03.04 Nutrition in Pregnancy

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Overview

  1. Expected weight gain is 25-35 lbs for women with a normal prepregnancy weight
  2. Education on healthy food options and good nutrition is essential

Nursing Points

General

  1. Promote healthy food and weight gain
  2. Mother is NOT eating for two
    1. Increase of approximately 300 calories/day
    2. Increase of 500 calories/day for lactation after delivery

Assessment

  1. Monitor for pica
    1. Eating non-food substances (clay, ice, starch)
    2. May have cultural influences
  2. Cultural Considerations
    1. Ensure you assess for cultural needs or influences before making dietary recommendations
      1. We can help to accommodate
    2. In religions that routinely fast, pregnant women are typically exempt but they may choose to limit or change intake during traditional fasting times
  3. Foods to avoid
    1. Seafood high in mercury (swordfish, shark, King mackerel, etc).  
    2. May have foods with small amounts of mercury, but limit servings to a few meals a week (shrimp, trout, catfish).  
    3. Limit tuna to less than 6oz/week due to inconsistent mercury levels
    4. All raw fish
    5. Undercooked meat, eggs, poultry
    6. Lunchmeat
      1. Could heat lunchmeat until steaming to avoid listeria
    7. Unpasteurized foods
      1. Some cheeses
    8. Excessive caffeine
      1. 1 cup a day
    9. Alcohol
      1. No safe amount, see FAS lesson
    10. Unwashed fruits and veggie
  4. Assess water intake
  5. Good amounts of calcium needed for the fetal bone and teeth development
  6. Prenatal vitamin
  7. Iron deficient anemia
    1. Common in pregnancy
    2. Spinach and legumes are high in iron

Therapeutic Management

  1. Some prenatal discomforts can be remedied with dietary changes
    1. Eliminate chocolate or caffeine for heartburn
    2. Increase carb intake for nausea
    3. Small frequent meals to help with nausea

Nursing Concepts

  1. Nutrition
  2. Human Development

Patient Education

  1. The importance of healthy diet
  2. Important facts
    1. Foods to avoid
    2. Prenatal vitamins
    3. Calcium
    4. Necessary calories
  3. Provide resources for further reading and reliable places to go with questions
    1. Educate vegetarian or vegan clients about the importance of consumption of complete proteins and vitamins (Vit D, calcium, zinc, B12, omega 3’s)

Reference Links

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Video Transcript

I will explain nutrition in pregnancy and the importance of healthy nutrition.

It is important in pregnancy that healthy nutrition is maintained not just for the mother and fetal development but even has been found to go further and affect the child’s health throughout life
So the expected weight gain is 25-35 lbs for women with a normal prepregnancy weight. Underweight women should gain 28-40 lbs and Overweight should gain 15-25 lbs.I wanted to point out that you might have a normal or underweight person that is less healthy then an obese person and vise versa. Just because someone is small doesn’t mean they have good nutrition so this can not be overlooked. Helping the patients understand healthy food options and good nutrition is essential.
So let’s look at some of the things we need to assess in our pregnant patients. We need to monitor a patient for pica. Pica is when a patient eats non food substances. Examples of this are clay, ice, starch. It usually means they are deficient in something such as iron and crave other items. Cultural influences should always be assessed. What cultural influences do they practice that deal with nutrition? Are there foods they avoid or certain things they eat on certain days? We can help accommodate if we know. Seafood can be high in mercury and should really be avoided. We want low mercury. Some meals with shrimp, trout, or catfish are lower in mercury and can be eaten a few times a week. Tuna is less consistent in mercury so this should be limited because of inconsistency. Raw fish should absolutely never be eaten. Undercooked meat, eggs, poultry should be avoided. If meat is cooked well done it is safe. Lunch meat should be avoided because of possible listeria bacteria. If the patient wants to heat the deli meat that is ok to eat.
Caffeine is ok in pregnancy but in moderation. Caffeine intake should be 200mg or less of caffeine a day. This is around 1-1.5 cups of coffee. Alcohol needs to be avoided. There’s really no known safe amount of alcohol in pregnancy. Fruit and vegetable intakes should be assessed. It is important that the diet includes fruits and veggies but we need to make sure they are washed well. Water intake is very important. We need to assess that the patient is getting enough water.
Cheeses that are not pasteurized are unsafe. They need to eat pasteurized cheese. Usually if it is a soft cheese that means it is non-pasteurized. This is feta and goat cheese as examples. Iron is something a lot of women need added to their diet because they become anemic. Foods high in iron are things like legumes and spinach. Good amounts of calcium are needed in pregnancy not just for regular health but also for fetal bone and teeth growth. Prenatal vitamins are also essential to continue to encourage. We need to make sure this is being taken specifically for the extra folic acid. The folic acid will help prevent neural tube defects.
Some prenatal discomforts can be remedied with dietary changes for instance eliminating chocolate or caffeine could help with heartburn discomfort and the women that suffer with nausea could increase carbohydrates and eat small frequent meals to help.

Nutrition and human development are the nursing concepts because we need to have good nutrition to have good human development in pregnancy.
Calcium is important to remember for fetal bone and teeth development. Remember that meats should not be undercooked and deli meat needs to be heated. Seafood that is low in mercury is ok in moderation and no raw fish. Cheeses need to be pasteurized. Weight gain is also important to remember. Overweight women should gain 15-25 lbs. Normal weight should gain 25-35 lbs and underweight women should gain 28-40 lbs. Caffeine is ok in moderation and remember chocolate and teas have caffeine in them

Make sure you check out the resources and videos that are attached to this lesson. Also review food items that are high in iron, folic acid, and foods to avoid as these are frequent test questions. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 7

The nurse is caring for a client who just discovered she is pregnant. The after visit summary states to take folic acid supplements during pregnancy, so the client inquires about the reasoning for this. Which of the following is the most appropriate response?

  • Question 2 of 7

A 28-year-old client is pregnant with her first child and is at the doctor’s office for a prenatal exam. The client is in her first trimester and the nurse is providing information about an appropriate diet during pregnancy. Which of the following information is correct?

  • Question 3 of 7

Which statement by an 8 week pregnant client indicates the need for further teaching?

  • Question 4 of 7

A nurse is teaching a patient about the importance of folic acid during pregnancy. Which statement by the nurse is most appropriate?

  • Question 5 of 7

A nurse is teaching a pregnant client about nutrition in pregnancy. Which statement by the client indicates she has understood the teaching?

  • Question 6 of 7

A nurse is providing nutrition education to a pregnant patient who practices a vegetarian lifestyle. Which information is the most important for a nurse to provide?

  • Question 7 of 7

A nurse is assisting a pregnant client to develop a diet plan. What should the nurse do first?

Module 0 – OB Course Introduction

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