April McMurray
March 7, 2013
Pregnancy Project
Part 1
Subject data:
1. Name: Angie
2. Description of individual: Stay-at-home mother of one, with a part time job as a nurse;
married to an accountant. Busy.
3. Age: 30
2. Obstetrical history:
1. Parity and outcome: G2P1--I have had 2 pregnancies and one full-term delivery.
2. Interconceptual period: 26 months
3. First child's birth weight: 9 lbs 1 oz
4. Child will be 3 in April
5. Lactation experience: Lactation was hard at the beginning. A wouldn't latch on and I
didn't get enough help at the hospital. He lost too much weight and I had to take him back
into the doctor's. Once he got it down the experience was a good one. Around 9 months
he would hardly nurse--too busy!--but we hung onto a few feedings until he turned one.
3. Estimated delivery date: 4/12/13
4. Laboratory data: Hemoglobin: 11; hematocrit: 34%; blood glucose: 131. Tests were all
around 28 weeks. (At my first prenatal check-up, around 9 weeks, my hct was 40%, so
that was a significant drop.)
5. Chronic conditions: restless leg syndrome; bulging disc at L4-5 (sees chiropractor,
injured back); chronic rhinitis
6. No cigarette/alcohol/drug use.
7. Nutritional deficiencies: No known nutritional deficiencies but I was not tested prior to
pregnancy. My iron levels have to be kept high to manage RLS but I suspect they were in
"normal" range even if they were low to me (which I don't know about).
8. Use of medications/supplements prior to pregnancy: liquid multi-vitamin; probiotic;
inconsistent use of fish oil, calcium, magnesium, Vit D, and a multi-mineral pill.
Ibuprofen as needed for back pain. Various (topical), essential oils as needed.
9. Exercise: 4-5 times (115 min/week) prior to pregnancy. 3-5 (90 minutes/week) times
most weeks of pregnancy. I vary my routine: swimming (laps or aerobics class), elliptical
machine, weight lifting, and walking. Before pregnancy I also ran and biked.
10. No known allergies.
Nutritional Assessment:
1. 24 hours diet recall: (Subject commented: PS, this is about average for me. I've done
way better through parts of pregnancy and a little bit worse sometimes. But we've had
lots of bday celebrations lately so on random days I've had 1-2 desserts or treats):
Breakfast: 1 large bowl (2 c) of Quaker Oat squares with skim milk (1½ c); small handful
of almonds (1 oz); 1 scrambled egg; 1 cup orange juice
Snack: 1 granola bar; 2 mint lifesavers
Lunch: Red Robin: hamburger on whole wheat bun, with guacamole (1 tbsp) and bacon
(2 slices) (plus tomato, lettuce, and onion); side of steamed broccoli (1½ c); nibble of A's
fries (¼ c)
Snack: 1 cup leftover movie theater popcorn; a handful of animal graham crackers (4-5)
Dinner: 2 c pasta, ¼ c ground turkey meat, ½ c mushroom sauce (cream of mushroom
with skim milk), ¾ c edamame, ½ c baby carrots, 2 cups skim milk, 1½ c homemade
applesauce
2. Does not use food assistance programs.
3. Current use of medications/supplements: Multi-vite, iron (takes with vit. C), probiotics,
fiber, calcium/magnesium/vit. D (separate supplements but taken together)
Recommended but not prescribed by midwife, chiropractor (pro-biotics and multi-vite),
neurologist (iron for restless leg treatment).
4. Estimated % of income spent on food: 15%
5. General cooking & eating habits: 3 meals a day with a snack in between each one. I
stop eating by 8 pm unless I need a bedtime snack (in pregnancy only). I eat out 1-2 times
per month. I "cook" my own meals but that involves a lot of sandwiches, fresh fruits &
veggies, and ready-to-eat snacks such as yogurt or string cheese. I am learning to stay
organized with planning/shopping/cooking so some weeks I do really well, and even hide
pureed vegetables in the things I cook, but some weeks I resort to the sandwiches,
leftovers, etc. Unfortunately, sometimes I get busy and forget to eat until I'm starved, and
then I snack on crackers or other snacks while I make my real meals. This happens a few
times a week. I generally limit desserts and sugar to 2 days a week outside of pregnancy.
In pregnancy I have done well overall but I have cheated sporadically as I felt I needed
to.
Pre-pregnancy weight: 140 lbs. Height: 66 inches.
Pre-pregnancy BMI: 22.6 kg/m2
Current weight: 169 lbs.
Weight gain: 29 lbs; according to the pregnancy weight gain chart, Angie has gained just
a little bit too much weight given the week of pregnancy she is at. However, since I only
have her pre-pregnancy and current weight, I don't know how consistently she has gained
weight during her pregnancy. She is still within the total weight gain recommendation for
her pre-pregnancy BMI. Also, she will complete 35 weeks of pregnancy on Friday, and if
her weight stays the same, she will be within the recommendations.
Nutrition Care Plan:
There are no significant risk factors present in this pregnancy. Angie is getting slightly
over the some of the recommendations, but she tries to exercise regularly and overall eats
a balanced diet. However, the diet analysis I did for her did not include her supplement
intake, and even without them she is getting the recommended amounts of almost all the
vitamins and minerals. I don't think she is getting over the UL with these supplements,
but it is a possibility. I would want to verify that she is taking a typical prenatal
supplement to ensure that.
The recommendations I could give her are a little tricky, since she is a registered nurse
and so she trusts her own sources of information. She is also following the
recommendations from her own medical personnel. I know that Angie is concerned about
gaining too much weight in her pregnancy because that happened with her first
pregnancy, so I would probably just advise her to pay attention to her weight gain over
the next few weeks, but overall, she probably can continue to eat the way she is eating
currently and just cut back slightly on the calories, possibly by cutting down slightly in
grains and dairy.
Part 2
I had a really great conversation with my sister about her diet. She is a nurse
and already very health-conscious, so I felt like we could have a very productive
discussion, more than me just telling her what she was doing right and wrong.
In fact, for the most part, she was already doing a pretty good job with her
diet when I did the first part of the assignment. She was consuming too many
calories and gaining weight a little too quickly, but just barely. The points I chose to
emphasize were that she is doing well overall: her intake was close to the
recommended ranges, and she was consuming a well balanced diet where she could
get the nutrients she needed for herself and her baby. Ultimately, it’s better that she
get slightly too much than too little, which I explained to her.
She actually felt really relieved—she understands enough about the needs of
her baby’s growth that she puts that first. During her first pregnancy she followed
the advice in a book, and gained 50 pounds by the end. She knew that it was too
much weight, but she felt confused because she had been following the advice of the
nutritionist. It affected her self-esteem and even her relationship with her husband,
and so she was really nervous about this pregnancy because she didn’t want to gain
so much. However, she also didn’t want to jeopardize her child.
Since her baby is past its due date, she won’t really implement all the little
things I shared with her, but she did feel relieved and more confident about her next
pregnancy. She feels like she can cut back a little more and her baby will still be
healthy. She is interested in charting her growth more closely next time to make
sure she continues to gain the right amount.