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Objectives

Objectives. To produce a healthy, normal weight infant while minimizing the short and long term health risks to the mother To determine the appropriate weight gain during pregnancy for the normal weight, underweight, overweight and adolescent pregnant woman. Objectives (cont.).

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Objectives

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  1. Objectives • To produce a healthy, normal weight infant while minimizing the short and long term health risks to the mother • To determine the appropriate weight gain during pregnancy for the normal weight, underweight, overweight and adolescent pregnant woman

  2. Objectives (cont.) • To recognize the additional energy, vitamin and mineral requirements during pregnancy and lactation • To recommend dietary modifications to help alleviate nausea, heartburn and constipation during pregnancy • To develop skills to help promote and maintain breast-feeding

  3. Prenatal Nutrition

  4. Questions with nutritional implications for the obstetric history and physical exam

  5. Present illness • General: recent weight change, poor weight gain, edema, dehydration • G.I. complaints: Diarrhea, nausea, vomiting, heartburn, constipation

  6. Medical History • Prenatal vitamins, nutritional supplements, herbs, remedies? • Iron supplements • Food allergies • Non-food cravings • Obstetric history

  7. Social History • Alcohol? • Special Diet? • How many meals and snacks daily? • Avoid any specific foods? • Milk: how much, type? • Lactose intolerance

  8. Family History • Familial occurrence of dx • History of children with fetal anomalies

  9. Review of symptoms • General: Fatigue, weight change • Month: teeth, gums, lips, tongue • GI/abdomen: Appetite, food intolerance, nausea, constipation, diarrhea

  10. Physical Exam: Anthropometric data • Height • Current weight • Prepregnancy weight • Prepregnancy BMI = {[wt (kg)] / ht2 (m2)} • Weight gain during pregnancy so far

  11. Laboratory Evaluation • Glucose • Hematocrit • Hemoglobin

  12. Maternal weight gain

  13. Underweight • BMI < 19.8 • Total weight gain 28 - 40 lbs. • 5 lbs./ 4 weeks

  14. Normal • BMI = 19.8 - 26 • Total weight gain 25 - 35 lbs. • 4 lbs./ 4 weeks

  15. Overweight • BMI = 26.1 - 29 • Total weight gain 15 - 25 lbs • 2.6 lbs./ 4 weeks

  16. Adolescent • Pounds to bring weight near normal for height • Pounds for 9 month interval of growth • Pounds recommended for pregnancy

  17. Nutritional requirements • Energy: + 300 kcal/day in 2nd and 3rd trimester • Protein: RDA = 60 g • Calcium • Folate • Iron

  18. Nutritional Problems • Nausea and vomiting (hCG) • Constipation (progesterone) • Heartburn

  19. Lactation Management

  20. Benefits of Breast-feeding

  21. Infant • Decreased incidence of infection • Protection against autoimmune diseases • Good jaw and tooth development • Mother - Infant bonding

  22. Mother • Accelerated weight loss • Delayed return of ovulation • Improved bone remineralization • Reduced ovarian and premenopausal breast cancer risk • Easy, clean, economical

  23. Maternal nutritional requirements • Energy: + 500 kcal/day, progressive weight loss not to exceed 4.5 lb/month • Protein: RDA = 65 g • Calcium: 1200 mg (same as prenatal) • Iron requirement is decreased • Prenatal supplements • Fluids 2-3 quarts/day

  24. Contraindications • Maternal infections: TB, typhoid, rubella, mumps, HIV and CMV • Maternal medications: most chemotherapeutic agents, illegal substances. "If you wouldn't prescribe it for the baby, think carefully about giving it to the mother.” • Infant: galactosemia, some congenital deformities of the palate

  25. Breast-feeding promotion and support • Education of mother and family • Provision for early and frequent mother infant contact • Concept of "demand and supply” • Solutions for work related concerns: pumping and storage • Proper feeding technique and breast care

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