Nutritional Health
Nutritional Health

Nutritional state before and during pregnancy have a direct bearing on the her
health and on fetal growth and development.

Hyperplasia-early in pregnancy, fetal growth occurs by an increase in the
number of cells formed.

Hypertrophy-late in pregnancy, occurs by enlargement of existing cells.

Nurses must educate their patients on the importance of good nutrition.

Recommended Weight Gain:

adequate nutrients to the fetus and her own nutrition.

adequate protein

weight gain of 11.2 to 16 kg (25 to 40 lbs)

1 lb / month during the 1st trimester
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1 lb/ week during the last 2 trimesters (3-12-12)

excessive is > 6.6 lbs in the last 2 trimesters or < 2.2 lbs/ month

underweight women should gain 30 to 40 lbs

obese women should gain less 15 lbs

multiple pregnancy- 1 lb / wk for total of 40 to 45 lbs

sudden gains suggest fluid retention

Components of Health Nutrition:

Caloric Needs:

total 2500 calories/day

never less than 1500 calories/ day

Protein Needs:

60 g/day

meat, poultry,fish, yogurt, eggs, milk, beans & rice, legumes & rice, or beans
& wheat.

Fat Needs:

linoleic acid necessary for new cell growth

vegetable oils are a good source

Vitamin Needs:

folate deficiency>fetal neural tube defect
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vitamin D deficiency>diminished bone density of fetus and mother
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Prenatal Vitamins (Natalins)

Mineral Needs:

needed for new cell building

calcium - 1200 to 1500 mg
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phosphorus - eat foods high in protein

iodine - 175 ug daily(seafood is best source)

iron - 30 mg dietary supplement of 30 mg / day

organ meats, eggs, green leafy vegetables, whole grain, enriched breads,
dried fruits (OJ increases absorption)

black stools and constipation

may need a stool softener- Colace

Fluoride:

aids in formation of teeth

Sodium:
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maintains fluid balance in body

to much salt results in retention of fluids
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Zinc:

synthesis of DNA and RNA

15 mg in meats, liver,eggs and seafood.

Fluid Needs:

increase water to promote kidney function

2 glasses daily plus 1 quart of milk

Fiber Needs:

increase fiber-broccoli, asparagus, fruits and green leafy vegetables

Foods to Avoid:

caffeine

artificial sweeteners

weight loss diets
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Ask for a 24 hour nutrition recall
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Areas of assessment
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Monitor H&H and UA
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Promoting Nutritional Health
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Set nutritional outcomes by looking at the woman’s lifestyle.
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Family considerations
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Financial considerations
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Cultural considerations
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Managing Common Problems:
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Nausea and vomiting
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once a day is common
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acupressure, antimotion sickness wrist bands, avoiding fluids with meals,
increasing carbohydrates, eat dry crackers or sourball candies



disappears by 4th month
Cravings
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strange desires for foods
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Pica
Pyrosis (heartburn) burning sensation along esophagus caused by
regurgitation of gastric contents into lower esophagus.

due to decreased gastric motility that slows gastric emptying

relieved by small frequent meals and do not lie down immediately after
eating
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Maalox or Amphojel
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Hypercholesterolemia:
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elevated cholesterol

may be due to increased progesterone

gallstone formation and cardiovascular disease

eat moderate amounts of fat, oat bran, fish, butter substitutes, broil meats,
minimum use of salad oils, exercise daily
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Special Needs:
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Adolescent:
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they are continuing to grow also
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high caloric intake (2500 calories / day); need calcium, iron, folic acid.
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avoid foods that their parents see as important (milk, fruit, vegetables)
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meal-cheese and sausage pizza, milk and apple
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snack frequently need good snacks
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Woman Over Age 40:
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not studied a lot - decreased kidney function
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high fluid intake
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packed or fast-foods
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Decreased Nutritional Stores:
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high parity, short intervals between pregnancies or dieting depletes reserves

may have anemia, decreased K, folate, iron, thiamine
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Underweight Women:
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defined as 10% to 15% less than ideal body weight for her height or BMI <
19.8
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low birth weight infants

poverty, stress, depression, eating disorders
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major reason - insufficient intake of food due to chronic poor nutritional habits

24 hour nutrition recall

need 3500 calories; 500 calorie increase = additional 1 lb/week

Overweight Women:
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20% above her ideal body weight or BMI over 26.1

risks - diabetes, hypertension, excessive fetal growth, prolonged pregnancies,
ambulating is difficult

dieting not recommended during pregnancy not below 1500 to 1800
calories/day

walk daily and decrease carbohydrates
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Vegetarian Woman:

different types

lack of vitamin B12 (from meats), calcium (dark leafy vegetables), vitamin D
(milk and sunlight)

need a prenatal supplement

Phenylketonuria PKU:

inherited disorder-cannot convert amino acid phenylalanine into tyrosine; used
for cell growth

Fetus can develop microcephaly, intrauterine growth restrictions, neurological
damage.

Foods low in phenylalanine- OJ, bananas, squash, spinach, peas.

Proteins contain high levels

Begin low phenylalanine diet 3 months prior to pregnancy
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Multiple Pregnancy:

gain more weight with greater speed
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Smoking, Drugs or Alcohol:

general nutrition problems

Many Fast Food Meals:
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90% women work outside the home

prepare a good lunch the night before
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Lactose Intolerance:

sugar in milk is lactose and people have difficulty digesting lactose

nausea, diarrhea, cramps, gas, bloatedness

can eat cheese, yogurt, soy milk

Hyperemesis Gravidarum:

nausea and vomiting prolonged past week 12 or so severe that dehydration,
ketonuria, weight loss

may need to be hospitalized for IV RL