Nutrition Counseling For Anemia in Pregnancy Do nutrition and weight evaluation. Evaluate if patient is taking prenatal vitamin daily and the prescribed amount (if any) of supplemental iron. Evaluate what patient already knows about anemia. Important to teach on first visit: Ask: Do you know what anemia is? Clarify based on their answers: Anemia is a problem with the blood that is usually caused by lack of iron in the blood - and that is usually caused by lack of iron in the foods that we eat. People with anemia often feel tired, weak, low in energy. They may have headaches, pale skin, dizziness, shortness of breath, or chronic infections To avoid anemia, and to correct anemia – it is important to avoid processed foods that are low in nutrition and eat foods that are rich in nutrition. Foods that usually have no nutrition or very little nutrition are sugary foods and sugary drinks. They should be avoided. (point out those eaten on food recall or food diary) Also, limit fruit juice to 4 ounces per day or less - fruit juice will ruin the appetite for more nutritious foods (point out any excess fruit juice they drank on their food recall or food diary) Give them a list of sugary foods and sugary drinks that should be avoided – it is best to keep these out of the house so they are not a temptation: cakes, cookies, candies , ice cream, chocolate, sweet breads, lollipops, popsicles, Jello, flan, sugary cereals, flavored yogurts, (Hispanic favorites: ’pan dulce’, ‘arroz con leche’), and sugary drinks: soda , Gatorade, Koolaid, fruit punch, Sunny Delight , Tampico, Tang, Caprisun, lemonade, instant iced tea from powder, bottled iced tea, Powerade, Kern’s, Schnapple, Quik, ‘high energy drinks’, (Hispanic favorites: ‘agua de jamaica’, ‘agua de tamarindo’ , ‘horchata’, ‘maicena’, ‘atole’, ‘champurrado’, ‘Chocomil’, ‘Jackult’ ‘aguas de fruta’), “and there are many more” Point out that in soda there is absolutely no iron at all, and no other nutrients, so, people who drink it are more likely to develop anemia as well as other deficiencies Teach the WIC (Women, Infants, and Children Supplemental Food Program) Daily Food Guide for how to eat during pregnancy (Guia de Alimentación Diaria): Display the Daily Food Guide for Pregnancy and explain how to use it. Ask them if they know which foods are high in iron (they usually know one or two). Add to what they know & correct misinformation. Highlight (or circle) in yellow foods that are rich in iron. All the foods in the protein group are rich in iron (name several of them as you highlight the group). All vegetables are a good source of iron, especially the dark green vegetables and dark green leafy vegetables - like spinach, broccoli, greens, and dark green lettuce (highlight these as you mention them). Eating the daily recommended 3 servings of vegetables is an important source of iron. Emphasize the importance of taking prenatal vitamin supplements daily and iron supplements as prescribed by the provider. (brainstorm strategies to help them do this, as needed) May be important to teach on the first visit: Sugary foods and drinks and too much fruit juice cause excess weight gain (in addition to being a major cause of anemia) The milk group has very little iron (point it out to the mothers with babies or toddlers, especially if the child is still using a baby bottle after one year of age). Too much milk can contribute to anemia (it ruins the appetite for other foods that are richer in iron) Optional teaching for first visit: Iron helps carry oxygen in the red blood cells. If there is not enough oxygen in the blood we may feel a lack of energy. The person often doesn’t feel like working as much as usual, or playing, or talking as much as usual. If you avoid sugary foods and sugary drinks and fruit juice, you will have more appetite for the nutritious foods found on the Daily Food Guide (point to all the foods on the handout). That will result in a better iron intake. Pregnant women often develop anemia secondary to significant nausea/vomiting at the beginning of pregnancy, especially if they didn’t take their prenatal vitamins during that period. This is also true for women who have had inadequate weight gain for other reasons. Where there is a lot of growth - there is a lot of iron used - and in pregnancy there is a lot of growth. (so greater chance for anemia) Sometimes anemia is caused by excess loss of blood (for example: during surgery or in non-pregnant women with heavy menstruation) To avoid constipation - a common side effect of taking iron supplements: if you eat the recommended number of servings of vegetables (3+/day) and fruits (2+/day) every day, you are unlikely to have constipation. Information for the professional: During pregnancy anemia is diagnosed when the hemoglobin level is <11.0 mg/dl in the 1st trimester, <10.5 in the 2nd trimester, or <11.0 in the 3rd trimester. (or Hct <33, 32, or 33 in 1st, 2nd, or 3rd trimesters respectively) WIC gives iron enriched formula up to one year of age. Afterwards, cow’s milk is introduced. Milk should be limited to 16 to 24 ounces in young children. Vitamin C does enhance the absorption of iron. If they ask about this – tell them that Vitamin C rich foods enhance the absorption of iron, but if they are eating the recommended number of fruits and vegetables every day, they are likely to get a good amount of vitamin C. (you can show them on the Daily Food Guide the section for Vitamin C rich fruits and vegetables) If the provider has told them to take their iron supplements with orange juice tell them that it is better to eat an orange than to drink the orange juice. In any case, they should limit total daily fruit juice to no more than 4 ounces per day. Animal flesh i.e. beef, chicken, fish, seafood, etc. has iron in the heme state which is absorbed better than non-heme iron found in plant foods i.e. vegetables, legumes, nuts, seeds Other anemias: in iron deficiency anemia the MCV value is low (<80); in folic acid deficiency anemia and Vitamin B12 deficiency anemia the MCV value is high (>95); If folic acid deficiency anemia is suspected, counsel regarding a healthy diet following the Daily Food Guide, a diet rich in fruits and vegetables, avoiding sugary foods and drinks, and limiting fruit juice to 4 ounces per day or less. If labs confirm a folate deficiency, a handout with folate rich foods can be given. Vitamin B12 anemia is the least common form of anemia, but can occur if the client is a strict vegetarian who eats no animal proteins (also known as a vegan diet).