Maternal Nutrition-presentation in nursing

Gynecology and obstetrics

1. Maternal Nutrition
Food and Nutrition
Pre-pregnancy
Pregnancy
Postpartum

2. Introduction
The nutritional needs of women during antenatal and
postnatal periods and sometimes also to the period
prior to conception (i.e. during adolescence)
Maternal undernutrition or chronic energy deficit is
defined as having a body mass index of <18.5

3. Cont..
Nutrition important factor that influence the outcome of
pregnancy.
Maternal nutritional status a significant factor, both
because it is potentially alterable and because good
nutrition before and during pregnancy is an important
preventive measure for a variety of problems.
These problems include birth of low-birth-weight (LBW)
(birth weight of 2500g or less) and preterm infants.
Evidence is growing that a mother’s nutrition and lifestyle
affect the long-term health of her children.
Thus the importance of good nutrition must be
emphasized to all women of childbearing potential.

4. Key components of nutrition care during the
preconception period
Nutrition assessment that includes appropriate weight for
height and adequacy and quality of dietary intake and habits
Diagnosis of nutrition-related problems or risk factors such
as diabetes, phenylketonuria (PKU), and obesity
Intervention based on an individual’s dietary goals and plan
to promote appropriate weight gain, ingestion of a variety
of foods, appropriate use of dietary supplements, and
physical activity.
Evaluation as an integral part of the nursing care provided
to women during the preconception period and pregnancy,
with referral to a nutritionist or dietitian as necessary

5. Maternal Nutrition

6. Nutrient Needs before Conception
The first trimester-embryonic and fetal organ
development.
A healthful diet before conception is the best way to
ensure that adequate nutrients are available for the
developing fetus.
Folate or folic acid intake is of particular concern in
the periconceptionperiod.
Folate is the form in which this vitamin is found
naturally in foods, and folic acid is the form used in
fortification of grain products and other foods and in
vitamin supplements.

7. Neural tube defects (failure in closure of the neural
tube) are more common in infants of women with
poor folic acid intake.
Proper closure of the neural tube is required for
normal formation of the spinal cord, and the neural
tube begins to close within the first month of
gestation, often before the woman realizes that she is
pregnant

8. Sources of Folic Acid
Foods Providing 500mcg or More per
Serving
•Liver: chicken, turkey, goose (100g [3.5oz])
Foods Providing 200mcg or More per
Serving
•Liver: lamb, beef, veal (100g [3.5oz])
Foods Providing 100mcg or More per
Serving
•Legumes, cooked (½ cup)
•Peas: black-eyed, chickpea (garbanzo)
•Beans: black, kidney, pinto, red, navy
•Lentils
•Vegetables (½ cup)
•Asparagus
•Spinach, cooked
•Papaya (1 medium)
•Breakfast cereal, ready-to-eat ½ to 1 cup)
•Wheat germ (¼ cup)
Foods Providing 50mcg or More per
Serving
•Vegetables (½ cup)
•Broccoli
•Beans: lima beans, baked beans, or pork and
beans
•Greens: collards or mustard, cooked
•Spinach, raw
•Fruits (½ cup)
•Avocado
•Orange or orange juice
•Pasta, cooked (1 cup)
•Rice, cooked (1 cup)
Foods Providing 20mcg or More per
Serving
•Bread (1 slice)
•Egg (1 large)
•Corn (½ cup)

9. Pregnancy

11. Pregnancy Changes

16. Body Fluid Changes

17. Nutritional requirement During
Pregnancy

18. Nutrient Needs during Pregnancy
Nutrient needs are determined by the stage of
gestation.
The amount of fetal growth varies during the
different stagesof pregnancy.
During the first trimester, the synthesis of fetal
tissues places relatively few demands on maternal
nutrition.
Therefore during the first trimester, when the
embryo or fetus is very small, the needs are only
slightly increased over those before pregnancy.

19. In contrast, the last trimester is a period of
noticeable fetal growth when most of the fetal stores
of energy sources and minerals are deposited.
Thus as fetal growth progresses during the second
and third trimesters, the pregnant woman’s need for
some nutrients increases greatly.

20. Factors that contribute to the increase in
nutrient needs include the following factors:
The uterine-placental-fetal unit.
Maternal blood volume and constituents:
During pregnancy the total blood volume increases by
about 40% to 50% over normal.
The plasma volume increases by 50% in women in their
first pregnancies and more than this in multifetal
pregnancies.
Although red blood cell (RBC) production also is
stimulated, the expansion of RBC mass is not as great as
that of plasma volume.
Maternal mammary development.

21. Dietary Reference Intakes(DRIs)
DRIs (www.iom.edu) have been established for the people
of the United States and Canada and are updated
regularly.
The DRIs include recommendations for daily nutritional
intakes that meet the needs of almost all (97% to 98%) of
the healthy members of the population.
They are divided into age, sex, and life-stage categories
(e.g., infancy, pregnancy, and lactation), and they can be
used as goals in planning the diets of individuals

22. NUTRIENT (UNITS) RECOMMEN
DATION
FOR
NONPREGN
ANT
WOMAN *
RECOMMENDATION
FOR PREGNANCY *
RECOMMENDATIO
N FOR
LACTATION*
ROLE IN RELATION TO
PREGNANCY AND
LACTATION
FOOD SOURCES
Energy (kilocalories
[kcal] or kilojoules
[kJ]†)
Variable First trimester, same as
nonpregnant; second
trimester, nonpregnant
needs + 340kcal (1424 kJ);
third trimester,
nonpregnant needs +
452kcal (1892 kJ)
First 6 months,
nonpregnant needs +
330kcal (1382 kJ);
second 6 months,
nonpregnant needs +
400kcal (1675 kJ)
Growth of fetal and
maternal tissues; milk
production
Carbohydrate, fat,
and protein
Protein (g) 46 First trimester, same as
nonpregnant; second and
third trimesters,
nonpregnant needs + 25g‡
Nonpregnant needs
+ 25g
Synthesis of the products
of conception; growth of
maternal tissue and
expansion of blood
volume; secretion of milk
protein during lactation
Meats, eggs, cheese,
yogurt, legumes (dry
beans and peas,
peanuts), nuts, grains
Water (L) in food and
beverages
2.7 3 3.8 Expansion of blood
volume, excretion of
wastes; milk secretion
Water and beverages
made with water,
milk, juices; all foods,
especially frozen
desserts, fruits,
lettuce and other
fresh vegetables
Fiber (g) 25 28 29 Promotes regular bowel
elimination; reduces long-
term risk for heart disease,
diverticulosis, and diabetes
Whole grains, bran,
vegetables, fruits, nuts
and seeds

23. Minerals
NUTRIENT (UNITS) RECOMMENDATI
ON FOR
NONPREGNANT
WOMAN *
RECOMMEND
ATION FOR
PREGNANCY *
RECOMMEND
ATION FOR
LACTATION*
ROLE IN RELATION TO
PREGNANCY AND
LACTATION
FOOD SOURCES
Calcium (mg) 1300/1000 1300/10001300/1000Fetal skeleton and
tooth formation;
maintenance of
maternal bone and
tooth mineralization
Milk, cheese, yogurt,
sardines or other fish
eaten with bones left in,
deep green leafy
vegetables except
spinach or Swiss chard,
calcium-set tofu, baked
beans, tortillas
Iron (mg) 15/18 30 10/9 Maternal
hemoglobin
formation, fetal liver
iron storage
Liver, meats, whole grain
or enriched breads and
cereals, deep green leafy
vegetables, legumes,
dried fruits
Zinc (mg) 9/8 12/11 13/12 Component of
numerous enzyme
systems, possibly
important in
preventing
congenital
malformations
Liver, shellfish, meats,
whole grains, milk

24. Fat-Soluble Vitamins
A (mcg) 700 750/7701200/1300Essential for cell
development, tooth
bud formation, bone
growth
Dark green leafy
vegetables, dark
yellow vegetables and
fruits, liver, fortified
margarine and butter
D (mcg) 5 5 5 Involved in absorption
of calcium and
phosphorus, improves
mineralization
Fortified milk and
breakfast cereals;
salmon, tuna, and
other oily fish; butter,
liver
E (mg) 15 15 19 Antioxidant (protects
cell membranes from
damage), especially
important for
preventing breakdown
of red blood cells
(RBCs)
Vegetable oils, green
leafy vegetables,
whole grains, liver,
nuts and seeds,
cheese, fish
NUTRIENT (UNITS) RECOMMENDATI
ON FOR
NONPREGNANT
WOMAN *
RECOMMEND
ATION FOR
PREGNANCY *
RECOMMEND
ATION FOR
LACTATION*
ROLE IN RELATION TO
PREGNANCY AND
LACTATION
FOOD SOURCES

25. Water-Soluble Vitamins
C (mg) 65/75 80/85 115/120Tissue formation
and integrity,
formation of
connective tissue,
enhancement of
iron absorption
Citrus fruits,
strawberries,
melons, broccoli,
tomatoes, peppers,
raw dark green
leafy vegetables
Folate (mcg)400 600 500 Prevention of
neural tube defects,
increased maternal
RBC formation
Fortified ready-to-
eat cereals and
other grain
products, green
leafy vegetables,
oranges, broccoli,
asparagus,
artichokes, liver
B6or
pyridoxine
(mg)
1.2/1.3 1.9 2 Involved in protein
metabolism
Meats, liver, dark
green vegetables,
whole grains
NUTRIENT (UNITS) RECOMMENDATI
ON FOR
NONPREGNANT
WOMAN *
RECOMMEND
ATION FOR
PREGNANCY *
RECOMMEND
ATION FOR
LACTATION*
ROLE IN RELATION TO
PREGNANCY AND
LACTATION
FOOD SOURCES

26. Energy Needs
Energy (kilocalories[kcal]) needs are met by
carbohydrate, fat, and protein in the diet.
No specific recommendations exist for the amount of
carbohydrate and fat in the diet of the pregnant women,
but the intake of these nutrients should be adequate to
support the recommended weight gain.
Although protein can be used to supply energy, its primary
role is to provide amino acids for the synthesis of new
tissues.
Longitudinal assessment of weight gain during pregnancy is
the best way to determine whether the kcal intake
isadequate

27. Weight Gain
Varies among women.
The primary factor to consider in making a weight-gain
recommendation is the appropriateness of the prepregnancyweight for
the woman’s height whether the woman’s weight was normal before
pregnancy or whether she was underweight or overweight.
Maternal and fetal risks in pregnancy are increased when the mother is
significantly underweight or overweight before pregnancy and when
weight gain during pregnancy is either too low or too high.
Severely underweight women are more likely to have preterm labor and
to give birth to LBW infants. Both normal-weight and underweight
women with inadequate weight gain have an increased risk for giving
birth to an infant withintrauterine growth restriction (IUGR).
Greater-than-expected weight gain during pregnancy may occur for
many reasons, including multiple gestation, edema, gestational
hypertension, and overeating.

28. Weight Gain
When obesity is present (either preexisting obesity or obesity that
develops during pregnancy), there is an increased likelihood of
macrosomia and fetopelvicdisproportion;
operative vaginal birth;
emergency cesarean birth;
postpartum hemorrhage;
wound,
genital tract, or urinary tract infection;
birth trauma;
late fetal death.
Obese women are more likely than normal-weight women to have
preeclampsia and gestational diabetes.
A commonly used method of evaluating the appropriateness of weight
for height is thebody mass index (BMI),which is calculated by the
following formula:

29. Cont..!
TISSUE KILOGRAMS POUNDS
Fetus 3.2-3.9 7-8.5
Placenta 0.9-1.1 2-2.5
Amniotic fluid 0.9 2
Increase in uterine tissue 0.9 2
Breast tissue 0.5-1.8 1-4
Increased blood volume 1.8-2.3 4-5
Increased tissue fluid 1.4-2.3 3-5
Increased stores (fat) 1.8-2.7 4-6

30. Nutritional Requirments

31. Vitamins

32. Cont..

33. Importance of Balanced and Proper
Nutrition During Pregnancy

34. Consequences and Pregnancy
Outcomes