Index

A

Abortion, spontaneous, 17, 26, 29

Adolescents, 23, 60

Adverse outcomes of pregnancy

in low-income women, 93

obesity and, 19

preconceptional nutrition and, 6, 16, 18

prenatal nutrition and, 6, 20

in underweight women, 19

AIDS, 25, 27, 28, 50;

see also HIV infection

Alcohol use

documentation of, 42

fetal effects, 18, 19, 25, 27

interventions, 45

and prenatal nutrition, 28

and preterm delivery, 25

and zinc excretion, 17

Anemia

HIV infection and, 27

iron-deficiency, 21, 45

nutrient deficiency and, 21

postpartum, 33

in underweight women, 19

Anorexia nervosa, 20

see also Eating disorders

Anthropometric measurements, 44, 48, 63, 78-79

B

Basic nutrition services

assessment, 42, 44, 45, 48-49, 63, 102

breastfeeding support, 30, 58-60

characteristics of, 9

delivery of, 57-64

health maintenance, 44, 49, 63-64

importance of, 5-6

for infants, 61-64

interventions, 45, 49, 64

knowledge base of providers, 48, 62-63

management skills, 49

for neonates, 57-61

overview of, 2, 42

personnel, 9, 43, 62

postpartum, 30

recipients, 9

skills of providers, 48-49, 63

Bedrest, nutritional care during, 25, 44

Birth weight

size categories for, 78

WIC participation and, 5-6, 25, 30

see also Low-birth-weight infants;

Very-low-birth-weight infants

Body mass index, weight gain recommendations by, 23



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Nutrition Services in Perinatal Care Index A Abortion, spontaneous, 17, 26, 29 Adolescents, 23, 60 Adverse outcomes of pregnancy in low-income women, 93 obesity and, 19 preconceptional nutrition and, 6, 16, 18 prenatal nutrition and, 6, 20 in underweight women, 19 AIDS, 25, 27, 28, 50; see also HIV infection Alcohol use documentation of, 42 fetal effects, 18, 19, 25, 27 interventions, 45 and prenatal nutrition, 28 and preterm delivery, 25 and zinc excretion, 17 Anemia HIV infection and, 27 iron-deficiency, 21, 45 nutrient deficiency and, 21 postpartum, 33 in underweight women, 19 Anorexia nervosa, 20 see also Eating disorders Anthropometric measurements, 44, 48, 63, 78-79 B Basic nutrition services assessment, 42, 44, 45, 48-49, 63, 102 breastfeeding support, 30, 58-60 characteristics of, 9 delivery of, 57-64 health maintenance, 44, 49, 63-64 importance of, 5-6 for infants, 61-64 interventions, 45, 49, 64 knowledge base of providers, 48, 62-63 management skills, 49 for neonates, 57-61 overview of, 2, 42 personnel, 9, 43, 62 postpartum, 30 recipients, 9 skills of providers, 48-49, 63 Bedrest, nutritional care during, 25, 44 Birth weight size categories for, 78 WIC participation and, 5-6, 25, 30 see also Low-birth-weight infants; Very-low-birth-weight infants Body mass index, weight gain recommendations by, 23

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Nutrition Services in Perinatal Care Bottle feeding, 58, 73-74 formula composition, 73 introduction of, 75 premature or sick infants, 73-74 preparation, storage, and handling of formula, 74 Breastfeeding barriers to, 59, 72 benefits of, 57 breast pump use, 60, 72, 74 cesarean section and, 59 contraindications, 72 education on, 58, 59 enteral, 58, 73-74 HIV infection and, 72 initiation of, 58, 75 manual expression of milk, 60, 72 mastitis, 59 national health goals, 57 nutrition services needs, 15, 30, 53 premature or sick infants, 72-74 prescription medication and, 59 rates, 58 recommendations, 3, 4, 105 support for mothers, 43, 45, 52, 58-60, 61, 62, 63-64 see also Human milk Bronchopulmonary dysplasia, 68, 69, 76 Bulimia, 20; see also Eating disorders Bulimia nervosa, 20 see also Eating disorders C Calcium lactation needs, 31 neonatal requirements, 69, 70 postpartum, 30 RDAs, 22 supplementation, 26 Celiac disease, 20 Cesarean delivery and breastfeeding, 59 obesity and, 19 postpartum nutrition requirements, 33 Cholestasis, 70, 75 Cigarette smoking cessation programs, 27 fetal effects of, 27 and prenatal nutrition, 27-28 and preterm delivery, 25 prevalence of, 27 Cocaine, 28, 68; see also Drug abuse Computer-based patient records and systems, 97 Congenital malformations, 17, 18, 68, 75 Continuity of nutritional care approaches for improving, 93-94 challenges to, 93 computer-based patient records and systems, 97 coordinated services, 94-95 patient-carried health diaries, 95-97 recommendations, 2, 3, 10-11, 61, 105 referral to outside services, 102 Crohn's disease, 20, 50 Cystic fibrosis, and prenatal nutrition, 29-30, 50 D Diabetes mellitus. and blood glucose control, 23-24, 26, 33 and congenital malformations, 17 fetal effects, 26, 68 gestational, 19, 26, 33, 43, 45, 50 insulin dependent, 2 multiple gestation and, 25 preconceptional nutrition, 17 preexisting, 6, 17, 50 prenatal nutrition, 2, 25-26, 43, 45 Diet data collection, 44 information about, 44 postpartum, 34 Dietitians, 2 communication between providers and, 42 definition, 7n.d neonatal, 84-85, 86 preconceptional role of, 18 prenatal role of, 24, 26, 50 qualifications, 51, 62, 84, 85, 86 recommendations, 3, 105 referral to, 45 services provided by, 10, 43, 50 Drug abuse fetal effects of, 25, 68 interventions, 45 and prenatal nutrition, 28, 50 and preterm delivery, 25 E Eating disorders (maternal), 50 preconceptional nutrition and, 18 team care, 45, 53

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Nutrition Services in Perinatal Care Energy intake diabetes mellitus and, 26 and gestational weight gain, 21 hypertensive disorders and, 26 lactation needs, 31 normal prenatal needs, 23 phenylketonuria and, 29 RDAs, 22 Enteral feeding of neonates defined, 71 formulas, 73 human milk, 72-73 F Families, involvement in care, 2, 10, 82, 103 Federal food and nutrition programs and benefits, 45, 46-47 Feeding methods, see Infant feeding methods Fetal alcohol syndrome, 18, 19, 28 Fetal growth restriction alcohol use and, 28 prenatal nutrition and, 21, 25, 50 Folate deficiency, 21 lactation needs, 31 metabolism-altering drugs, 17 and neural tube defects, 18-19 postpartum, 30 RDAs, 22 supplements, 18-19 Food, benefits of federal programs, 46-47 Food intake and gestational weight gain, 21 postpartum, 34 see also Diet G Gastric banding or stapling, 19, 50 Gastrointestinal disorders HIV infection and, 27 and prenatal nutrition, 2, 27, 29, 45, 50 prepregnancy nutrition and, 2, 20 Gestational age, 78 Glucose intolerance, 25, 30 maternal blood, 17, 23-24, 26, 33 self-monitoring of, 26 H Health department, maternal and child health unit, 41 Health diaries, patient-carried, 95-97, 105 Health problems indicating a need for special nutrition services neonatal, 67-68 postpartum, 33 preconceptional, 17-20 prenatal, 23-30, 50 Hemoglobin/hematocrit, 21, 31, 44 High-birth-weight babies, 19 HIV infection and breastfeeding, 72 fetal effects of, 27 and prenatal nutrition, 27 Home visits, 6, 60-61, 62, 64, 71 Hospitals, support of breastfeeding by, 59 Human immunodeficiency virus, see HIV infection Human milk banks, 72-73 fortification of, 72 handling and storage of, 74 HIV in, 72, 73 pasteurization of, 73 preterm delivery and, 72 qualities of, 57, 72 tube feeding with, 73-74 Hyperglycemia, 70; see also Diabetes mellitus; Glucose Hyperemesis gravidarum, and prenatal nutrition, 24, 50 Hypertensive disorders obesity and, 19 postpartum weight loss, 32 and prenatal nutrition, 24, 26, 50 Hypoglycemia, 33, 83 I Illegal drugs, see Drug abuse; and individual substances Inborn errors of metabolism, 61, 68, 73, 81, 102 Infant feeding methods enteral, 72-75 fluid restriction, 76 formulas, 58, 73 human milk, 57, 72-73 information on, 61 parenteral, 70, 75-76 tube feeding, 70, 74-75 see also Bottle feeding; Breastfeeding

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Nutrition Services in Perinatal Care Infants delivery of basic nutrition services for, 61-64 morbidity, 19 PKU, 18 see also Neonates; Preterm, handicapped, and sick infants Infection, maternal, 25, 26 Insulin, 26, 33 Intensive care, neonatal, 81-82 Intrauterine growth retardation, see Fetal growth restriction Iron deficiency, 21; see also Anemia neonatal requirements, 69 postpartum, 31, 33 RDAs, 22 supplements, 21, 44 L Lactation diet and, 31 nutrient and energy needs, 31-32 RDAs, 22, 31 and weight, 32 Lactose intolerance, 43, 45, 73 Liver disorders, 20, 50 Low-birth-weight infants causes, 68, 93 defined, 67, 78 maternal PKU and, 18 maternal weight-for-height and, 23 nutritional care and, 6, 95 preconception nutrition and, 16, 30 preterm birth and, 24 rates, 67-68 RDAs, 69 see also Birth weight; Preterm, handicapped, and sick infants Low-income women, 43, 59, 60, 62, 93 M Macrosomia, 19, 26 Magnesium lactation needs, 31 RDAs, 22 Malabsorption syndrome, 29, 50 Maternal and Child Health Program, 94-95, 105 Maternal morbidity, 19 Medicaid, 6, 7, 41, 95 Mental retardation, 18, 28, 29 Midwives defined, 10n.e nutrition-related qualifications, 10, 51, 62 Migrant workers, 7, 58, 93, 96 Minerals lactation needs, 31 neonatal requirements, 69, 70 RDAs, 22 Monitoring anthropometric changes, 78-79 food and fluid intake and output, 76-77 head circumference, 79 laboratory values, 80 length of infant, 79 neonates, 76-80 weight changes, 79 Multiple gestation, and prenatal nutrition, 24, 25, 44, 50 N Necrotizing enterocolitis, 68, 70, 72, 75 Neonates basic care for, 57-61 breastfeeding, 58-61 comprehensive nutritional care, 61-62, 82 feeding methods, 58-61, 71-76 home visits and other early follow-up, 60-61 hypocalcemia, 21 see also Infants; Low-birth-weight infants; Preterm, handicapped, and sick infants; Very-low-birth-weight infants Neonatologists, 84, 85 Neural tube defects, 18 Newborns, see Neonates Nurses and nurse-practitioners, nutrition-related qualifications, 51, 62, 84-86 Nutrients excessive intakes of, 21 normal prenatal needs, 21-23 postpartum replenishment of, 30-31 Nutrition education documentation, 42 in federal programs, 46-47 infant feeding, 58, 59, 62, 63 materials, 43 role of dietitians in, 43 Nutrition services changes in content of care, 7 development and testing of implementation strategies, 3, 53, 106

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Nutrition Services in Perinatal Care documentation of care, 3, 105 family involvement in care, 103 improvement in delivery of, 101-104 levels of care, 8-9 outreach activities, 43, 51 preconceptional goals, 15-16 referral to outside services, 102 see also Basic nutrition services; Special nutrition services Nutritional care plans, 2, 52, 71, 104 O Obesity and adverse outcomes of pregnancy, 19 nutritional counseling, 45 Orofacial anomalies, 68, 74 Overweight, and energy intake post partum, 32 P Parenteral nutrition defined, 71 maternal, 24, 29-30 neonatal, 70, 71, 75-76 training of parents, 75-76 Patients computer-based records and systems, 97 education, 25, 27, 58, 59 health diaries, 95-97 individualized care, 10 Peer counselors, 51, 64 Pharmacists, nutrition-related qualifications, 51, 84, 85 Phenylketonuria, 2, 45 infant, 61, 68, 73 preconceptional nutrition, 17, 18 prenatal nutrition, 28-29 Physical activity/exercise, and energy intake by lactating women, 31 Physicians, nutrition-related qualifications, 10, 51, 62 PKU, see Phenylketonuria Postpartum care breastfeeding support, 60 nutrition considerations at, 33-34, 60-61 providers, 42 Postpartum nutrition conditions warranting special services, 33 lactation and, 31-32 replenishing nutrient stores, 30-31 special considerations at postpartum visit, 33-34 and weight loss, 32-33 WIC, 6 Practitioners education and training, 53, 59, 82, 85-86, 104 recommendations, 3, 52, 104 Preconception care components of, 16 importance of, 15-16 providers, 42 Preconceptional/interconceptional nutrition adverse outcomes of previous pregnancy and, 16, 18-19, 30 chronic conditions or diseases and, 20 diabetes mellitus and, 17 eating disorders (maternal), and, 20 goals of services, 15-16 health conditions warranting special services, 17-20 interventions, 20, 52 phenylketonuria and, 18 weight-for-height (maternal) extremes and, 19 Preeclampsia, 19, 25, 26, 32, 33 Pregnancy outcomes, see Adverse outcomes of pregnancy Recommended Dietary Allowances, 21, 22 Prenatal care access, 41 documentation, 42 home visits, 42 model for, 95 providers, 42 strategies to increase utilization, 43 Prenatal nutrition alcohol use and, 28 cigarette smoking and, 27-28 in complicated pregnancies, 23-30, 52 cystic fibrosis and, 29-30 diabetes mellitus and, 25-26 drug abuse and, 28 energy demands, 23 fetal growth restriction and, 25 gastrointestinal disorders and, 29 HIV infection and, 27 hyperemesis gravidarum and, 24 hypertensive disorders and, 26 importance of services, 5-6 multiple pregnancy and, 25 in normal pregnancies, 21-23

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Nutrition Services in Perinatal Care nutrient demands, 21-23 phenylketonuria and, 28-29 preterm birth risk and, 24-25 renal disorders and, 27 systemic health problems and, 25-27 Prenatal visits, 24-25 Preterm delivery, 7, 50 causes, 68 interventions, 24-25 preconception nutrition and, 16 predictors, 24, 93 prenatal nutrition and risk of, 24-25 by underweight women, 19 Preterm, handicapped, and sick infants adapting to changing needs of, 69-70 anthropometric changes, 78-79 breastfeeding, 73-74 comprehensive nutritional care, 67-68, 71, 82 defined, 67-68 delivery of services for, 80-88 education and training of providers, 82, 85-86 evaluation of program for, 83 family involvement in care, 82, 103 feeding methods, 58-61, 71-76 follow-up care in the community, 83-84 food and fluid intake and output, 76-77 growth patterns, 77, 78 head circumference, 68, 78, 79 infection prevention and detection, 77 intensive care, 80, 81-82, 102 intermediate care, 80, 83, 84, 86 knowledge base and clinical skills of team members, 86-88 laboratory values, 80 length, 78, 79 medical therapies and nutrition, 70 metabolic variables, 77 monitoring, 76-80 nutrient intake, 77 nutrient requirements, 69 nutritional goals, 68 nutrition-related problems, 81 personnel qualifications, 84-85 physical and physiologic limitations in, 70 RDAs, 69 team care, 82, 84-88 weight changes, 79 see also Low-birth-weight infants; Very-low-birth-weight infants Protein, dietary intake neonatal requirements, 69, 70 phenylketonuria and, 29 RDAs, 22 Providers of nutrition services qualifications, 51, 84-86 see also Dietitians R RDAs, see Recommended Dietary Allowances Recommendations breastfeeding promotion and support, 3, 4, 105 continuity of nutritional care, 2, 3, 10-11, 61, 105 development and testing of implementation strategies, 3, 53, 106 dietitian services, 3, 105 documentation of nutritional care, 3, 105 education and training of practitioners, 3, 52, 104, 105 family involvement in care, 2, 10, 103 nutritional care plans, 2, 52, 104 patient-centered, individualized care, 2, 3, 10, 69, 102, 104 payment for special nutrition services, 4, 105-106 preconceptional care, 3, 105 previously published, 2, 9-11 team care, 2, 10, 52, 103 Recommended Dietary Allowances, 21, 22, 69 Records computer-based, 97 patient-carried, 95-96 Renal disorders neonatal, 76 and prenatal nutrition, 27, 45, 50 Respiratory distress syndrome, 26, 68, 74, 83 Retinol, excessive amounts of, 17 Riboflavin, RDAs, 22 S Shoulder dystocia, 19 Small for gestational age, 78, 79 Sodium restriction, hypertensive disorders and, 26 Special nutrition services activities, 52-53 adapting to changing needs, 69-70 assessment, 27, 50, 52, 54, 69, 82, 87

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Nutrition Services in Perinatal Care components of, 9, 81-84 comprehensive nutritional care, 52, 82 conditions requiring, 67-68 coordination of, 93 delivery of, 50-55, 80-88 education and training of providers, 85-86 evaluation of, 83 family involvement, 82 feeding methods, 71-76 follow-up care in the community, 83-84 individualized nutritional care plan, 71 intensive care, 81-82 intermediate care, 83 intervention, 45, 54, 87-88 knowledge base for providers, 53, 86-87 management skills, 54-55, 88 maternal health conditions warranting, 17-20, 24-30 medical therapies and, 70 monitoring, 76-80 for neonates, 67-88 overview, 2, 50 payment for, 4, 105-106 personnel, 9, 51, 84-85 physical and physiologic limitations and, 70 postpartum, 33 prepregnancy, 17-20 recipients, 9 training and consultation, 82 Special Supplemental Food Program for Women, Infants, and Children, see WIC Study approach and scope, 8-9 background information, 6-7 focus, 1-2 organization of report, 3, 11 purpose, 1, 5 Supplements, see Vitamin/mineral supplements Support groups for mothers, 59-61 T Team care composition of team, 103 maternal, 45, 51, 62 neonatal, 70, 75, 84-85 recommendations, 2, 10, 52, 103 Tobacco smokeless products, 27 see also Cigarette smoking Tube feeding gastrostomy, 74-75 maternal, 29 nasogastric, 74 neonatal, 70, 73-75 transpyloric, 75 Twins/triplets, 33, 60, 61; see also Multiple gestation, and prenatal nutrition U Underweight women, adverse pregnancy outcomes, 19 V Very-low-birth-weight infants, 6 defined, 67, 78 energy metabolism, 69-70 handicap rates for, 83-84 head circumference, 79 intermediate care for, 83 laboratory values for, 80 nutritional requirements, 72 rates, 67-68 Vitamins deficiency, 21 excessive amounts of, 17 lactation needs, 31 neonatal requirements, 69 postpartum, 30 RDAs, 22 Vitamin/mineral supplements, 45 appropriateness of, 22-23 calcium, 26, 32 cystic fibrosis and, 29 folate, 18-19 HIV infection and, 27 iron, 21 lactation and, 32 multiple pregnancy and, 25 postpartum, 30, 32 preterm birth risk and, 25 W Weight, measurement, 44; see also Anthropometric measurements Weight-for-height (maternal) and birth weight, 23 categories, recommended weight gain by, 23 extremes, 19 fetal effects, 25 low, 25, 44 preconceptional nutrition and, 18

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Nutrition Services in Perinatal Care Weight gain, gestational documentation, 42 and fetal growth, 21, 25 low, 25, 29, 45 measurement, 44 recommended ranges, 23 Weight loss HIV infection and, 27 hypertension treatment with, 20 interventions, 27 medications, 33 postpartum nutrition and, 30, 32-33 WIC, 28 benefits, 46 birth weight and participation in, 5-6, 25, 30 coordination with Maternal and Child Health Program, 94-95, 105 eligibility, 46 federal and state funding for, 20-21 growth of program, 7 lactation supplements, 32 postpartum participation, 6 referral to, 102 role in provision of nutrition services, 41-42, 62