Nutrition Counseling For The Pregnant Woman With Inadequate Weight Gain
Do nutrition and weight evaluation to try to determine the cause of inadequate weight gain.
Important to teach on first visit:
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Discuss the importance of adequate weight gain during pregnancy. (women who don’t gain
enough weight during pregnancy often have smaller babies, and smaller babies often have more
health problems)
Eat 5 to 6 or more small meals per day. Eat every 2 to 3 hours or more often.
Aim for the WIC (Women, Infants, and Children Supplemental Food Program) Daily Food Guide
recommended number of servings for all food groups as a minimum, and more as you are able.
Allow patient to eat higher fat foods, if tolerated. For example, If the patient is drinking regular
milk, you can let them continue with it without saying anything.
Avoid sugary foods and sugary dinks (they lack nutrients/nutrition and ruin the appetite for more
nutritious foods)
Give them a list of sugary foods and sugary drinks that should be avoided:
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”
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Take advantage of every time you are hungry or have an appetite by eating a meal or healthy
snack (don’t wait hours before eating). If you leave the house, take along healthy snacks in your
purse.
May be important to teach on the first visit:
 Limit fruit juice to 4 ounces per day or less (giving this counsel on the first visit will usually be
helpful, but sometimes you may want to allow them to continue a higher fruit juice intake (if it is
100% fruit juice) until a follow-up visit.
 Add extra fats to foods. (this is important if they already seem to be eating a large amount of food)
Ask them if they know which foods are high in fat. Wait for a response from them. Give them
examples of high fat foods (vegetable oil, olive oil, butter, cream, cream cheese, sour cream,
salad dressings, avocado, olives, cheese, nuts, seeds, peanut butter). They can add these to
vegetables, fruits, legumes, meats, grains, etc.
Optional teaching for first visit:
 Have fruit available/eat fruit instead of the sugary foods or sugary drinks. Try making fruit shakes
with fruit and whole milk or evaporated milk (don’t add sugar or Quik).
 If you are not used to eating vegetables, try different vegetables and different vegetable recipes.
If you like only 1 or 2 or 3 types of vegetables, it’s okay to eat the same ones every day. Add
extra fats to vegetables for flavor and calories.
 Eat whole grains instead of processed grains (examples of whole grains include 100% whole
wheat bread, brown rice, 100% rye or 100% whole wheat crackers, oatmeal, 100% whole wheat
pasta, corn tortillas). Add extra fats to whole grains for flavor and calories.
 The benefits of exercise during pregnancy are:
- along with proper diet, it helps prevent excess weight gain (which is not the immediate
concern, but always considered a potential concern for the future)
- less discomforts in pregnancy – for example, less chance of back pain because abdominal
and back muscles are stronger
- it helps all the hormones work better, so you feel better and have less chance of developing
diabetes during pregnancy (better control of blood sugars)
- delivery is usually easier for those who have exercised regularly during the pregnancy
Information for the professional:
Causes of inadequate weight gain in pregnancy:
- nausea/vomiting (see separate section for counseling on
nausea/vomiting in pregnancy)
- poor appetite related to stress or depression or unknown reason
- fear of excess weight gain or possible eating disorder
- very busy/overly busy lifestyle
- economic issues, lack of food in the house.
- a fairly rare occurrence is when the person is so concerned about eating healthy that everything
they eat is very low in fat.
Inadequate weight gain can be followed by a high rate of weight gain
as the woman’s appetite returns and/or food intake is increased. This high rate of weight gain is
called “catch-up” weight gain and is considered acceptable (this patient should also be counseled
regarding exercise and to avoid sugary foods and sugary drinks, and to limit fruit juice to 4 ounces per
day or less – in order to prevent an excess rate of weight gain that is above normal ‘catch-up’ weight
gain).
If a patient continues to lose weight, they are at risk for developing ketone bodies in their blood, which
is dangerous for the baby, and can affect the baby’s intelligence)
In pregnancy the total amount of weight gained as well as the rate of weight gain is important in a
healthy pregnancy.