PREGNANCY PROJECT. Brianne Squires 2/28/14 NDFS 424. PART I (Complete Sections I V): I. Identifying data (1 point)

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1 PREGNANCY PROJECT Brianne Squires 2/28/14 NDFS 424 PART I (Complete Sections I V): I. Identifying data (1 point) A. Chelsea B. Chelsea is attending BYU, majoring in elementary education. She is working at a supplement company in Provo as a consultant. Her husband is also working and in school, so they are very busy between the two of them. II. Health history (10 points) A. 19; her first period was at the age of 13. B. No previous obstetrical history C. July 9, 214 D. No lab data known E. No illnesses or chronic conditions F. No alcohol, drug or cigarette use G. No previous nutritional deficiencies, but she was slightly anemic. This had been corrected prior to pregnancy. H. No use of medicines prior to pregnancy, except for birth control. I. Not a lot of exercise before pregnancy. She considers walking up the RB stairs everyday her exercise now. J. No allergies or food intolerances. III. Nutritional assessment (10 points) SUMMARIZE: (1) Chelsea s macronutrient intakes are all adequate and appropriate for her pregnancy. She is consuming 33% fat, 52% carbohydrate and 16% protein. Each of these macronutrients are good percentages and distributions for her pregnancy. (2) Based on the MyPlate recommendations, Chelsea is not doing the best she could be. She is eating 10 oz of grain; however all of them are refined while she needs at least half of her grains to be whole grain. She is only consuming about half of the needed vegetable intake because she had a small salad with lunch. Her only form of fruit is in juice, which is only ¼ cup out of the recommended 2 cups. Chelsea is consuming almost 5 cups of dairy through cheese and milk, which is plenty. Protein needs of 6.5 oz are recommended, however Chelsea is only consuming 1.5 oz according to the MyPlate printout. Finally, it is recommended she only consume 330 kcal or less of empty calories, but Chelsea consumed about 950 kcal in empty calories. Overall, she could do better at eating a MyPlate balanced meal.

2 (3) Chelsea s vitamin and mineral intakes are adequate in a lot of areas. However, her iron levels are 19mg while the recommendation is 27mg. Her magnesium is also low; she consumed 213mg of the required 350mg. The final mineral that was under is potassium. Chelsea ate 1942 mg of the recommended 4700 mg, which is less than half of what is needed. When it came to vitamins, Chelsea had intakes of 1.6 mg of Vit B6, 62 mg of Vit C, 4 ug of Vit D, 6 mg of Vit E, and 67 ug of Vit K. These values are all low because recommendations are 1.9 mg for B6, 85 mg Vit C, 15 ug Vit D, 15 mg Vit E, and finally 90 ug of Vitamin K. Chelsea also only consumes 202 mg of the recommended 450 mg of Choline. A. No food assistance programs used. B. Not currently using food assistance programs C. 20% D. Chelsea and her husband typically eat out on Saturdays, but cook dinner all other nights. Some days are every man for himself style, but she tries to cook as many nights as she can. Sometimes it s as easy as putting a frozen lasagna in the microwave. IV. Weight graphed (4 points) A. State: (1) lbs. (2) 5 6 (3) Pre-pregnancy BMI is 20.9 B. Plot Weight Gain: Current weight is 137 lb, plotted on chart. C. Interpret Weight Gain: Expected weight gain for Chelsea in her fourth month of pregnancy is between 6 and 8 pounds. Her weight gain is approximately 7 pounds, which is perfect for this point in her pregnancy. V. Nutritional care plan (15 points) A. The biggest nutritional risk factors for this pregnancy are the low intake of important vitamins and minerals. Her food intake and macronutrient distribution is excellent, so I would put a major focus on making sure the baby will develop properly with all needed vitamins and minerals. Having low vitamin D, for example, could be harmful to bone and skeletal development because of the vitamin s crucial role in mineralization and calcium deposition. Another example is her low iron intake. It is important to have iron for adequate oxygen movement to the mother and baby, as well as to combat fatigue in the mom. Each of the vitamins and minerals she is low on could affect the baby s growth and development to some extent. Chelsea s fiber intake is also low, and it may be beneficial to increase for later constipation problems. B. If Chelsea is not already consuming a multivitamin or some sort of supplement, I would advise her to do so. I believe it would be more beneficial to increase healthy food intake in order to get these needed nutrients, which she could easily do by increasing whole grain, fruit and vegetable consumption. Since her vegetable intake was so low, increasing green leafy and other colorful vegetables will help her achieve this goal. I think in order for Chelsea to see the importance of getting adequate nutrients, it would be beneficial to go through the importance of each vitamin and mineral she is low in and emphasize the role it plays in her and her baby s health..

3 Pregnancy project part II Chelsea was a great subject to work with. Without overwhelming her with too much information, she and I went over the basic guidelines of the ChooseMyPlate layout and the different groups involved in that. She was very aware of the different food groups, but was not entirely sure why it mattered how much of specific food groups we eat from. I explained to her that aside from keeping portions and weight under control, there are benefits of each food group needed for optimal function of our bodies, and in her case, the baby girl she is carrying. We spent some time going through each group and understanding the different serving sizes, equivalents, and recommendations for her. For example, she learned that although refined grains are alright in moderation, at least half of her grain servings should be whole grains. Chelsea now knows that whole grains include foods such as whole grain pasta and bread, and even brown rice. A serving of whole grain bread, for example, contains sources of protein, fiber, zinc, iron, manganese, and are often fortified with B vitamins. B6, she learned, is helpful in pregnancy for nausea and for metabolism of macronutrients in the body. Her daily recommended intakes are 1.9 mg per day, which is more than she was ingesting. After going through the different food groups, discussing foods as described above, and making suggestions, Chelsea learned a great deal about the importance of consuming enough vitamins and minerals, especially during pregnancy. We also discussed the possibilities of her decreasing the amount of refined grains and added sugars consumed in the diet. A great way of doing this is to increase fruits, vegetables and protein foods in order to get enough vegetables and other food groups into her diet that provide more nutritious benefits. Overall, I think Chelsea handled the advice well. The most important priority to her right now is the health of her baby, so she was very interested to hear what I had to say. I do think some of the information got overwhelming because there is so much we could talk about, but she asked questions whenever she needed to and seemed to retain the information. I asked her questions to see how she was absorbing the information and she appeared to be taking it all in. I am not sure how much Chelsea will comply with the nutritional changes I suggested because of her lack of time, energy, and cravings. I do believe she will try the best she can to implement change in her diet as she continues in her pregnancy. Also, if she does not see changes in her diet happening and is not able to change, she desires to take a multivitamin to ensure her baby is getting everything needed for healthy growth and development. I think I did a good job teaching her; however I did have to remind myself not to say more than I needed to. I am learning that the more I understand in my classes, the harder it is to simplify it for those who need a basic knowledge and understanding. As long as I kept that in mind, I feel that my teaching job was clear and helpful. I do think she will try to follow my advice, and may keep up with it for a week or so, but I could see her forgetting once school, work, and life gets busier and harder.

4 Chelsea's Food Groups and Calories Report 01/25/14-01/25/14 Your plan is based on a 2400 Calorie allowance during your 2nd trimester of pregnancy. Food Groups Target Average Eaten Status Grains 8 ounce(s) 10 ounce(s) Over Whole Grains 4 ounce(s) 0 ounce(s) Under Refined Grains 4 ounce(s) 10 ounce(s) Over Vegetables 3 cup(s) 1¼ cup(s) Under Dark Green 2 cup(s)/week 0 cup(s) Under Red & Orange 6 cup(s)/week ¾ cup(s) Under Beans & Peas 2 cup(s)/week 0 cup(s) Under Starchy 6 cup(s)/week 0 cup(s) Under Other 5 cup(s)/week ½ cup(s) Under Fruits 2 cup(s) ¼ cup(s) Under Fruit Juice No Specific Target ¼ cup(s) No Specific Target Whole Fruit No Specific Target 0 cup(s) No Specific Target Dairy 3 cup(s) 4¾ cup(s) Over Milk & Yogurt No Specific Target 1 cup(s) No Specific Target Cheese No Specific Target 3¾ cup(s) No Specific Target Protein Foods 6½ ounce(s) 1½ ounce(s) Under Seafood 10 ounce(s)/week 0 ounce(s) Under Meat, Poultry & Eggs No Specific Target 1½ ounce(s) No Specific Target Nuts, Seeds & Soy No Specific Target 0 ounce(s) No Specific Target Oils 7 teaspoon 0 teaspoon Under Limits Allowance Average Eaten Status Total Calories 2400 Calories 2328 Calories OK Empty Calories* 330 Calories 938 Calories Over Solid Fats * 602 Calories * Added Sugars * 336 Calories * *Calories from food components such as added sugars and solid fats that provide little nutritional value. Empty Calories are part of Total Calories. Note: If you ate Beans & Peas and chose "Count as Protein Foods instead," they will be included in the Nuts, Seeds & Soy subgroup.

5 Meals from 01/25/14-01/25/14 Chelsea's Meals Your plan is based on a 2400 Calorie allowance during your 2nd trimester of pregnancy. Date Breakfast Lunch Dinner Snacks 01/25/14 1 single serving box (1 oz) Apple Jacks Cereal 1 medium slice Bread, garlic 2 piece or stick (4" x 1" x 3/4") Cheese sticks, breaded, baked or fried EMPTY 1 container (4 oz) Blueberry yogurt, low fat 1 cup Fruit drink (Lemonade, Limeade, Snapple, Minute Maid Fruit Punch) 1 cup Fruit drink (Lemonade, Limeade, Snapple, Minute Maid Fruit Punch) ½ cup Milk, reduced fat (2%) 2 piece (2-1/2" x 4) Lasagna, with beef 1½ sandwich Grilled cheese sandwich 2 miniature Muffin, blueberry 1 cup Salad, garden, lettuce, tomato, carrots, no dressing

6 Chelsea's Nutrients Report 01/25/14-01/25/14 Your plan is based on a 2400 Calorie allowance during your 2nd trimester of pregnancy. Nutrients Target Average Eaten Status Total Calories 2400 Calories 2328 Calories OK Protein (g)*** 71 g 90 g OK Protein (% Calories)*** 10-35% Calories 16% Calories OK Carbohydrate (g)*** 175 g 303 g OK Carbohydrate (% Calories)*** 45-65% Calories 52% Calories OK Dietary Fiber 28 g 14 g Under Total Fat 20-35% Calories 33% Calories OK Saturated Fat < 10% Calories 13% Calories Over Monounsaturated Fat No Daily Target or Limit 11% Calories No Daily Target or Limit Polyunsaturated Fat No Daily Target or Limit 6% Calories No Daily Target or Limit Linoleic Acid (g)*** 13 g 14 g OK Linoleic Acid (% Calories)*** 5-10% Calories 5% Calories OK α-linolenic Acid (g)*** 1.4 g 1.6 g OK α-linolenic Acid (% Calories)*** % Calories 0.6% Calories OK Omega 3 - EPA No Daily Target or Limit 1 mg No Daily Target or Limit Omega 3 - DHA No Daily Target or Limit 4 mg No Daily Target or Limit Cholesterol < 300 mg 222 mg OK Minerals Target Average Eaten Status Calcium 1000 mg 1585 mg OK Potassium 4700 mg 1942 mg Under Sodium** < 2300 mg 4260 mg Over Copper 1000 µg 1040 µg OK Iron 27 mg 19 mg Under Magnesium 350 mg 213 mg Under Phosphorus 700 mg 1500 mg OK Selenium 60 µg 140 µg OK Zinc 11 mg 14 mg OK Vitamins Target Average Eaten Status Vitamin A 770 µg RAE 875 µg RAE OK Vitamin B6 1.9 mg 1.6 mg Under Vitamin B µg 5.4 µg OK

7 Vitamin C 85 mg 62 mg Under Vitamin D 15 µg 4 µg Under Vitamin E 15 mg AT 6 mg AT Under Vitamin K 90 µg 67 µg Under Folate 600 µg DFE 731 µg DFE OK Thiamin 1.4 mg 2.1 mg OK Riboflavin 1.4 mg 2.8 mg OK Niacin 18 mg 23 mg OK Choline 450 mg 202 mg Under Information about dietary supplements. ** If you are African American, hypertensive, diabetic, or have chronic kidney disease, reduce your sodium to 1500 mg a day. In addition, people who are age 51 and older need to reduce sodium to 1500 mg a day. All others need to reduce sodium to less than 2300 mg a day. *** Nutrients that appear twice (protein, carbohydrate, linoleic acid, and α-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.