Client A is a 27 year old African American female who is currently pregnant.

Her weight
is 203 pounds, and stature is 57. Her usual body weight is 168 pounds. The clients usual BMI
is 26.3, and her ideal body weight for height is 135 pounds. The client eats 3 meals and one
snack per day. She is averaging around 1709 calories daily.
Client A has been diagnosed with gestational diabetes. According to Webb, the treatment
of gestational diabetes is to include modifications to lifestyle. Most with gestational diabetes are
not recommended to take insulin or other medications whether oral or by injection due to risk of
the medication crossing the placental barrier. The key to the diet of the gestational diabetic
diagnosed woman is to balance meals, and monitor the carbohydrate types consumed. Fast
absorbing, simple carbohydrates are to be avoided and should be replaced by low-glycemic, slow
absorbing, complex carbohydrates. All foods that have sugars added (refined foods and simple
carbohydrates that have sugar additions during processing) should be avoided or limited in the
diet. Client A is currently consuming several refined carbohydrates in her diet. Biscuits, Doritos,
and rolls are simple carbohydrates that could pose a negative effect on her blood sugar. She
currently avoids fruit at the suggestion of her doctor. When asked further detail on the absence of
fruit, she noted that her certified nurse mid-wife originally recommended a very strict diet to her.
After visiting her high-risk doctor, Client A was recommended to a nutritionist who suggested
she consume more fruits and balance these items out with protein and fibers to prevent quick
absorption and spikes to her blood sugar.
Another treatment to monitor the blood glucose levels of those with gestational diabetes
is blood glucose monitoring. Clients are taught to draw their own blood through finger pricks and
use strips with testing devices to determine their glucose level. Blood is typically drawn at
specific times, 1 hour post meals and once before breakfast. If more than three readings return

outside of normal range, the pregnant client is suggested to schedule an appointment with her
physician to assess whether further glucose lowering therapy is needed (Webb, 2013).
In addition to blood sugar complications that could be caused by excessive refined
carbohydrate intake, the clients diet is lacking in many key nutrients for a healthy pregnancy.
Folate and iron are a major vitamin and mineral missing in Client As diet. Client A is currently
supplementing her diet with prenatal vitamins as well as primrose oil. Primrose oil has been used
to prevent high blood pressure in pregnancy as well as prevent late deliveries and shorten labor
times (WebMD, 2013). Folate, or folic acid is one of the B complex vitamins. It is essential to a
healthy pregnancy. Several complications can occur without an adequate supply of folate to the
fetus. One complication, spina bifida is the condition where a childs spinal chord is exposed due
to a failure of the spinal column to close. Extensive surgeries as well as potential life-long
disabilities occur to those infants affected with spina bifida. Anencepholy, another folate
deficiency caused disorder is characterized by failure of the brain to develop. Majority of these
infants fail to thrive and die upon birth. Pregnant women need an average of 600 mcg folic acid
daily (Wolff, 2012).
Client A currently averages 280mcg per day through caloric intake. This level alone is
insufficient as meeting her needs. Client A does however regularly take prenatal vitamins which
supply the additional amount needed. Some dietary sources of folate the client can include are
leafy greens, beans, pasta, breads and fortified cereals (Wolff, 2012).
Another micronutrient deficiency Client A is experiencing through a deficit in dietary
intake is iron. Iron deficiencies are common in many, and several groups of people are
particularly at risk. Pregnant women are one of these at-risk groups. Client A also has blood
relatives who have been diagnosed as anemic. This further impacts her risk for deficiency. Iron is

essential during pregnancy and the World Health Organization recommends iron
supplementation to prevent deficiencies. Gestational anemias do sometimes occur, and they are
treated with iron supplementation. Oral, intravenous and intramuscular treatments are available
should this occur (Remacha, 2000).
Currently, Client A is taking in an average of 17 mg of iron daily. The recommended
amount is 27 mg. While supplementation can help, it is best to get this micronutrient from foods
for the most efficient absorption. Iron is necessary for the development of the fetus and also
helps in preventing premature births. Taking in adequate iron also deters anemia which has
symptoms that can cause the mother to feel lethargic. Some iron rich foods include whole grains,
fortified cereals, beef and chicken.

References
Nihira, M., M.D. (2012, July 7). Your healthy pregnancy diet: Top nutrients. Retrieved from
http://www.webmd.com/baby/pregnancy-diet-nutrients-you-need
Remacha, A. F. (2000). Strategies for the Prevention and Treatment of Iron Deficiency during
Pregnancy. Clinical Drug Investigation, 19(6), 29-43.
Webb, J. (2013). Diagnosis and treatment of gestational diabetes. Nurse Prescribing, 11(1), 14.
WebMD. (2013). Evening primrose oil. Retrieved from http://www.webmd.com/vitaminssupplements/ingredientmono-1006-EVENING PRIMROSE OIL.aspx?
activeIngredientId=1006&activeIngredientName=EVENING PRIMROSE OIL
Wolff, T., M.D. (2012, July 16). Folic acid fact sheet. Retrieved from
http://www.womenshealth.gov/publications/our-publications/fact-sheet/folic-acid.html