LESSON 10 NDMU | College of Arts and Sciences | Nursing

Notre Dame of Marbel University

College of Arts and Sciences
Nursing Department

LESSON 10
PREGNANCY & LACTATION

Figure 2.5.1. Asthma

LESSON 10 NDMU | College of Arts and Sciences | Nursing

LESSON 10: PREGNANACY & LACTATION

Introduction
This course packet adds information about prenatal nutrition, an important aspect to help
ensure a healthy outcome for both a woman and her child. Inadequate nutrition during
pregnancy can affect not only fetal health but the child’s health for years to come.

Intended Learning Outcomes

At the end of this course packet, the student-nurses can:
1) Identify the nutritional requirements for pregnant and lactating mothers
2) Plan a whole day menu considering these nutritional requirements
3) Integrate nutrition knowledge with nursing process to achieve quality
maternal and child health nursing care.

Kickstart!
Activity: Open the FNRI website (https://www.fnri.dost.gov.ph/ ) and search for the Daily
Nutritional Guide Pyramid for Filipino Pregnant Women. Answer the following:
1. How many glasses of Water/Beverage is recommended? _______________
2. Give an example of Fish, Shellfish Meat & Poultry recommended for a pregnant wom-
an to consume? _________________
3. How many glasses of Milk/Milk products is recommended? _________________
4. What kind of exercise is recommended for pregnant women? _________________
5. Give an example of Fats and oils recommended for a pregnant woman to consume?
_________________
LESSON 10 NDMU | College of Arts and Sciences | Nursing

Definition
PREGNANCY
• Pregnancy or gestation is the period when the fertilized ovum implants itself in the
uterus, undergoes differentiation, and grows until it can support extra uterine life.
• Consists of 3 trimesters which correspond to the 3 main phases: implantation, organ-
ogenesis and growth
• Pregnancy lasts for 37-40 weeks

Nutritional Goals during Pregnancy

• Ensure optimum nutrition before, during and after pregnancy
• Provide adequate nutrition to meet increased maternal and fetal nutrient demands

Nutrition in Pregnancy
CALORIE ALLOWANCES
• 80,000 kcal = total energy cost of storage plus maintenance during course of pregnancy
• 300 kcal/day = rough estimation of daily energy cost during pregnancy

WEIGHT GAIN
• A small weight gain is observed during 1st trimester, a more rapid weight gain happens in 2nd tri-
mester, and a slower weight gain is recorded during 3rd trimester
• 24 pounds = average weight gain during pregnancy
• Normal weight gain = Gain of 1.5 to 3.0 lbs during the 1st trimester and a gain of 0.8 lb per week dur-
ing the remainder of pregnancy
• IMPORTANT: Pattern of weight gain is more important than total amount gained.

UNDERWEIGHT
• High risk of having low birth weight infants
• Higher rates of pre term deaths and infant deaths

OVERWEIGHT & OBESE

• High risk of complications like hypertension, gestational diabetes and postpartum infec-
tions
• Complications of labor and delivery
• Increased likelihood of a difficult labor & delivery, birth and trauma and cesarean section
for large babies
• Doubled risk of neural tube defects
LESSON 10 NDMU | College of Arts and Sciences | Nursing

Nutrient Allowances during Pregnancy

PROTEIN ALLOWANCES
• 68 grams/day for adult Filipino pregnant woman
• 73 grams. Day for pregnant adolescents (59 grams for protein allowance required + 14 grams additional
for pregnancy)
• IMPORTANT: 2/3 of proteins should be animal origin of the highest biologic value such as meat, milk,
eggs , poultry and fish. (10 grams can be added to the normal protein allowance for simplicity)

CALCIUM ALLOWANCES
• An adequate supply of vitamin D is essential in the use of calcium and phosphorous needed to calci-
fy the fetal bones and teeth.
• Daily intake of calcium must be increased from 0.5 to 0.9 to that o the non-pregnant adult’s daily
allowance

IRON ALLOWANCES
• 700 to 1000 mg of iron must be absorbed and utilized by the mother throughout the pregnancy.

IODINE ALLOWANCES
• Inadequate intake of iodine may result in goiter of the mother or child
• Increased need may be met by use of iodized salt in food

VITAMIN ALLOWANCES
• Thiamin & niacin: increased in proportion to the calorie increase
• Riboflavin: increased according to higher protein level
• Vitamin D: Need is increased during pregnancy to make easier utilization of greater amounts of cal-
cium & phosphorous
• Vitamin C: Need is increased because it is vital in tissue structure
• Vitamin A: important in the epithelial cells during organogenesis and is necessary to ensure good
vision
• Folic Acid & Vit. B 12: important in the synthesis of RBC. If inadequate folic acid is taken during
the course of pregnancy, megaloblastic anemia may occur and neural tube defects may be seen on
the infant (supplement of 0.4 to 1.0 mg of folic acid)
• Vitamin B6 & Pyridoxine: Prevents severe nausea & vomiting associated with childbearing
LESSON 10 NDMU | College of Arts and Sciences | Nursing

Complications of Pregnancy & Dietary Modifications

RAPID WEIGHT GAIN OR LOSS

• Excessive weight gain during pregnancy = 3 kg or more per month in 2nd and 3rd trimester
• Sudden increase in weight after about the 20th week of gestation is a cause for suspecting water retention
• Excessive weight gain in the 2nd or 3rd trimesters can lead to eclampsia
• Gain of less than 500g/month during 1st trimester of pregnancy and 250 g during 2nd trimester is a mater-
nal risk factor.
• Pregnant women showing inadequate weight gain are more likely to deliver low birth weight infants, or to
have premature deliveries, abortions or offspring with brain and nerve damage,

TOXEMIA
• Toxemia clinical manifestations: Rapid weight gai, edema, high blood pressure, excretion of albumin in
the urine, and convulsions
1. Acute toxemia of pregnancy: onset after 24th week
A. Pre eclampsia—hypertension with proteinuria and edema
B. Eclampsia—convulsions or coma, associated with hypertension, proteinuria and edema
2. Chronic Hypertensive vascular disease
A. Without superimposed acute toxemia
B. With superimposed acute toxemia
ANEMIA
• Macrocytic anemia = combined iron and folic acid deficiency
• Produce anemia in babies and increases chances of premature birth

DIABETES
• Pregnant woman with diabetes is more prone to develop pre eclampsia, pyelonephritis and polyhy-
dramnios (excess of amniotic fluid) and the baby has higher risk of dying in utero
• Control of blood glucose levels is considered vital for good prognosis of the fetus

CONSTIPATION
• Pressure exerted by the developing fetus on the digestive tract, lack of exercise and insufficient bulk in
the diet cause constipation
• Consumption of fresh fruits, vegetables, adequate fluid and regular exercise can correct this condition

ALCOHOL, CAFFEINE, & NICOTINE

• Smoking during pregnancy = lowers mean birth weight and increases risk of perinatal mortality
• Alcohol ingestion during pregnancy = Fetal alcohol syndrome (CNS disorders, mental retardation,
growth and facial deformities
• Caffeine during pregnancy = can cross the placenta rapidly; fetus cannot metabolize caffeine
LESSON 10 NDMU | College of Arts and Sciences | Nursing

PREGNANCY IN ADOLESCENTS REPEATED PREGNANCIES

• Iron deficiency anemia • As parity increases, tendency toward lower nu-
• Prolonged labor trient intake also increases
• Higher rates of stillbirths, pre term births and low birth • Gestation in close interval depletes the maternal
weight infants reserves of nutirents

PREGNANCY IN OLDER WOMEN

• Hypertension and diabetes
• Higher rates of premature births and low birth weight
• Birth defects
• Fetal death

Definition
LACTATION
Preparation for assuring an adequate supply of good quality breast milk must begin at
the onset of pregnancy. Most of the dietary essentials are increased over and above the re-
quirements during pregnancy to meet the demands of milk production.

Food Needs in Lactation

NUTRITIONAL REQUIREMENTS
• Calories - An additional of 1000 calories above the normal allowance is needed
- 120 calories is required to produce 100 ml of milk
• Protein - Additional 20 g to the normal allowance is needed to compensate for the protein
lost in milk
- 2g of food protein is required to produce 1 g of milk protein
• Calcium & Phosphorous - an increase of 0.5 mg to the normal allowance I needed to pre-
vent severe depletion of maternal calcium
• Iron - additional intake is recommended for blood lost in parturition
• Vitamin A - An additional 2000 IU to the normal allowance is needed to provide the
amount of vitamin A secreted in milk
• Vitamin B1, Riboflavin, Vitamin C—An additional allowance is needed for milk secre-
tion
• Fluids—An intake of 8 glasses or more is recommended to increase milk production
LESSON 10 NDMU | College of Arts and Sciences | Nursing

Factors Affecting Milk Secretion

DIET
• Meat and vegetable soups, milk, and fruit juices = galactagogues (milk secretion stimulat-
ing)

NUTRITIONAL STATE OF MOTHERS

• Energy yielding constituents of human milk are maintained at the expense of the maternal
stores while the water soluble vitamins and Vitamin A are low in poorly nourished mothers
• Co morbidities in a pregnant woman can lessen quality and quantity of milk flow

EMOTIONAL AND PHYSICAL STATES

• Attitude affects milk secretion. Anxiety, frustration and worrying about staying at home
can halt flow of milk

SUCKLING
• As the baby feeds for longer periods of time, the supply of milk increases in proportion to
the body’s demands

USE OF CONTRACEPTIVE DRUGS

• Contraceptive pills = depresses milk flow; triggers cessation of lactation (osteria)

THINK!
Answer this: Rita, a pregnant 19 year old, works at a fast-food restaurant. She states she
is too nauseated in the morning to eat before she leaves for work, and her salary is not
enough to cover the vitamins prescribed by her physician. Create a meal plan that will
adequately supply Rita with the vitamins and minerals she needs, considering her socio-
economic status and her condition.

References
Cruz-Caudal, M. L. (2019). Basic Nutrition and Diet Therapy. Quezon City: C&E Publishing.
Grodner, M. (2012). Foundations and Clinical Applications of Nutrition: A Nursing Approach.
Singapore: Elsevier.
Wilson, T., & Bray, G. (2015). Nutrition Guide for Physicians. New York: Humana Press.