Question

Renee is a 21-year-old African American woman in her 35th week of pregnancy. She is married and the mother of two young children. Her pre-pregnancy BMI was 18.1. She has gained 24 pounds since becoming pregnant, but at her most recent prenatal visit, she was found to have lost a pound over the past week. She says that her weight loss is due to “stress.” Renee says she enjoys eating canned spinach cooked in tomato sauce with chopped onions and craves “Napoleon” flavored ice cream. Her 24-hour recall is as follows:

Breakfast:16 oz kiwi strawberry drink  

Lunch: 16 oz lemonade

1½ baked chicken breast

3 cups canned spinach cooked in canned tomato sauce and onion

2 slices of carrot cake with cream cheese frosting

Snack: 8 oz whole milk

1 peanut butter and jelly sandwich

Dinner: 16 oz decaffeinated tea

5 oz beef and rice dinner

4 scoops Neapolitan-style ice cream

Snack: 24 oz water

1 buttermilk biscuit

1. Why can’t the nurse use Renee’s current weight to calculate a BMI for her?

2. Considering Renee’s pre-pregnancy BMI, what weight gain goals would you give Renee?

3. What other factor besides energy intake from foods could cause a pregnant woman to gain weight?

4. On reviewing her 24-hour dietary recall, what suggestions might you have for Renee about:

a.   her food choice for breakfast?

b.   her intake of fruits and vegetables?  

c.   her intake of concentrated sweets?  

d.   increasing her calcium intake?

Answer 1

1. ANS: Yes, because it is expected for her to gain weight within the recommended range based on her pre-pregnancy body mass index.

2. ANS: During the first trimester Renee may not gain an ounce, or at a maximum of 3 to 4 pounds because the baby is still small. In her second trimester, will start to grow and it is normal for her to gain approximately 14 pounds. In her third trimester the baby weight gain will increase but her weight gain may taper off and she will gain around 10 pounds. It is also possible to lose a pound or two during the ninth month of pregnancy.

3. ANS: Age, it is normal to gain a little weight as a person grows older, and genes may affect a person’s weight directly or indirectly.

4. ANS: On reviewing her 24-hour dietary recall, what suggestions might you have for Renee about the following:
Her food choice for breakfast: Drink only one cup of fruit juice or substitute the fruit for fresh fruit.

Her intake of fruits and vegetables: She needs to increase her intake of fruits and vegetables.

Her intake of concentrated sweets: She needs to decrease her intake of concentrated fruits and eat more fruits for natural sugar.

Increasing her calcium intake: She needs to increase her calcium intake so that she is consuming at least 3 cups of milk daily.