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Nutrition Services in Perinatal Care
Nutrition Services in Perinatal Care
SECOND EDITION
Committee on Nutritional Status During Pregnancy and Lactation
Food and Nutrition Board
Institute of Medicine
National Academy of Sciences
National Academy Press
Washington, D.C.
1992
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Nutrition Services in Perinatal Care
NATIONAL ACADEMY PRESS
2101 Constitution Avenue, N.W. Washington, DC 20418
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy’s 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.
This study was supported by project no. MCJ 117018 from the Maternal and Child Health Program (Title V, Social Security Act), Health Resources and Services Administration, U.S. Department of Health and Human Services.
Library of Congress Catalog Card No. 92-60920
International Standard Book Number 0-309-04694-7
Additional copies of this report are available for sale from:
National Academy Press
2101 Constitution Avenue, NW Washington, DC 20418
S553
Copyright 1992 by the National Academy of Sciences
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.
First Printing,July 1992
Second Printing,January 1993
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Nutrition Services in Perinatal Care
COMMITTEE ON NUTRITIONAL STATUS DURING PREGNANCY AND LACTATION
ROY M. PITKIN (Chair),*
Department of Obstetrics and Gynecology, School of Medicine, University of California, Los Angeles, California
BARBARA ABRAMS,
Program in Public Health Nutrition, School of Public Health, University of California, Berkeley, California
LINDSAY H. ALLEN,
Department of Nutritional Sciences, University of Connecticut, Storrs, Connecticut
MARGIT HAMOSH,
Division of Developmental Biology and Nutrition, Georgetown University Medical Center, Washington, D.C.
JANET C. KING,
Department of Nutritional Sciences, University of California, Berkeley, California
CHARLES MAHAN,
Department of Health and Rehabilitative Services, State Health Office, Tallahassee, Florida
JAMES MARTIN,
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi
CHRISTINE OLSON,
Division of Nutritional Sciences, Cornell University, Ithaca, New York
LINDA A. RANDOLPH,
Department of Community Medicine, Mount Sinai School of Medicine, on assignment to Carnegie Corporation of New York, New York, New York
KATHLEEN M. RASMUSSEN,
Division of Nutritional Sciences, Cornell University, Ithaca, New York
JOHN W. SPARKS,
Department of Pediatrics, University of Texas, Houston, Texas
Staff
CAROL WEST SUITOR, Study Director
YVONNE L. BRONNER, Research Associate (until July 1991)
SHEILA MYLET, Research Associate
GERALDINE KENNEDO, Administrative Assistant
*
Member, Institute of Medicine
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Nutrition Services in Perinatal Care
FOOD AND NUTRITION BOARD
M.R.C. GREENWOOD (Chair),
University of California, Davis, California
DONALD B. McCORMICK (Vice Chair),
Emory University School of Medicine, Atlanta, Georgia
PERRY L. ADKISSON,
Department of Entomology, Texas A&M University, College Station, Texas
LINDSAY H. ALLEN,
Nutritional Sciences, University of Connecticut, Storrs, Connecticut
DENNIS M. BIER,
Pediatric Endocrinology and Metabolism, Washington University School of Medicine, St. Louis, Missouri
EDWIN L BIERMAN,
University of Washington School of Medicine, Seattle, Washington
MICHAEL P. DOYLE,
Department of Food Science and Technology, University of Georgia, Griffin, Georgia
JOHANNA T. DWYER,
Frances Stern Nutrition Center, New England Medical Center Hospital, Boston, Massachusetts
JOHN W. ERDMAN, Jr.,
University of Illinois, Urbana, Illinois
NANCY FOGG-JOHNSON,
Consumer Healthcare Division, Miles Incorporated, Elkhart, Indiana
CUTBERTO GARZA,
Division of Nutritional Sciences, Cornell University, Ithaca, New York
K. MICHAEL HAMBIDGE,
Department of Pediatrics, University of Colorado Medical Center, Denver, Colorado
JANET C. KING,
Department of Nutritional Sciences, University of California, Berkeley, California
JOHN E. KINSELLA,
University of California, Davis, California
LAURENCE N. KOLONEL,
Cancer Center of Hawaii, University of Hawaii, Honolulu, Hawaii
SANFORD MILLER,
Graduate School of Biomedical Sciences, University of Texas, San Antonio, Texas
MALDEN C. NESHEIM,
Office of the Provost, Cornell University, Ithaca, New York
ROY M. PITKIN (Ex Officio),
Department of Obstetrics and Gynecology, University of California, Los Angeles, California
STEVE L. TAYLOR (Ex Officio),
Department of Food Science and Technology, University of Nebraska, Lincoln, Nebraska
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Nutrition Services in Perinatal Care
Staff
CATHERINE E. WOTEKI, Director
MARCIA LEWIS, Administrative Assistant
SUSAN WYATT, Financial Associate
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Nutrition Services in Perinatal Care
Acknowledgments
The committee wishes to express its appreciation to the many people who made important contributions to this report by providing source materials or special written reports, sharing their views during workshops, commenting on drafts, or otherwise serving as resource persons. In particular, the committee wishes to thank David H. Adamkin, Department of Pediatrics, University of Louisville, Louisville, Ky.; Diane M. Anderson, Medical University of South Carolina, Charleston, S.C.; Cheryl Bowen, Maryland Institute for Emergency Medical Services Systems, University of Maryland, Baltimore, Md.; Mary Sue Brady, Department of Nutrition and Dietetics, Indiana University School of Medicine, Indianapolis, Ind.; Helen Varney Burst, Nurse Midwifery Program, Yale University, New Haven, Conn.; Jennifer Burton, Nurses Association of the American College of Obstetricians and Gynecologists, Washington, D.C.; Ronald Chez, Department of Obstetrics and Gynecology, University of South Florida, Tampa, Fla.; Julie A. Clapp, Delaware Health and Social Services, Dover, Del.; Harriet H. Cloud, Nutrition Division, Sparks Center for Developmental and Learning Disorders, University of Alabama, Birmingham, Ala.; Garris Keels Conner, National Association of Neonatal Nurses, Birmingham, Ala.; Susan Conner, County of Riverside Department of Health, Riverside, Calif.; Carlyle Crenshaw, Jr., Department of Obstetrics and Gynecology, University of Maryland Hospital, Baltimore, Md.; Katherine Davis, University of Mississippi Medical Center, Jackson, Miss.; Diane Dimperio, Department of Obstetrics and Gynecology, University of Florida, Gainesville, Fla.; Judith A. Ernst, Department of
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Nutrition Services in Perinatal Care
Nutrition and Dietetics, Indiana University School of Medicine, Indianapolis, Ind.; S. Ann Evans, American Association of Critical-Care Nurses, Aliso Viejo, Calif.; Walter Faubion, University of Michigan Medical Center, Ann Arbor, Mich.; Ann M. Ferris, Department of Nutritional Sciences, University of Connecticut, Storrs, Conn.; Kyle Grazier, School of Public Health, University of California, Berkeley, Calif.; Robert Graham, American Academy of Family Physicians, Kansas City, Mo.; Erica Gunderson, Children's Hospital of San Francisco, San Francisco, Calif.; Ronald Gutberlet, Department of Pediatrics, Mercy Medical Center, University of Maryland, Baltimore, Md.; Gordon L. Klein, University of Texas Medical Branch, Child Health Center, Galveston, Tex.; Ronald E. Kleinman, Massachusetts General Hospital, Boston, Mass.; Becky Klingbail, University of Louisville, Louisville, Ky.; Winston Koo, University of Tennessee, Memphis, Tenn.; Ann Koontz, Maternal and Child Health Bureau, Hyattsville, Md.; Michele Lawler, Food and Nutrition Service, U.S. Department of Agriculture (USDA); James A. Lemons, Riley Newborn Follow-up Program, Indiana University School of Medicine, Indianapolis, Ind.; Brenda Lisi, Food and Nutrition Service, USDA, Alexandria, Va.; Gerald B. Merenstein, University of Colorado, Denver, Colo.; Renee McCleery, University of Texas Medical Branch, Galveston, Tex.; Laurie J. Moyer-Mileur, Nutrition Research, University of Utah, Salt Lake City, Utah; Sue Murvich, Lutheran Hospital, La Crosse, Wis.; Betty Jo Nelsen, Food and Nutrition Service, USDA, Alexandria, Va.; Stephanie Phelps, University of Tennessee, Memphis, Tenn.; Karyl Rickard, Department of Nutrition and Dietetics, Indiana University, Indianapolis, Ind.; Sandra Robbins, George Washington University Medical Center, Washington, D.C.; Helen Schauffler, School of Public Health, University of California, Berkeley, Calif.; Shirley Shelton, American College of Obstetricians and Gynecologists, Washington, D.C.; Melody Thompson, Children's Hospital, Columbus, Ohio; Jacqueline Jones Wessel, Children's Hospital Medical Center, Cincinnati, Ohio; Catherine W. Wiggins, National Association of Neonatal Nurses, Washington, D.C.; and Debra Wilson, University of Michigan Medical Center, Ann Arbor, Mich.
In particular, the committee wishes to acknowledge the essential role of the project director, Carol Suitor, in the development of this report. Without her assistance throughout the span from conception to printing, it could not have been done. Thanks also to many other staff members of the Food and Nutrition Board, the Institute of Medicine, and the Academy Complex, especially Catherine E. Woteki, Geraldine Kennedo, Yvonne Bronner, Sheila Mylet, Susan Wyatt, Sally Stanfield, and Leah Mazade.
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Nutrition Services in Perinatal Care
Contents
List of Tables and Charts
xiii
Executive Summary
1
1
Introduction
5
Background Information
6
Study Approach and Scope
8
Previously Published Recommendations and Underlying Assumptions
9
Patient-Centered, Individualized Care
10
Family Involvement in Care
10
Team Care
10
Continuity of Care
10
Organization of the Report
11
References
11
2
Nutritional Concerns of Women in the Preconceptional, Prenatal, and Postpartum Periods
15
Preconceptional Nutrition
15
Goals of Preconceptional Nutrition Services
15
Health Conditions Warranting Special Nutrition Services Before Pregnancy
17
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Prenatal Nutrition
20
Nutritional Demands of Normal Pregnancy
21
Nutrition in Complicated Pregnancies
23
Postpartum Nutrition
30
Replenishing Nutrient Stores
30
Nutrition Recommendations for Lactating Women
31
Weight Loss
32
Conditions Warranting Special Nutrition Services
33
Special Considerations at the Postpartum Visit
33
Summary
34
References
34
3
Basic and Special Nutrition Services for Women in the Preconceptional, Prenatal, and Postpartum Periods
41
Delivery of Basic Nutrition Services
42
Overview of Basic Services
42
Personnel
43
Knowledge Base and Clinical Skills
48
Delivery of Special Nutrition Services
50
Overview of Special Services
50
Personnel
51
Knowledge Base and Clinical Skills
53
Summary
55
References
55
4
Basic Nutrition Services for Newborn Infants
57
Basic Care for the Neonate
57
Planning for the Support of the Breastfeeding Woman
58
Home Visits and Other Early Follow-up
60
Delivery of Basic Nutrition Services for Infants
61
Personnel
62
Knowledge Base and Clinical Skills
62
Summary
64
References
65
5
Newborns Who Need Special Nutritional Care
67
Background
67
Conditions That Often Require Special Nutritional Care
67
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Challenges That Confront Clinicians
68
The Nutritional Care Plan
71
Feeding Methods
71
Enteral Feedings
72
Methods of Enteral Feeding
73
Parenteral Feeding
75
Monitoring
76
Food and Fluid Intake and Output
76
Anthropometric Changes
78
Laboratory Values
80
Clinical Observations
80
Nutrition Services Delivery for Neonates with Special Needs and Their Families
80
Components of Special Nutrition Services
81
Personnel
84
Education and Training of Health Care Providers
85
Knowledge Base and Clinical Skills
86
Summary
88
References
88
6
Providing for the Continuity of Nutritional Care
93
Coordinated Services
94
Patient-Carried Health Diaries
95
Computer-Based Patient Records and Systems
97
Summary
98
References
98
7
Closing Remarks and Recommendations
101
Measures for Improving Nutritional Care
102
Patient-Centered, Individualized Care
102
Family Involvement in Care
103
Team Care
103
Nutritional Care Plans
104
Education and Training of Practitioners
104
Recommendations
104
References
106
Index
107
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List of Tables and Charts
Tables
2-1
Recommended Dietary Allowances for Nonpregnant Pregnant, and Lactating Women
22
2-2
Recommended Total Weight Gain Ranges for Pregnant Women
23
Charts
1-1
Characteristics of Basic and Special Nutrition Services
9
3-1
Basic Nutritional Care Activities for Expectant and New Mothers
44
3-2
Eligibility for Federal Food and Nutrition Programs and Program Benefits
46
3-3
Special Nutritional Care Activities for Expectant and New Mothers with Complex Needs
52
5-1
Examples of Conditions That Require Special Nutrition Management of the Neonate
68
5-2
Nutrition-Related Variables That May Need to Be Monitored for Newborns Who Require Special Care
77
5-3
Examples of Nutrition-Related Problems of Preterm, Infants That Can Be Detected by Laboratory Tests
81
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