Promoting Good Nutrition In

Pregnancy
• Diffusion
– Fetus receives water and electrolytes
– Substance move from an area of higher
concentration (maternal blood) to lower
concentration (Fetal blood)
• Facilitated transport
– With enzymatic activity, glucose moves to the
fetus
• Active transport
– Amino acids, calcium and iron move into the
circulation
 Steps in Promoting good nutrition
A. Start with diet history
A. Diet history taking
A. Assessment history of what the woman ate in the last two
or three days (from breakfast to midnight snacks)
B. Ask the woman to list down all foods that she took in the
past 48 to 72 hours.
B. Provide Nutritional instruction
A. Increase calories for energy
A. Total non pregnant woman needs 2,200 kcal and during
pregnancy she needs additional 300 kcal , a total of
2500kcal
2. Increase Protein The dietary reference intake
(DRI) for women is 44 to 50 g. The need for protein
for pregnant women is 70 to 80 g/ day. Or
additional 30 g to the normal daily requirement.
Additional 20 g of protein necessary for lactating
mothers.
Protein is necessary for:
A. growth and repair of maternal tissues,
breasts, uterus and placental
B. Increased maternal blood volume and
C. growth and Development of the fetus
3. Decrease fats
Fats are difficult to digest and can
contribute to gastrointestinal discomfort.
Daily quota of 90g fat coming mainly from
animal sources.
The pregnant woman needs adequate
supply fats in order to promote the absorption
and utilization of fat- soluble vitamins A, D,E,K.
4. Decrease carbohydrates
Human Placental Lactogen (HPL), the major insulin
antagonist in pregnancy spares maternal glucose for fetal
use.
Carbohydrates should be decreased during the
second and third trimesters during which time, there is
increased HPL secretion.
Fetal Brain Drain – rapid growth of the fetal brain
in the first trimester depletes maternal glucose which can
result in early pregnancy faintness or dizziness even
vomiting.
-Fetal glucose brain drain warrants an increased
carbohydrates intake in the first trimester.
5. Increase major minerals
a. iron
-Hemoglobin of fetus at term is 17 to 21 g/100ml of
blood ( a level necessary to oxygenate the blood
intrauterine life
-After week 20, the iron is stored in the liver through the
first 3 months of life
-DRI for iron for pregnant women is 30 mg
-Example : organ meat ; eggs; green and leafy vegetable,
whole grain, enriched breads and dried fruits
-Iron supplement can turn the stool black and women
can be constipated; increase fluid intake and stool
softener such as docusate sodium (colace)
• calcium and phosphorus
( skeleton and teeth, for bone formation)
-eat foods high in calcium and vitamin D
( necessary for calcium to be absorbed from the
gastrointestinal tract and to enter bones )
-recommended amount of calcium is 1,200 to
1,500mg
-if a woman cannot drink milk or eat cheese, she
can be prescribed a daily calcium supplement.
-Most foods high in protein is also high in
phosphorous
• Iodine
• is essential for the formation of thyroxine and
proper functioning of the thyroid gland
-If iodine deficiency occurs it can cause thyroid
enlargement (goiter) in women
-In extreme instances, it can cause hypothyroidism
to fetus –may lead to infant’s being cognitively
challenged
-DRI for iodine 175ug daily
-Seafood is the best source once a week
-Iodized salt
• Severe iron deficiency can result in cretinism
and marked mental retardation
6. Increased essential vitamins
a. Vitamin C 80 to100 mgs.
- excess may prove harmful in pregnancy
(cohchrane, 1965) identified scurvy in
normally fed infants whose mothers
received large doses of vitamin c during
pregnancy.
• b. Folic Acid/ Folate
– Folic acid(folacin) is necessary for red blood cell
formation and is found in fresh fruits and
vegetables
– Inadequate intake of folic acid a megaloblastic
anemia may develop ( large but ineffective red
blood cell.
– Folic acid can prevent neural tube defects
– Should eat foods high in folic acid vegetables and
fruit and a prenatal vitamin that contains folic acid
supplement of 0.4 to 1.0
• c. Vitamin B1
- to help in red blood cell formation and to
provide a coenzyme in protein metabolism, 4ug
vit b12 is recommended.
C. Emphasize the number of daily servings of
essential foods
1. Protein- rich foods: 4 servings
2. Milk and dairy products: 4 servings
3. Grain and grain products: 4 servings
4. Fruits and vegetables : 4 servings divided
into
2 servings of green, leafy vegetables
1 serving of vitamin C- rich fruit or vegetable
1 serving of other fruit or vegetable, as
desired
D. Provide guidance in selection of proper foods emphasizing quality
and not quantity
avoid empty or zero- calorie foods like softdrinks, cakes,
doughnuts and spaghetti
E. Identify nutrition risk factors
1. low socio economic status affects quantity and quality of foods
2. bizarre food patterns
3. smoking
4. alcoholism and drug addiction (Fetal alcohol syndrome)
5. vegetarian diet leads to inadequate intake of protein and
B12
6.adolescent age group diet usually inadequate in nutritious
food
7. underweight and obesity