Providing Lifelong Nutrition Skills
to Pregnant Adolescents
Carrielyn Rhea, BSN RN | FNP/PHL Program at UVA | GNUR 8610
Abstract
• The United States has the highest
adolescent pregnancy rate in the
developed world
• Every 31 seconds an adolescent becomes
pregnant in the United States
• Current research shows that nutrition
during adolescent pregnancy is directly
associated with the outcome of the infant
at delivery
Abstract – 2
• Many programs exist to provide nutrition
counseling and nutrition resources to
pregnant adolescents
• Expansion is needed on how to shop and
select nutritionally sound foods and how to
prepare them
• 1 on 1 time with a nutrition counselor to
individualize program
• Taking small groups into a grocery store to shop
• Providing basic storage and cooking classes
Nutrition & Adolescent Pregnancy
• Adolescents: 12-18 years of age
• Pregnancy in the adolescent years is a time of
great nutritional risk
• Adolescents who are at greater risk for becoming
pregnant, are often more likely to have inadequate
nutrition
• Adolescents have a higher rate of:
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low birth-weight infants
preterm labor
infant mortality
• These risks can be reduced by proper nutrition
during pregnancy
Literature Summary
Research Studies
1. Nutritional needs of pregnant adolescents are greater
than those of adult women (Frisancho et al., 1983; Scholl et al., 1990)
2. Increased needs compete with the needs of the
developing fetus (Frisancho et al., 1983; Scholl et al., 1990)
3. Weight gain during pregnancy is directly associated
with infant birth weight and infant mortality (Hediger et al., 1990)
4. Intake of macro and micro nutrients is directly
associated with infant birth weight and preterm labor
(Scholl et al., 1991; Baker et al., 2009)
5. Diet’s low in protein, fat, and energy are associated with
less subcutaneous fat. Children born to mothers with less
subcutaneous fat are more likely to develop hypertension
later in life (Adair et al., 2001)
Literature Summary
Gaps in Knowledge
• Specific recommendations were not
made for:
• Amount of weight gain needed
• Amount of macro nutrients (fat, protein, and
carbohydrates)
• Amount of micro nutrients (vitamins, minerals, and
nutrients)
Literature Summary
Current Programs
These programs provide nutrition counseling
and nutrition resources to pregnant adolescents
• National
– Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC)
– Expanded Food and Nutrition Education Program
(EFNEP)
• Local
– Teen Parent Programs
– Pregnancy Help Centers
Literature Summary
Gaps in Current Programs
• Many adolescents do not know how to:
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Select good produce and meat in a grocery store
Read a food label
Store food
Prepare and cook nutritionally sound meals
• Current programs do not teach these skills
PROJECT OBJECTIVE:
Comprehensive program that will provide
pregnant adolescents with the knowledge
and skills necessary for lifelong nutrition
for both her and her child
Health Belief Model
• This model looks at an individual’s
motivation to engage in a health promoting
behavior by understanding that person’s:
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Perceived susceptibility
Perceived severity
Perceived benefits
Perceived barriers
Cues to action
Self-efficacy
(Edberg, 2007)
Applying the Model
• Brochure to highlight:
• Nutrition risks of pregnant adolescents
• Statistics of positive outcomes from good maternal
nutrition
• Statistics of negative outcomes from poor maternal
nutrition
• Highlights of the proposed program and how it will
benefit them
Applying the Model – 2
• Brochure will help pregnant adolescents to
see their:
• Susceptibility to poor outcomes
• Consequences if they do not eat properly
• Benefits if they do eat properly
• Overcome barriers to resources
• Motivate them to seek action
Applying the Model – 3
• Brochure to be placed in:
• Pregnancy Help Centers
• Local Obstetrician’s offices
• School nurse’s offices/school wellness centers
Implementation Plan
Once pregnant adolescents are referred
and/or choose to enroll in the program, they
will be empowered to obtain self-efficacy by:
• Having weekly nutrition classes as a group
• Meeting 1 on 1 with a nutrition counselor
initially and then once a month to determine
their body mass index (BMI), goal for weight
gain, and to monitor that weight gain
Implementation Plan – 2
• Being encouraged to enroll in WIC in order to
receive food stamps and food resources
• Going grocery shopping with a nutrition
counselor in groups of 2-3 to have hands-on
practice with:
• Selecting good produce and meat
• Reading nutrition labels
• Making healthy selections while maintaining a
budget
• Having basic food storage and cooking
lessons from nutrition counselor
“Nutrition Counselor”
• A nutrition counselor may be a:
• Nutritionist
• Nurse practitioner
• Other health care professional with an interest
in and the training necessary to be a nutrition
counselor
Innovation
• Specifically addresses the nutrition needs
of pregnant adolescents
• Individualizes plan for each pregnant
adolescent
• Utilizes multiple learning modalities to
increase student comprehension:
• Hands-on learning
• Classroom instruction
• 1 on 1 instruction
Innovation – 2
• Provides skills necessary for lifelong
nutrition
• Is a comprehensive program that takes
nutrition and food consumption from start
to finish
• Empowers pregnant adolescents to obtain
self-efficacy as in the HBM
Innovation – 3
Knowledge (what to eat and how much)
Financial Resources (to pay for food)
Selecting & Purchasing Food
Preparing, Consuming, & Storing Food
Evaluation
• Participants will be evaluated by:
• Weight gain throughout pregnancy
• Return demonstrations of learned skills
• Food diaries
• Program will be evaluated by:
• Outcome of newborns at delivery compared with
the national average of newborns born to mothers
of the same age
• Course evaluations submitted by the students both
during and after the completion of the program
Budget Estimate
• Expenses to include:
• Project manager salary
• Nutrition counselor’s pay (based on having 5
students to begin, 14 hours per week)
• Classroom materials
• Materials to print brochures
• Training funds
• Funds for food used during cooking classes
• Public transportation for students to get to grocery
store if needed
References – 1
• Adair, L.S., Kuzawa, C.W., & Borja, J. (2001). Maternal energy
stores and diet composition during pregnancy program adolescent
blood pressure. Circulation: Journal of the American Heart
Association, 104, 1034-1039. doi: 10.1161/hc3401.095037.
• Baker, P.N., Wheeler, S.J. Sanders, T.A., Thomas, J.E., Hutchinson,
C.J., Clarke, K., Berry, J.L., Jones, R.L., Seed, P.T. & Poston, L.
(2009). A prospective study of micronutrient status in adolescent
pregnancy. American Journal of Clinical Nutrition, 89, 1114-1124.
• Dubois, S., Coulombe, C., Pencharz, P., Pinsonneault, O., &
Duquette, M. (1997). Ability of the Higgins nutrition intervention
program to improve adolescent pregnancy outcome. Journal of the
American Dietetic Association, 97 (8), 871-878.
• Edberg, M. (2007). Essentials of health behavior: Social and
behavioral theory in public health. Boston, MA: Jones and
Bartlett.
References – 2
• Frisancho, A.R., Matos, J. & Flegel, P. (1983). Maternal nutritional
status and adolescent pregnancy outcome. American Journal of
Clinical Nutrition, 38, 739-746.
• Hediger, M.L., Scholl, T.O., Ances, I.G., Beisky, D.H., & Wexberg
Salmon, R. (1990). Rate and amount of weight gain during
adolescent pregnancy: associations with maternal weight-for-height
and birth weight. American Society for Clinical Nutrition, 52, 793799.
• Lenders, C.M., McElrath, T.F., & Scholl, T.O. (2000). Nutrition in
adolescent pregnancy. Current Opinion in Pediatrics, 12 (3), 291296.
• Pregnant and parenting adolescents. (2011). North Carolina
Expanded Food and Nutrition Education Program website.
Retrieved from: http://www.ces.ncsu.edu/ EFNEP/pt.html.
References – 3
• Scholl, T.O., Hediger, M.L., Khoo, C., Healey, M.F., & Rawson, N.L.
(1991). Maternal weight gain, diet and infant birth weight:
correlations during adolescent pregnancy. Journal of Clinical
Epidemiology, 44 (4/5), 423-428.
• Scholl, T.O., Hediger, M.L., & Ances, I.G. (1990). Maternal growth
during pregnancy and decreased infant birth weight. American
Journal for Clinical Nutrition, 51, 790-793.
• Stevens-Simon, C. & McAnarney, E.R. (1996). Adolescent
pregnancy. In R.J. DiClemente, W.B. Hansen and L.E. Ponton
(Eds.) Handbook of Adolescent Health Risk Behavior, (pp. 313-332).
New York: Plenum Press.
• Teen parents: nutrition curriculum for pregnant and parenting teens.
(2007, February). University of Missouri Extension website.
Retrieved from:
http://extension.missouri.edu/publications/DisplayPub.aspx?P=N715
References – 4
• Wallace, J., Bourke, D., Da Silva, P., & Aitken, R. (2001). Nutrient
partitioning during adolescent pregnancy. Journals of Reproduction
and Fertility, 122, 347-357.
• Wallace, J.M., Luther, J.S., Milne, J.S., Aitken, R.P., Redmer, D.A.,
Reynolds, L.P., & Hay, W.W. (2005). Nutritional modulation of
adolescent pregnancy outcome: a review. Placenta, 27, S61-S68.
doi: 10.1016/j.placenta.2005.12.002.
• WIC factsheet (2010, May 5). Food & Nutrition Service USDA
website. Retrieved
from: http://www.fns.usda.gov/wic/factsheets.htm