Risk factors identified during pregnancy.
(a) Anemia of pregnancy. Many pregnant patients have a lack of iron
stores large enough to meet the needs of pregnancy.
(b) Pregnancy-induced hypertension (PIH). This may be seen in more
patients with poor diets. However, there is no definite documentation of PIH's
relationship to the diet.
(c) Inadequate weight gain. This may be an indication of maternal and
fetal malnutrition (intrauterine growth retardation (IUGR)). It is important to document
the pattern of weight gain in pregnancy as well as the total amount of weight gained.
(d) Excessive weight gain. This may be due to fluid retention.
However, the pregnant woman should be carefully assessed for PIH.
d. Caloric Requirements of Pregnancy.
(1) Daily caloric requirements for a pregnant woman are about 300 more
than their normal requirements of 2300 to 2700 calories. The exact requirements are
dependent on the patient's age, multiple birth, and the patient's activity. Calories should
be selected for quality rather than quantity. "Empty calories" do not count.
(2) Pregnancy is not the time to correct weight problems. Maintenance of a
minimum of 1500 calories a day is essential for fetal development throughout the
pregnancy. Patients who gain extra weight the first seven months then decide to cut
back so as not to go overweight deprive the fetus of:
(a) Nutrients necessary when the fetal brain cells are growing the
(b) Nutrients necessary when the protective layer of fat is being
(3) Foods rich in protein, iron, and essential nutrients are recommended to
be eaten on a daily basis. During the first two trimesters of pregnancy, iron is
transferred to the fetus in moderate amounts, but during the last trimester when the
fetus builds its reserve, the amount transferred is accelerated ten times.
(4) Recommended weight gain for a normal pregnancy is 24 to 30 pounds.
See figure 9-1 for the distribution of weight gained after 40 weeks of pregnancy.