Nutritional Guidelines for Pregnant Woman

U.S. Department Of Agriculture Food Pyramid

Food Group Recommendations

Because not all foods in a food group are created equal, the U.S. Department of Agriculture makes the following recommendations for choosing foods within a food group.

Grains

• Make half your grains whole. Eat at least 3 oz of whole-grain cereals, breads, crackers, rice, or pasta every day;
• 1 oz is about 1 slice of bread, about 1 cup of breakfast cereal, or 1/2 cup of cooked rice, cereal, or pasta.

Vegetables

• Vary your veggies;
• Eat more dark-green veggies like broccoli, spinach, and other dark leafy greens;
• Eat more orange veggies, like carrots and sweet potatoes;
• Eat more dry beans and peas like pinto beans, kidney beans, and lentils.

Fruits

• Focus on fruits;
• Eat a variety of fruit;
• Choose fresh, frozen, canned, or dried fruit;
• Go easy on fruit juices.

Milk

• Consume calcium-rich foods;
• Go low-fat or fat-free when you choose milk, yogurt, and other milk products;
• If you don't or can't consume milk, choose lactose-free products or other calciums sources, such as fortified foods and beverages.

Meats and Beans

• Go lean with protein;
• Choose low-fat or lean meats and poultry;
• Bake it, broil it, or grill it.
• Vary your protein routine; choose more fish, beans, nuts, and seeds

For a 2,000 calorie diet, you need the amounts below from each food group:

Grains:                   Eat 6 oz every day
Veggies:                 Eat 2 1/2 cups every day
Fruits:                    Eat 2 cups every day
Milk:                      Get 3 cups every day; for kids ages 2 to 8 years, 2 cups
Meats and Leans:   Eat 5 1/2 oz every day

Find you balance between food and physical activity

• Be sure to stay within your daily calorie needs;
• Be physically active for at elast 30 minutes most days of the week;
• About 60 minutes a day of physical activity may be needed to prevent weight gain;
• For sustaining weight loss, at least 60 to 90 minutes a day of physical activity may be required;
• Children and teenagers should be physically active for 60 minutes every day, or most days.

Know the limits on fats, sugars, and salt (sodium)

• Make the most of your fat sources from fish, nuts, and vegetable oils;
• Limit solid fats like butter, stick margarine, shortening, and lard, as well as foods that contain these;
• Check the Nutritional Facts label to keep saturated fats, trans fats, and sodium low;
• Choose food and beverages low in added sugars. Added sugars contribute calories with few, if any, nutrients.

Health Nutrition for Pregnant Mother

Healthy Mother

Nutrition During Pregnancy

Calories

• Requirement exceeds pre-pregnancy needs by 300 calories per day (from 2,200 kcal/day to 2,500 kcal/day)
• To support maternal-fetal tissue synthesis;
• To meet increased basal metabolic needs;
• To provide optimal use of protein and tissue growth

Proteins

• Requirement exceeds pre-pregnancy needs by 14 to 16 grams per day (from 44 to 46 g/day to 60 g/day)
• For expansion of blood volume;
• For tissue growth'
• For adequate amino acid intake for fetal development

Fats

• 20% to 35% of woman's daily calorie intake
• Linoleic acid
• Essential for new cell growth;
• Must be supplied by the diet;
• Found in vegetable oils, such as corn, olive, peanut, and safflower oils.

Vitamins

• Intake of all vitamins should be increased
• Necessary for tissue synthesis and energy production;
• Requirements for fat and water soluble vitamins increase
• Intake of varied, healthy diet usually supplies the requirement for all of the vitamins except folic acid;
• Folic acid is particularly important;
• Promotes fetal growth and prevents anemia;
• Intake should be increased from 400 to 800 mcg/day;
• Sources include green, leafy vegetables, eggs, milk, and whole-grain bread.

Minerals

• Intake of all minerals should be increased, including iodine, calcium, phosphorus, and zinc;
• Drinking fluoridated water is important to aid in tooth formation; if fluoridated water is unavaiblable, a fluoride supplement should be prescribed;
• The average American diet does not provide enough iron to prevent iron deficiency anemia; recommended supplemental iron intake is 30 to 60 mg per day.
• Sodium restrictions is no longer advocated because it has been associated with hormonal and biochemical changes;
• The National Research Council (NRC) recommends an increase in daily sodium intake of 69 mg over the normal dietary requirment of 2,400 mg;
• Excessive sodium may lead to hypertension by altering fluid and electrolyte balance.

Developmental Tasks of Pregnancy

Acceptance of Pregnancy

General Characteristics

Depending on the woman's age, tasks may include acceptance and comfort with body image, development, of a personal value system, adjustment to an adult identity, and internalization of sexual role and identity. Other tasks include acceptance of pregnancy's termination at the time of the delivery and the maternal role, and resolution of fears about childbirth and bonding. The woman's partner also achieves these same developmental tasks.

First trimester: Acceptance of the Pregnancy

• Pregnancy confirmation may leave some couples with disbelief, shick, or amazement;
• The woman and her partner must learn to accept the reality of the pregnancy;
• Most couples experience some degree of ambivalence;
• Feeling the fetus move or seeing the fetus on an ultrasound can help the couple achieve acceptance; and
• In accepting the pregnancy, the partner also accepts the woma as she undergoes he changes associated with pregnancy.

Second Trimester: Acceptance of the Baby

• The woman and her partner work to accept the baby;
• Acceptance of the baby refers to acknowledgement that the fetus is a distinct individual, separate from another;
• Feeling the fetus move or hearing its heart beat demonstrates that the fetus is an active being;
• Anticipatory role playing, for example with the woman or partner imagining the type of parent she or he will be, may occur;
• The woman and her partner begin active preparations for the baby; and
• The partner may feel left out with all the information being focused on the woman and fetus; time is needed to ensure that the partner is given the information and support required.

Third Trimester: Preparation for Parenthood

• The couple work on preparing to become parents;
• The couple begin to demonstrate "nesting" behavior, such as preparing the baby's room, shopping for necessary baby items, and discussing names;
• The couple may attend the childbirth education classes; and
• The couple may review relationships with their own parents and engage in role-playing and fantasizing about being a parent.

Common Discomforts During the Second and Third Trimester

Second and Third Trimester Discomforts

The Second and Third Trimester

Heartburn

Causes

• Relaxation of the cardiac sphincter;
• Decreased GI Motility;
• Increased production of progesterone; and
• Gastric displacement

Interventions

• Encourage the woman to eat small, frequent meals spaced throughout the day;
• Caution her to avoid fatty and fried foods and caffeine products;
• Suggest that she remain upright for at least 1 hour after eating; and
• Encourage her to check with her health care provider before using an over-the-counter antacid.

Constipation

Causes

• Oral iron supplements;
• Displacement of the intestines caused by the fetus; and
• Bowel sluggishness caused by increases progesterone and steroid metabolism.

Interventions

• Encourage the woman to engage in moderate daily exercise;
• Advise the increased intake of fluids and foods high in fiber;
• Urge the woman to maintain regular elimination patterns and avoid ignoring the urge to defecate; and
• Caution the woman to avoid the use of mineral oil, which can deplete her level of fat-soluble vitamins.

Hemorrhoids

Causes

• Pressure on the pelvic veins by the enlarging uterus, which interferes with venous circulation; and
• Increased pressure secondary to constipation.

Interventions

• Describe ways to avoid constipation;
• Caution the woman against prolonged standing and wearing constrictive clothing;
• Suggest the use of a topical ointment or anesthetic if allowed;
• Encourage the use of witch hazel compresses;
• Teach the woman how to perform sitz baths or apply warm soaks; and
• Encourage the woman to lie on her left side with her feet slightly elevated.

Backache

Causes

• Postural adjustments of pregnancy secondary to curvature of the lumbosacral vertebrae that increases with uterine enlargement.

Interventions

• Teach the woman  how to use proper body mechanics;
• Encourage the woman to maintain good posture;
• Suggest that she wear low to mid heel shoes;
• Recommend that the woman walk with her pelvis tilted forward;
• Advise the woman to apply local heat to the back if necessary;
• Suggest sleeping on a firmer mattress or using a board under the current mattress to add firmness; and
• Teach the woman how to do pelvic rocking or tilting exercises.

Leg Cramps

Causes

• Pressure from the enlarging uterus;
• Poor blood circulation;
• Fatigue; and
• Balance in the calcium-phosphorus ratio

Interventions

• If necessary, assist the woman with measures to alter calcium and phophorus intake;
• Encourage frequent rest periods with the elgs slightly elevated;
• Encourage her to wear warm clothing; and
• Teach her what to do during a leg cramps by pulling the toes upward the leg while pressing down on the knee.

Shortness of Breath

Causes

• Pressure of the uterus on the diaphram

Interventions

• Encourage the woman to maintain proper posture, especially when standing;
• Suggest that the woman use semi-Fowleer's position when sleeping and use additional pillows for support; and
• Encourage a balance of activity and rest.

Ankle Edema

Causes

• Poor venous return from the lower extremities; aggravated by prolonged sitting or standing and by warm weather; and
• Fluid retention

Interventions

• Recommend that the woman lie on her side in bed to enhance glomerular filtration rate of the kidneys;
• Encourage the woman to avoid wearing tight, constrictive clothing;
• Advise her to elevate her legs during the rest periods;
• Urge her to dorsiflex her feet when standing or sitting for prolonged periods; and
• Suggest that she get up and move every 1 to 2 hours when sitting for long periods.

Common Discomforts During the First Trimester

Discomforts during the First 3 months of Pregnancy

The First Trimester

Nausea and Vomiting

• Called as morning sickness, but it may occur anytime during the day.

Causes

• Hormonal changes;
• Fatigue;
• Emotional factors; and
• Changes in carbohydrates metabolism

Interventions

• Instruct the mother to avoid greasy, highly seasoned foods;
• Encourage her to eat small frequent meals;
• Advise her to eat dry toast or crackers before getting out of bed in the morning; and
• Suggest intake of complex carbohydrates with the onset of nausea.

Nasal Stuffiness, Discharge, or Obstruction

Causes

• Edema of the nasal mucosa from elevated estrogen levels

Interventions

• Encourage the use of a cool-moist humidifier;
• Suggest the use of normal saline nose drops or nasal spray; and
• Advise the mother to apply cool compress to the nasal area.

Breast Enlargement and Tenderness

Causes

• Increased estrogen and progesterone level

Interventions

• Encourage the use of a well-fitting bra with wide shoulder straps for support;
• Reinforce the need for maintaining good posture; and
• Advise the mother to wash her breast and nipple area with water only.

Urinary Frequency and Urgency

Causes

• Pressure of the enlarging uterus on the bladder
• Around the 12th week the  uterus rises into the abdominal cavity, causing symptoms to disappear; and
• Symptoms recur in the thir trimester as the uterus again presses on the bladder.

Interventions

• Suggest to the mother that she decrease her fluid intake in the evening to minimize nocturia (urinary frequency at night times);
• Encourage her to limit the intake of caffeinated beverages;
• Reinforce the need to promptly respond to the urge to void in order to prevent bladder distention and urinary stasis;
• Teach her how to perform Kegel's Exercises; and
• Teach her the signs and symptoms of urinary tract infection and instruct her to promptly report any she experiences.

Increased Leukorrhea (vaginal discharges)

Causes

• Hyperplasia of vaginal mucosa; and
• Increased mucus production by the endocervical glands.

Interventions

• Encourage the mother to bathe daily and avoid using soap on the vulvar area;
• Reinforce the need to wipe from front to back;
• Urger her to wear loose, absorbent cotton underwear and to avoid tight pants and pantyhose;
• Suggest the use of panty liners or perineal pads and frequent changing if discharges is bothersome;
• Caution her to avoid douching; and
• Instruct her to notify the health care provider immediately if the discharge changes in color or odor.

Increased Fatigue

Causes

• The increased effort of the body to manufacture the placenta; and
• The need to adjust to the many other physical and emotional demands of pregnancy.

Interventions

• Encourage frequent rest periods as much as possible;
• Offer suggestions to obtain rest during the day at home or at work;
• Encourage intake of a balanced diet with iron supplements;
• Suggest the use of warm milk or warm shower or bath before going to bed at night to aid in relaxation; and
• Advise engaging in moderate regular exercise.

Normal Signs of Pregnancy

Signs and Symptoms of Pregnancy

Signs and Symptoms of Pregnancy

Presumptive

• Amenorrhes (in about 80% of patients) or slight, painless spotting of unknown cause in early gestation (in about 20% of patients);
• Nausea and vomiting;
• Urinary frequency and urgency;
• Breast enlargement and tenderness;
• Fatigue;
• Quickening (partial fetal movement);
• Thinning and softening of the fingernails; and

Intensified skin pigmentation.

Probable

• Uterine enlargement;
• Goodell's sign (softening of the cervix);

Chadwick's Sign

• Chadwick's sign (bluish mucous membranes of the vagina, cervix and vulva);
• Braxton Hicks contractions (painless uterine contraction that recur throughout pregnancy);
• Ballottement (passive fetal movement in response to tapping of the lower portion of the uterus or cervix);
• Laboratory test results indicating pregnancy;
• Sonogram results showing the characteristics ring of the gestational sac (visible as early as 4 to 6 weeks of gestation); and
• Palpable fetal outline.

Positive

• Fetal heartbeat detected by 17 to 20 weeks of gestation;
• Ultrasonography results as early as 6 weeks of gestation;
• Fetal movements felt by examiner after 16 weeks of gestation; and
• Visualization of fetus and fetal outline.

Normal Pregnancy

Pregnant Mother

Overview of the trimesters of pregnancy

First Trimester (1st - 3rd month)

• Lasts from weeks 1 through 12 and is a critical time in the pregnancy;
• Rapid cell differentiation makes the developing embryo or fetus highly susceptible to the teratogenic effects of viruses, alcohol, cigarettes, caffeine, and other drugs;
• The woman usally experiences physical changes, such as amenorrhes (absence of menstruation), urinary frequency, nausea and vomiting (more severe in the morning or when the stomach is empty), breast swelling and tenderness, fatigue, increased vaginal secretions, and constipation;
• 7 to 10 days after conception, a serum pregnancy test can usaully detect the presence of human chorionic gonadotropin (hCG);
• A pelvic examination, performed 6 to 8 weeks later, shows uterine enlargement, Chadwick's sign, and Hegar's sign.

Second Trimester (4th - 6th month)

• Lasts from weeks 13 through 27;
• Uterine and fetal size increase substantially;
• The woman gains weight, the waistline thickens, and the abdomen enlarges;
• Reddish streaks (striations) may become apparent as abdominal skin stretches;
• Pigment changes may cause skin alterations, such as linea nigra, melasma (mask of pregnancy) and a darkening of the areola of the nipples;
• Other physical changes include diaphoresis (massive perspiration), increased salivation, indigestion, continuing constipation, hemorrhoids, nosebleeds, and some dependent edema;
• The breast become larger and heavier, and about 19 weeks after the last menses they may secrete colostrum.
• By week 20, the fetus is large enough for the mother to feel its movement (quickening).

Third Trimester (7th - 9th month)

• Lasts from weeks 28 through 40;
• The woman experiences Braxton Hicks contractions - sporadic episodes of painless uterine tightening - which help strengthen uterine muscles in preparation for labor;
• Increasing uterine size may displace pelvic and intestinal structures, causing indigestion, protrusion of the umbilicus, shortness of breath and insomnia;
• The woman's center of gravity changes; she may experience backaches beacuse she walks with a swaybacked posture to counteract the frontal weight.