Over the past quarter century, there has been an increased awareness of the positive relationship between maternal weight gain during pregnancy and birth weight of the newborn. This awareness is compounded by the recognition of socioeconomic differences in dietary quality and the pregnancy performance which has heightened concern about the nutritional status of the pregnant woman .The woman's body mass index should be determined at the initial prenatal visit to allow for preconceptional intervention recommendations if her status is under- or overweight. An individualized goal for weight gain during pregnancy should be set, and any major or potential nutritional risk factors should be identified. The woman should be asked about her food intake, and, if necessary, she may be referred to a registered dietitian or nutritionist for dietary counseling. A woman's nutrition before pregnancy may have profound effects on reproductive outcome Underweight women who gain little weight during pregnancy are at particularly high risk. Educational materials on nutrition that are available from the American College of obstetricians and Gynecologists, the U.S. Public Health Service, and the March of Dimes may be given to the patient. All patients should be referred or to the Women, Infants, and Children (WIC) program for assistance.
Ante-partum Dietary Recommendations: The recommended dietary allowances (RDA) and recommended energy intakes for adolescent and young adult women when nonpregnant, pregnant, and lactating are listed in the table in this section of the manual. These recommendations should be considered a general guide to nutrition in formulating a balanced diet.
Although energy intakes are based on median weights, RDA for nutrients are judged to meet the known needs of practically all healthy persons. Changes in the RDA from those published a
decade ago include listing allowanced for micro-nutrients during pregnancy, rather than increments, and separating recommendations for the lactating woman by the length of lactation.
- Caloric Intake: It is important to try to balance the benefits of increased fetal growth with the risks of complicated labor and delivery and of postpartum maternal weight retention. The increased demands of pregnancy require on average 300 kcal/d, but the actual caloric intake will vary based on the mother's pre-pregnancy height and weight. Weight gain will also vary if the mother is carrying twins. Regardless of maternal weight gain, there is little evidence that caloric intake influences fetal development.
Prenatal Laboratory Testing at Initial Visit
- Blood Rh negative titer, antibody screen
- Rubella titer
- Syphilis screen
- Pap smear (cervical cytology)
- Urinalysis, including microscopic exam and infection screen
- Urine protein and glucose
- Urine screen for urinary tract infection (UTI)
- Hepatitis B titer
- HIV titer
- Maternal serum alpha-feto-protein (MSAFP)f 16-18 weeks gestation)
- Toxoplasmosis - if indicated
- Tuberculosis - if indicated
- Group B Streptococcus - if indicated
- Cytomegalovirus (CMV) - if indicated
- Oral glucose tolerance testing when there is history of macrosomic, or malformed infant, fetal death; or first degree family history of diabetes