Assignment 1 Pre-pregnancy Case Study

1. Amandas pre-pregnancy BMI is calculated at 18.9. I took Amandas weight in

pounds and divided it by her height in inches squared. This number I
multiplied by the number 703. (110/(64)) * 703 = 18.88.
2. Amandas weight gain is lower than it should be at 19 weeks according to her
BMI. Since Amanda is on the lower end of the normal BMI range, she needs
to gain around the upper end of the weight range. According to the weight
chart, Amanda should have gained around 12 pounds by 19 weeks, but she
only gained 3 pounds.
3. Total Weight Gain
a. During Amandas first trimester she should have gained around 7
pounds.
b. Amanda should gain around 35 pounds during her entire pregnancy
because of her pre-pregnancy weight. Amanda has a lower normal BMI
and to help promote healthy growth for her fetus it is recommended
that she gain a greater amount weight.
4. I would suggest that Amanda continues to gain the appropriate amount of
weight for her BMI. I would also recommend that Amanda separate her solids
from her liquids when eating and that she stay away from foods that make
her nauseous. All three of these practices are considered safe methods for
pregnant women.
5. Iron is very important during pregnancy because of the increase in blood
volume. Iron is important in the transportation of oxygen in the body and to
keep oxygen levels adequate for mother and baby, iron levels need to be
increased. Amanda is still above the cut-off level for being diagnosed with
iron-deficiency anemia. At 19 weeks, the cut-off for iron-deficiency anemia is
indicated by hemoglobin levels being below 10.5. Amandas level is currently
at 10.7, therefore she is still above the cut-off, but is close to being
diagnosed.
6. Smoking can be damaging to the fetus. The chemicals from cigarettes can
damage the placenta and it can make the placenta detach from the uterus.
This causes issues with nutrient and oxygen transfer and lowers the supply
available to the fetus and can cause low birth weight, Sudden Infant Death
Syndrome and miscarriage. I would recommend that Amanda try nicotine
replacement therapy and counseling. Sometimes admitting the problem and
being able talk to another about it can help one overcome their addiction.
7. The first concern I have about Amandas visit, is the amount of exercise that
she does compared to her weight gain. Exercise is beneficial for pregnant
women, but should be moderate and she should still be able to gain the
appropriated weight. Also, the women should not become overheated,
dehydrated, and exhausted by the time they are done. Amanda is running 10
miles a day and this is expelling more calories than she is taking in, and this
is restricting the amount of nutrients and calories that the fetus is taking in.
Also, I was concerned about her previous experience with bulimia. The

combination of her previous bulimia, excessive exercise, and low BMI could
cause problems with her weight gain and nutrient intake later in pregnancy.
8. Amanda is at risk for a LBW infant due to the fact that her weight gain is
below the recommended amount and that she smokes. Both of these factors
cause low nutrient intake and a decreased growth rate.
9. I think that Amanda would benefit going to Maternity Management classes.
She would learn about new born care and receive help making feeding
choices. This program also helps with family dynamics and because of her
divorce this might help her work through some of those issues. I also think
that Amanda would benefit from a counseling program for eating disorders. I
think that this program will help her eat better so she can gain the
recommended amount of weight. Also, I think that this will help her prepare
herself for the physiological challenges she may undergo with the weight gain
and change of body image.
10.At this point in Amandas pregnancy I would recommend that she start taking
a prenatal or multivitamin, stop smoking, and increase intake of calories in
order to improve her nutritional status.
11.At 30 weeks gestation Amanda is in her 3rd trimester.
12.Amanda has not gained the recommended amount of weight according to her
pre-pregnancy BMI. At 30 weeks Amanda should have gained around 24
pounds and she has only gained 15 pounds. This puts here in the weight gain
range for an overweight woman.
13.To alleviate Amandas heartburn I would recommend that she eat smaller
more frequent meals and that she avoids foods that seem to make heartburn
worse.
14.Amanda is not eating an appropriate diet compared to the recommendations
from Choosemyplate.com. Amanda is not consuming enough calories for her
pregnancy. She doesnt eat enough dairy products for adequate calcium
intake. Amanda also consumes too much coffee and too little water. Amanda
needs to consume more whole grains in order to meet the requirements and
to increase her energy intake. Amanda also doesnt consume enough protein
for an adequate diet.
15.I would suggest that Amanda snack more often and every hour drink a glass
of water. I also think that Amanda should eat more fruits and vegetables. In
order to increase Amandas grain intake I would suggest that she eat a bagel
or breakfast on her way to work while drinks her coffee. Amanda also needs
to eat more yogurt to increase her calcium intake since she doesnt like to
drink milk. I also think that if Amanda would take some time off during work
to eat an actual meal this would improve her diet tremendously. All of these
suggestions will help Amanda improve her prenatal diet.
16.At this point I would tell Amanda that it is normal for women to start to feel
bad about their image around this time, but she must realize that much of
the weight she has gained isnt necessarily fat. She also has the baby, the
increased blood volume, body fluids, placenta, and many other factors that
add to the weight. I would also tell Amanda that she is doing great she has

about 2 months left and then her baby will be here. Amanda has also done
well on cutting back on her smoking and this will help the babies oxygen
levels increase significantly.
17.I would tell Amanda that breastfeeding is very beneficial for both her and her
baby. There is research to show that exclusively breastfeeding for 6 months
reduces the risks of illness and gastrointestinal infections in infants.
Breastfeeding is not a significant form of weight loss however. Average
weight loss, while taking in at least 1500 calories, is about 1 pound per week.
It could take at least a year to be close to your pre-pregnancy weight.
18.I would ask Amanda how often she goes out and drinks with her friends. I
would also ask Amanda if she eats a lot of swordfish and sushi.

References
Brown, Judith E. Nutrition Through the Life Cycle. Stamford, Connecticut: Yolanda
Cossio.; 2014.
Johnston, Deeona E. Class Notes. 2014
Centers for Disease Control and Prevention Staff. Reproductive Health: Tobacco
Use and Pregnancy. Centers for Disease Control and Prevention.
http://www.cdc.gov/reproductivehealth/tobaccousepregnancy/. Updated
8/5/2014. Accessed 9/18/2014.
Bowen, Dr. Michael. Pregnancy and Smoking. Netdoctor.
http://www.netdoctor.co.uk/health_advice/facts/pregnantsmoking.htm.
Updated 2/25/2013. Accessed 9/18/2014.
ANRED Staff. Eating disorders and Pregnancy. ANRED.
http://www.anred.com/pg.html. Published 2011. Accessed 9/23/2014.