Today you are meeting with Meghan, a 39 year old non-Hispanic, White woman who is 20 weeks pregnant. Meghan has been referred to you, a Registered Dietitian, by her obstetrician. This is Meghan's first pregnancy. Meghan is regional sales manager for an upscale clothing store that is having some economic difficulties right now; her company is in the middle of closing some stores and "downsizing." Meghan shares with you that this was an unexpected pregnancy. Meghan had always wanted to be a mother, but she was very busy building her career and never felt like it was the right time to "settle down." Now she states that she is excited about her pregnancy, and has already been buying baby clothes and redecorating the second bedroom in her condo. Meghan attended a preconception health education class and will start a prepared childbirth class next month. Meghan is an only child. Meghan's mother and her mother's new husband live in New York, and as a newly retired couple, plan to travel a lot and spend their winters in Mexico.
Meghan had been dating the father of the baby, Peter, for about six months when she discovered that she was pregnant. Peter is 50 years old, an executive at Microsoft, and has two children ages 22 and 24. Peter was initially reluctant to have another child, but being a mother was very important to Meghan, and Peter agreed to support her during this pregnancy. The work team that Peter leads is currently in the middle of a big push for the roll out of a new version of their software product.
Meghan is uncertain about breastfeeding at this point. She plans to go back to work a month after she delivers, and is concerned that it would be too difficult to combine her work load with breastfeeding.
Fitness is important to Meghan. She was a competitive runner in high school and college. Meghan and Peter are part of a group of friends who socialize together during strenuous adult bike and ski trips. Meghan continues to run about 15 miles a week - having cut back from about 30 miles per week before she was pregnant, due to increased fatigue. She has a membership in a health club, and typically uses the weights and the Stairmaster "2 or 3 times" per week. She ways that In the last month she has added a water aerobics class to her routine to compensate for the reduction in her running.
There is a strong family history of obesity in Meghan's family; her father died at age 55 of heart disease that was probably related to the diabetes he developed in his 40s. Meghan tells you that she worries about having a big baby who will be at high risk for these conditions as an adult. Meghan also tells you that she has had to "work" to keep her weight under control, and she has found that a 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 125 pounds.
Meghan's prepregnancy weight was 120 pounds. She is 69 inches tall. Today her weight is 126 pounds.
Meghan'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 Meghan had a 50 gram oral glucose screen. Results at one hour were 120 mg/100 ml. Meghan's hematocrit today is 29%.
Meghan tells you that she is taking fish oil capsules to reduce her risk of developing hypertension and calcium to prevent leg cramps. She tried standard prenatal vitamins but they seemed to increase her nausea.
Before the visit you asked Meghan to keep three day food records. She brings them with her today. She states that this pattern is typical. Because she spends many days on the road visiting stores, 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, but she tries to get together with a group of friends every Sunday morning. Meghan 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, Meghan 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 1/2 cup egg substitute scrambled 12 ounces of coffee with 4 ounces whole milk |
Breakfast
3 slices bacon 1/2 cup egg substitute scrambled 12 ounces of coffee with 4 ounces whole milk |
| Lunch
6 ounces vacuum packed tuna 12 oz diet sprite 2 rice cakes (brown rice, plain) 1 1/2 ounce Pouligny-Saint-Pierre cheese |
Lunch
6 ounces vacuum packed salmon 12 oz diet sprite 2 rice cakes (brown rice, plain) 1 1/2 ounce Pouligny-Saint-Pierre cheese | |
| Snack
4 ounce plain whole milk yogurt 2 cups Dieter Herbal Tea (Nature's Med-Kit) |
Snack
4 ounce plain whole milk yogurt 2 cups Dieter Herbal Tea (Nature's Med-Kit)
|
Snack
4 ounce plain whole milk yogurt 2 cups Dieter Herbal Tea (Nature's Med-Kit)
|
| Dinner
6 ounces salmon - grilled 1/2 cup asparagus 12 ounces whole milk
|
Dinner
6 ounces grilled chicken breast (meat only) 2 cups Romaine lettuce (shredded) 1 Tablespoon Basalmic Vinegrette 4 cherry tomatoes 12 ounces whole milk
|
Dinner
6 ounces sole baked in lemon juice and 1 Tablespoon butter 1 cup steamed broccoli 1Tablespoon olive oil 12 ounces whole milk |
Pregnancy Weight Gain Grids: http://www.nal.usda.gov/wicworks/Sharing_Center/NY/prenatalwt_charts.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/About/Content.aspx?id=8375
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.
Promoting and Supporting Breastfeeding: http://www.eatright.org/About/Content.aspx?id=8377