Prenatal Care & Maternal Nutrition - Concept Map
Quality Prenatal (Antenatal) Care and Maternal Nutrition for Safe Pregnancy Outcomes
Related concepts
Goals and Schedule of Antenatal Care
Sub concepts
- DOH minimum 4 ANC visits
- WHO 2016 model: 8 contacts
- Visit frequency schedule (every 4 weeks until 28 weeks, every 2 weeks 28-36 weeks, weekly after 36 weeks)
- First (booking) visit comprehensive assessment
- Every-visit ongoing assessments
- High-risk pregnancy monitoring
Relationship to central
Foundational framework for organizing prenatal interventions
First (Booking) Visit Assessment
Sub concepts
- Full menstrual history
- GTPAL obstetric history
- Medical and family history
- Social risk screening
- EDD calculation by Naegele's rule
- Complete physical examination
- Pelvic examination
- Baseline laboratory work (blood type, Rh, CBC, glucose, urinalysis, VDRL, HIV, HBsAg)
- Rh-negative identification and anti-D planning
Relationship to central
Comprehensive baseline data collection for risk stratification
Every-Visit Ongoing Assessments
Sub concepts
- Weight measurement and trend analysis
- Blood pressure monitoring (screen for hypertension)
- Urine dipstick (protein and glucose detection)
- Fundal height measurement and tracking
- Fetal heart rate auscultation (normal 110-160 bpm)
- Leopold's manoeuvres for fetal position
- Fetal movement counts (kick counts)
- Danger signs review and reinforcement
Relationship to central
Continuous monitoring for maternal-fetal well-being and early problem detection
Tetanus Immunisation (Td Schedule)
Sub concepts
- Td1: first visit, early pregnancy
- Td2: ≥4 weeks after Td1, ≥2 weeks before delivery (protects newborn)
- Td3: ≥6 months after Td2
- Td4: ≥1 year after Td3
- Td5: ≥1 year after Td4 (lifetime protection)
- Child Protected at Birth (CPAB) concept
- Administration: 0.5 mL IM (deltoid muscle)
- Duration of neonatal protection
Relationship to central
Prevention of maternal and neonatal tetanus through immunisation
Iron and Folic Acid Supplementation
Sub concepts
- Recommended dose: 60 mg elemental iron + 400 mcg folic acid daily
- Timing: throughout pregnancy and postpartum
- Iron functions: prevention and treatment of anaemia
- Folic acid functions: neural tube defect prevention, RBC formation
- Pre-conception folic acid initiation
- Absorption enhancement (vitamin C, empty stomach)
- Absorption inhibitors (milk, tea, coffee, antacids)
- Expected side effects (dark/black stools, constipation)
- Management of GI side effects
- Adherence counselling and troubleshooting
Relationship to central
Prevention of anaemia and neural tube defects
Other Essential Micronutrient Supplements
Sub concepts
- Calcium supplementation (fetal skeleton development, pre-eclampsia reduction)
- Iodine (fetal brain development, iodised salt via ASIN Law RA 8172)
- Vitamin A (needed for development; avoid megadoses and isotretinoin as teratogenic)
- Dietary sources versus supplementation
- Safe supplementation levels
Relationship to central
Support for fetal development and maternal health
Maternal Weight Gain and Nutritional Requirements
Sub concepts
- Recommended total weight gain by pre-pregnancy BMI (IOM guidance)
- Underweight: 12.5-18 kg
- Normal weight: 11.5-16 kg
- Overweight: 7-11.5 kg
- Obese: 5-9 kg
- Pattern of gain (minimal 1st trimester, ~0.4 kg/week 2nd-3rd trimester)
- Excessive gain with oedema as pre-eclampsia indicator
- Extra energy needs: +340 kcal 2nd trimester, +450 kcal 3rd trimester
- Protein requirements: +25 g/day for fetal and placental growth
- Carbohydrate adequacy for protein sparing and ketosis prevention
Relationship to central
Optimize fetal growth and maternal-fetal health
Key Micronutrients and Food Sources
Sub concepts
- Iron sources (meat, fish, dark leafy greens, malunggay, dried beans)
- Folate sources (dark green vegetables, legumes, fortified grains, citrus)
- Calcium sources (milk, small fish with bones, dilis, tofu, dark greens)
- Iodine sources (iodised salt, seafood)
- Vitamin C sources (citrus, guava, tomatoes) for iron absorption
- Malunggay as iron and vitamin-rich food supporting lactation
- Locally available, affordable, culturally acceptable foods
- Dried beans and monggo as protein and legume sources
Relationship to central
Evidence-based nutritional counselling using culturally appropriate Filipino foods
Foods and Substances to Limit or Avoid
Sub concepts
- Alcohol: no safe amount (fetal alcohol syndrome risk)
- Smoking and secondhand smoke (low birth weight, prematurity)
- Caffeine: limit to ≤200 mg/day (~1-2 cups coffee)
- High-mercury fish (methylmercury toxicity)
- Raw or undercooked meat, fish, and eggs (Listeria, Toxoplasma)
- Unpasteurised dairy products (Listeria risk)
- Unapproved medications, herbal products, supplements
Relationship to central
Prevention of teratogenic and infectious risks to fetus
Management of Common Pregnancy-Related Nutrition Issues
Sub concepts
- Nausea management (small frequent meals, dry crackers, odour avoidance)
- Constipation management (fibre, fluids, activity; worsened by iron)
- Pica assessment and counselling (may indicate iron deficiency)
- Adolescent pregnancy nutrition (higher needs, extra support)
- Closely spaced pregnancies (nutritional depletion concerns)
Relationship to central
Practical strategies for maternal comfort and adequate nutrition
Health Teaching Across Pregnancy
Sub concepts
- Danger signs recognition and reporting (bleeding, fluid leakage, severe headache, visual changes, facial/hand swelling, epigastric pain, fever, dysuria, decreased fetal movement, preterm contractions, convulsions)
- Activity and rest recommendations (moderate exercise, left-lateral rest, avoid overheating)
- Sexuality in normal pregnancy (avoid if bleeding, ruptured membranes, preterm labour risk)
- Substance and medication safety (verify all medicines)
- Immunisation safety (inactivated flu vaccine safe; live vaccines MMR, varicella contraindicated)
- Preparation for birth and newborn care (birth plan, breastfeeding intent, newborn care knowledge)
- Oral health during pregnancy (safe and important)
- Seatbelt use in pregnancy (lap belt below belly, shoulder strap between breasts)
Relationship to central
Comprehensive maternal education for safe pregnancy, birth, and newborn transition
Common Problems Screened in Prenatal Care
Sub concepts
- Anaemia (Hgb screening at booking and 3rd trimester, iron-folic acid management)
- Gestational hypertension and pre-eclampsia (BP, proteinuria, oedema screening)
- Gestational diabetes (screening 24-28 weeks, diet and insulin management)
- Infections (asymptomatic bacteriuria, UTI, syphilis, HIV, Hepatitis B screening and prophylaxis)
- Rh incompatibility (anti-D immunoglobulin for prevention)
- Abnormal fetal growth and lie (fundal height, Leopold's manoeuvres, ultrasound referral)
Relationship to central
Early detection and management of conditions threatening mother and fetus
Nursing Role and Health-Teaching Priorities
Sub concepts
- Building rapport and continuity of care
- Supplement adherence reinforcement and troubleshooting
- Danger-sign recognition teaching at every visit
- Addressing social determinants (nutrition on budget, safe home, IPV screening, support systems)
- Referral to social services and DOH programs
- Preparation for facility-based delivery
- Alignment with DOH maternal and newborn health programs
- Documentation and RA 9173 professional standards
Relationship to central
Professional nursing practice in antenatal care delivery
Concept connections
- Goals and Schedule of Antenatal CareFirst (Booking) Visit AssessmentBooking visit is the foundation establishing the baseline for subsequent visits; comprehensive history and labs determine risk stratification
- First (Booking) Visit AssessmentEvery-Visit Ongoing AssessmentsBaseline data from booking visit provides comparison point for ongoing assessments; abnormalities detected at follow-up visits are compared to booking baseline
- Every-Visit Ongoing AssessmentsCommon Problems Screened in Prenatal CareEach component of ongoing assessment (BP, urine, weight) screens for specific complications like pre-eclampsia, gestational diabetes, and anaemia
- Tetanus Immunisation (Td Schedule)Goals and Schedule of Antenatal CareTd immunisation is integrated into the antenatal care schedule; timing of Td doses is coordinated with pregnancy weeks and delivery preparation
- Iron and Folic Acid SupplementationMaternal Weight Gain and Nutritional RequirementsIron-folic acid supplements are part of comprehensive maternal nutrition; supplementation supports adequate weight gain and fetal development
- Iron and Folic Acid SupplementationCommon Problems Screened in Prenatal CareSupplementation addresses anaemia prevention; haemoglobin monitoring at booking and third trimester assesses effectiveness of iron-folic acid therapy
- Other Essential Micronutrient SupplementsMaternal Weight Gain and Nutritional RequirementsCalcium, iodine, and vitamin A supplements support specific aspects of fetal development and maternal health; integrated into overall nutritional plan
- Key Micronutrients and Food SourcesMaternal Weight Gain and Nutritional RequirementsFood sources provide the micronutrients needed for fetal growth and maternal health; dietary counselling complements supplementation
- Foods and Substances to Limit or AvoidHealth Teaching Across PregnancyAvoidance of teratogenic substances and unsafe foods is a critical health-teaching priority; reinforced at every visit
- Management of Common Pregnancy-Related Nutrition IssuesMaternal Weight Gain and Nutritional RequirementsManaging nausea, constipation, and pica ensures mother maintains adequate nutrition and appropriate weight gain despite pregnancy symptoms
- Health Teaching Across PregnancyNursing Role and Health-Teaching PrioritiesHealth teaching is a core nursing responsibility; repetition of danger signs and nutrition teaching at every contact is the nurse's primary intervention
- Common Problems Screened in Prenatal CareHealth Teaching Across PregnancyHealth teaching addresses prevention and early recognition of screened conditions; danger-sign teaching is the most critical protective intervention
- Nursing Role and Health-Teaching PrioritiesEvery-Visit Ongoing AssessmentsNurses conduct the ongoing assessments, document findings, and use assessment data to guide individualised teaching and referrals
- Maternal Weight Gain and Nutritional RequirementsKey Micronutrients and Food SourcesRecommended weight gain and energy are achieved through balanced intake of macronutrients and micronutrients from appropriate food sources
- Key Micronutrients and Food SourcesManagement of Common Pregnancy-Related Nutrition IssuesFood choice adjustments (e.g., smaller, frequent meals for nausea; fibre-rich foods for constipation) address pregnancy-related nutrition challenges while maintaining micronutrient intake
- Every-Visit Ongoing AssessmentsMaternal Weight Gain and Nutritional RequirementsWeight measurement at every visit tracks progress toward recommended gain; excessive gain with oedema signals nutritional and metabolic concerns
- First (Booking) Visit AssessmentIron and Folic Acid SupplementationBaseline labs (haemoglobin, blood type) at booking determine supplementation needs; Rh-negative status identified at booking guides anti-D prophylaxis
- First (Booking) Visit AssessmentCommon Problems Screened in Prenatal CareComprehensive booking assessment includes screening for anaemia, infections, hypertension risk, and gestational diabetes; baseline labs establish normal values
- Tetanus Immunisation (Td Schedule)Health Teaching Across PregnancyTd immunisation is explained during health teaching; woman is counselled on schedule and importance of Td2 for Child Protected at Birth
Diagrams
Prenatal Care & Maternal Nutrition - Comprehensive Concept Hierarchy
Comprehensive mind map showing all key concepts in prenatal care and maternal nutrition, organized from central goals through specific interventions, assessments, and nursing responsibilities. Displays the hierarchical relationships and interconnections between antenatal care components.
Antenatal Care Visit Schedule and Assessment Flow
Flowchart illustrating the antenatal care visit schedule progression based on gestational age, key assessment components at each visit, decision points for abnormal findings, and referral pathways. Shows how nurses implement the DOH minimum 4-visit schedule with appropriate frequency adjustments.
Iron-Folic Acid Supplementation: Prescription to Adherence
Detailed flowchart showing the complete iron-folic acid supplementation journey from prescription through adherence monitoring and postpartum assessment. Emphasizes troubleshooting of GI side effects, proper administration teaching, and strategies to optimize maternal compliance—a critical NLE topic.
Tetanus Immunisation Schedule in Pregnancy (Td)
Step-by-step flowchart of the Philippine tetanus-diphtheria (Td) immunisation schedule during pregnancy. Shows the minimum intervals between doses, importance of Td2 for neonatal protection, and the progression of the five-dose series. Critical for NLE questions on maternal immunisation and CPAB concept.
Maternal Weight Gain Tracking and Pre-eclampsia Detection
Clinical flowchart demonstrating weight gain monitoring by pre-pregnancy BMI category and the decision pathway for detecting pre-eclampsia through sudden weight gain combined with oedema, hypertension, and proteinuria. Links prenatal nutrition assessment to serious maternal complication screening.
Danger Signs in Pregnancy: Recognition and Response Pathway
Comprehensive danger-signs assessment and response pathway covering seven categories of life-threatening complications in pregnancy. Emphasizes the nurse's role in teaching recognition at every contact and the unified response of seeking facility-based emergency care—a cornerstone of NLE antenatal care questions.
Recommended Micronutrient Sources in Pregnancy Diet
Pie chart showing the recommended macronutrient distribution for optimal prenatal nutrition, highlighting the balanced approach to protein (for fetal growth), carbohydrates (for energy and protein sparing), and healthy fats (for fetal nervous system development).
Progression of Antenatal Care Status and Outcomes
State diagram illustrating the progression of pregnancy status from initial low-risk classification through antenatal care, with pathways for detection of high-risk conditions, management of complications, and preparation for facility-based delivery—reflecting the DOH approach to risk-based antenatal care.
Nutritional Counselling for Special Populations in Pregnancy
Detailed flowchart for nutritional assessment and counselling in vulnerable or special-population pregnant women, including adolescents, those with closely spaced pregnancies, low socioeconomic status, and those with pica. Demonstrates culturally sensitive and resource-appropriate nursing intervention aligned with Philippine health programs.