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The First Prenatal Visit
Pages 33-50

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From page 33...
... O Infant feeding plans? Physical ExamiIIabon O General appearance O Breast examination O Weight for height: estimate prepregnancy body mass index category if not charted for use ir1 giving weight gain advice O Anemia: Hemoglobin <11.0 gull during first or third trimester, ~lO.S gull during second trimester (nonsmokers)
From page 34...
... and recommend nutrient supplements as needed may be addressed earlier if control of nausea and vomiting associated with pregnancy is not a problem) Promote appropriate weight gain Advise about control of heartburn and constipation Help plan for eating well if on bed rest Treat inverted nipples (third trimester)
From page 35...
... Physical Examination Gerleral appearance Breast Examination Weight Anemia: Hemoglobin
From page 36...
... O Anemia? Foriron deficiency 60 to 120 mgof elemental iron daily; at a different time, 15 mg of zinc and 2 mg of copper and given as part of a vitamin/mineral supplement O Continuation of folate supplementation to help prevent neural tube defects?
From page 37...
... By careful attention to information in the medical record, the nutrition questionnaire, the patient's responses to sample questions, and results of the physical examination and laboratory tests, the provider can set priorities and encourage active patient involvement in addressing those priorities. The provider should consider the need to link the woman with support services, including those provided by case management and home visiting programs, especially when there is concern that this may be the only patient contact until delivery.
From page 38...
... " · Are you currently breastfeeding? Weight If height and recent weight are not available from the medical record, ask: · How much did you weigh at your last penod?
From page 39...
... · Check medical record for recent preconceptional BMI. If unavailable, estimate it using the woman's height and recalled preconceptional weight ant!
From page 40...
... . Very early in pregnancy, supplemental folate may help prevent neural tube defects among women who have had a pregnancy affected by such a defect.
From page 41...
... Because of their special concerns about body image, adolescents usually benefit from such guidance. Discomforts and Dietary Practices Women who have poor appetites, who skip meals often, or who are purposely limiting their food intake may eat too little food to support optimal weight gain and fetal growth during pregnancy.
From page 42...
... Infant Feeding Breastfeeding is recommended for all infants in the United States under ordinary circumstances.2 Many women make their infant feeding decisions before pregnancy or early in pregnancy~ften without having contact with breastLeeding women or encouragement from health care providers. Physical Examination General Appearance Signs of an eating disorder include dental enamel erosion, little subcutaneous fat, and (rarely)
From page 43...
... Dietary Practices · Using appropriate matenals, provide guidance on sound eating practices based primarily on the Dietary Guidelines. Use an approach that considers the woman's reaming style, learning ability, literacy, native Tankage, and other learner characteristics.
From page 44...
... · Assist with dietary improvement: reinforce positive aspects of the diet; help the woman to set realistic goals (e.g., one change at a time or small changes in related behaviors) ; and encourage her to commit to one change, possibly in writing (a contract for change)
From page 45...
... . · While you are pregnant, the only sure way to avoid the possible harmful effects of alcohol on the fetus is to avoid drinking alcoholic beverages entirely.
From page 46...
... to support the baby's growth; weight gain in later pregnancy goes mainly toward the growth of the baby. During the second and third trimesters, the recommended rate of gain is slightly more than 1 Ib (0.S kg)
From page 47...
... · Avoid drinking coffee and tea. Avoid drinking citrus fruit juices and water upon arising.
From page 48...
... Offer written information on breastfeeding or alert the woman and her family to sources of visual and oral information, including breastfeeding counselors. Videotapes may be helpful.
From page 49...
... If a woman has diabetes mellitus, phenylketonuria, 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 appropri ate follow-up care.
From page 50...
... · Assist women in recovery to develop a sense of reasonable amounts of food to eat, especially if they are concerned about high weight gain. History of Delivering an Infant with a Neural Tube Defect If the first prenatal visit occurs in the first trimester of pregnancy, the Centers for Disease Control recommends: "Unless contraindicated, they Women who have had a pregnancy involving a fetus or infant affected with a neural tube defect]


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