Download File

Di Micco
10/26/2009
Carolyn Di Micco
NFS 394
Pregnancy Analysis
Background Information
1. Chrissy Schabacker is currently thirty eight weeks pregnant. She has always had good
overall health including low blood pressure and low LDL cholesterol levels. Although
Chrissy has never been diabetic, she was diagnosed with gestational diabetes in her 26th
week of pregnancy.
2. My overall impression of Chrissy’s health is that she is doing very well. Chrissy looks
healthy and happy; she has that pregnancy glow. Chrissy is aware of her gestational
diabetes and spaces out her meals very well. She also tries to limit her sweets to just one
sweet thing per day.
3. Chrissy’s pre-pregnancy weight was 130 pounds, and she is 5’5”, giving her a BMI of
21.6. For her first trimester, Chrissy gained three pounds. Chrissy gained ten pounds for
her second trimester, and fourteen pounds in her third trimester when we spoke at her 37th
week of pregnancy. It is recommended that you gain 2-4 pounds in the first trimester, and
2-4 pounds per month during the second and third trimesters. For Chrissy, I suggest to
keep gaining weight and eating the same way that she has been. She only has a short two
weeks left in her pregnancy. I suggest that Chrissy gain a half pound per week in her last
remaining weeks.
4. Chrissy’s choice is breast feeding her child.
Dietary Analysis
A. Chrissy only consumed about five ounces of grains, none of which were whole grains.
Chrissy met the two cup requirement for fruits, but consumed 2 ½ of the three cups of
1
Di Micco
10/26/2009
vegetables. Out of the three recommended cups of milk per day, she consumed two cups.
Chrissy ate six of the 6 ½ ounces of meat and beans recommended, and she ate about 5 ½
teaspoons of the seven teaspoon recommendation for oils.
B. According to the Food Frequency Questionnaire (FFQ), Chrissy only consumes about 2
servings of grains per day; the MyPyramid Food guide for pregnant women suggests 8
ounces of grain per day, and to “make half your grains whole.” The FFQ also reported
Chrissy to consume about 2 servings of fruit, a serving of meat and beans, 2 servings of
vegetables, and about 2 ½ servings of milk each day. The MyPyramid Food Guide
recommends 2 cups of fruit each day, 6 ½ ounces of meat and beans, 3 cups of
vegetables, and 3 cups of dairy each day for pregnant women. According to the FFQ,
Chrissy is lacking in grains, meat and beans, vegetables, and dairy.
C. Chrissy’s 24-hour food recall and FFQ were very similar, only yielding major differences
in grain and meat and bean consumption. In the 24-hour food recall, Chrissy consumed 5
ounces of grains, but usually consumes only 2 servings of grains per day according to the
FFQ. In the 24-hour recall, Chrissy had 2 cups of fruit, and in the FFQ she normally
consumes just slightly under 2 servings of fruit per day. Chrissy met the 6 ½ ounces of
meat and beans recommended by MyPyramid in her food recall, but according to the
FFQ she usually consumes a serving per day. Chrissy reported eating 2 ½ cups of
vegetables on the day of her 24-hour food recall, but the FFQ reported only 2 servings
per day being normal. In her food recall, Chrissy reported consuming 2 cups of dairy, but
the FFQ reported about 2 ½ cups of dairy per day to be her norm.
2
Di Micco
10/26/2009
Number of Servings Consumed Daily
24-Hour Food Recall
Grains
Fruit
Meat
Vegetables
Dairy
5
2
6½
2½
2
Food Frequency
Questionnaire
2
2
1
2
2½
D. I believe the Food Frequency Questionnaire to be more accurate for my client. She
consumes very little meat, and does not eat beans at all. Although Chrissy consumed 6 ½
ounces of meat on the day of the food recall, I believe this to be a rare occasion. Looking
at the FFQ, Chrissy scored most food items in the meat and beans very low on the scale,
with the most frequent being chicken and turkey two times per week. Chrissy also told
me during the interview that she does not like beans, and therefore never cooks them for
her and her husband to eat. Chrissy also explained that she really loves fruit, and it’s the
one thing that really remains constant in her diet. According the FFQ, Chrissy eats a
variety of fruits and vegetables, and gets her daily recommendation each day. The FFQ
determined Chrissy’s daily intake of vegetables to be 2 cups per day, which makes sense
considering Chrissy told me the only vegetables she mostly eats are in her salads, and she
makes sure to eat a salad each day. I was very impressed with her salads; they are full of
variety and mixed vegetables, giving her optimal nutrition in a small meal. Chrissy puts
green and red bell peppers in her salad each night, alternating days. I believe the FFQ to
be more accurate with Chrissy’s dairy intake because Chrissy told me in our interview
that she loves cereal and eats it very often. She also told me that she eats a cheese stick or
yogurt everyday for breakfast. Finally, Chrissy’s FFQ results for grains revealed that she
only consumes about two servings per day. Perhaps this is why she has developed
3
Di Micco
10/26/2009
gestational diabetes? I don’t know much about gestational diabetes, but perhaps her lack
of grains in her diet has caused her to not be able to handle and utilize glucose efficiently
in her pregnancy.
E. I estimated Chrissy’s daily intake of protein to be about 15 grams per day, carbohydrate
to be about 90 grams per day, fat to be about 40 grams per day, and total calories to be
about 1400-1500 kilocalories per day. The RDAs for protein for pregnant women is 71
grams per day. It is recommended that women with gestational diabetes consume 30
kilocalories per kilogram of body weight, if normal weight (as determined by BMI).
Chrissy had a normal BMI before pregnancy, and if I look at her latest weight – 157
pounds – she should be consuming 2140 kilocalories per day. Chrissy needs to consume
740 more kilocalories per day. It is recommended that pregnant women with gestational
diabetes make 40% of their daily intake carbohydrates, and 30% of their daily intake fats.
According to this recommendation, Chrissy should consume about 71 grams of fat per
day, 214 grams of carbohydrate per day, and 161 grams of protein per day. Chrissy is
currently under by 145 grams of protein per day, 124 grams of carbohydrate per day and
about 30 grams of fat per day.
F. I estimated Chrissy’s iron intake to be about 7 milligrams per day, her fiber to be about
13 mg per day, her folic acid to be about 190 micrograms per day, her Calcium intake to
be about 950 milligrams, her Vitamin A to be about 670 micrograms per day, and her
Vitamin C to be about 65 milligrams per day. It is recommended that pregnant women
consume 600 micrograms of dietary folate per day, and 400 micrograms of folic acid
from fortified foods per day, so Chrissy needs to consume about 210 micrograms more of
folic acid per day. The Vitamin A recommendation for pregnant women is 770
4
Di Micco
10/26/2009
micrograms per day, so she should consume about 100 more micrograms. The Vitamin C
recommendation is 85 milligrams per day, so she needs about 20 more milligrams. The
Calcium recommendation for pregnant women is 1000 milligrams, so Chrissy only needs
about 50 more milligrams per day. The fiber recommendation is 28 grams per day, so she
needs about 15 more grams per day.
G. I tried to keep in mind all of the food items that my client loves to eat, since she seems to
have a very small range of foods that she eats. I tried to include all the foods that my
client would be likely to eat, as opposed to those she would never eat. For example, I did
not include beans since my client never eats them. Since Chrissy has gestational diabetes,
her recommended kilocalorie intake per day is 2140. Of the 210 kcals/day, Chrissy
should be eating about 214 grams of carbohydrate, and she definitely needs to incorporate
more whole grains into her diet. Chrissy should be consuming about 71 grams of fat per
day, and about 161 grams of protein per day. Here is my recommendation for Chrissy’s
diet:
Breakfast:
A spinach omelet:
2 cups egg whites
½ cup nonfat mozzarella, shredded
½ cup spinach
1 cup coffee
1 Half & Half creamer
1 packet of sugar
Morning Snack:
½ cup nonfat yogurt
1 large apple or peach
Lunch:
1 cup chopped lettuce
½ cup diced tomatoes
¼ cup diced green peppers
¼ cup diced red peppers
5
Di Micco
10/26/2009
½ c diced carrots
2 tablespoons Lite Italian Dressing
Afternoon Snack:
1 cup skim milk
1 cup granola
Dinner:
2 cups whole wheat pasta
6 ounces diced chicken breast, without the skin
1 clove garlic
1 cup broccoli florets
3 tablespoons olive oil for sautéing the vegetables
This diet will approximately give Chrissy 160 grams of protein, 75 grams of fat,
250 grams of carbohydrates, and 2100-2200 kilocalories. From this diet, Chrissy will also
consume about 28 grams of fiber, about 1470 micrograms of Vitamin A, about 240
milligrams of Vitamin C, and about 1500 milligrams of calcium. This diet has 6 ounces
of grains, 3 cups of vegetables, 2 cups of fruit, 4 cups of milk, and 8 ounces of meat. The
meals should be evenly spaced so Chrissy does not experience a diabetic attack, and her
breakfast has 24 grams of carbohydrate in it. It is important to keep the carbohydrate
content below 30 grams for breakfast a diabetic attack.
6