Nutrition During Pregnancy and Lactation An Implementation Guide (1992) / Chapter Skim
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Follow-Up Visits
Follow-Up Visits
Pages 51-68
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From page 51... ...
Health habits? Physical Examination O Weight; involve the woman in plotting her weight on chart; note weight change Anemia: repeat hemoglobin or hematocrit tests as needed for follow-up O Glucose screen at 24 to 28 weeks of gestation Basic Guidance 1~ Reinforce healthful practices A!
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From page 52... ...
O Dietary control of chronic disorders? O Inadequate nutrient or energy intake related to food choices?
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From page 53... ...
Attention is directed toward problems such as Tow or excessive weight gain, inadequate nutrient intake, multiple gestation, gestational diabetes mellitus, anemia, inadequate resources, or gastrointestinal syrnptorns. In this chapter, care that is appropriate at every visit is distinguished from care that is most relevant at specific times during the pregnancy.
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From page 54... ...
History. Sample Questions General If the nutrition questionnaire revealed problems at the time of the initial visit, consider administering it during the second and third trimesters as a quick way to identify continuing problems.
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From page 55... ...
· If there are young children in the household, ask: Where do you keep the pills? Behavioral Changes · What dumges in e'Gerri5e have you made?
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From page 56... ...
Indications to assess weight gain farther are shown in the box. Weight Changes That Signal the Neect for Further Evaluation in the Second and Third Trimesters Women of at feast moderate weight (Prepregnancy BMI >19.~: · Gain of less than 2 Ib (1 kg)
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From page 57... ...
The practice of pica (eating nonfood substances) may limit nutrient intake and have adverse hematologic or gastrointestinal effects.
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From page 58... ...
Adequate weight gain for BMI status suggests adequate energy intake but does not guarantee diet quality The average weekly amount of weight gained increases in the second trimester, and women may express more concerns about their body image. High or low weight gain may result from measurement errors, dietary prob58 Nutrition Dunug Pregnany and Lactation
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From page 59... ...
Laboratory Evaluation Resolving anemia may improve the mother's sense of well-being by relieving shortness of breath, fatigue, headache, and dizziness. Infants of iron-deficient mothers may have an increased risk of Tow birth weight, prematurity, and perinatal mortality A positive glucose screen calls for diagnostic testing for glucose tolerance.
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From page 60... ...
· As appropriate, provide anticipatory guidance on how to obtain assistance for successful lactation and realistic information about feeding frequency. In the third trimester, resume the discussion of infant feeding.
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From page 61... ...
· Suggest strategies for relieving or avoiding nausea and vomiting and ways to maintain adequate fluid and food intake. (See box in Tab 3, page 47.)
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From page 62... ...
Suggest, as appropriate: · Let meg;'ve you the none ala Livid or chewable preparation if you have discus swallowing ttiblets. · Taking iron to treat iron-defiacn~ anemia helps to reduce fatigue, headache, Liminess, and shortness of breath and increases your ability to adapt to blood loss at the time of delivery.
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From page 63... ...
· Avoid taking laxatives unless recommended by your health care provider. Positive Glucose Screen · Perfo~ diagnostic testing for diabetes mellitus.
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From page 64... ...
? · Does her energy expenditure exceed her energy intake?
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From page 65... ...
· Has the woman stopped smoking recently? The advantages of smoking cessation offset any disadvantages associated by gaining some extra weight.
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From page 66... ...
For the Heaith Professional: Pica identify pica practices that may be Hartley! because they interfere with the ingestion of adequate amounts of food, they may lead to intestinal obstruciion or impaction, or they may involve toxic substances.
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From page 67... ...
· Choose nutritious foods that are easy to eat, easy to prepare or ready to eat, enjoyable cold or at room temperature, and not messy Convenient choices include individual cans, bottles, or boxes of juice; pieces of fresh fruit; heat-and-serve (microwave) dinners; sandwiches; hard-boiled eggs; nuts; and cheese, milk, and other dairy products.
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