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2007UNIVERSITYOFPENNSYLVANIASCHOOLOFMEDICINENUTRITIONDURINGPREGNANCYANDLACTATIONSARAHBARTS,RD,LDNOB/GYNREGISTEREDDIETITIANHOSPITALOFTHEUNIVERSITYOFPENNSYLVANIASBARTSOBGYNUPENNEDU2007UNIVERSITYOFPENNSYLVANIASCHOOLOFMEDICINEOBJECTIVESTOPRODUCE,HEALTHY,NORMALWEIGHTINFANTSWHILEMINIMIZINGHEALTHRISKSTOTHEMOTHERTODETERMINEAPPROPRIATEWEIGHTGAINDURINGPREGNANCYFORNORMAL,UNDERANDOVERWEIGHTWOMENTORECOGNIZETHEADDITIONALENERGY,VITAMINANDMINERALREQUIREMENTSFORWOMENDURINGPREGNANCYTOUNDERSTANDCHANGINGNUTRITIONALNEEDSDURINGPREGNANCY2007UNIVERSITYOFPENNSYLVANIASCHOOLOFMEDICINEINCREASEDNUTRITIONALRISKPREGNANTWOMENWHOAREDRUGORALCOHOLABUSERSVEGETARIANSSMOKERSANOREXICORBULIMIC,UNDERWEIGHT,OROBESEPREGNANTWOMENWITHHYPEREMESISPOORWEIGHTGAINORWEIGHTLOSSDEHYDRATION,CONSTIPATIONPREEXISTINGMEDICALCONDITIONS2007UNIVERSITYOFPENNSYLVANIASCHOOLOFMEDICINEOBSTETRICALHISTORYPASTMEDICALHISTORYWTGAINEDINPREGNANCYCURRENTDIETARYINTAKEPATTERNSANDETOHVITAMIN,MINERALANDHERBALINTAKEPICADIRT,STARCH,CLAY,ICE,DETERGENTCAFFEINEANDOTHERFLUIDSNAUSEA,VOMITING,ANDHEARTBURNCONSTIPATION2007UNIVERSITYOFPENNSYLVANIASCHOOLOFMEDICINEOBSTETRICALPHYSICALEXAMLOWPREPREGNANCYWEIGHTANDLOWMATERNALWEIGHTGAINARERISKFACTORSFORINTRAUTERINEGROWTHRETARDATIONLOWBIRTHWEIGHTBABYINCREASEDINCIDENCEOFPERINATALDEATHNEEDTOASSESPREPREGNANCYWEIGHTBMICURRENTWEIGHTBMIWEIGHTGAINFROMPREVIOUSVISIT2007UNIVERSITYOFPENNSYLVANIASCHOOLOFMEDICINERECOMMENDEDWEIGHTGAIN300152568114OVERWEIGHTBMI252992535114159NORMALWEIGHTBMI192492840127182UNDERWEIGHTBMI51Y/O1200MG/DAYINCREASEDREQUIREMENTSDURINGTHETHIRDTRIMESTERSUPPLEMENTATIONSHOWNTOREDUCEHYPERTENSIONDURINGPREGNANCYDIETARYSOURCESMILK,YOGURT8OZ,CHEESE1OZ300MGCALCIUMORANGEJUICEFORTIFIED1CUP300MGBROCCOLI,KALE1CUPCOOKED90MGBOKCHOY,MUSTARDGREEN1CUPCOOKED180MGTOFUMADEWITHCALCIUMCITRATECUP260MGCANNEDSALMON3OZ180MG2007UNIVERSITYOFPENNSYLVANIASCHOOLOFMEDICINENEURALTUBEDEFECTSNTDPREVENTIONROLEOFFOLATEFOLATEDEFICIENCYISTHEMOSTCOMMONDEFICIENCYDURINGPREGNANCYFUNCTIONSSERVESASACOFACTORINONECARBONTRANSFERS,NUCLEICACIDSANDAMINOACIDSANDTHEREFOREREQUIREDDURINGPERIODSOFRAPIDGROWTHINCREASEDMATERNALERYTHROPOESISCAUSESINCREASEDFOLATENEEDSDURINGSECONDANDTHIRDTRIMESTERSROLEINPREVENTIONNTDARETHOUGHTTORESULTFROMADIETARYDEFICIENCYOFFOLATEAND/ORAGENETICDEFECTAFFECTINGFOLATEMETABOLISMDURINGPREGNANCY,THENEURALTUBEISFORMEDFROMTHE18THTOTHE26THDAYOFGESTATION2007UNIVERSITYOFPENNSYLVANIASCHOOLOFMEDICINEFOLATEREQUIREMENTSINPREGNANCYADEQUATEFOLATEISCRITICALBEFOREANDDURINGTHEFIRST4WEEKSOFPREGNANCYSINCE50OFPREGNANCIESAREUNPLANNEDANDMOSTWOMENDONOTSEEKPRENATALCAREUNTIL8WEEKSGESTATION,FOLATESUPPLEMENTSPRIORTOCONCEPTIONARECRITICALTOPREVENTNTDFOLATEANTAGONISTSTAKENDURING2NDOR3RDTRIMESTERDOUBLESFETALCVDEFECTSPHENOBARBIOTICPHENYTOINPRIMIDONECARBAMAZEPINETRIMETHOPRINTRIAMTERENE2007UNIVERSITYOFPENNSYLVANIASCHOOLOFMEDICINEKNOWLEDGETHATFOLATEPREVENTSBIRTHDEFECTSSTILLLOW01020304050199519971998200020012004SOURCEMARCHOFDIMESSURVEY19952004BASEDON2000NONPREGNANTWOMENAGE18TO452007UNIVERSITYOFPENNSYLVANIASCHOOLOFMEDICINEWOMENTAKINGADAILYMULITVITAMINCONTAININGFOLATE0102030405019951997199820002001200220032004SOURCEMARCHOFDIMESSURVEY19952004BASEDON2000NONPREGNANTWOMENAGE18TO452007UNIVERSITYOFPENNSYLVANIASCHOOLOFMEDICINEFOLATEREQUIREMENTSINPREGNANCYDRI600GPREGNANCYOR500GLACTATINGFEMALE,400GFORNONPREGNANTWOMANBEANS,PEAS,ORANGEJUICE,GREENLEAFYVEGETABLES,FORTIFIEDCEREALSAREGOODSOURCESPRENATALVITAMINSCONTAIN1000GFOLATE2007UNIVERSITYOFPENNSYLVANIASCHOOLOFMEDICINEFOLATEINTAKEINNONPREGNANTWOMEN1639Y/OUS19881994234238202261050100150200250300TOTALPOPULATIONWHITENONHISPANICBLACKNONHISPANICMEXICANAMERICANUG/DAYADAPTEDFROMTHEDEPARTMENTOFHEALTHANDHUMANSERVICESCENTEROFDISEASECONTROLANDPREVENTION,JULY20022007UNIVERSITYOFPENNSYLVANIASCHOOLOFMEDICINEFOLICACIDKNOWLEDGEANDBEHAVIOR199520044012247733102080282452020406080100TAKEFOLICACIDDAILYKNEWFOLICACIDSHOULDBETAKENBEFOREPREGNANCYKNEWFOLICACIDCANPREVENTBIRTHDEFECTSAWAREOFFOLICACID199520022004PERCENTSOURCEMARCHOFDIMESSURVEY19952004BASEDON2000NONPREGNANTWOMENAGE18TO452007UNIVERSITYOFPENNSYLVANIASCHOOLOFMEDICINEWHYWOMENMIGHTBEENCOURAGEDTOTAKEADAILYMULTIVITAMIN3334441134010203040IFPREGNANTSOMEONETOREMINDMEMOREINFOABOUTBENEFITSREMEMBEREDTOTAKENEEDEDVITAMINSFEELINGRUNDOWNCHANGEINHEALTHADVISEDBYAHEALTHCAREPROVIDERPERCENTSOURCEMARCHOFDIMESSURVEY20022007UNIVERSITYOFPENNSYLVANIASCHOOLOFMEDICINEIRONINPREGNANCYIRONISANESSENTIALELEMENTINALLCELLSOFTHEBODYDURINGPREGNANCY,MATERNALBLOODVOLUMEINCREASES2030IRONNEEDSINCREASEFROM18TO27G/DAYDURINGPREGNANCYDEFICIENCYINCREASESRISKOFMATERNALANDINFANTDEATH,PRETERMDELIVERY,ANDLOWBIRTHWEIGHTBABIES2007UNIVERSITYOFPENNSYLVANIASCHOOLOFMEDICINEDIAGNOSISOFIRONDEFICIENCYANEMIATHECDCREFERENCECRITERIAFORANEMIADURINGPREGNANCYFIRSTTRIMESTERHGB110G/DLORHCT33SECONDTRIMESTERHGB104G/DLORHCT32THIRDTRIMESTERHGB110G/DLORHCT332007UNIVERSITYOFPENNSYLVANIASCHOOLOFMEDICINEIRONDEFICIENCYANEMIASUSCEPTIBLEPOPULATIONSPREGNANTWOMENWHOHAVENOTBEENTAKINGIRONSUPPLEMENTSINFANTSANDCHILDRENMENSTRUATINGFEMALESTEENSLOWINCOMEWOMENETIOLOGYPOORIRONINTAKEONLY25OFFEMALES1249MEETNEEDSDIETWITHLOWBIOAV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