Sheri

Sotto
NDFS 424
February 29, 2016
Pregnancy Project Part 1

I.

Identifying Data
A.
B.

II.

Collette
Stay at home mom, wife of a security clearance investigator

Health History
A. Age: 32
B. 1) 4 live births, currently pregnant,
2) Interconceptual Period of 1 year 5 months
3) Birth weights of previous infants: Aaron 7lbs 8oz, BreeAnna 5lbs 14oz,
Emary 7lbs 10 oz, Ethan 7lbs 13oz
4) Childrens Ages: 10, 8, 4, and 1
5) Lactation experience: all 4 latched well, and never ran out of milk.
Nursed each for one year, first for 14 months
C. Estimated Delivery Date; May 24th, 2016
D. Laboratory data: Oct 8, 2015 Lab values
Hemoglobin 13
Hematocrit 40.2
E. None
F. None
G. Previous Nutritional Deficiencies: Typically low in iron
H. Supplements: Prenatal vitamins
I. Exercise/activity: Chase children all around the house and stairs all day
J. No allergies

III.

1)

Nutritional Assessment
A.

Food Groups and Calories Report

Your plan is based on a 2600 Calorie allowance during your 3rd trimester of pregnancy.

Food Groups

Target

Average Eaten Status

Grains

9 ounce(s)

9 ounce(s)

OK

Whole Grains

4 ounce(s)

3 ounce(s)

Under

Refined Grains

4 ounce(s)

6 ounce(s)

Over

Vegetables

3 cup(s)

1 cup(s)

Under

Dark Green

2 cup(s)/week

0 cup(s)

Under

Red & Orange

7 cup(s)/week

cup(s)

Under

Beans & Peas

2 cup(s)/week

0 cup(s)

Under

Starchy

7 cup(s)/week

0 cup(s)

Under

Other

5 cup(s)/week

cup(s)

Under

Fruits

2 cup(s)

3 cup(s)

Over

Whole Fruit

No Specific Target

1 cup(s)

No Specific
Target

Fruit Juice

No Specific Target

2 cup(s)

No Specific
Target

Dairy

3 cup(s)

3 cup(s)

Over

Milk & Yogurt

No Specific Target

1 cup(s)

No Specific
Target

Cheese

No Specific Target

2 cup(s)

No Specific
Target

Protein Foods

6 ounce(s)

9 ounce(s)

Over

Seafood

10 ounce(s)/week

0 ounce(s)

Under

Meat, Poultry & Eggs

No Specific Target

9 ounce(s)

No Specific
Target

Nuts, Seeds & Soy

No Specific Target

0 ounce(s)

No Specific
Target

Oils

8 teaspoon

5 teaspoon

Under

Limits

Limit

Average Eaten Status

Total Calories

2600 Calories

2569 Calories

OK

 Added Sugars

< 260 Calories

56 Calories

OK

Saturated Fat

< 260 Calories

386 Calories

Over

Note: If you ate Beans & Peas and chose "Count as Protein Foods instead," they will be
included in the Nuts, Seeds & Soy subgroup.

2)

Nutrients Report

Your plan is based on a 2600 Calorie allowance during your 3rd trimester of pregnancy.

Nutrients

Target

Average Eaten Status

Total Calories

2600 Calories

2569 Calories

OK

Protein (g)***

71 g

133 g

OK

Protein (% Calories)***

10 - 35% Calories 21% Calories

OK

Carbohydrate (g)***

175 g

OK

Carbohydrate (% Calories)***

45 - 65% Calories 43% Calories

Under

Dietary Fiber

28 g

20 g

Under

Total Sugars

No Daily Target
or Limit

104 g

No Daily Target
or Limit

Added Sugars

< 65 g

14 g

OK

Total Fat

20 - 35% Calories 37% Calories

Over

Saturated Fat

< 10% Calories

15% Calories

Over

Polyunsaturated Fat

No Daily Target
or Limit

6% Calories

No Daily Target
or Limit

Monounsaturated Fat

No Daily Target
or Limit

13% Calories

No Daily Target
or Limit

Linoleic Acid (g)***

13 g

15 g

OK

Linoleic Acid (% Calories)***

5 - 10% Calories

5% Calories

OK

-Linolenic Acid (% Calories)*** 0.6 - 1.2%

Calories
1.4 g
-Linolenic Acid (g)***

0.8% Calories

OK

2.2 g

OK

Omega 3 - EPA

No Daily Target
or Limit

6 mg

No Daily Target
or Limit

Omega 3 - DHA

No Daily Target
or Limit

54 mg

No Daily Target
or Limit

Cholesterol

< 300 mg

915 mg

Over

276 g

 Minerals

Target

Average Eaten Status

Calcium

1000 mg

1413 mg

OK

Potassium

4700 mg

2890 mg

Under

Sodium**

< 2300 mg

4628 mg

Over

Copper

1000 g

1371 g

OK

Iron

27 mg

24 mg

Under

Magnesium

360 mg

335 mg

Under

Phosphorus

700 mg

2139 mg

OK

Selenium

60 g

171 g

OK

Zinc

11 mg

23 mg

OK

Vitamins

Target

Average Eaten Status

Vitamin A

770 g RAE

1048 g RAE

OK

Vitamin B6

1.9 mg

3.0 mg

OK

Vitamin B12

2.6 g

10.0 g

OK

Vitamin C

85 mg

180 mg

OK

Vitamin D

15 g

7 g

Under

Vitamin E

15 mg AT

8 mg AT

Under

Vitamin K

90 g

80 g

Under

Folate

600 g DFE

746 g DFE

OK

Thiamin

1.4 mg

2.7 mg

OK

Riboflavin

1.4 mg

3.5 mg

OK

Niacin

18 mg

28 mg

OK

Choline

450 mg

630 mg

OK

Information about dietary supplements.

*** Nutrients that appear twice (protein, carbohydrate, linoleic acid, and -linolenic acid) have two separate
recommendations:

1) Amount eaten (in grams) compared to your minimum recommended intake.

2) Percent of Calories eaten from that nutrient compared to the recommended range.
You may see different messages in the status column for these 2 different recommendations.


3)

Meals Summary

Your plan is based on a 2600 Calorie allowance during your 3rd trimester of pregnancy.
Breakfast

Lunch

1 cup Kellogg's

Raisin Bran
Cereal

Dinner

1 medium (2-3/4"

2 cup Apple juice

2 cup Fried

across) Apple, raw

Snacks

rice, with pork

1 cup Milk,
reduced fat (2%)

cup, cooked,
diced Beef, pot
roast, braised or
boiled, lean only
eaten

2 regular slice

3 slice (1 oz)

Cheddar cheese

2 dash (1/16 of a

teaspoon) Salt,
table

Bread, 100% whole

wheat

8 square Cracker,

saltine

2 large egg(s)

1 slice (1 oz)

Cheese, Cheddar

Scrambled egg

(no milk added),

cooked with
nonstick spray

4 square Cracker,

saltine

1 medium leaf
Lettuce, iceberg,
raw

tablespoon
Mayo, regular

2 slice Ham,

luncheon meat,

prepackaged or
deli

cup Red pepper,

cooked (no salt or
fat added)

B. 1) Macronutrient Distributions:


43% calories from carbohydrate. Recommended: 45-65% = LOW


37% of calories from fat. Recommended: 20-35% = HIGH


21% of calories from protein. Recommended: 10-35% = GOOD

2) Grains: Recommended 9 oz. Actual Intake: 9 oz. She met the overall



grain requirement, but had too many refined grains, and not



enough whole grains overall.


Vegetables: Recommended 3.5 cups. Actual Intake: 1 cup. Vegetable



intake was very low overall.


Fruits: Recommended: 2 cups. Actual intake: 3.5 cups. Fruit intake



was a little high overall.


Dairy: Recommended: 3 cups. Actual intake:3.75 cups. Dairy intake



was also a little above the recommended level.


Protein: Recommended: 6.5 oz (with 10 oz seafood per week). Actual



intake: 9.5 oz. Protein intake was a little high overall, and also



too low in seafood (assuming that her intake did not vary to



include seafood later on in the week, but she does have tuna



fish sandwiches occasionally so I think she is okay with the



seafood.)

3) Vitamins and Minerals:


Too high: Cholesterol (915g with <300g recommendation)




Sodium (4628mg with <2300mg recommendation).


Too Low: Dietary Fiber (20g with 28g recommendation)



Potassium (2890mg with 4700mg recommendation)



Iron (24mg with 27mg recommendation)



Magnesium (335mg with 360mg recommendation)



Vitamin D (7 g with 15 g recommendation)



Vitamin E (8 mg AT with 15mg AT recommendation)



Vitamin K (80 g with 90 g recommendation)


C. WIC milk, cereal, yogurt, cheese, fruit, eggs, peanut butter, and additional
items for pregnant women include carrots and tuna fish.

E. 10-15% of income spent on food.

F. Cooking and Eating Habits: Collette tries to eat every 2 hours, and makes
almost all their food homemade due to picky eaters. She has found that protein is
good to avoid nausea (eggs, peanut butter, and cheese). She doesnt have any foods
that she dislikes expect pop tarts and really sugary things because they leave a bad
aftertaste when shes pregnant. She has had no cravings with this pregnancy, and
also noticed that smells are stronger in general, but nothing in particular that is
annoying to her.

IV.

Weight Graphed
A.


B.

1) Pre pregnancy weight: 120 lbs (or 54.5kg)

2) Height: 5ft 5 inches (1.65m)
3) Pre-pregnancy BMI = 20
See Weight Gain Chart below:

C.
Interpretation: At 20 weeks, Collette weighed 146 lbs, meaning that she
has gained about 26 pounds over the course of her pregnancy thus far. This is
within the recommended range of 25-35 pounds for women with a pre-
pregnancy BMI in the normal range, however, at 20 weeks, the max she should
have gained would have been 12 lbs, indicating that either she underestimated
her pre-pregnancy weight or she has gained far too much weight too early in her
pregnancy.

V. Nutritional Care Plan:

A. Summary: The most significant risk factor that I can see is too rapid weight
gain. At least in this 24-hour recall she didnt seem to exceed the 2600 calorie/day
recommendation, but her intake of calories from fat was above the recommended
level. Collettes weight gain should improve as she replaces more of the calories
from fat with a more balanced diet of vegetables and other carbohydrates. Collettes
diet is currently too low in vegetables, and therefore a few vitamins and minerals
found in vegetables as well such as Dietary Fiber, Potassium, Iron, and Vitamin K are
also low. She could increase her vegetable intake by having a salad with one of her
meals, or replacing some of her saltines and cheese snacks with vegetables such as
carrot sticks or sweet bell peppers. Especially because Collette has a history of being
iron deficient, she needs to increase her iron intake by 3g per day, either with food
sources or in an iron supplement. I would also recommend increasing Vit D intake
either through a supplement or fortified dairy products as she is low in Vit D as well.



B. Gaining weight at an appropriate rate during pregnancy is important
because gaining over the recommended range can lead to increased risk of
gestational diabetes, large birth weight infants, C-sections, hypertension, and
postpartum weight retention. However, because she has had four healthy weight
babies in the past with none of these conditions, my concern is less than it could be
otherwise and I suspect that her estimation of her pre-pregnancy weight was
slightly off. Getting sufficient iron is important to prevent iron-deficiency anemia.
Adequate Vitamin D levels are important for fetal bone formation, lowering risk of
infections, and it also decreases the risk of cavities in the infant.

To help Collette make these dietary changes I would include educational
materials that included lists of foods and/or supplements that contain the vitamins
and minerals that she needs to increase, as well as a list of easy vegetable based
snacks or main dishes to help her increase her vegetable intake.

Pregnancy Project Part II

I. Education: Here is copy of the email that I sent to Collette:

Here are some recommendations that I have come up with based on the information
you gave me when we met a while ago. A couple of disclaimers: I only know your
diet for one 24 hour period, so obviously it is not a perfect representation of what
you eat. Also, I am not a professional, so if I happen to recommend anything that
your doctors disagree with, please follow what your doctor says!

With that said, I hope that you find some of these suggestions to be helpful to you!
You are an amazing mother!!

For you:
Overall your diet looks really good! You get plenty of fruit, dairy, and grains,
and dont eat too many processed foods which is great. My main suggestion for you
would be to increase the number of veggies you eat. Your vegetables were a little
low, and your protein was a little high, so maybe try and replace some of your
protein based snacks (like cheese/crackers and nuts) with vegetable based ones
(like carrot sticks, celery, chips and salsa or guacamole, etc). I noticed that Emary
was also a little low in vegetables so Ive attached a list of fun ways to get kids to eat
vegetables, which of course can work for you too! Also, dont feel like you need to
include a meat in every meal there are lots of veggie based meals you can try like
salads and vegetable based stir-fries as well.
Increasing your vegetables will not only help balance your diet, but also help
you to increase your fiber intake as well as some other vitamins and minerals such
as potassium, vitamin K, and iron which were also a little low. Just for your
reference I have also attached a chart that compares your 24 hour- recall diet to the
Choose My Plate recommendations - this is a great guide to follow! (Choose My
Plate is the new Food guide pyramid, and is a great way to make sure you are getting
a good balance of all the different food groups; grains, vegetables, fruits, protein, and
dairy).

Please let me know what you think, or if you have any questions/concerns!

Veggie-Prep Ideas:
Have a challenge getting your family to eat vegetables? Then maybe you need to get
sneaky so they can reap the benefits. If veggies meet with family resistance, try
these suggestions to fit them in.
Serve salsa. Salsa (with tomatoes, beans or other veggies) served with pita,
bagel or tortilla chips doesn't seem like a vegetable.
Blend them in. Put shredded carrots in mashed potatoes, or mix them with
potatoes for a twice-baked version, chopped broccoli in macaroni and cheese,
layered zucchini in lasagna, or shredded spinach in slaw.
Wrap it up. Hide veggies in a tortilla wrap, under pizza cheese or at the

bottom of a pita.
Serve one-dish meals. That way, they can't push away the veggie side dish.
http://www.eatright.org/resource/food/nutrition/healthy-eating/sneak-em-in

Collettes Food Groups and

Calories Report

Your plan is based on a 2600 Calorie allowance during your 3rd

trimester of pregnancy.

Food Groups

Target

Average
Eaten

Status

Grains

9 ounce(s)

9 ounce(s)

OK

Whole Grains

4 ounce(s)

3 ounce(s)

Under

Refined Grains

4 ounce(s)

6 ounce(s)

Over

Vegetables

3 cup(s)

1 cup(s)

Under

Dark Green

2 cup(s)/week

0 cup(s)

Under

Red & Orange

7 cup(s)/week

cup(s)

Under

Beans & Peas

2 cup(s)/week

0 cup(s)

Under

Starchy

7 cup(s)/week

0 cup(s)

Under

Other

5 cup(s)/week

cup(s)

Under

Fruits

2 cup(s)

3 cup(s)

Over

Whole Fruit

No Specific
Target

1 cup(s)

No Specific
Target

Fruit Juice

No Specific
Target

2 cup(s)

No Specific
Target

Dairy

3 cup(s)

3 cup(s)

Over

Milk & Yogurt

No Specific
Target

1 cup(s)

No Specific
Target

Cheese

No Specific
Target

2 cup(s)

No Specific
Target

Protein Foods

6 ounce(s)

9 ounce(s)

Over

Seafood

10 ounce(s)/week 0 ounce(s)

Meat, Poultry &

Eggs

No Specific
Target

Nuts, Seeds & Soy No Specific

Target
8 teaspoon
Oils

Under

9 ounce(s)

No Specific
Target

0 ounce(s)

No Specific
Target

5 teaspoon

Under

 Limits

Limit

Average
Eaten

Status

Total Calories

2600 Calories

2569 Calories OK

Added Sugars

< 260 Calories

56 Calories

OK

Saturated Fat

< 260 Calories

386 Calories

Over

Note: If you ate Beans & Peas and chose "Count as Protein Foods instead,"
they will be included in the Nuts, Seeds & Soy subgroup.

II. Reflection:

When I initially met with Collette to collect information for this assignment

she seems very receptive to the idea of improving her diet and finding ideas for how
to help her and her family eat better. At the same time, she is also very competent as
a mother of four, and I dont think that she felt a great need to change anything
drastically because her family is pretty healthy as is. She was curious to see what I
would have to say though.

When I sent her the feedback from the assignment, her and her kids were
sick with the stomach flu, and her husband was about to be deployed in a few weeks
to the middle east for a 6-month duty there. She told me that she was pretty
overwhelmed with everything, and that she probably wouldn't get the chance to
look over the suggestions for a while. Even though I think Collette would be open to
making the suggested changes, I think the biggest barrier for her will be finding the
time and energy to even think about it. Life as a mom, pregnant lady, and military
wife is stressful and hectic, and making nutrition changes when everything seems to
be going well health-wise is probably very low on her priority list. Considering this, I
probably could have improved my education by summarizing the main point in
bullet point format rather than in paragraph form so that she is more likely to read
and at least be aware of the suggestions that I had for her.