QUESTIONS TO ANSWER ON THE WRITE UP

Explain additional signs and symptoms that might indicate a patient’s nonadherence to recommended lifestyle changes as it relates to the topics your colleagues selected.

Provide alternative treatment and management strategies for patients presenting with signs and symptoms of nonadherence to the recommended lifestyle changes as it relates to the topics your colleagues selected

Week 9 Discussion: Maternal Nutritional Habits

Nutrition during pregnancy plays a big role in proper fetal development and subsequent growth and development (Tahir et al., 2019). In fact, intrauterine nutrition has impacts that can impact lifelong organ structure and function (Tahir et al., 2019). Additionally, a woman’s BMI during pregnancy can have direct impacts on obesity risk in offspring which may manifest early on as macrosomia and large-for-gestational age birth weight (Tahir et al., 2019). For these reasons, it is crucial to identify these patterns as early as possible in order to provide early intervention. For the focus of this discussion, maternal nutrition as it relates to gestational diabetes, hydration, and basic nutrition will be discussed.

Early Signs and Symptoms of Poor Nutrition During Pregnancy

One lifestyle change and important education point for women during pregnancy includes increasing their intake of water. Many women do not take in enough water prior to becoming pregnant and have not established good habits. Too often women overlook this important part of their health and there can be signs and symptoms that occur related to dehydration. One sign that a patient can easily be educated about is paying attention to their urine color, as it has been demonstrated that it is a valid marker of hydration status in pregnant women (Bardosono, Morin, Guelinckx, & Pohan, 2017). Providing a urine color chart as a simple handout is one way to provide a reference for the patient (Bardosono et al., 2017). Each prenatal visit is a great time for education and assessment of each patient for any signs of dehydration or poor nutritional status. This may be evidenced by a patient’s vital signs or inappropriate weight gain. Additionally, we often educate on the importance of resting and drinking water when a woman is having a lot of Braxton Hicks contractions earlier than expected as this can be a sign of dehydration.

During clinical, I have experienced several pregnant patients who have complaints of feeling lightheaded or dizzy, which can be a sign of hypoglycemia. Women in pregnancy may be combating food aversions, nausea, vomiting, and other reasons for poor eating habits. Education regarding the importance of eating small, frequent meals that contain protein is important in order to avoid episodes of hypoglycemia. This is important for any pregnant woman, not just those diagnosed with gestation diabetes or with a previous history of diabetes. Women diagnosed with gestational diabetes need to be even more attentive to their diet. Nutrition therapy continues as the first-line approach to treatment for gestational diabetes mellitus (Hernandez, & Brand-Miller, 2018). The goal of nutrition throughout pregnancy is to support maternal, placental, and fetal metabolic needs to hopefully introduce habits that will lead to a lifetime of healthy eating (Hernandez & Brand-Miller, 2018). Signs and symptoms of women with gestational diabetes not being compliant with the recommended diet include signs of hypoglycemia or hyperglycemia. These can range from dizziness, sweating, tremors, headaches, confusion, extreme thirst, and so forth.

Impact of Nonadherence on Patient and Fetus

Nonadherence to lifestyle recommendations as it relates to obesity and weight in pregnancy can have serious consequences on maternal and fetal health. It can lead to gestational hypertension, preeclampsia, and as discussed above gestational diabetes (Lamminpaa, Vehvilainen-Julkunen, & Schwab, 2018). The risks to the fetus include insulin resistance, hyperlipidemia, large for gestational age birthweight, and future childhood weight issues and obesity (Lamminpaa et al., 2018). In addition, poor maternal nutrition reduces growth of bone and muscle and increases adipose tissue of the fetus (Lamminpaa et al., 2018).

Treatment and Management Strategies

Management of nutrition during pregnancy needs to be approached on an individual basis taking into consideration each patient’s cultural preferences, current risk factors, socioeconomic status, and any other factors that may impact their nutrition. General guidelines for nutrition during pregnancy include a balanced daily diet, avoiding raw fish and undercooked rare steak/hamburger meat, limited caffeine intake, no alcohol, and increased intake of foods that are rich in calcium, omega 3, and iron (Moran-Lev et al., 2019). These are general guidelines, but each patient may present with various signs of nonadherence to recommended nutrition and will require a tailored approach for management. One mother I encountered was anemic and not improving with the prescribed iron, and after some discussion, I learned she had not been taking it for quite some time. It wasn’t that she did not want to, but it made her sick right away and she threw it up. We discussed creative ways to help her tolerate the iron such as taking it with food and prior to bedtime instead of in the morning. This is just one example of why it is important to educate at each appointment. This patient wasn’t trying to be noncompliant but simply couldn’t tolerate her prescribed medicine.

For gestational diabetic patients, education is huge because they are not only trying to understand the changes happening to their body during pregnancy but now they are having to address a new diagnosis that requires careful attention to diet and activity. Providing recommendations on healthy foods and managing gestational diabetes with diet only is first-line treatment, but if this fails the introduction of oral antidiabetic agents may be necessary and potentially even insulin. Providing patients with information regarding signs and symptoms of hypoglycemia and hyperglycemia is key to ensuring they seek medical attention when necessary. It’s also important, as mentioned above, to emphasize proper water intake. Recommending a tracking system or a way to become more aware of how much water is being consumed daily can help increase water intake.

Resources

Bardosono, S., Morin, C., Guelinckx, I., & Pohan, R. (2017). Pregnant and breastfeeding women: Drinking for two? Annals of Nutrition & Metabolism, 70 Suppl 1, 13–17. https://doi-org.ezp.waldenulibrary.org/10.1159/000462998

Hernandez, T. L., & Brand-Miller, J. C. (2018). Nutrition therapy in gestational diabetes mellitus: Time to move forward. Diabetes Care, 41(7), 1343–1345. https://doi-org.ezp.waldenulibrary.org/10.2337/dci18-0014

Lamminpaa, R., Vehvilainen-Julkunen, K., & Schwab, U. (2018). A systematic review of dietary interventions for gestational weight gain and gestational diabetes in overweight and obese pregnant women. European Journal of Nutrition, 57(5), 1721–1736. https://doi-org.ezp.waldenulibrary.org/10.1007/s00394-017-1567-z

Moran-Lev, H., Bauer, S., Farhi, A., Nehama, H., Yerushalmy-Feler, A., Mandel, D., & Lubetzky, R. (2019). Nutrition and the use of supplements in women during pregnancy: A cross-sectional survey. Food and Nutrition Bulletin, 40(2), 231–240. https://doi-org.ezp.waldenulibrary.org/10.1177/0379572119833857

Pillai, S. M., Sereda, N. H., Hoffman, M. L., Valley, E. V., Crenshaw, T. D., Park, Y.-K., … Govoni, K. E. (2016). Effects of poor maternal nutrition during gestation on bone development and mesenchymal stem cell activity in offspring. Plos One, 11(12), e0168382. https://doi-org.ezp.waldenulibrary.org/10.1371/journal.pone.016838

Tahir, M. J., Haapala, J. L., Foster, L. P., Duncan, K. M., Teague, A. M., Kharbanda, E. O., … Demerath, E. W. (2019). Higher maternal diet quality during pregnancy and lactation is associated with lower infant weight-for-length, body fat percent, and fat mass in early postnatal life. Nutrients, 11(3). https://doi-org.ezp.waldenulibrary.org/10.3390/nu11030632