To increase awareness of nutritional demands for pregnancy in pregnant women through education.

1. To increase awareness of nutritional demands for pregnancy in pregnant women through education. Dependent variable: awareness of nutritional demands for pregnancy Target population: pregnant women Independent variable: education Kelly Busch & Chelsea Tonn WIC Nutritionists. They are “responsible for the documentation of nutritional risk and the development of nutrition care plans designed to meet participant needs. The WIC Nutritionist will assist in determining the eligibility of program applications through WIC Certification and/or Recertification process. Additional responsibilities include: assisting in the preparation of nutrition materials and nutrition reports, assuring smooth operations at satellites, and performing outreach through educational activities to potential program participants.”

2. What is the general need for a change in the awareness of nutritional demands for pregnancy in pregnant women? Specific aspects of nutrition while pregnant can have a blood pressure effect later on in the child’s life (Adair, Kuzawa, & Borja, 2001) • If pregnant women don’t consume enough vitamins and minerals while pregnant it can affect the babies’ weight at the time of birth (Coutts, 2000) • The consumption of iodine is important before, during and after pregnancy (Delange 2004) • Has shown that vitamin D is suggested to have protective effects against type 1 diabetes ( Dong et.al 2013) • There is a critical window of nutritional outcomes when it comes to the health of the child and how breast feeding is an important part of the offspring’s diet (Gruszfeld & Socha, 2013) • More women are entering pregnancy already overweight which is then leading to increasing risks of fetal malformations. (Henriksen MD, 2008) • Poor nutrition during the lactation stage causes intra uterine growth retardation (Udipi, Ghugre, & Antony, 2000) • Reducing the amount of iron deficiency in children while developing in the womb with the mother taking a supplement of iron during the pregnancy. (Zhou, Gibson, Crowther, Baghurst, & Makrides, 2006) • Folic Acid supplement (400 microgram/day) is recommended (Choi

3. Theoretical Definition: Knowing how to eat in ways that promote the health of the pregnant woman and fetusThrough fruits, Vegetables, Dairy, Grains and Protein with an emphasis on Vitamin D, iron, Iodine and folic Acid and Prenatal supplementation (Hogan, 2013) (Usda, 2013) (Dong et.al 2013)(Zhou 2013) (Delange 2004) (Choi 2008) (Coutts 2000)

4. Valid test • Explain why you should: • 1. Have fruit each day (5pts) __________________ • 2. Have vegetables each day (5pts) _________________ • 3. Have Grains each day (5pts) ____________________ • 4. Have Dairy each day (5pts) _____________________ • 5. Have Protein each day (5pts) ____________________ • 6. Get Vitamin D each day(5pts) ___________________ • 7. Get Iron each day (5pts) ________________________ • 8. Get Iodine each day (5pts)_______________________ • 9. Get Folic Acid each day(5pts)_____________________ • 10. Take a prenatal supplement each day (5pts) ___________ • It shows how much knowledge pregnant women would have on knowing how much of each food group and supplements is needed per day in order to maintain an adequate diet of showing the nutritional demands that are required for pregnancy. Our test is based off of our model which is then based off of the American Pregnancy Association- Pregnancy Nutrition research and the test measures what it purports to measure.

5. Operational definition • Scoring • 40-50 shows very high awareness • 30-39 show high awareness • 20-29 shows adequate • 10-19- shows low awareness • 00-09- shows very low awareness

6. Identify Measurable Objectives • At the end of the 2month program Mrs. Jones would score 4 out of 5 on her explanation of why she should have fruit each day. • At the end of the 2month program Mrs. Jones would score 4 out of 5 on her explanation of why she should have grains each day. • At the end of the 2month program Mrs. Jones would score 4 out of 5 on her explanation of why she should have protein each day. • At the end of the 2 month program Mrs. Jones would score 4 out of 5 on her explanation of why she should get iron each day. • At the end of the 2 month program Mrs. Jones would score 4 out of 5 on her explanation of folic acid each day • At the end of the 2month program Mrs. Jones would score 4 out of 5 on her explanation of why she should take a prenatal supplementation each day.

7. Plan an Evidence based program • Our Program The “Tusch” Program is based off of Texas WIC State Agency program-Giving Your Baby the Best Start ( Texas Department of State Health Services 2013). Our Program is made up of two parts: Active Learning and Passive Learning. • The Passive Learning will be watching movies, lecturing on material. • Active Learning- Group Discussion, Worksheets/Foodlogs , Planning a weekly menu.http://www.dshs.state.tx.us/wichd/nut/mnlessons-nut.shtm We will be meeting once a week on Saturdays for 2 months

9. Meal Makeover Activity • Michelle is 24 years old and 16 weeks pregnant. Now that she has a baby on the way, Michelle wants to make healthier food choices. • Below is a list of what Michelle had for breakfast and lunch yesterday. Help her out by suggesting ways that she could make her breakfast and lunch healthier. Look at the MyPlate picture for ideas and remember that small changes can make a big difference!

10. MEAL MAKEOVER ACTIVITY CON’t • Meal • Michelle’s Breakfast • • 2 large donuts • • 12 oz. can of fruit punch • Michelle’s Lunch • • Double meat hamburger with cheese and mayonnaise • • Large French fries • • 16 oz. bottle of Dr. Pepper • • 1 slice of pecan pie Making the Meal Healthier

11. SAMPLE MENU

12. Sample Pregnancy Food Log

13. Behavior Change Model • Pregnant women know what to do to increase their awareness of nutritional demands in pregnancy by coming to our program • Pregnant women know how to increase their nutritional demands by attention in our program • Pregnant women are motivated in increasing their awareness of nutritional demands. Facilitator: Want to give their baby the best start on life. • Pregnant women believe that changing their awareness of nutritional demands during pregnancy is important Barrier: They may think that their nutrition may not effect her baby. • Pregnant women have a supportive environment while changing the nutritional demands for their pregnancy Barrier: Significant other may not be eating a healthy lifestyle. Faciliator: Significant other may participate in cooking healthy meals

14. Evaluate to see change in pregnant women Post Test X O(Tusch Program Program Group: 40/50Texas WIC Nutrition Program 2 months) O Post test Control Group: 20/50 Threats to Internal Validity: Selection- If we give a pre test pregnant women may go out and research nutrition information on pregnancy therefore making our program less effective. Mortality- Pregnant women may drop out due to miscarriages or early birth depending on how along they are in their pregnancy.

15. Mission Fit • Did we meet our mission by increasing the awareness of nutritional demands of pregnancy in our program. We would know that we met our mission by the high scores of the Program group on the post-test in comparison with the control group.

16. Communication/Marketing. • Text4baby: “Text4baby is the first mobile information service designed to promote maternal and child health through text messaging. Women who text BABY (or BEBE for Spanish) to 511411 receive three free text messages a week, timed to their due date or their baby's birth date, through pregnancy and up until the baby’s first birthday. The messages address topics such as labor signs and symptoms, prenatal care, urgent alerts, developmental milestones, immunizations, nutrition, birth defect prevention, safe sleep, safety, and more. Text STOP to discontinue messages or HELP for help at any time. Text4baby is supported and promoted by a public-private partnership of over 1000 health departments, academic institutions, health plans, businesses, and the federal government. Text4baby is the largest national mobile health initiative reaching over 555,000 moms since launch in 2010.” We can use this model as a basis for a specific nutritional app for our population. They can become informed about it through their doctor’s offices, health departments, etc. https://text4baby.org/

17. Grant Information • The Allen Foundation makes grants to projects that benefit human nutrition in the areas of education, training, and research. One of their policies is “To support programs for the education and training of mothers during pregnancy and after the birth of their children, so that good nutritional habits can be formed at an early age” and that is certainly what our mission is as well. • $ Amount based on how much is being applied for • https://www.allenfoundation.org/default.asp

18. Webliography • Aaltonen, J., Ojala, T., Laitinen, K., Piirainen, T. J., Poussa, T. A., & Isolauri, E. (2008). Evidence of Infant Blood Pressure Programming by Maternal Nutrition during Pregnancy: A Prospective Randomized Controlled Intervention Study. The Journal of Pediatrics, 79-84. • Adair, L. S., Kuzawa, C. W., & Borja, J. (2001). Maternal Energy Stores and Diet Composition During Pregnancy Program Adolescent Blood Pressure. Chapel Hill: University of North Carolina. • Choi, H. (2008). Nutrition in Pregnancy. Korean Journal of Obstetrics and Gynecology, 481-491. • Coutts, A. (2000). Nutrition and the life cycle. 1: Maternal nutrition and pregnancy. British journal of nursing , 1133. • Delange, F. (2004). Optimal Iodine Nutrition during Pregnancy, Lactation, and the Neonatal Period. International Journal of Endocrinology and Metabolism, 1-12. • Dong, J., Zhang, W., Chen, J., Zhang, Z., Han, S., & Qin, L. (2013, September 12). Vitamin d intake and risk of type 1 diabetes: a meta-analysis of observational studies. Suzhou, China. • Gruszfeld, D., & Socha, P. (2013, September 6). Early nutrition and health: short- and long-term outcomes. Warsaw, Poland. • Henriksen MD, P. T. (2008). Nutrition and Pregnancy Outcome. Nutrition Reviews, S19-S23. • Hytten, F. E. (1979). Nutrition in Pregnancy. Postgraduate Medical Journal, 295-302. Hogan, P. (2013, October). Theoretical Definition. (K. Busch, & C. Tonn, Interviewers) Ladipo, O. A. (2000). Nutrition in pregnancy: mineral and vitamin supplements. The American Journal of Clinical Nutrition, 280s-290s.

19. Webliography cont. • Oncel, M., Calisici, E., Ozdemir, R., Yurttutan, S., Erdeve, O., Karahan, S., & Dilmen, U. (n.d.). Is Folic Acid Supplementation Really Necessary In Preterm Infants With ≤32 Weeks of Gestation? Journal of Pediatric Gastroenterology and Nutrition. • Prentice, A. (2004). Nutrition and Pregnancy. Women's Health Medicine, 22-24. • Rossin-Slater, M. (2013). WIC in Your Neighborhood: New Evidence on the Impacts of Geographic Access to Clinics. Journal of Public Economics. • Tsatsoulis, A., Wyckoff, J. A., & Brown, F. M. (2009). Diabetes in Women: Pathophysiology and Therapy. New York : Humana Press. • Udipi, S., Ghugre, P., & Antony, U. (2000). Nutrition in pregnancy and lactation. Journal of the Indian Medical Association, 548-557. • USDA. (2013). Health & Nutrition Information for Pregnant & Breastfeeding Women. Retrieved from USDA- choose my plate : http://www.choosemyplate.gov/mypyramidmoms/ • WIC, Texas. (2013, March 14). WIC Nutrition - Maternal Nutrition Lesson Plans. Retrieved from Texas Department of State Health Services: http://www.dshs.state.tx.us/wichd/nut/mnlessons-nut.shtm • Williamson, C. (2006). Nutrition in Pregnancy. Nutrition Bulletin, 1467-3010. • Women's nutrition and pregnancy risks discussed at WHO meeting. (2012, January 17). Papua New Guinea Post-Courier (Port Moresby). Port Moresby, Papua New Guinea: Nationwide News Pty Limited. • Zhou, S. J., Gibson, R. A., Crowther, C. A., Baghurst, P., & Makrides, M. (2006). Effect of iron supplementation during pregnancy on the intelligence quotient and behavior of children at 4 y of age: long-term follow-up of a randomized controlled trial. The American Journal of Clinical Nutrition, 1112-1117.

20. Reflection This project helped our professional intellect by having us research literature and review it to see if there was even a need to increase the awareness of nutritional demands in pregnancy for pregnant women. This project also helped us identify what it was that would help increase pregnant women’s knowledge of increasing their nutritional demands. We had to deeply delve into literature and programs to see if they were evidence based and effective. This project also gave us more practice on APA formatting. We also found this program to work to our advantage when one day when we have children of our own. We will know what the proper and adequate servings and amounts are needed in order to live a healthy pregnancy.