Nutrition Services in Perinatal Care Second Edition (1992) / Chapter Skim
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2 Nutritional Concerns of Women in the Preconceptional, Prenatal, and Postpartum Periods
2 Nutritional Concerns of Women in the Preconceptional, Prenatal, and Postpartum Periods
Pages 15-40
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From page 15... ...
This, in turn, aThe term preconception visits may be applied to periodic health visits for women, to family planning visits, or to visits specifically targeted to preparing for conception.
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From page 16... ...
To this end, a periodic health visit for women of childbearing age should include assessment to identify indicators of possible nutrition problems, education relating to healthful dietary practices, and counseling, referral, or other interventions as needed to solve or reduce the adverse effects of such problems. Detailed information on these care activities is given in Nutntion Dunng Pregnancy and Lactation: An Implementation Guide.7 The following section briefly discusses the nutrition-related health conditions that have been most closely linked to unfavorable pregnancy outcomes.
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From page 17... ...
These malformations occur in the first weeks after conception, often well before many women enter prenatal care. Many of these anomalies, however, may be prevented by the normalization of maternal blood glucose values throughout the first 12 weeks of gestation.~3 For blood glucose values to be normal at conception, it is desirable to provide the nutrition and medical sentences needed to achieve metabolic control well before conception.~4~5 In one recent study that involved intensive education and treatment, the incidence of major congenital anomalies in the group treated before conception was 1.2%, compared with 10.9% in the group treated at 6 weeks of gestation or later.
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From page 18... ...
is usually discontinued in adulthood, when elevated serum levels of phenylalanine have been presumed to be no longer neurotoxic. If pregnancy occurs, however, excessive amounts of phenylalanine in the maternal serum are associated with an extremely high incidence of mental retardation, microcephaly, low birth weight, and congenital heart disease among infants who themselves have not inherited PKU.~9-2t There is evidence that the occurrence of these problems can be reduced (although not perhaps eliminated)
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From page 19... ...
However, because both high and low prepregnanc y weight are associated with increased risk of various unfavorable pregnancy outcomes, it is prudent to achieve normal weight for height before conception through healthful diet and exercise. Underweight women are at increased risk of delivering a low-birth-weight infant;r° they may also be at increased risk of pregnancy complications such as antepartum hemorrhage, premature rupture of the membranes, preterm delivery, anemia, and endometritis.32~33 Obese women are at increased risk for complications (e.g., chronic hypertension, preeclampsia, gestational diabetes mellitus, and cesarean delivery34)
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From page 20... ...
Published information on this problem during pregnancy is largely anecdotal but suggests that increased efforts are needed to identity women with bulimia nervosa.40 Other Chronic Conditions or Diseases Prior to pregnancy, dietary counseling may substantially improve the nutritional status of women with serious chronic gastrointestinal disorders such as Crohn's disease, celiac disease, or liver disorders. Preconceptional nutritional interventions such as weight loss programs for the treatment of hypertension and modified diets to control blood lipids may be useful alternatives to medications that are not considered desirable for the fetus.
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From page 21... ...
Table 2-2 summarizes recommendations for total gestational weight gain. In a study of nearly 7,000 births, Parker and Abrams47 found that maternal weight gains within these recommended ranges were associated with better outcomes: fewer infants were either small for gestational age or large for gestational age, and fewer woman had cesarean deliveries.
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From page 22... ...
However, vitamin-mineral supplementation is recommended in certain situations. Therefore, the routine assessment of dieta~y practices is recommended for all pregnant women in the United States to determine the need for more intensive dietary counseling, for vitamin or mineral supplements, or both.
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From page 23... ...
The dispensing of supplements, however, is not considered a satisfactory substitute for a well-balanced diet or for taking steps to improve access to food.~° Energy Pregnant women need a sufficient intake of energy to support recommended weight gain. "Women who are thinner before pregnancy tend to have babies that are smaller than those of their heavier counterparts with the same gestational weight gain" (p.
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From page 24... ...
On the other hand, some conditions that complicate pregnancy, such as multiple gestation and chronic hypertension, ordinarily require increased attention to basic nutrition services but not complex dietary management. The following section clarifies why certain conditions ordinarily warrant special nutrition services or extended basic services.
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From page 25... ...
Because cigarette smoking, excessive alcohol intake, and illegal substance use all lead to an increased likelihood of preterm birth, the entire health care team needs to assist the woman who uses these substances to quit and to obtain outside help. If preterm labor occurs and is treated with bedrest and tocolytic therapy, the woman may need extra nutritional care to deal with problems (e.g., decreased appetite, increasing constipation, glucose intolerance)
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From page 26... ...
200~.6~ Nutntional assessment, planning, and counseling are coordinated with medical management as a component of collaborative prenatal care.~7~66~9 At present, no consensus exists concerning the most favorable dietary recommendations for pregnant women with diabetes mellitus.69~72 In all approaches, however, the proportion of fat and carbohydrate is controlled in some way, usually the proportion of simple sugars is decreased, and generous intake of food sources of fiber is encouraged. The distribution of food in meals and snacks is also controlled.
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From page 27... ...
Because the effect of the virus on the fetus appears to be quite varied and unpredictable, it seems advisable to provide dietary management that not only avoids maternal weight loss but encourages normal weight gain during pregnancy, provides the nutrients essential to the proper functioning of the immune system,80 and includes education concerning the prevention of foodborne diseases. ~ Conditions Involving Unhealthy Behaviors Cigarette Smoking.
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From page 28... ...
Alcohol Use. Alcohol intake during pregnan~especially if the intake is high- Is associated with fetal anomalies, prenatal or postnatal growth restnction, and mental retardation.93 Information about alcohol abuse often emerges in a nutritional history; all members of the health care team are advised to learn to ask specific questions, such as those presented by Sokol and collea~es,94 lo improve the chance of detecting the problem.95 Masis and Maybe provide evidence that a comprehensive local program can help to prevent fetal alcohol syndrome.
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From page 29... ...
Because women with cystic fibrosis may have difficulty consuming and absorbing enough nutrients, they are at increased risk of low weight gain during pregnancy.~07 They may need extra nutritional support using alternative feeding methods such as parenteral nutrition,~08 especially if the work of breathing inter
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From page 30... ...
On average, infants born to the women who were supplemented for 5 to 7 months postpartum weighed 131 g more, were 0.3 cm longer, and had a lower risk of being of low birth weight. Replenishing Nutrient Stores Stores of several nutrients (e.g., calcium, vitamin B6, folate)
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From page 31... ...
In general, an additional SOO kcal of energy daily is recommended throughout lactation.46 This recommendation assumes that there will be gradual loss of maternal body fat to supply some of the energy needed during lactation. A higher increment in energy intake is recommended for lactating women who are slender.
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From page 32... ...
3 Women ordinarily lose weight through 4 to 6 months post partum;~4 however, some women gain weight, even if they are breastteeding. After a period of rapid weight loss in the first few weeks pOSt partum, the average rate of weight loss by lactating women is 0.5 to 1.0 kg (~1 to 2 lb)
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From page 33... ...
For example, assessment of blood glucose status is appropriate for women who experienced gestational diabetes, assessment of blood pressure and of renal status may be indicated for women who experienced preeclampsia, and monitoring of iron status is desirable for women at increased risk of anemia because of hemorrhage associated with delivery. If any abnormal findings are observed, special nutrition services may be initiated.
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From page 34... ...
Report of the Subcommittee on Nutritional Status and Weight Gain During Pregnancy and the Subcommittee on Dietary Intake and Nutrient Supplements
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1991. Folic acid and neural tube defects (editonal)
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1988. Total parenteral nutrition for the treatment of severe hyperemesis gravidarum: maternal nutritional effects and fetal outcome.
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1989. G~cemic control in gestational diabetes mellitus-how tight is tight enough small for gestational age versus large for gestational age?
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1982. Examination of current dietary recommendations for individuals with diabetes mellitus.
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From page 39... ...
Grits 1990. The Handbook to Plan, Implement ~ Evaluate Smoking Cessation Programs for Pregnant Women.
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From page 40... ...
1992. Factom that influence weight loss in the puerperium.
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