b.

Nutritional health on Prenatal Clients

Week 3 – Day 2

BERNICE RAZIEL U. CALIWAGAN, RN, MAN

MATERNAL AND CHILD HEALTH NURSING

Bernice Raziel U. Caliwagan, RN MAN

 OBJECTIVES
• Discuss the recommendations for healthy
nutrition during pregnancy.
• Identify National Health Goals related to
nutrition and pregnancy that nurses can help
the nation achieve.
• Use critical thinking to analyze the effects of
different life situations on nutrition patterns
to create ways nutritional health can be both
improved and family centered.

Bernice Raziel U. Caliwagan, RN MAN

• Assess a woman for nutritional adequacy during
pregnancy.
• Formulate nursing diagnoses related to nutritional
concerns during pregnancy.
• Develop expected outcomes to assist a pregnant
woman achieve optimal nutrition during pregnancy.
• Plan health teaching strategies such as ways to increase
folic acid and calcium intake to promote optimal
nutritional intake during pregnancy.

Bernice Raziel U. Caliwagan, RN MAN

• Implement nursing care that encourages healthy
nutritional practices during pregnancy.
• Evaluate expected outcomes for achievement and
effectiveness of care.
• Identify areas related to nutrition and pregnancy that
could benefit from additional nursing research or
application of evidence-based practice.
• Integrate nutrition knowledge with nursing process to
achieve quality maternal and child health nursing care.

Bernice Raziel U. Caliwagan, RN MAN

Bernice Raziel U. Caliwagan, RN MAN
 RELATIONSHIP OF MATERNAL NUTRITION TO
INFANT HEALTH
• During pregnancy, a woman must eat
adequately to supply enough nutrients to the
fetus, so it can grow, as well as to support her
own nutrition (Crombleholme, 2009).
• Adequate protein intake is vital for building
body framework.

Bernice Raziel U. Caliwagan, RN MAN

• Moderate intake is necessary most especially
during holidays/special events.
• Positive reinforcement, such as praising, a
basic rule of teaching, enhances learning, self-
esteem, and compliance more than criticism.
• Avoid the word “high” in terms of food intake
such as “high protein”. Instead, give specific
amount of servings, “Eat three servings of
some type of meat or fish every day.”

Bernice Raziel U. Caliwagan, RN MAN

• “Foods that are best for you during
Pregnancy” or “Pregnancy Nutrition.” These
statements sound more positive and refer
more closely to what you are encouraging a
woman to do.

Bernice Raziel U. Caliwagan, RN MAN

RECOMMENDED WEIGHT GAIN
FOR PREGNANT WOMAN

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.shutterstock.com%2Fimage-
vector%2Fillustration-featuring-pregnant-woman-weighing-herself-
218502772&psig=AOvVaw1bBeixCddeSAWwWaW_Fjr8&ust=1600612848459000&source=images&cd=vfe
&ved=0CAIQjRxqFwoTCIDk4tS59esCFQAAAAAdAAAAABAD

Bernice Raziel U. Caliwagan, RN MAN

• A weight gain of 11.2 to 15.9 kg (25 to 35 lb) is
recommended as an average weight gain in
pregnancy.
• If a woman is at high risk for nutritional
deficits, a more precise estimation of
adequate weight gain can be calculated (Rode
et al., 2007). This is done by computing body
mass index (BMI), the ratio of weight to
height.

Bernice Raziel U. Caliwagan, RN MAN

Bernice Raziel U. Caliwagan, RN MAN
• EASIEST WAY TO GET BMI:

BMI = lbs x 703/inches²

Bernice Raziel U. Caliwagan, RN MAN

• WEIGHT GAIN DURING PREGNANCY:
>1lb/month – 1st trimester
>1lb/week – 2nd to 3rd trimester

* weight gain is considered excessive if it is more

than 3 kg (6.6 lb) a month during the second and
third trimesters; it is less than usual if it is less than
1 kg (2.2 lb) per month during the second and
third trimesters.

Bernice Raziel U. Caliwagan, RN MAN

• WEIGHT GAIN DURING PREGNANCY:
>UNDERWEIGHT – GAIN ADDITIONAL 0.5 kg per
month (30-40 lbs)
>OVERWEIGHT – GAIN 0.3 kg/month, or (15–25
lbs)
>MULTIPLE PREGNANCY – GAIN ADDITIONAL
1lb/week (40 to 45 lbs)

Bernice Raziel U. Caliwagan, RN MAN

Components of Healthy Nutrition
for the Pregnant Woman

Bernice Raziel U. Caliwagan, RN MAN

 1. Energy (Calorie) Needs
• The DRI of calories for women of childbearing
age is 2200. An additional 300 calories, or a
total caloric intake of 2500 calories, is
recommended to meet the increased needs of
pregnancy.

Bernice Raziel U. Caliwagan, RN MAN

• In addition to supplying energy for a fetus, this
increase provides calories to sustain an
elevated metabolic rate in the woman from
increased thyroid function and an increased
workload from the extra weight she must
carry.

Bernice Raziel U. Caliwagan, RN MAN

• Advise women to obtain calories from
complex carbohydrates (cereals and grains)
rather than simple carbohydrates (sugar and
fruits) because these are more slowly digested
so help regulate glucose and insulin levels.
https://www.google.com/url?sa=i&url=https%3A%2F%2Fstylesatlife.com%2Farticles%2Fbread-during-
pregnancy%2F&psig=AOvVaw0VZS2QsYaG37LJGWzlB3aM&ust=1600697559685000&source=images&cd=
vfe&ved=0CAIQjRxqFwoTCLjK45719-sCFQAAAAAdAAAAABAK

Bernice Raziel U. Caliwagan, RN MAN

 2. Protein Needs
• The DRI for protein in women is 46 g/d. During
pregnancy, the need for protein increases to 71 g
daily.
• Vitamin B12 is found almost exclusively in animal
protein.
• Extra protein is best supplied by meat, poultry,
fish, yogurt, eggs, and milk, because the protein
in these forms contains all nine essential amino
acids, or is complete protein.

Bernice Raziel U. Caliwagan, RN MAN

• A woman with a family history of high
cholesterol levels (hypercholesterolemia)
probably should not eat more than two or
three eggs per week.
• Milk is a rich source of protein.
• Yogurt or cheese may also be substituted for
milk, or milk may be incorporated into
custards, eggnogs, or cream soups.

Bernice Raziel U. Caliwagan, RN MAN

https://www.google.com/url?sa=i&url=https%3A%2F%2Fstylesatlife.com%2Farticles%2Fmilk-during-
pregnancy%2F&psig=AOvVaw0eAXhcnTBNPdBpgfSgjDjz&ust=1600698193256000&source=images&cd=vf
e&ved=0CAIQjRxqFwoTCNCCgM739-sCFQAAAAAdAAAAABAT
https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.alamy.com%2Fplate-of-fresh-meat-
chicken-beef-and-fish-salmon-on-a-salad-leaves-held-by-a-pregnant-woman-
image365673317.html&psig=AOvVaw3sa0lsjSQhZGxu_lMdFMDO&ust=1600698354082000&source=imag
es&cd=vfe&ved=0CAIQjRxqFwoTCIDW8pr49-sCFQAAAAAdAAAAABAD

Bernice Raziel U. Caliwagan, RN MAN

 3. Vitamin Needs
• Vitamin deficiency can result in several
common problems. For example, vitamin D,
essential for calcium absorption, when
lacking, can begin to diminish both fetal and
maternal mineral bone density.
• Lack of vitamin A results in tender gums and
poor night vision.

Bernice Raziel U. Caliwagan, RN MAN

• Varied diet with plenty of fruits and
vegetables plus daily prenatal vitamins.
• Pregnant clients who were on oral
contraception prior, should take extra
vitamins. Oral contraception can deplete
Vitamins A, B and Folic Acid.
• Vitamin D is recommended if pregnant client
stays at home most of the day or if she lives in
a place with less sunny days.

Bernice Raziel U. Caliwagan, RN MAN

• Folic acid is necessary for red blood cell
formation.
• Women should eat foods high in folic acid
such as vegetables and fruit and should take a
prenatal vitamin that contains a folic acid
supplement of 0.4 to 1.0 mg (Subramanian et
al., 2008).

Bernice Raziel U. Caliwagan, RN MAN

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.123rf.com%2Fphoto_77062673_pregnant-
woman-healthy-eating-vegetables-and-
fruit.html&psig=AOvVaw1jH9oySAuu9YMapUUcLPxf&ust=1600699026148000&source=images&cd=vfe&v
ed=0CAIQjRxqFwoTCOCzntr69-sCFQAAAAAdAAAAABAW

Bernice Raziel U. Caliwagan, RN MAN

 4. Fat Needs
• Only linoleic acid, an essential fatty acid
necessary for new cell growth.
• Vegetable oils are a good source. In addition,
using vegetable oils (e.g., safflower, corn,
olive, peanut, and cottonseed) that have a low
cholesterol content rather than animal oils
(butter) is recommended for all adults as a
means of preventing hypercholesterolemia
and coronary heart disease.

Bernice Raziel U. Caliwagan, RN MAN

 • Women should also try and ingest omega-3
oils, found primarily in fish, omega-3–fortified
eggs, and the newer omega-3–fortified
spreads (Bourre, 2007).
https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.soscuisine.com%2Fblog%2F5-facts-about-
eating-fish-during-
pregnancy%2F&psig=AOvVaw1zSuhN2OoeDIbTI7LToQWr&ust=1600699323190000&source=images&cd=
vfe&ved=0CAIQjRxqFwoTCOiTu_H79-sCFQAAAAAdAAAAABAf

Bernice Raziel U. Caliwagan, RN MAN

 5. Mineral Needs
• Calcium and Phosphorus. The skeleton and
teeth constitute a major portion of a fetus.
Tooth formation begins as early as 8 weeks in
utero. Bones begin to calcify at 12 weeks.
➢pregnant women need to eat foods high in
calcium and vitamin D.
➢The recommended amount of calcium during
pregnancy is 1300 mg.
Bernice Raziel U. Caliwagan, RN MAN
• Iodine. Iodine is essential for the formation of
thyroxine and, therefore, for the proper
functioning of the thyroid gland. As thyroid
function increases during pregnancy, a woman
needs to ingest enough iodine during
pregnancy to supply this increased need.
➢The DRI for iodine is 220 g daily during
pregnancy. Seafood is the best source of
iodine.

Bernice Raziel U. Caliwagan, RN MAN

• Iron. A fetus at term has a hemoglobin level of
17 to 21 g per 100 mL of blood, a level that is
necessary to oxygenate the blood during
intrauterine life. Iron is needed to build this
high level of hemoglobin. The DRI for iron for
pregnant women is 27 mg. An average diet
supplies about 6 mg of iron per 1000 calories.

Bernice Raziel U. Caliwagan, RN MAN

➢Foods richest in iron (e.g., organ meats; eggs;
green, leafy vegetables; whole grains;
enriched breads; dried fruits).
➢Set client’s expectation about stool
characteristics and constipation.

Bernice Raziel U. Caliwagan, RN MAN

• Fluoride. Because fluoride aids in the
formation of sound teeth, a pregnant woman
should drink fluoridated water. In an area
where the water is not fluoridated either
naturally or artificially, supplemental fluoride
may be recommended.

Bernice Raziel U. Caliwagan, RN MAN

• Sodium. Sodium is the major electrolyte that
acts to maintain fluid in the body: when
sodium is retained rather than excreted by the
kidneys, an equal or balancing amount of fluid
is also retained.

Bernice Raziel U. Caliwagan, RN MAN

• Zinc. Zinc is necessary for the synthesis of DNA
and RNA. The DRI for zinc during pregnancy is
12 mg, or an increase of 3 mg over
prepregnancy needs. Foods such as meat,
liver, eggs, and seafood.

Bernice Raziel U. Caliwagan, RN MAN

 6. Fluid Needs
• Extra amounts of water are needed during
pregnancy to promote kidney function
because a woman must excrete waste
products for two.
• Two or three glasses of fluid daily over and
above the three servings of milk
recommended by the food pyramid is a
common recommendation during pregnancy
(a total of six to eight glasses daily).

Bernice Raziel U. Caliwagan, RN MAN

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.todaysparent.com%2Fpregnancy%2Fbeing
-pregnant%2Fhow-much-
water%2F&psig=AOvVaw102GRS06AXvu6vEUCDDE0a&ust=1600700430817000&source=images&cd=vfe&
ved=0CAIQjRxqFwoTCKj6y_f_9-sCFQAAAAAdAAAAABAN

Bernice Raziel U. Caliwagan, RN MAN

 7. Fiber Needs
• Eating fiber-rich foods, foods consisting of
parts of the plant cell wall resistant to normal
digestive enzymes such as broccoli and
asparagus, are a natural way of preventing
constipation, because the bulk of the fiber left
in the intestine aids evacuation.
• Advantage of lowering cholesterol levels and
may remove carcinogenic contaminants from
the intestine.

Bernice Raziel U. Caliwagan, RN MAN

• Encourage women to eat plenty of fresh fruits
and vegetables, especially green, leafy
vegetables, to provide fiber. Eating fiber-rich
foods this way is a better choice for preventing
constipation than taking a fiber laxative. Doing
so allows a woman to receive nutrients from
the food as well as preventing constipation
(Derbyshire, 2007).

Bernice Raziel U. Caliwagan, RN MAN

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.alamy.com%2Fstock-photo-young-
pregnant-woman-at-home-eating-broccoli-vegetables-29779491.html&psig=AOvVaw1iJANTvmRZ-
gaV1nv9omGU&ust=1600700630622000&source=images&cd=vfe&ved=0CAIQjRxqFwoTCNjdzdmA-
OsCFQAAAAAdAAAAABAD

Bernice Raziel U. Caliwagan, RN MAN

Foods to Avoid or Limit in
Pregnancy

Bernice Raziel U. Caliwagan, RN MAN

 1. Excess Seafood
• Women should eat up to 12 ounces (2 to 3
meals) of seafood or shellfish a week for their
omega-3 and iodine content.
• Seafood such as shark, swordfish, king
mackerel or tilefish are high in mercury
contamination, however, so should be avoided
(Genuis, 2008).

Bernice Raziel U. Caliwagan, RN MAN

• Five types of fish that are low in mercury are
shrimp, canned light tuna, salmon, pollock,
and catfish.

Bernice Raziel U. Caliwagan, RN MAN

 2. Foods With Caffeine
• Caffeine is a central nervous system stimulant
capable of increasing heart rate, urine
production in the kidney, and secretion of acid
in the stomach (Rolfes, Pinna, & Whitney,
2009).
• A daily intake of caffeine of two or three cups
of coffee has not been associated with low
birth weight.

Bernice Raziel U. Caliwagan, RN MAN

• To limit their caffeine intake, women may
need to limit not only the amount of coffee
they drink but also other sources of caffeine
such as chocolate, soft drinks, and tea.
• Green tea has less caffeine than black tea.
Both herbal teas and decaffeinated tea are
readily available.

Bernice Raziel U. Caliwagan, RN MAN

• A cup of coffee contains approximately 120
mg of caffeine, whereas a cup of hot chocolate
contains only 10 mg. Baking chocolate, used
for cake frostings and glazes, is
proportionately higher, containing about 35
mg of caffeine per ounce.

Bernice Raziel U. Caliwagan, RN MAN

https://www.google.com/url?sa=i&url=https%3A%2F%2Fparenting.firstcry.com%2Farticles%2Fdrinking-
coffee-during-pregnancy-is-it-
dangerous%2F&psig=AOvVaw0tfOzoq1Wl_wPt5Aiw5ZnW&ust=1600701341120000&source=images&cd=
vfe&ved=0CAIQjRxqFwoTCMCYtamD-OsCFQAAAAAdAAAAABAD

Bernice Raziel U. Caliwagan, RN MAN

 3. Artificial Sweeteners
• Artificial sweeteners are used to improve the
taste and to limit the caloric content of foods.
It is probably safest for pregnant women to
reduce their intake of these.
• Sweetener aspartame has been approved by
FDA but for pregnancy client, it is still
unknown if it is truly safe for consumption.

Bernice Raziel U. Caliwagan, RN MAN

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.health.harvard.edu%2Fblog%2Fartificial-
sweeteners-sugar-free-but-at-what-cost-
201207165030&psig=AOvVaw0TslWpK9bMD1197qO0VYI4&ust=1600701584712000&source=images&cd=
vfe&ved=0CAIQjRxqFwoTCMiD5J2E-OsCFQAAAAAdAAAAABAD

Bernice Raziel U. Caliwagan, RN MAN

 4. Weight Loss Diets
• As a rule, weight reduction is not healthy
during pregnancy. Liquid reducing diets and/or
diets that are combined with weight-reducing
drugs are particularly contraindicated during
pregnancy because they may lead to fetal
ketoacidosis and poor growth.

Bernice Raziel U. Caliwagan, RN MAN

Bernice Raziel U. Caliwagan, RN MAN
Bernice Raziel U. Caliwagan, RN MAN
Bernice Raziel U. Caliwagan, RN MAN
• Reference/s:
Maternal and Child Health Nursing: Care of the
Childbearing and Childrearing Family; 8th
Edition, Pillitteri, Adele; Wolters Kluwer
Lippincott Williams & Wilkins; 2017

Bernice Raziel U. Caliwagan, RN MAN

Thank you! =)

beya

Bernice Raziel U. Caliwagan, RN MAN