Today you are meeting with Elizabeth, a 35 year old non-Hispanic, White woman who is 23 weeks pregnant. This is Elizabeth's first pregnancy. Elizabeth is a sales representative for a pharmaceutical company. Elizabeth is married to David, a 47 year old physician. David has 3 children, aged 9, 12 and 15 from a previous marriage.
Elizabeth shares with you that she carefully planned this pregnancy. David was initially reluctant to have another child, but being a mother was very important to Elizabeth and David agreed to go ahead with a pregnancy. They have been married for 18 months. Elizabeth attended a preconception health education class and will start a prepared childbirth class next month.
Elizabeth is uncertain about breastfeeding at this point. She plans to go back to work three weeks after she delivers, and is concerned that it would be too difficult to combine her work load with breastfeeding.
Fitness is important to Elizabeth. She studied ballet for several years during her childhood and adolescence, and has continued to take dance classes as an adult. Elizabeth and David's social life is centered around group events that often include adult bike and ski trips. Elizabeth has a membership in a health club, and typically uses the weights and the Stairmaster 2 or 3 times per week. In the last month she has added a water aerobics class to her routine.
There is a strong family history of obesity and diabetes in Elizabeth's family, and David's father died at age 55 of heart disease. Elizabeth tells you that she worries about having a big baby who will be at high risk for these conditions as an adult. Elizabeth also tells you that she has had to "work" to keep her weight under control, and she has found that a high protein - low carbohydrate diet is the most effective approach for her. She tells you that once, when she failed to follow this diet for a few weeks her weight "ballooned" to 115 pounds.
Elizabeth's prepregnancy weight was 108 pounds. She is 67 inches tall. Today her weight is 115 pounds.
Elizabeth's health history is unremarkable. Her blood pressure today is within normal limits. She denies use of drugs or tobacco.
With this pregnancy she continues to experience, fatigue, nausea, intermittent constipation and heartburn.
Last week Elizabeth had a 50 gram oral glucose screen. Results at one hour were 120 mg/100 ml. Elizabeth's hematocrit today is 28%.
Elizabeth is taking fish oil capsules to reduce her risk of developing pregnancy induced hypertension and calcium to prevent leg cramps. She tried standard prenatal vitamins but they seemed to increase her nausea.
Before the visit you asked Elizabeth to keep three day food records. She brings them with her today. She states that this pattern is typical. Because she spends many hours most days visiting medial practices, she makes a point of taking her lunch and snack with her in a cooler so that she won't have to buy food of unknown quality on the road. Weekends are variable depending on her social schedule. Elizabeth and Tom frequently travel and entertain on the weekend. Elizabeth states that she works hard to avoid foods with fat and sugar. She will occasionally have one glass of wine or beer at social events. In addition to the foods and beverages listed below, Elizabeth tells you that she usually carries a water bottle around with her and she makes a point of drinking at least 2 liters of water a day - more if it is hot or she has been exercising.
| Day One | Day Two | Day Three |
| Brunch 2 ounce Lox 1 ounce low fat cream cheese 1/2 plain bagel 12 ounce non-fat latte 3 ounces mimosa (1/2 champagne, 1/2 orange juice)
|
Breakfast
3 slices bacon 2 egg substitutes scrambled 12 ounces of coffee with 2 ounces non-fat milk |
Breakfast
3 slices bacon 2 eggs scrambled 12 ounces of coffee with 2 ounces non-fat milk |
| Lunch
Tuna salad ( 6 ounces water packed tuna, 1 Tbsp. mayonnaise, 1 Tbsp. chopped celery) 12 oz diet sprite 2 rice cakes (brown rice, plain) |
Lunch
Tuna salad ( 6 ounces water packed tuna, 1 Tbsp. mayonnaise, 1 Tbsp. chopped celery) 12 oz diet sprite
| |
| Snack
8 ounce plain non-fat yogurt 2 cups Dieter Herbal Tea (Nature's Med-Kit) |
Snack
1 1/2 ounce Pouligny-Saint-Pierre cheese 1 slice low calorie bread
|
Snack
1 1/2 ounce Pouligny-Saint-Pierre cheese 2 rice cakes |
| Dinner
12 ounces non-fat milk 8 ounces salmon - grilled 1/2 cup green peas
|
Dinner
8 ounces grilled chicken breast (meat only) 2 cups Romaine lettuce (shredded) 1 Tablespoon Caesar salad dressing 1 Tablespoon parmesean cheese 12 ounces non-fat milk
|
Dinner
8 ounces sole baked in lemon juice and 1 Tablespoon butter 1/2 cup baked potato flesh 1Tablespoon butter 12 ounces skim milk |
Pregnancy Weight Gain Grids: http://www.perinatology.com/Archive/Weightgrid.pdf
Food Safety for Moms to Be: http://www.cfsan.fda.gov/~pregnant/while.html
Nutrition and lifestyle for a healthy pregnancy outcome: http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/advocacy_adar1002b_ENU_HTML.htm
Natural Medicines Comprehensive Database (must access from UW recognized computer) http://www.naturaldatabase.com/
Recommendations to Prevent and Control Iron Deficiency in the United States:
http://www.cdc.gov/mmwr/preview/mmwrhtml/00051880.htmAmerican College of Obstetricians and Gynacologists: Exercise during pregnancy and the postpartum period. ACOG committee on Obstetric Practice. Obstet Gynecol. 2002 Jan;99(1):171-3. Available through UW eJournals.