1. Maternal Nutrition Chapter 13

2. Prenatal nutrition effected by: Nutritional status prior to pregnancy Maternal age- adolescents need more calories Parity- # of pregnancies and time in-between • Nutritional problems that effect cell division can have permanent consequences

3. Maternal Weight Gain • Normal weight woman- 25-35 lbs. • Ideal pattern 3.5-5 lbs first trimester • 1 lb/week for duration of pregnancy • 3-5 lbs. in one week------ Think PIH • Increase caloric intake by 300 kcal/day during second and third trimester

4. Carbohydrates and Protein • Carbohydrates- primary source of energy. • Source- dairy, fruits vegs, whole wheat cereals, bread • Protein-required for tissue growth, 60gms/day • Source- animal products • Vegans must combine foods • Fats- more completely absorbed

5. Minerals • Calcium and phosphorous- 1200mg/day • Needed for bone and teeth growth • Iodine- deficiency can result in hypothyroidism • Sodium- fluid balance • Zinc- protein metabolism and synthesis of DNA and RNA

6. Iron • Iron- increase requirement due to blood volume • Anemia associated with PT birth and maternal morbidity • Difficult to meet daily requirement with diet • 30mg ferrous sulphate/day • Cause GI upset and constipation • Nursing interventions

7. Vitamins • Fat soluble-A,D,E,K stored in liver • Vitamin A- skin, GI tract, metabolism, nerve fibers, vision • Source- green, yellow, orange vegs., yolk cream butter milk • Vitamin D- assist with absorption of calcium and phosphorous • Source same as vitamin A

8. Vitamins • Vitamin E- normal cell structure, formation of RBCs • Source- nuts, oils, grains, greens, eggs • Vitamin K- essential for clotting, synthesis occurs in intestine by E. choli • Source- greens and liver

9. Vitamins • Excreted in urine • Maternal levels fall, fetal levels rise • Vitamin C • Source- fruit, pot., broccoli, leafy greens • Vitamin B • Source- pork, liver, pot., cereals, bread, milk, eggs, fish, poultry

10. Folic Acid • Needed for growth reproduction, lactation, prevent anemia • Deficiency associated with NTD • Recommended supplement of .4mg/day • 50%-70% of NTD could be prevented by taking folic acid • Literature supports folic acid in birth control pills

11. Vegetarianism • Must eat proper combination of foods • Refer to dietician • Need to supplement diet with B12 and calcium

12. Eating Disorders • Pica- eat dirt, clay, starch, metal, matches • Bulimia- binging, purging, laxatives • Anorexia- fear of weight gain and fat, excessively exercise

13. Nursing Assessment • Incorporate culture into nutritional care • Determine socioeconomic level • For teens consider eating patterns over time • Assess for WIC

14. Postpartum Nutrition • Initially lose 10-12 lbs • Approximately 6 months to lose weight • Multiparous take longer to lose weight • H&H return to normal in 2-6 weeks • Constipation • Reduce caloric intake by 300kcal/day

15. Nursing Mothers • Increase caloric intake by 200 kcal =500 above pre pregnancy • Increase protein intake • Need calcium, iron, fluids • Avoid foods that cause newborn distress