Maternal and Fetal Nutrition
Chapter 9
Nutritional Needs Before Conception
 First trimester crucial for embryonic and fetal organ development
 Healthful diet before conception ensures that adequate nutrients are available for
developing fetus
 Folate or folic acid intake important in the periconceptual period
o Neural tube defects are more common in infants of women with poor folic acid
intake
o See Box 9.1 (p. 207) for Food Sources of Folate
o Food sources here:
 H
o 600 mcg Folate recommended for pregnancy (vs. 400 mcg when not pregnant)
 If having twins or has history of baby w/ neural tube defects  Rx 1 mg
or more
Nutritional Risks Factors in Pregnancy
 Adolescence
 Use of tobacco, alcohol, drugs
 Multifetal pregnancy
 Low Hemoglobin
 Diabetes
 Anorexia/Eating disorders
 Lactose intolerance
 Over or under weight
What is the recommended weight gain for a pregnant woman with a normal BMI and a single
fetus?
a) 5-10 lbs
b) 15-20 lbs
c) 25-35 lbs
d) 40-50 lbs
Answer: 25-35 lbs
Weight gain charts by BMI
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*Weight loss in pregnancy is NOT recommended*
o After they have the baby we can talk about weight loss diets
Recommended Rate of growth:
o 1st trimester (2-4 lbs)
o 2nd trimester (1 lb/week)
o 3rd trimester (1 lb/week)
Excessive weight gain in pregnancy  chronic overweight after delivery
o Risk for HTN, Type 2 DM, etc.
o Could lead to having a macrosomic baby  problems with birth
Tissues Contributing to Weight Gain at 40 Weeks Gestation (normal BMI)
The pregnant woman should decrease her protein intake.
a) True
b) False
Answer: False
Food Sources for Various Nutrients
 See Table 9.1 (pp. 208 & 209) for a review of Nutrients and Food Sources
o Look at food sources!
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Sources of Protein:
o Lean meats, poultry, eggs, dairy (yogurt, cheese, milk), soy milk (/products)
o If vegan or vegetarian- complete proteins (beans “legumes”/rice), peanut butter
on whole wheat bread, whole grain cereal with soy milk
Sources of Calcium:
o Dairy, dried fruits (figs, raisins), dark leafy green veggies, fish (sardines, salmon /
fish canned with bones), nuts (almonds, brazil nuts)
o If lactose intolerant- yogurt, cheese, lactase supplement, lactose-free milk
Foods rich in what vitamin should be combined with non-meat sources of iron (i.e. legumes) in
order to increase iron absorption?
a) Vitamin A
b) Vitamin B
c) Vitamin C
d) Vitamin D
Answer: Vitamin C- orange juice etc
Iron
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Lean meat, dark green leafy veggies, eggs, whole grain/enriched bread or cereals, dried
fruits, legumes, shellfish, molasses
o Absorption is higher in animal products
o Can be improved in non-animal products if combined with Vitamin C
Many women will need Iron supplements during pregnancy (can develop iron-deficiency
anemia)
o How to take:
 Between meals
 On empty stomach
 With beverage that is NOT tea, coffee, or milk
 Can take after a meal if having GI upset, but this decreases absorption
 Can cause constipation
 Increase fluids & fiber to prevent
o S/e:
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Fluids
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Nausea
Constipation
Black tarry stools
Teaching box pg 222
WATER
Milk & juice contribute water (and excess sugar)
Soda/diet soda should be used in moderation (no nutritional value)
Caffeine in moderation
What should the nurse teach concerning salt use?
a) May season to taste while cooking
b) Add salt after serving if you want
c) Cut all sodium from diet
Answer: A
Salt
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Season to taste WHILE cooking
No adding salt after
Avoid excessively salty foods
o Read labels
Body DOES need salt for adequate placental perfusion
o Rare that provider will Rx a no slat diet
Other Nutritional Issues During Pregnancy
 Alcohol
o NO “safe amount” during pregnancy
 Caffeine
o Data inconclusive
o Recommend limiting caffeine
 Artificial Sweeteners
o No adverse effect on mom/fetus UNLESS mom has PKU disease
 Adolescents
o Can have problems with nutrition during pregnancy
o Weight gain should be in upper half of range bc young mom is growing as well as
baby
 Preeclampsia
o High BP in pregnant woman, who typically does NOT have high BP
o Avoid with well-balanced diet
 Lactation
o Breastfeeding
o For first 6 months of nursing  mom should…
 Increase energy intake by 400-500 kilocalories
 Increase fluid intake
 Avoid excessive caffeine, alcohol, smoking
Vegetarianism
 Basic Foods include:
o Veggies
o Fruits
o Legumes
o Nuts
o Seeds
o Grains
 Lacto-vegetarians
o Include milk products
 Lacto-ovo vegetarians
o Include dairy and eggs
 Vegans
o Consume ONLY plant-based nutrients
 Dietary/nutritional issues
o Vitamin B12 deficiency
 Take supplement or fortified foods (soy milk)
o Calcium
 Supplements
o Iron & Zinc
 Talk to provider about supplements
o Plant proteins are often incomplete
 Grains, dried beans, peas, nuts, seeds can give all essential amino acids
needed
Pica
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Consuming non-food substances or excessive amount of foods low in nutritional volume
o Leads to a loss of minerals, contamination of heavy metals (lead), toxic
substances, or they may ingest parasites
EX:
o Ice
o Freezer frost
o Corn starch
o Laundry starch
o Baby powder
o Clay
o Dirt
o Coffee grounds
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o Soap
Side effects:
o Iron deficiency anemia
o Low or high weight gain
o Constipation
o Impaction in their gut
o Decreased nutrient absorption
o Dental caries
Risks of Pica
o Nutritious foods displaced from diet
o May limit absorption of nutrients, especially minerals
o Contamination with heavy metals (like lead) or toxic substances
o Ingestion of parasites
Nursing interventions
o Offer dry powdered milk as nutritional substitute for starches
o Juice pops for ice chewing
o Mints to distract
o Lemon candies to decrease cravings
Food Safety Alerts
 Good website: https://www.foodsafety.gov/risk/pregnant/index.html
 #1 Avoid fish high in Mercury
o High Mercury fish - Avoid shark, swordfish, king mackerel, and tilefish
 Bigger fish: higher in mercury
o Low mercury fish - May eat as much as 12 oz of a variety of fish and shellfish low
in mercury
 Shrimp, salmon, pollock, catfish, canned light tuna
 Limit albacore to 6 oz per week.
 #2 Listeria
o Do NOT consume unpasteurized milk, including soft cheeses
o Hot dogs, luncheon meats, deli meats should be heated to steaming before
consuming
o Deli made salads such as egg, chicken, ham, seafood should NOT be eaten
o Avoid raw seafood & reheat smoked seafood
 #3 Toxoplasmosis
o Avoid raw/undercooked meat
o Wash vegetables and fruit
o Avoid cat feces or soil contaminated with cat feces
 Fence in garden
o Avoid unpasteurized goats’ milk & dairy products made from it
 #4 Salmonella
o NOTHING made with uncooked (raw) eggs
 Cookie dough is NOT safe
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#5: Bone meal (as a calcium source)
o May be contaminated with lead
o Ask provider about safe calcium supplements
Eating Disorders and Pregnancy
(source: National Eating Disorders Association)
 Maternal risks
o Poor nutrition
o Dehydration
o Cardiac irregularities
 Women dealing w/ anorexia who have lost a lot of weight often die from
cardiac irregularities
o Severe depression
o Preterm birth
o Labor complications
o Hypertension
 For those who are bulimic/binge eating
o Difficulty breast feeding
 Trouble making milk
o Post-Partum depression
 Fetal risks
o Poor development
o Preterm birth
o LBW- low birth weight
o Respiratory distress
o Feeding difficulties
o Other perinatal complications
 Care
o Women with ANOREXIA may have trouble getting pregnant bc they don’t have
enough fat to have enough estrogen to ovulate and get pregnant
o Women with BULLEMIA can still get pregnant
o Triggers: Body changes, body image changes, increased emphasis on weight gain,
being weighed-in at every visit
 Weigh-in idea
 Have them stand on scale backwards
 Edu breastfeeding will help with post-partum weight loss
 Work with nutritionist
 Decrease stress
 Encourage honest and open communication
 Individual counseling
 Childbirth/parenting classes
What should breastfeeding mother do to maintain an adequate milk volume?
a) Decrease calorie intake
b) Increase calorie intake
c) Maintain current calorie intake
Answer: Increase calorie intake