- we need that for mineralization of
fetal bones and teeth and also the calcium absorption and retention increases during
pregnancy. Sodium needs are also increased during pregnancy
and they need that to provide an expanded blood volume for the needs of the fetus as
well. That doesn’t mean that we are going to encourage
them to eat all these high salt foods, it just means most of us in our daily routine
take in more sodium than we need anyways so most of the time pregnant woman will just
be able to get enough with just her normal diet. Like I just said, food is the best source
but if not they may have supplements. Woman with adequate diets may not need supplements
except for iron or folic acid. I can tell you in my years of nursing that
probalby 99% of all pregnant woman are prescribed extra vitamins and supplements. Assessment of each woman’s individualized
needs determines whether she needs that supplementation. Water- we always know water is important and
we really need but we definitely need it when woman are pregnant because of the expanded
blood volume, as part of the increased maternal and fetal tissues as well. We encourage them to drink 8-10 cups and most
of it should be water. They want to be careful with their caffeine
intake anyway, that is not good for baby so we try and gear them to stay away. We usually can say one cup of coffee or tea
or one pop a day isn’t horrible. We want to get them to stay away from, they
don’t need a lot of the juices just because of the high sugar content with that. Not that they can’t have any juice but their
fluid intake should be mainly water. A couple reference points you can refer them
to My Plate, it is that guide to healthy living, talks about the different food groups, and
this is a good guideline if you are looking for some teaching to do with a pregnant woman
that is a very good resource to be able to use. A few food precautions that we talk about
with our pregnant woman are they need to avoid large fish because of the high mercury content,
smaller fish they can have once a week. Eggs need to be fully cooked and they should
stay away from nitrates which are in lunch meat and processed meat as well. Factors that can influence nutrition: age,
typically teens are going to be a little worse just because they are not going to have the
good nutrition to begin with so they usually are going to be lacking to begin with and
then they get pregnant and baby takes the nutrients so then they can have issues as
well. What is their nutrition knowledge? It is amazing what some people think is considered
healthy or they think they have had one apple today so I have met my fruit and vegetable
intake today. They don’t have that knowledge. Do they exercise, are they active? If they are, then they may be able to take
in more calories. What about their culture? Certain cultures eat just certain foods during
pregnancy so you have to look at that as well because that can influence as well. Risk factors is socioeconomic is of course
one of our biggest things because of the poverty. There are food supplement programs out there
but once again, when someone is getting assistance, there is not a whole lot of regulation on
what type of foods they can buy. So just because they can get that assistance
doesn’t mean they are necessarily eating nutritionally fit foods. Vegetarisim- meeting the requirements of the
pregnant vegetarian can be hard. Hard to get in all of the protein that they
need and depending on if they are just vegetarian or if they are doing the true vegan, then
you have issues with their calcium as well. If they are lactose intolerant, most of the
time we can work around that because we can find other sources to get that calcium in
but sometimes there are adaptations that need to be made. Nausea and vomiting of pregnancy can cause
a woman of course to loose a lot of weight in the beginning and not getting the nutritional
intake that they should be having. Typically the nausea and vomiting for most
women is done when the first trimester is done so once they get past that they can continue
getting the good nutrients in at that point. Anemia- because we just talked about how much
iron they need and so how anemia is very common during pregnancy. A couple other things are abnormal prepregnancy
weight and this could be too little or too much. Both of those things can be risk factors. If they have an eating disorder. You know you can still have someone who can
have anorexia or bullemia and get pregnant so those can be problems. They could have food cravings and aversions
which is called pica. This is where woman crave to eat things that
are non foods- laundry soap, paper, anything like that is not food. Sand or anything. That truly happens to a lot of people . Also
if they are multiparity or mulitifetal pregnancies, their nutritional differences are going to
be different as well. Also some nutritional risk factors include
substance abuse. Smoking, caffeine, alcohol, drugs. With that adolescence we have talked about
that already. Their nutrient needs are going to be different. Some of their common problems is they either
not eating well to begin with or maybe the ydon’t have the finances to be able to get
what they needed as well. We do need to teach the adoloscence. One of the first things we should talk about
is when they are doing their prenatal visits is the importance of nutrition and what their
guidelines are. You have to be very specific. Remember you have to find out what is it they
like? It doesn’t do you any good to tel lthem you
need to eat 5 servings of vegetables a day if they don’t like vegetables. Lets see what they like and try and come up
with a plan of healthy things to be able to get all of t heir vitamins in by giving them
choices of things that they actually will eat. After birth if a woman is lactating, which
means breast feeding, they need the extra calories for energy. Their first 6 months they usually need about
and extra 330 calories a day. After the second 6 months they need an additional
400 calories and that is just because baby is getting bigger nad taking more from mom
as well. The breastfeeding is a nice way for mom to
loose a lot fo weight. Sometimes they don’t have time to eat all
of these extra calories and baby is taking it from them so a lot of times breast fed
oms loose their pregnancy weight quicker than if thy aren’t breastfeeding. Other things as far as nutrition concerns
we need to look at is dieting, we don’t want moms to really diet because baby is still
needs that and they need that as well. In adolscence we talked about that already,
the vegan diet is hard for the woman to be able to get enough nutrients for herself and
baby if she is breastfeeding. The avoidance of dairy products because once
again baby needs some of that and so does mom. If they have an inadequate diet sometimes
they won’t have a good milk production if they are not eating well enough. Alcohol- it is a problem if they are breastfeeding
they cannot obviously drink and then breast feed. So that is a huge concern. Caffeine really is recommnded as very little
just as it is in pregnancy as it is in lactation. Fluids- every time they sit down they should
to breastfeed they should be drinking some water. Foods to avoid, this is pretty individualized. Some people can’t eat anything that is gas
forming . So they can’t do the broccoli, cabbage, things like that because baby has a hard time
with it. I have known women before that have had to
give up all sorts of things and they has to give up chocolate and they had to give up
almost anything that was an irritant and they basically had a pretty bland diet why they
were breastfeeding. That again is individualized .Some babies
can tolerate things and others can tolerate more than others. If they are not breastfeeding, they can return
to their prepregnancy diet that they were on. The nurse should assess the mother’s understanding
the amount of food she needs for the food groups, so still do some nutritional counseling
and if they are trying to do some weight loss, talk to them about healthy food choices and
trying to be active and doing some type of exercise as well can help.

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