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Nutrition For Pregnancy and Lactation, Fourth Edition
C. M. Bareuther, RD

C211 15 CPEUs HARD COPY REPLACED WITH C269
C211E 15 CPEUs ELECTRONIC REPLACED WITH C269


This up-to-date comprehensive manual (166 pgs) will enable you to:

  • utilize a five part nutritional assessment process
  • plan effective nutritional intervention strategies
  • recognize the physiological changes in pregnancy and how they affect nutritional
  • needs and feeding strategies
  • identify how alcohol, artificial sweeteners, caffeine, contaminants, nicotine and drugs affect nutritional intake and maternal-fetal health during pregnancy and lactation
  • relate how exercise influences prenatal nutritional needs and postnatal lactation
  • define gestational diabetes and pregnancy-induced hypertension, and identify nutritional intervention in these disorders
  • learn about special needs of teens, multifetal pregnancies, vegetarians and mothers who have diabetes, hypertension, allergies and HIV
  • formulate safe and effective nutrition intervention for weight reduction postpartum, for lactating and non-lactating women

For more information and customer comments, click here.

Approved by CDR, CBDM

For RDs & DTRs: Suggested Learning Need Codes for the Prof. Dev. Portfolio:
3000, 3010, 3020, 3030, 3040, 3090, 3100, 4000, 4040, 4090, 4120, 4130, 4140, 4180, 5000, 5090, 5190, 5200, 5260, 5310, 5350, 5370, 5420, 8010, 8080

NUTRITION FOR PREGNANCY AND LACTATION
Fourth Edition

Carol M. Bareuther, RD

Copyright 2011 Wolf Rinke Associates, Inc. All rights reserved for this self-directed, accredited learning program. Reproduction in whole or part without written permission from the publisher is prohibited.

CUSTOMER COMMENTS

Melissa Hemond: "I wish I had read this before I had my twins! There was info here I didn't find elsewhere. A great resource and help for next time and to assist friends, family and clients."

Laurie Wasserman: "Informative, interesting material. Moderate cost. Clear precise instructions."

Perbhjot Sran, MA, RD: "Very organized and user friendly."

Randi Freedman: ". . . easily understandable information- very useful in my practice."

Michelle Landry: "I like the questions being practical case study."

Stephanie Collins: "Exercises to practice skills."

Beth Yuro: "The tables were included throughout the chapters. They were informative and easy to follow."

Laura Gomez-Vega: "Deep and actualized information."

Brenda Tucker: "Excellently organized, very current information and a quick and easy reference tool."

Anna Petrov, RD: "Concise, to the point, no "fluff" to wade through."

Melissa Wiles, RD: "I've been a WIC nutritionist. This should be required reading to have that job. Wonderful!"

Amelia Murphy Bell: "Peer-reviewed course. Well referenced text. Questions dove-tailed with the course book well."

Marilyn Musgrave, MS RD LD: "This was an especially good product for anyone working for WIC, especially those just beginning work for WIC. All topics addressed. Fit right into what WIC does for pregnant women.

OVERVIEW AND INSTRUCTIONS

Conception, pregnancy and lactation are a normal part of a woman's life cycle that uniquely leads to the creation of another human being. In this way, a woman's health is intimately linked to the health and well-being of future generations. Preconceptional nutritional status and adequate nutrient intake during pregnancy are key factors to a successful birth outcome. Data from the USDA's Special Supplementary Nutrition Program for Women, Infants and Children (WIC) aptly illustrate this point. Program participation is associated with higher dietary intakes of energy, protein, iron, calcium, magnesium and vitamins C, B6, B12, thiamin, riboflavin and niacin. More specifically, WIC enrollment has been found to increase birthweight from 51 to 117 grams (gms), reduce rates of low and very low birthweight (infant birthweight less than 2,500 gms and 1,500 gms, respectively), and reduce the rate of preterm birth (birth before 36 weeks gestation) (Devaney, 2007). Furthermore, supplemental foods provided to WIC participants who exclusively breastfeed their infants have also been found to be cost saving both in formula non-expenditures and infant health care costs. Thus, the nutrition professional plays an essential role in the health and well-being of both mother and infant.
Chapter I discusses the current status of today's woman's nutritional health. Information continues with a discussion of dietary factors that can affect fertility. A framework for preconceptional care is provided.
Chapter II reviews the five-part nutritional assessment process in the context of pregnancy.
In Chapter III, discussion begins with the physiology of pregnancy, followed by an explanation of specific nutrient needs and ways to fulfill these needs. This theoretical information is presented in the form of a prenatal meal plan. Guidance is given for variations in this plan, such as vegetarian food choices, lactose intolerance, adolescence, multifetal pregnancy and food safety. The chapter concludes by focusing on feeding problems such as hyperemesis, heartburn, pica and constipation; lifestyle concerns like the use of artificial sweeteners, nicotine, caffeine and alcohol during pregnancy; and the nutritional management of diabetes, hypertension and eating disorders during pregnancy.
Chapter IV progresses into the topic of lactation with a review of the status of breastfeeding initiation and benefits of breastfeeding for mother and infant. As with pregnancy, specific nutrient needs during lactation are discussed, followed by suggestions for implementation in the form of a general meal plan and advice on variations to this basic plan. Discussion then addresses lifestyle concerns that can affect the lactation process as well as the health of mother and infant.
Chapter V concludes with the topic of weight management for lactating and nonlactating women.
A case study provides the opportunity to apply the overall information gained to life situations and is included after the final chapter.
This learning program is a Level 2 Continuing Professional Education (CPE) program approved for 15 CPE units (CPEUs). Level 2 means that you have general knowledge of the literature and professional practice in the areas covered. The focus of the program is to enhance knowledge and application.
To get the most benefit from this program, we suggest you adhere to the following four steps:

Step 1: Review the objectives for the learning program.
Step 2: Study each chapter. As you read, think of patients from your own practice that fit the situation described.
Step 3: Assess what you have learned by completing the self-assessment instrument at the end of this learning program.
Step 4: Compare your answers to the answer key that has been provided. If you score at least 80 percent correct, you are ready to transfer your answers to the CONTINUING PROFESSIONAL EDUCATION REPORTING FORM. If you scored less than 80 percent correct, re-read this learning program until you score at least 80 percent correct.

After you have successfully completed the program, complete the CPEU REPORTING FORM and
Mail to: Wolf Rinke Associates, Inc., 13621 Gilbride Lane, Clarksville, MD 21029,
Or fax to: (410) 531-9282,
Or submit on-line at www.easyCPEcredits.com.

We will e-mail your Certificate of Completion.
When you submit your CPEU Reporting Form to us via mail, fax or www.easyCPEcredits.com, be sure to write your correct email address in the space provided on the CPE Reporting Form. If writing by hand, be sure to print your e-mail address clearly.

To ensure that our e-mails are delivered to your inbox (instead of your junk/spam folders), please add cpesupport@wolfrinke.com to your Address Book or Safe List of allowed email senders. Also, be sure to allow attachments from this email address.

HAPPY LEARNING!

Carol M. Bareuther, RD

OBJECTIVES

Upon completion of this accredited, self-directed learning program, you should be able to:

  • Recognize the link between past and present nutritional status, and its effect on conception, maternal health, fetal growth and a successful birth outcome.
  • Identify nutritional, non-nutritional and lifestyle factors that affect fertility.
  • Describe the relationship and importance of preconceptional and prenatal folic acid supplementation to the prevention of neural tube defects in infants.
  • Specify two key teaching frameworks for preconceptional, prenatal and postnatal nutrition counseling.
  • Recognize the five parts of the nutritional assessment process and understand their usefulness in planning nutritional intervention preconceptionally, prenatally, and postnatally.
  • Calculate BMI and relate this figure to recommended weight gain during gestation for single, twin and multifetal pregnancies.
  • Plot prenatal weight gain and assess the adequacy of the rate and total amount of weight gain.
  • Identify anemia in pregnancy, its definition, evaluation and dietary intervention.
  • Define the physiological changes that occur in pregnancy and lactation.
    Interpret the nutritional needs of pregnancy and lactation as defined by the RDA into meal plans.
  • Relate the nutritional needs of pregnancy to a vegetarian eating style.
  • Define the nutritional, emotional and educational needs of pregnant teens.
  • Identify food assistance programs that can benefit pregnant and lactating women.
  • List situations when a vitamin-mineral supplement may be appropriate
    preconceptionally, prenatally and postnatally.
  • Recognize how alcohol, artificial sweeteners, caffeine, contaminants, nicotine and drugs affect nutritional intake and maternal-fetal health during pregnancy and lactation.
  • Relate how exercise influences prenatal nutritional needs and postnatal lactation success.
  • Define gestational diabetes and pregnancy-induced hypertension, and identify nutritional intervention in these disorders.
  • Specify breastfeeding benefits for both mother and infant.
  • Identify nutrient needs during lactation and ways women can consume them in regular and vegetarian meal plans.
  • Recognize the issues surrounding infant allergy and mother's diet in lactation.
  • Specify current policy regarding breastfeeding and HIV-1 infection.
  • Formulate safe and effective nutrition intervention for weight reduction postpartum, for lactating and nonlactating women.

TABLE OF CONTENTS

CHAPTER I: NUTRITION AND FERTILITY 1
A. Food and Nutrient Consumption Trends In Women 1
B. Effects of Undernutrition, Overnutrition and Diet Composition on Fertility 2
C. Oral Contraceptives' Effect On Nutrient Status 5
D. Preconceptional Nutritional Care 6
CHAPTER II: NUTRITION ASSESSMENT IN PREGNANCY 10
A. Medical, Social and Diet Histories 10
B. Anthropometrics 11
C. Biochemical Measurements 17
D. Clinical Evaluation 20
E. Drug Review 21
CHAPTER III: NUTRITION FOR PREGNANCY 22
A. Physiology of Pregnancy 22
1. Blood Volume and Composition 22
2. Gastrointestinal System 22
3. Renal Function 23
4. Cardiovascular and Respiratory Systems 23
5. Placenta 24
B. Nutrient Needs 24
1. Calories 24
2. Protein 26
3. Fat 27
4. Vitamins and Minerals 28
C. Feeding the Prenatal Woman 35
1. Prenatal Meal Plan 35
a. Implementation 36
b. Variations 39
i. Vegetarian diets 39
ii. Lactose Intolerance 41
iii. Obesity 44
iv. Adolescence 44
v. Multifetal Needs 45
vi. Food Safety 45
c. Supplementation 46
2. Feeding Concerns 48
a. Nausea 48
b. Cravings and Pica 51
c. Gastroesophageal Reflux (Heartburn) 52
d. Constipation 53
e. Exercise 54
3. Substances of Concern During Pregnancy 55
a. Alcohol 55
b. Artificial Sweeteners 57
c. Caffeine and Herbal Teas 58
d. Contaminants 61
e. Nicotine 63
f. Recreational Drugs 64
D. Medical-Nutritional Concerns Of Pregnancy 65
1. Diabetes Mellitus 65
2. Pregnancy-Induced Hypertension 67
3. Eating Disorders 69
CHAPTER IV: NUTRITION FOR LACTATION 71
A. Incidence, Benefits and Promotion of Breastfeeding 71
B. Physiology of Lactation 73
C. Nutrient Needs 75
1. Calories 75
2. Protein 76
3. Fats 77
4. Vitamins and Minerals 78
5. Fluids 79
D. Feeding the Lactating Woman 80
1. Lactation Meal Plan 80
a. Implementation 82
b. Variations 83
i. Vegetarian Diets 83
ii. Infant Allergy and Intolerance in Breastfeeding 84
iii. Multifetal Needs 85
c. Supplementation 85
2. Special Concerns During Breastfeeding 86
a. Alcohol 87
b. Caffeine 88
c. Contaminants 88
d. Drugs 89
e. Exercise 92
f. HIV and Hepatitis Infection 93
g. Nicotine 94
CHAPTER V: WEIGHT REDUCTION IN THE POSTPARTUM PERIOD 96
A. During Lactation 97
B. NonLactation 98
CASE STUDY 100
APPENDIX A: MyPyramid 105
APPENDIX B: MyPyramid for Pregnancy and Breastfeeding 109
APPENDIX C: Prenatal Weight Gain Grids for Underweight, Normal Weight, Overweight and Obese Women 113
Pre-pregnancy Underweight Women 114
Pre-pregnancy Normal Weight Women 115
Pre-pregnancy Overweight Women 116
Pre-pregnancy Obese Women 117
REFERENCES 118
FOR YOUR CONTINUING LEARNING 142
RESOURCES 143
LIST OF ABBREVIATIONS 147
GLOSSARY 148
SELF-ASSESSMENT QUESTIONS 149
ANSWER KEY 160
ABOUT THE AUTHOR 165
ABOUT WOLF RINKE ASSOCIATES INC. 166

ABOUT THE AUTHOR

Carol M. Bareuther is a registered dietitian and member of the Women and Reproductive Nutrition Practice Group. A New Jersey native, she holds a bachelor of science degree in dietetics from Marshall University, Huntington, WV, and completed a dietetic internship at the University of Kentucky Medical Center, Lexington, KY. She completed post-graduate training in nutrition at the University of Kentucky and Drexel University in Philadelphia, PA.
Bareuther started her career as a pediatric-obstetric dietitian at the University of Kentucky Medical Center. Subsequently, she worked as a clinical dietitian at the Hospital University of Pennsylvania, Philadelphia, PA; as therapeutic dietitian at the Roy L. Schneider Community Hospital, St. Thomas, U.S. Virgin Islands; and currently as a nutritionist for the Virgin Islands Special Supplementary Nutrition Program for Women, Infants and Children (WIC). She has authored American Dietetic Association-approved, self-directed, accredited learning programs, Nutrition for Infants and Children, and Nutrition Therapy for Children with Attention Deficit Hyperactivity Disorder, published by Wolf Rinke Associates, Inc.
Bareuther works part-time as a freelance writer and has contributed food and nutrition articles to national publications such as Cooking Light, Vegetarian Gourmet, Deli Business, Produce Business, Food Distribution Magazine, Veggie Life, HeartCorps, Cruising World, Best Recipes, Vegetarian Journal, Fancy Food, Chefs, Caribbean Travel & Life, Latitudes South, and Pillsbury's Fast and Healthy Magazine. From 1995 to 1999, Bareuther was the syndicated columnist for Copley News Services' Kitchen Kids.
An author as well as a journalist, Bareuther has published two books, Virgin Islands Cooking and Sports Fishing in the Virgin Islands. She has co-authored Slim-To-Shore with Jan Robinson and Native Recipes, produced by the University of the Virgin Islands Cooperative Extension Service.
Since 1996 she has co-hosted "Nutrition In Good Taste," a weekday radio nutrition program on WVWI AM 1000, which airs throughout the eastern Caribbean. Since 2000, Bareuther has co-hosted "Shape Up Virgin Islands," a monthly half-hour PBS TV program that seeks to show culturally relevant ways to prepare healthful foods and incorporate physical activity.
Bareuther is the mother of two children and, in her spare time, enjoys cooking with her children, swimming, hiking and reading.

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