Nutrition during Pregnancy Case Study 1. BMI = (Weight in Pounds / ( Height in inches x Height in inches ) ) x 703 BMI = (110/(64 x 64)) x 703 BMI = 18. 9 Michelle’s BMI is determined in the normal range. 2. Regarding die IOM Guidelines and the weight gain chart on Blackboard Michelle? s weight gain should be 6 – 12 pounds. Presently, she is recording a weight gain of only one pound. 3. Michelle should gain weight: a. Considering the slides (Maternal Weight Gain & Pregnancy Outcomes) 2 – 4 pounds during her first trimester are recommended, compared to the “Prenatal Weight Gain Chart” on Blackboard 2 – 6 pounds shown. . During her entire pregnancy she has to gain 25 – 25 pounds on the recommendation of WIC gain chart. The weight gain is connected to her Ibs. 4. Michelle is suffering from nausea and vomiting. Here are three suggestions to decrease: a. She should avoid stress as much as possible. (Lecture slides: Nutrition Assessment and Guidance in Pregnancy) b. Dietary interventions can help decreasing nausea and vomiting, e. g. separate liquid and solid food intake and select foods that are well tolerated as well as avoiding foods that triggers nausea. Brown, Judith E. , 129) c. From my own experience as a pharmacist, I can recommend her to stand up very slowly. The body has to adapt to position changes. Eating small portions slowly and frequently can also be a cheap and helpful strategy, too. 5. Iron is important during pregnancy, because it prevents the risk of preterm delivery and low-birth-weight infants by two to three times. Furthermore, iron-deficiency during pregnancy can cause lower scores in intelligence, language, gross motor, and attention tests(Brown, Judith E. , 119).
Iron binds on hemoglobin in the blood. It is responsible for the transport of oxygen through the body and provides oxygen supply especially in the brain. Under examination her hemoglobin status about 10. 7g/dL. She is in the lower level of the normal range (<10. 6 g/dL- <10. 5 g/dL in the gestational weeks 16 – 20). For this reason and regarding the slides, she should take supplement with 30 mg ferrous iron daily. Michelle? s fatigue could also be an indication for anemia. 6. Michelle smokes half a package of cigarettes per day.
Smoking leads to several diseases for the infant, e. g. otitis media, asthma, and respiratory infections as well as GI-dysregulation. Furthermore, it is known that mothers who are smoking are less likely to breastfeed. It reduces the milk production. Unless to say that it also increases the risk of cancer and heart attack. (Brown, Judith E. , 205) I have pointed out two suggestions for Michelle: To stop or reduce smoking. First of all, there are financial benefits, regarding the little amount of money the family has to deal with.
Secondly, nicotine decreases the oxygen supply and maybe the reason for her fatigue. When she is getting bored, Michelle should prefer chewing gum instead of smoking a cigarette. 7. According to experience, mothers who are smoking during the pregnancy and gaining too little weight are at high risk for a premature delivery and a low birth weight of the infant. (Lecture slides: Fetal Development &Maternal Physiologic Changes) 8. Yes, as discussed in the previous question, she has gained too little weight.
In addition, teenage moms frequently tend to nutrient deficiency due to poor diet, fast food and slimming diets. Another reason is her age of 16. Her uterus is probably not completely developed and there is a higher risk for genetic defects for in young mothers. 9. WIC is a special supplemental nutrition program for women, infants, and children who are at nutrition risk. This is administered by the U. S. Department of Agriculture. The mission is providing health in low-income population with supplements, education, and screening.
MDD (Montreal Diet Dispensary) are specialized with low-income and high risk pregnant females with nutritional support. (Brown, Judith E. , 130) 10. At first, it is important that Michelle takes support from WIC or MDD for learning how to change her eating pattern and lifestyle in a healthier way. Secondly, she has to take supplements to prevent any forms of deficiency, e. g. iron, folic acid, iodine, and DHA. Thirdly, she should stop or decrease smoking; it will help her increase her appetite and gain weight. 11.
Michelle is now at 28 weeks gestation, so she is in her third trimester. 12. Michelle gained 13 pounds compared to her pre-pregnancy weight. She is supposed to gain 15-22 pounds at this stage of time. Based on this fact, she did not gain enough weight. 13. Michelle suffers from heartburn, which is a regular symptom in this period of pregnancy, because the fetus is growing and puts pressure on the other organs. Recommendations to decrease heartburn are eating small meals and more frequently. Do not go to bed with a full stomach and keep the upper part of the body higher.
Generally, avoid foods that seem to make heartburn worse. (Lecture slides: Nutrition Assessment and Guidance in Pregnancy) 14. “MyPyramid”, recommended for each trimester, amounts from each food group. Compared to the recommendation for the third trimester, Michelle? s eating pattern has to be changed completely. To examine each food group, Michelle needs 7 ounces of grains a day and half of it whole, 3 cups vegetables of different variations, 2 cups of fruits, 3 cups of milk to get calcium, and at least 6 ounces meat and beans to get a higher level of protein.
In fact, she does not fulfill the conditions. Her grain source is the white bread in the cheeseburger as well as the “milk” source in cheese. The meat in the cheeseburger and in the sausages is the protein source. This is not enough and contains too much sugar and fats. The banana is the only fruit in her 24 hour diary, but unfortunately is also not enough for her needs. I would recommend her to leave out the energy drinks and coke. Besides the high sugar level it contains caffeine and phosphor. Caffeine is allowed, but in moderate levels.
This means one cup a day. Phosphor decreases the calcium level in the bones, which is not requested. At least, I note that her meal plan contains almost fast food ingredients. There are many approaches to improve her eating pattern. 15. Michelle has to change her eating pattern. I am going to give six suggestions, which will be realizable regarding her opportunities. a. Take the service from WIC or MDD for supporting her knowledge in nutrition and improving behavior within her lifestyle. Have a look at “MyPlate” website and check your status. b.
Drink fewer beverages that contain caffeine and phosphor, replace them with red bush tea or peppermint tea. Due to the fact that she is going to breastfeed, she should be aware of the fact that smoking decreases the milk production, too. c. Decrease the limits of sweets, sugar in food and beverages and use low fat items. d. Select healthy snacks, such as fresh fruit, and vegetables. e. Cook by yourself! It will help you to get more sensitive about what your foods you contain. f. Based on the fact, that she does not like dairy products, I would recommend her to get water rich of calcium. 6. Presently, Michelle is gaining weight and feeling unwell with this situation. For this reason, I would explain the reasons and what happened with her body(e. g. the storage of fats and proteins and their necessary meaning) and with her fetus at the moment (e. g. development). She should enjoy this time. Besides this, breastfeeding is a wonderful opportunity to lose weight after delivery. She is on the right track, because she decreased her cigarette consumption, and I would encourage her to go on. 17. Breastfeeding has a lot of benefits.
It averts the risk of cancer and osteoporosis and affects the weight loss positively. Besides that, it is free and she can save money. The advantages for the infant are the prevention of diseases in the future and fortification of the immunologic system. (Lecture slides: Breastfeeding) 18. I would ask her for feedback and if she is interested in bringing her boyfriend with her for the next visit. I would ask her, if she wants me to go shopping with her. So I will be able to discuss her choices and offer her a replacement.