It is important for a pregnant woman to understand the nutritional requirements for the proper development of the fetus and in order to maintain maternal health. Several changes to the diet are required so that all the nutritional needs of the developing fetus are met and food deficiencies do not compromise the health of the mother and the fetus. But just as undernourishment is harmful, overweight and obesity during pregnancy have to be avoided. Consumption of foods from all the five groups has to be ensured. Intake of Calcium, Iron and Folate and Zinc are important to meet the developmental needs of the fetus. Weight gain through the duration of the pregnancy should be gradual and consistent. Undue increase in weight can occur if high calorie foods containing saturated fats and sugar are consumed. Junk foods that are high in added salt have to be avoided too. Counselling of pregnant mothers through short lessons on nutrition is an effective method for disseminating information and answering questions about nutrition that expectant mothers might have.
The aim of the lesson is to educate expectant mothers in Australia about the importance of taking a balanced diet and ensuring that their own nutritional needs and the nutritional requirements of the fetus are met.
As a result of attending the lesson the participants will be able to
- explain the importance of consumption of fruits and vegetables
- describe how important it is to consume dairy and proteins
- enlist the foods that contain grains
- express the importance of drinking water
- identify foods that may contain excess salt, sugar or saturated fats or bacterial pathogens.
It is important for expectant mothers to take a balanced diet for the proper development of the fetus. On the one hand food must be rich in nutrients like folate, iron and vitamins and on the other consumption of excess calorie rich foods can cause gestational weight gain (Bookari, Yeatman, & Williamson, 2016). An assessment of the knowledge and adherence to guidelines on diet yielded results that were not satisfactory. Although pregnant women were highly motivated and understood the importance of nutrition, their adherence to proper nutrition was poor (Bookari, Yeatman, & Williamson, 2017). The information about the necessity to meet the dietary recommendations of micronutrients like iodine was found to be inadequate. The health professionals require more training in how to to counsel pregnant women about meeting dietary recommendations (Lucas, Charlton, Brown, Brock, & Cummins, 2014). The importance of nutrition education programs has been felt across population subgroups and expectant mothers form an important subgroup (Hendrie, Coveney, & Cox, 2008). The unmet need of balance between nutrition and physical activity during pregnancy can cause overweight and obesity. It has been found that only 50% of pregnant women receive counselling on nutrition causing low consumption of fruit and higher consumption of sugar containing soft drinks and unhealthy take-away meals (de Jersey, Nicholson, Callaway, & Daniels, 2013).
It is important that when a brochure on nutrition is given to the client, instructions about how to refer to the information should be a part of the counselling by the midwife. If the brochure is handed over and not referred to during the counselling it is very unlikely that the client will follow the instructions printed in the brochure (Geraghty, Lindsay, Alberdi, McAuliffe, & Gibney, 2015). Among pregnant adolescents the knowledge about healthy eating is there but they find it difficult to give up unhealthy foods. If they are trained in the company of other adolescents as their peers to choose better foods, given lessons in cooking and choosing affordble and healthy foods, they are more likely to adhere to advice about nutrition (Wise, 2015).
The major nutritional requirements during pregnancy can be met by consumption of vegetables and legumes. A variety of vegetables of different colours should form part of the diet. More than 7 servings of fruit a day should be part of the dietary intake. Grain (preferably whole) is a source of energy and can be obtained from cereals, polenta, pasta, rice, pasta or noodles. Lean meat, such as, poultry or tofu and beans/legumes are good sources of nutritional protein. An adequate intake of dairy products that include milk, yoghurt or cheese also ensures optimal health of pregnant mothers and the fetus. Drinking plenty of water is necessary.
It is recommended that expectant mothers should reduce the intake of saturated fats, added sugar and salt. Foods that can contain these ingredients are chips, biscuits, processed meats, cakes, pies and pastries. It is a healthy practice to avoid popular junk food, such as, pizzas and burgers crisps, potato chips and fried and savoury packaged snacks. Rather than consuming saturated fats it is better to consume mono- and poly-unsaturated fats that can be obtained from nuts, sedds, nut butters, avocados and olives. It is important to red food labels carefully and avoid buying and consuming foods that have higher salt content. With careful selection it is possible to buy foods that have lower concentration of salt. Several categories of drinks contain high amounts of added sugar. These include soft drinks, fruit juices, energy and sports drinks, confectionary and compotes - these drinks are best avoided because they provide hardly any nutritional benefits but add a lot of calorie count to one's intake. It is important for pregnant women to avoid alcohol altogether.
Important guidelines also address the issue of food safety, since pregnant women are at a higher risk of food poisoning, they should avoid consumption of food that is likely to contain pathogens. Bean sprouts should be consumed only after thorough cooking, sandwich meats and soft cheeses like feta and camembert are best not consumed. Raw eggs or half-cooked eggs may be contaminated with Salmonella. Several varieties of fish may be contaminated with mercury and may be consumed in small quantities once a week or once a fortnight only. Hard cheeses can be safely consumed. It is important to ensure intake of fibre through the consumption of fruits and vegetables to prevent constipation, a common occurrence during pregnancy (/n55h_healthy_eating_during_pregnancy.pdf, 2013).
The use of various kinds of teaching aids that may be visual or audio-visual are necessary because these form concrete experiences that accelerate learning and are likely to be retained by the learner for a longer period.
The use of audio-visual aids in the dissemintion of nutrition information to pregnant women can be effective. Rather than using abstarct imagination concrete perceptual images deliver the message more effectively. Teaching aids can include power point presentations with pictures. Videos can be embedded in the presentation or shown separately. Flip charts, black boards, white boards, flash cards, posters and bulletin boards can be used as visual teaching aids. Paper handouts, brochures, pamphlets and flash cards can be used to disseminate information. Projector slides or transparencies can also be used effectively as visual aids (Weiss, et al., 2016).
Title of lesson: Nutrition in pregnancy
The lesson will last for 15 minutes and shall consist of the following:
-welcoming the participants of the program followed by an overview of the nutrition information session.
- the participants will introduce each other and name one healthy favourite food
- a video titiled 'healthy pregnancy diet' will be played for the participants
- participants will be encouraged to ask questions about diet and nutrition
-participants will be engaged in a role play where a conversation between the doctor and the mother will be enacted on why calcium, iron and folate are important in the diet of a pregnant woman.
-comments will be invited
- after a discussion on the comments handouts of the Australian Guidelines on healthy eating during pregnancy will be distributed
-participants will be asked for a verbal and written feedback on the session and any questions about the nutrition of pregnant women will be answered.
- Participants will be thanked for attending the session.
-Improvements if suggested by the participants will be incorporated in future sessions.
In conclusion, the dissemination of important information through a guided lesson in a group can answer the questions that expectant mothers may have. A group lesson promotes the exchange of ideas amongst the prticipants. Adherence to nutritional guidelines is more likely once the various aspects of the five food groups are discussed. Dissipation of information through an audio visual aid such as a video lasts longer in the memory of the participants of the program. The five important groups of food- vegetables, beans, fruits, protein, eggs, fatty fish, whole grains and water ensure that the bioavilability of vitamins and minerals is maintained in the diet. Aspects of food safety, such as, staying away from mercury containing sea-food, identifying foods like raw eggs and sprouts that may harbour bacteria are importnt precautions to be kept in mind by the pregnant women. A diet rich in fibre can prevent constipation. A lesson plan and a discussion are effective means of counselling pregnant women about dietary precautions to be followed.
/n55h_healthy_eating_during_pregnancy.pdf. (2013). Retrieved from https://www.eatforhealth.gov.au: https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n55h_healthy_eating_during_pregnancy.pdf
Bookari, K., Yeatman, H., & Williamson, M. (2016). Exploring Australian women’s level of nutrition knowledge during pregnancy: a cross-sectional study. International Journal of Women's Health, 8: 405–419.
Bookari, K., Yeatman, H., & Williamson, M. (2017). Falling short of dietary guidelines - What do Australian pregnant women really know? A cross sectional study. Women Birth, 30(1):9-17.
de Jersey, S., Nicholson, J., Callaway, L., & Daniels, L. (2013). An observational study of nutrition and physical activity behaviours, knowledge, and advice in pregnancy. BMC Pregnancy and Child Birth, 13:115.
Geraghty, A., Lindsay, K., Alberdi, G., McAuliffe, F., & Gibney, E. (2015). Written nutrition communication in midwifery practice: what purpose does it serve? Nutrition and Metabolic Insights, 8(Suppl 1): 41–47.
Hendrie, G., Coveney, J., & Cox, D. (2008). Exploring nutrition knowledge and the demographic variation in knowledge levels in an Australian community sample. Public Health Nutrition, 11(12):1365-71.
Lucas, C., Charlton, K., Brown, L., Brock, E., & Cummins, L. (2014). Antenatal shared care: are pregnant women being adequately informed about iodine and nutritional supplementation? The Australian and New Zealand Journal of Obstetrics and Gynaecology, 54(6):515-21. .
Weiss, I., Stepanovic, S., Chinyemba, U., Bateman, J., Hemminger, C., & Burrows, E. (2016). Use of a Nutrition Behavior Change Counseling Tool: Lessons from a Rapid Qualitative Assessment in Eastern Zambia. Frontiers in Public Health, 4:179.
Wise, N. (2015). Pregnant Adolescents, Beliefs About Healthy Eating, Factors that Influence Food Choices, and Nutrition Education Preferences. Journal of Midwifery aand Women's Health, 60(4):410-8.
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