Knowledgable nutrition counseling can potentially have:

An enormous impact on pregnanc outcomes

Poor nutrition has been linked to:

 Preterm Labor

 IUGR

C/Section

 Other High Risk Outcomes

Prenatal and Fetal Nutritionn has recently been strongly linked to adult health outcomes such as:

Diabeties

Hypertension

Identification and Remediation of Nutritional Problems are Preventative Measures that can Increase;

Positive Pregnancy Outcomes

Recent Data Indicates that _____ and _____ of weight gain during prenancy is as important as total weight gain.

Rate and Quality

A Midwife must be aware of cultural, psychosocial and socioeconomic factors that influence _________ _______ so a cmprehensive plan suited for an individual client can be crafted.

Nutritional Status

African American, Hispanic American and Ameican Indian women are more likely to be ________ ________ than American Women of Nothern European Descent.

Lactose Intolerant

Being aware of the clients ______ ______ will allow appropriate data gathering and indivdualized plans to assist women in obtaining adequate ________ in pregnancy.

Ethnic Orgins

Nutrients

Pregnancy and Birth beliefs and practices are shaped by;

Culture

Dietary Practices are strongly;

Cultural

In May 2009 the Institute of Medicine revised their gestational weight guidelines, based on balancing the ______ and ______ of weight gain for both the mother's and developing child's health.

Benefits and Risks

______ and _____ are essential for fetal growth and development.

DHA and EPA

Some professional groups, incuding the United States Preventative Service Task Force (USPSTF) conclude that evidence is insufficient to recommend for or against ______ _________ for non anemic pregnant women.

Iron Supplementation

The CDC recommends _____ mg Iron daily during pregnancy.

30 mg

If a woman is anemic and needs supplementation the body response to supplementation is usually ______.

Rapid

If no improvement in Iron levels are seen, then the midwife must determine;

If the client is taking the Iron at all or correctly.

What helps Iron Absorption

Vitamin C

What are the two forms of Vitamin A found in foods?

Retinol and Carotene

Where are Retinols found

Meat Sources and Supplements

Where are Carotenes found?

Plant Sources that are yellow and  orange

When taking vitamin A supplements, what amount should you not go over?

10,000 IU

Which part of Vitamin A is thought to be toxic to fetuses in large amounts?

Retinol

Even though Carotene is converted to Retinol in the body you cannot eat enough to produce toxic amounts.

Food Safety sould be discussed with mothers at what time?

At the first prenatal visit and should be supplemented with take home information discussing foods to avoid and why.

When prescribing prenatal vitamins what should you be sure that they include?

Folic Acid

Iron

Calcium

DHA and EPA

According to the CDC Obesity is defined as being ____% above the ideal body weight.

30%

An estimated _____% of US adults are either overweight or Obese and ______ have a higher rate of obesity.

65%

Women

Some Obese and Overweight women will drastically _______ their diets upon a postive ______ ______.

Improve their diets

Positive Prgnancy Test

It must be emphasized that _____ _____ is not healthy during pregnancy.

Weight Loss

When the breakdown of body fat is used as energy, metabolism changes from _______ to ______ and causes the production of Ketone Bodies.

Glysolysis to Lipolysis

Ketone bodies are a kind of energy producing substance derived from breaking down of ______ and consumed as fuel during hunger by the cells.

Lipids

Excessive amounts of Ketone Bodies are harmful for fetal ______ ______ and can cause impaired ______ _____ and impaired behavioral growth of the child.

Brain Development

Cognitive Function

Women who become pregnant after Bariatric Surgery have a reduced risk of developing ________ _______.

Gestationa Diabetes

Women who become pregnant after Bariatric Surgery have an increased risk of having a _____ ____ _____ ____ infant.

Small for Gestational Age

Small for Gestational Age infants born to mothers who have had Bariatric Surgery is mostly likely due to;

Reduced Nutrient Intake and Reduced Absorption

It is very important for mothers who have had Bariatric Surgery to optimize their _____ ____ and gain _____ ______.

Nutritional Intake

Gain Adequate Weight

Most pregnant women will be able to meet nutritional needs of pregnancy through _____ alone and careful planning.

Diet

Vegans (who do not eat meat, fish, eggs, dairy) may also need to consume ______ _____ or ________. 

Fortified Foods or Supplements

It is estimated that _____% of women in the United States have an eating disorder currently or in the past.

5-6%

Eating Disorders Include;

Anorexia

Bulimia

Eating Disorder Not Otherwise Specified

Women diagnosed with ______ refuse to maintain their bodies at 85% or greater of ideal body weight.

Anorexia

Women with _____ may be missed more readily because these women are often a normal body weight.

Bulimia

Bulimia is characterized by episodes of _____ _____ accompanied by _______, laxatives or diurectic use, excessive exercise, or periods of fasting.

Binge Eating accompanied by Purging

Women with eating disorders are often intensely ashamed of their ____ _____.

Eating Habits

It is recommended the midwives routinely screen pregnant women for _____ ______ as part of the initial assessment and several times throughout pregnancy.

Eating Disorders

Women with current or past eating disorders often find that being ______ is a terrifying experience.

Weighed

What is another word for Geophagia and what does it mean?

Pica

An eating disorder that causes you to crave and eat non food items.

What are the three discussed theories as to why Pica ma develop during pregnancy?

1. Nutritional Deficiency - might be a response to iron deficiency or another mineral.

2. Cultural Factors - it is accepted in some cultures as a way to increase spirituality, or treating a physical illness such as 1st trimester nausea and vomiting.

3. Psychological Reasons - mental illness or trauma can trigger pica along with stress, fear or abuse. Most often seen in persons with developmental disiabilities.

What are four health complications that can arise from Pica that can be serious?

1. Lead Poisoning - eating soil, clay, paint with lead.

2. Bowel Obstruction - eating, rock, soil, clay can lead to constipation, inflammation and infection.

3. Parasitic Infection - eating soil, clay, grass can lead to pain weight loss and other side effects.

4. Perinatal Effects - Anemia and in extreme cases can prevent absorption of other essential minerals and nutrients.

Obesity in pegnancy is associated with an increased

risk of;

Preeclampsia

Gestational Diabetes

Cesarean Birth

Pregnant Women need how many servings of protein in their daily diet?

3-4 Servings

Regarding Caffeine a pregnant woman should limit her consumption to ho much?

200 mg a day

Pregnant Women who do not eat meat during pregnancy;

Can meet dietary requirements without additional supplements other than prenatal vitamins.

A BMI of 28.3 would increase a pregnant woman's risk of;

1. Vulvar Varicosities

2. Preeclampsia

3. Preterm Labor

4. 2nd Trimester Pregnancy Loss

Preeclampsia

Which of the following meals is highest in calcium?

1. Roasted Pumpkin seeds, slice of cheddar cheese, wheat crackers and pomegranate juice.

2. Grilled Salmon, rice salad, corn bread

3. Turkey sandwich with lettuce and tomato, 1/2 cup milk and 1 apple

4. 1 cup greek yogart & honey and 4 dried figs

1 cup greek yogart & honey and4 dried figs

What is appropriate to tell a woman about DHA intake in pregnancy?

She should eat 2 servings of DHA rich food per week

Sharon a 25 year old who admits to eating dirt sometimes during this pregnancy; you would worry about what?

Dental Injury

Maternal Anemia

Lead Poisoning

Parasitic Infection

A Woman with a BMI of <18.5 should gain

how much weight in the first trimeser?

At Least 5 lbs

Pregnant Adolescents commonly need to eat how many calories a day?

500 calories over the normal daily intake

Which of the following are associated with birth weight?

1. Prepregnancy weight and total weight gain

2. Total weight gain and educational level

3. BMI and timing of specific nutrients

4. Prepregnancy weight and BMI at term

Prepregnacy weight and total weight gain

BMI determination should guide _____ _____ _____.

Pregnancy Weight Gain

Who has an increased risk of NTD?

Obese Women and Women not getting the required amount of Folic Acid.

What is the recommended amount of Folic Acid supplementation for pregnancy?

400 mcg daily

During a prenatal diet assessment, African American women may need particular attention to;

Calcium and Vitamin D sources due to lactose intolerance

When counseling women on calcium intake during pregnancy, it is appropriate to tell women;

1000 mg a day and it is most needed starting at 12 weeks do to bone growth of the fetus.

What are the average calories for a pregnant woman during the first trimester?

2200 calories a day

 or

2500 calories a day throughout pregnancy

How many additional calories are needed for pregnancy?

none 1st trimester

350 a day 2nd trimester

450 a day 3rd trimester

or

2500 a day throughout pregnancy

How much protein per day during pregnancy?

60 g a day

or

3-4 servings

How many carbohydrates a day during pregnancy?

175 g a day

How much Omega 3 fatty acids?

200 - 300 mg DHA plus EPA

or

2 servings of Omega 3 rich fish per week

What is the subjective data needed for a

nutritional status? 

What is the objective data needed for

nutritional status?

weight and BMI (based on prepregnancy weight), skin, hair, nails, oral mucosa, gums, teeth, eyes, thyroid,and heart.

BMI of <18.5

Underweight

BMI of 18.5 - 24.9

Normal Weight

BMI of 25 - 29.9

Overweight

BMI of 30 and over

Obese

How much weight should a mother who is <18 BMI gain during pregnancy?

28 - 40 lbs total

or

5 lbs 1st trimester then +1 lb a week

How much weight should a normal weight woman gain during pregnancy?

25 - 35 lbs total

or

2-5 lbs 1st trimester then +1 lb per week

How much weight should an overweight mother gain during pregnancy?

15 - 25 lbs total

or

1-2 lbs 1st trimester then 2/3 lb per week

How much weight should an obese mother gain during pregnancy?

11 - 20 lbs total

or

0-1 lb 1st trimester then 1/2 lb per week 

Servings of fruit for pregnancy

2-4 servings

Servings of Veggies for pregnancy

4 servings

Servings of Dairy for pregnancy

3-4 Servings

Servings of Carbohydrates and grains for pregnancy

6-9 Servings

Complex not refined

What are 10 risk factors that can place a prenant woman at nutritional risk?

1. Adolescent        2. Smoking         3. Substance Abuse

4. Brief Interconceptional Period < 9 months

5. Multiple Gestation      6. Social Issues - homelessness

7. Weight loss during pregnancy

8. Low Maternal Gain

9. Easting Disorder

10. Bariatric Surgery

11. Restrictive Diet such as Vegan Diet

12. Prepregnancy underweight or oveweight or obese

What are the guidelines for Anemia in pregnancy?

1st Trimester

2nd Trimester

3rd Trimester

Hemoglobin and Hematocrit

<11    <33

<10.5  <32

<11    <33

What are Safe Sources for Vitamin D

and

How much?

600 IU daily

Dairy and Sunshine

What is a harmful Bacteria that can be found in refrigerated and ready to eat foods and unpasterized dairy products?

Listeria Monocytogenes

What kind of metal can be found in fish?

Methylmercury

Which fish have dangerous levels of methylmercury and should not be eaten by pregnant women or children?

Shark

Tilefish

King Mackerel

Swordfish

What is the parasite that is found in dirt, raw or undercooked meat, unwashed veggies, and cat feces?

T. Gondii

What is the name of the illness caused by T. Gondii?

Toxoplasmosis

What supplements should a Vegan be advised to take?

B12

Calcium

Folic Acid

Iron

DHA and EPA

Vitamin D

What are the three types of Bariatric Surgery?

Restrictive - Lap Band

Malabsorptive

Rous-en-Y

Why would you not use a OGTT on a woman who has

had a malabsorptive or Rous-en-Y surgery?

It can cause dumping syndrome.

you can use post prandal sugars a few days in a row to check for GDM.

Lap Bands can do OGTT

An Effective Treatment of Childbirth Fear?

To Improve a Woman's Confidence in Birth

With Regards to the psychological adjustments in pregnancy, the 3rd trimester is considered a period of;

Watchful Waiting

The Normal Pregnancy Grief Process Occurring in the 3rd Trimester;

Is attributed to anticipating loss of the special status of pregnancy.

A pregnant woman's normal fear of safety for herself and her baby often;

Increases her sense of vulnerability and dependency

In the 1st Trimester it is important to reassure women that;

Intercourse will not cause miscarriage

During the 1st Trimester it is common for women to feel;

Ambivalence

It would be appropriate to advise a pregnant woman to abstain from intercourse if;

She has a history of preterm birth <35 weeks gestation.

Pregnant women feel most erotic;

After 14 weeks gestation

Evidence-based reason for birth fear are;

Fear of pain and prior negative birth experience

Dysparunia is more likely to occur;

During the 3rd Trimester

Physical Changes

1st Trimester

N/V

Heartburn,Gastric Distress

Fatigue, Sleepiness

Pelvic Vasocongestion

Physical Changes

2nd Trimester

General Feeling of Well-Being

Physical Changes

3rd Trimester

Fatigue, Insomnia

BH Contractions

Enlarged Abdomen

Emotional Adaptations

1st Trimester

Ambivalent about pregnancy

Alterations of body image

Fear of Abortion

Emotional Adaptations

2nd Trimester

May be Introverted

Increased dependency needs

Increased feelings of femininity

Physical Adaptations

3rd Trimester

Seeks approval for self and fetus

Negative body Image

Anxiety about labor and delivery

Increased Vulnerability

Sexual Response

1st Trimester

Libido unchanged or decreased

Increased vasocongestion in pelvic organs with a more pronounced orgasmic platform

Glandular Hyperplasia more Lubrication

Sexual Response

2nd Trimester

Libiido unchanged or increased

Remission of early pregnancy discomforts stimulates

more interests in sex

Sexual Response

3rd Trimester

Decreased Libido

Dysparaunia and discomfort during Coitus

Educational Needs

1st Trimester

Changes in libido common during pregnancy

No correlation between sex and miscarriage

Abstan from sex with cramping, bleeding, or history of imcompetent cervix

Educational Needs

2nd Trimester

2nd Trimester usually the most comfortable part of pregnancy

Introduce alternative positions for lovemaking

Educational Needs

3rd Trimester

Abstain from sex after rupture of membranes or bleeding

(call doctor)

Alternatives to coitus

Abstain with a history of preterm labor (32-34 weeks)

What is the Ideal Self

The Image of who you want to be

What is the Actual Self

How one sees oneself at this time and this situation

What is the Body Image Self

It provides the structure and function of the self within the self image.

It allows one to orient oneself as a entity in the real world.

What is the Maternal Identity

the woman's internal sense of competence in the maternal role and her knowledge of her infant.

The theory of maternal role attainment is achieved through four phases;

Mimicry or Replication

Role Play

Fantasy

Resolution of role conflicts

What is an example of mimicry or replication?

the pregnant woman copies and adapts behaviors and practices of other women in the same situation

An example of role play

requesting to feed another infant

playing with toddlers a the park

baby sitting

An example of fantasy

The woman begins to imagine how it will be with her child

An example of Resolution of Role Conflicts

Examining and evaluating the fit of the new maternal role

Maternal Task of Pregnancy Are;

Seeking Safe Passage

Acceptance of Others

Binding In

Giving of Oneself

What is Seeking Safe Passage?

The woman works toward her own and her baby's intact survival of pregnancy and childbirth

What is Acceptance of Others?

It is loosening and reordering of existing relationship bond in order to make room for a relationship with the new baby.

The positive response shown by her partner or husband is very important in making a positive adjustment 

What is Binding In?

The mother's acceptance of the pregnancy and the emotional bond of love for the coming child

What is Giving of Oneself?

It involves caring and some degree of self deprivation on the part of the mother.

Readying the baby room

Following medical advice and regimes

What are the occupations Lead can be found in?

Painters, deleaders, smelters, stained glass, ceramic workers, welders, auto radiator repair

Where are sources of lead found?

Older homeswith lead paint, lead pipes

contaminated dirt

and certain occupations

What are the effects of lead?

Peripherial neuropathy, seizure, coma, cardiac arrest, cognitive disfunction, Death

Spontaneous abortionl, stillbirth, low birth weight, preterm, cognitive impairment developmental delays, minor malformations

What occupations can Mercury be found?

Dentistry, laboratory workers, healthcare workers, pharmaceuticals, shipyard, construction

What are some sources of Mercury?

Methylmercury in fish

 fungicides, antiseptics, electrical equipment, thermometers, dental amalgam, gold mines, batteries

Power plants are the largest industrial source

What are the problems mercury causes?

CNS problems, diarrhea, weight loss, abdominal pain, muscle twitching and cramping

neurolgic damage in infants exposed inutero, cerebral palsy, microencephaly, attention span, language, visua spatial skills, coordination

What does Organic Solvents cause?

major birth defects, lower birth weights, miscarriages,

12-13 major defects just from symptoms of exposure 

Where are Dioxins Found?

What Occupations?

Paper Mills, Pesticide Plants, Chlorine Plants

released into the environment are found in

food chain in adipose

beef, chicken, pork, dairy

What does Dioxins cause?

Inability to maintain pregnancy, decreased fertility reduced sperm counts, learning disabilities, immune system suppression, lung and skin problems, lower testosterone levels, cancer

Where can PCB's be found?

accumulated in fish, dairy, pork, beef, & people

 outlawed in US in 1979

used to be in transformers and capacitors

What do PCB's Cause?

infertility, prenatal death, growth retardation, poor short term memory, decreased birth weight, decreased IQ scores

An Occupational Health History Includes;

Current Job or career

are you exposed to chemicals or hazards

any symptoms or illness due to work

PCB's and Dioxins can both be found?

In animal meats and dairy

Women asking about hair dyes during pregnancy should be told what?

Reassured that there is no evidence of perinatal risk

The primary cause of congenital anomalies is;

Multifactoral

Part of a fetotoxic environmental assessment includes;

Asking about home exposure to substances