Nutrition During Pregnancy and Lactation An Implementation Guide (1992) / Chapter Skim
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The Preconception/Interconception Visit
The Preconception/Interconception Visit
Pages 19-32
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Physical Examination O General appearance O Weight and height: cletem~ine body mass index category \ O Anemia: Hemoglobin <12.0 gull (nonsmokers) Basic Guidance O The Dietary Guidelines O Physical activity O Weight maintenance or normalization O Avoidance or cutting back on the use of harmful substances An Implementation Guide 19
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Addressing Problems O Assist with access to food O Treat disorders requiring cliet therapy O Treat anemia: Foriron deficiency anemia 60 to 120 mg of elemental iron ciaiTy; at a different time of day, give 15 mg of zinc and 2 mg of copper as part of a vitamin/rnineral supplement O Consider folate supplementation to help prevent recurrent neural tube defects O Combat the use of harmful substances 20 Nutrition Dunng Pregnancy and Lactation
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For women who are actively preparing for pregnancy and want additional information, see Tab 3, "The First Prenatal Visit." It is assumed Mat before meeting with the health care provider the woman wid complete a nutrition questionnaire. If the woman has discus reading or other special circumstances apply, the questions should be asked in person in the woman's native language, using an approach that encourages unguided responses.
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· If an eating disorder is suspected, ask: Does it bother you to know that you are going to be weighed? If yes,Whenyonknowyonwillbe weighed, do you ever eat less?
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· Determine relative weight for height using body mass index (BMI) (see BMI chart in Tab 1~.
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Supplemental folate taken periconceptionally appears to help prevent neural tube defects in women who have previously hac! an affected pregnancy.
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See "Information About Drugs," Tab 10, for sources of information about prescription medications and overthe-counter products. Physical Examination General Appearance Signs of an eating disorder include dental enamel erosion, little subcutaneous fat, and (rarely3 swollen parotid glands and callouses on the knuckles.
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Weight-for-Height Status Obesity increases the risk of developing many chronic diseases and complications of pregnancy. Low weight for height increases the risk of delivering a low birth weight baby.
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· Encourage healthful eating practices and exercise to achieve or maintain a healthy weight (BMI within the normal range shown on page 13~. · Using appropriate materials, provide guidance on sound eating practices based primarily on the Dietary Guidelines and indicate that these practices also help prevent chronic diseases such as cancer and heart disease.
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· Choose a diet low in fat, saturated fat, and cholesterol. This reduces the risk of chronic disease and may help you manage your weight.
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Problems with Access to Food · Provide assistance or refer the woman so that she can obtain assistance with food, housing, insurance, and income support programs. (See Tab 10 for information about federal food and nutrition assistance programs.)
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If a woman has diabetes mellitus, phenylketonuna, renal disease, serious gastrointestinal disease, or other conditions requiring diet therapy, she should receive care from an experienced physician and dietitian. These providers should be consulted about appropriate follow-up care.
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History of Delivering an Infant with a Neural Tube Defect The Centers for Disease Control recommends that if a woman has had a pregnancy involving a fetus or infant affected with a neural tube defect, she should consult her physician as soon as she plans a pregnancy. "Unless contraindicated, they should be advised to take 4 mg per day of folic acid starting at the time they plan to become pregnant.
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