Health Problems Caused By Pregnancy 

Pregnancy and Nursing Concerns

    Nurses continue to conduct research in various areas related to
pregnancy. Predominant areas of inquiry include nutrition/obesity/gestational
weight gain, physical activity and exercise during pregnancy, the experience
and symptoms of pregnancy, HIV prevention and care, preventing negative
consequences of adolescent pregnancy, care during labor and birth, and health
promotion.

Nutrition, Obesity and Gastrointestinal Issues In Pregnancy 

    Nutrition, obesity, and gestational weight gain can impact birth
outcomes and how well a woman feels during pregnancy. Nutrition research has
focused on identifying optimal nutrition during pregnancy to promote fetal
growth and development while preventing excessive maternal weight gain
(Bechtel-Blackwell, 2002; Wiles, 1998). 

    Excessive weight gain during pregnancy
can contribute to postpartum weight retention and long-term weight gain and
later obesity (Walker, 1996). Adequate nutrition during pregnancy influences
maternal weight gain. Pattern of weight gain during pregnancy is significant.
Nurses have been instrumental in researching patterns of gestational weight
gain associated with optimal birth outcomes. 

    Obesity results from an imbalance
of energy. Over time, when more nutrients are consumed than burned, weight gain
occurs. Over time excessive nutrient intake results in weight gain and obesity.
Excessive weight gain during pregnancy, particularly over multiple pregnancies,
contributes to overweight and obesity in women. 

    Women who begin pregnancy are
overweight are at higher risk for increased gestational weight gain, postpartum
weight retention, and complications of pregnancy, including malpresentation,
arrested labor, and instrumental delivery.

Physical Activity and Exercise 

    Physical activity and exercise have been another predominant theme
of nurse researchers who study pregnancy. While it has been known for quite
some time that exercise and physical activity have benefits at every life
stage, exercise research during pregnancy has expanded in recent years. 

    This
expansion is partly due to the problem of obesity and excessive weight gain
during pregnancy, but also because exercise has been a useful modality in
health promotion and disease prevention efforts. For example, pregnant women
who exercise on a regular basis have improved birth outcomes and more energy. 

    Recent investigations have focused on the use of exercise during pregnancy to
prevent and treat hypertensive disorders and to keep weight gain within normal
limits, as recommended by the Institute of Medicine (IOM) based on pre- pregnancy
body mass index (BMI).

Relive of Symptoms 

    Symptoms of pregnancy and their relief are another focus for nurse
researchers. Maloni and others have extensively investigated the symptoms of
women placed on bed rest during pregnancy ( Maloni , Kane, Suen, & Wang,
2002; Maloni & Schneider, 2002; Maloni , Brezinski-Tomasi , & Johnson,
2001). 

    Nausea and vomiting during pregnancy have also been investigated
(Steele, NM, French, Gatherer-Boyles, Newman, &Leclaire , 2001; O’Brien,
Evans, & White-Me-Donald, 2002; Zhou, O’Brien, &Socken , 2001). FH
Chou, Lin, Cooney, Walker, and Riggs (2003) found that depressive symptoms were
correlated with nausea and vomiting and that social support was negatively
related to nausea and vomiting. 

    Depressive symptoms were also found to be
correlated with fatigue; however, the investigators did not examine which
symptom appeared first. 

    Other researchers have examined the pregnancy
experience among various groups, including adolescents with a planned pregnancy
(Montgomery, 2000, 2001, 2002), adolescent mothers, women with a high-risk
pregnancy, women with pregnancies conceived via in vitro fertilization, women
pregnant with multiples, pregnancy after previous loss, and the experiences of
new fathers (Finnbogadottir , Svalenius , & Persson, 2003). 

    In addition,
pregnancy and childbirth experiences of women of various cultures have been
investigated.

HIV Prevention During Pregnancy

    HIV prevention and care during pregnancy have also been
investigated by nurse researchers. HIV-positive pregnant women are a diverse
group. Many women discover their HIV status following conception. However, with
increasing frequency women who are HIV-positive are planning to become
pregnant. 

    Nurse investigators have examined HIV-positive women’s desire for
pregnancy despite their HIV disease and found that women do not wish to give up
the experience of motherhood and that they have a healthy focus on living life
and not limiting themselves-selves based solely on their HIV diagnosis (Sowell
&Misener , 1997). 

    Women also noted that with current medical advances their
chances of having a healthy pregnancy and uninfected infant are better than
ever before. HIV-positive women need a tremendous amount of support and care
during pregnancy and beyond. Nurses have taken the lead in identifying the
specific needs and care for this group of women.

Adolescence Pregnancy and Health Issues

    While the rates of adolescent pregnancy have decreased in recent
years and continue to decline, there are still nearly 1 million adolescents who
become pregnant each year. Nurses have investigated various support and
education programs to assist these young women with pregnancy and the
transition to motherhood ( Nuguyen , Carson, Parris, & Place, 2003). 

    Successful programs begin during pregnancy and continue through the child’s
early years. The focus of these programs is health promotion and teaching,
illness prevention, social support, accessing services, and networking ( Koniak
-Griffin et al., 2003). 

    Nurse researchers have also examined HIV prevention
among pregnant adolescents who are often at risk because they lack resources,
social status, and knowledge to protect themselves (Lesser, Oakes, & Koniak
– Griffin, 2003).

Aspects of Pregnancy and Nursing Research

    Nurse researchers have investigated various aspects of care during
labor and birth, including labor and pushing management among women with
epidural anesthesia (Mayberry, Strange, Suplee , & Gennaro, 2003), use of
birth plans (Lundgren, Berg, & Lindmark, 2003) , labor support by nurses
and others, cultural variations in the labor and birth experience (Callister,
2004), child birth education strategies, and pain reduction with interventions
such as ice (Waters & Raisler , 2003 ) . 

    MR Sleutel (2002) developed and
tested the Labor Support Scale with positive results.

Use of Labor Inducing Medicines 

    Additional areas related to labor and birth that need to be
examined include excessive rates of labor inductions present in many hospitals
throughout the US, Cesarean sections on demand, implications of increased
physician malpractice insurance leading to few physicians attending deliveries
and how this affects nursing care, birth outcomes, and the practice of
certified nurse midwives (CNMs). 

    Complementary and alternative therapies to relieve
labor pain also warrant additional research by nurses.

Conclusion

    Pregnancy is one of the few instances in which health promotion
efforts can have a direct and immediate impact. Various nurse researchers have
investigated health promotion during pregnancy in both a general sense of
health promotion behaviors and specific behaviors, such as nutrition in
pregnant adolescents (Symon &Wrieden , 2003), physical activity, smoking
cessation ( Maloni , Albrecht , Thomas, Halleran , & Jones, 2003), and drug
and alcohol avoidance. 

    Considerable research effort has also focused on
prevention of abuse and violence during pregnancy (Denham, 2003). The vast
majority of research with pregnant women has been focused on birth outcomes,
including rates of live birth, prematurity, low birth- weight, congenital
malformations, and other complications of pregnancy, labor, and/or birth.