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Katherine Silva

Pregnancy Analysis
NFS 394
Professor Linda Sebelia
Tiffany Anderson is 25 years old and expecting her first child. She is very exited
and involved with all the planning that goes in to a pregnancy. She is married, very
happy, and is currently renting a home in Warwick, Rhode Island. She graduated 2 years
ago with a bachelors degree in Childhood Education and is now working as Special
Education teacher where she enjoys her job working with children everyday.
Overall impression of health is good. She has a very vibrant and positive attitude
about the process she is going through and the delivery. Her top concern involves
intolerances to a variety of foods that cause her to experience nausea and vomiting on a
regular basis. I am concerned that she may not be getting enough calories and/or nutrients
if she is having such a hard time keeping food down. She admits to have been a relatively
picky eater before pregnancy, but since her morning sickness at the start of her
pregnancy, she has an even more limited selection of food that she likes. She actually lost
weight during her first trimester because of such severe nausea to foods she normally ate.
During her second trimester she gained back about 20 pounds, and now at 7 months and 2
weeks gestation, she is currently about 150 pounds and is back on track to a healthy
weight gain.
Her weight before pregnancy was around 145and she is 5'5. Her normal BMI of
24.1 tells me she should gain between 25-35 pounds from her starting weight of 145.
Now, in her third trimester she should be consuming about 2,852 calories and be putting

on a little more 1 pound a week after all that weight lost in the beginning of her
pregnancy.
Tiffany is planning on breastfeeding since she has learned a lot about the health
benefits and bonding practices through her doctor visits and reading material.

24 hr Food recall compared to the RDA's for pregnant women:


Group

24 hr Food Recall

RDA for Pregnant


Women

# of servings

# of servings

Grains

6.5 oz.

8 oz.

Friut

3.5 Cups

2 Cups

Protein

6.6 oz.

6.5 oz.

Vegetables

1 Cup

3 Cups

Dairy

2.5 Cup

3 Cups

Fats & Oils

4 tsp.

7 tsp.

Food Frequency Questionnaire compared to the RDA's for pregnant women:


Group

Food Frequency
Questionnaire

RDA for Pregnant


Women

# of servings

# of servings

Grains

7 Cups

8 oz.

Friut

4.5 Cups

2 Cups

Protein

6 oz.

6.5 oz.

Vegetables

3 Cups

3 Cups

Dairy

3 Cups

3 Cups

Fats & Oils

5 tsp.

7 tsp.

24 hr recall compared to the Food frequency questionnaire:


Group

24 hr Food Recall

Food Frequency
Questionnaire

# of servings

# of servings

Grains

6.5 oz.

7 oz.

Friut

3.5 Cups

4.5 Cups

Protein

6.8 oz.

6 oz.

Vegetables

1 Cup

3 Cups

Dairy

2.5 Cup

3 Cups

Fats & Oils

4 tsp.

5 tsp.

The 24-hour food recall and food frequency questionnaire worked together to
create the best available picture of Tiffany's diet in such a short period of time. A 3-day
recall would have been best, but with her busy schedule, I opted for the method with the
least amount of client burden. There are pros and cons to each of these data collection
methods. When done correctly, the 24-hour recall is highly detailed and contains exact
amounts of foods eaten in that specific time period. It gives me a clear picture on an
actual day's worth of food. The downside to this is that it may be possible to administer a
recall on a bad day or a day with an unusual schedule. These small windows of time
could produce inaccurate information on the client's normal habits. This is where the food
frequency questionnaire comes in to play. It provides more wide selection of food but it is
less accurate method then the 24-hour recall. These two methods of diet analysis work
best when used together to create the best representation of a regular diet.

Tiffany's estimated calories for her 24 hr food recall was 2,181. She
should be getting about 2,852 in her third trimester. This difference of 670 calories could
be incorporated with larger portion sizes and adding in another snack throughout the day.
It is very important that she is getting enough calories at this stage of pregnancy, as her
baby is really starting to grow now, gaining about one ounce a day. Although, meat
products have been an issue through the entire pregnancy, other sources protein such as
eggs and yogurt have helped with the lack of meat and has added about 75 grams of
protein in her diet. Carbohydrates are dominating the diet with about 298 grams per day.
The recommended amount is at least 175 grams. I don't think the amount of carbs is a
problem, but rather where they are coming from. She is getting an adequate amount of
fruit but a lot of her carbohydrates come from refined sources such as white bread and
sugary sweets. Her vegetable intake was only estimated at 1 cup per day. Increasing her
vegetable intake will be important to increase a variety of foods in her diet. At about 50
grams per day, or 10% of total calories, her fat content is about half of what she should be
getting. She included some healthy fats such as cashews and olive oil. Her baby is now
laying down a lot of fat stores so she should increase the amount of healthy fats by
including things like salad with an oil based dressing and avocado more often.
Tiffany's calcium intake is estimated to about 837mg per day compared to
the recommended 1000mg. She is not doing too bad but pregnancy can really drain
calcium stores from the mother at this stage and an extra class of milk or cheese slices on
her crackers would boost her intake to an adequate level. Iron estimates come in at 13.5
grams per day, which is under the recommended amount by half. It is almost always
impossible to get the amount of iron needed from diet alone during pregnancy. Since she

is extremely turned off to meat, some foods that she has been eating could help if
incorporated more in to her meals. Canned lite tuna and nuts like cashews will be
beneficial to her during this time where the baby is accumulating iron stores. Her prenatal
vitamin should be taken everyday to ensure enough is being supplied. Folic acid is
estimated at 387mg compared to the recommended 600mg. Foods that are rich in folic
acid are fortified cereals which she eats almost everyday. Beans and peas contain some
folic acid as well, but like iron, it's important to remember to supplement this
micronutrient, as it is hard to keep track of. Both vitamins A and C are within the healthy
range. Vitamin at 617mcg per day could be increased a little more to reach the 770mcg
recommendation. She likes carrots; so eating these raw for a snack would completely fill
her daily value. Vitamin C tends to be an easy vitamin to reach daily values, especially
for Tiffany. She craves a lot of citrus and 'clean foods' to combat her nausea. She is
getting 180mg out of the 85mg recommendation.
Fiber seems to be an issue as it estimates only 12g per day out of recommended
28g. Tiffany is not a fan of whole grains. She grew up eating white bread in her
household as a child and does not like the concept of dark, grainy, tough bread. I
explained to her some of the choice she has when it comes to whole grain. There are
breads that contain half whole grains, and half enriched four to improve textures and
create mild flavors. They dont all come with seeds and hard grains sprinkled all over
them. Trying this kind of bread for a while will help increase her fiber without drastically
changing her preferences.

New Diet:
Tiffany's diet should consist of 3 meals and 3 snacks a day. They should be spaced
out evenly and contain a balance of the five food groups. She can consume saltine
crackers and ginger ale as needed for nausea as well as getting fresh air, going for
moderate walks, and taking her prenatal vitamin at bedtime. An increase in dairy intake
with milk and cheese is recommended to compensate for sub par calcium levels. To
introduce extra calories, she should slowly more snacks and fat such as hummus, peanut
butter, cheese, and margarine. Veggies can be incorporated in small amounts throughout
her meals. If mixed in with other foods, or used with dips, they should be more palatable
for her to consume on a regular basis. Protein at dinnertime is usually difficult for
Tiffany, as she does not tolerate meat very well, especially at night. Complementary
protein sources like rice and beans offer her the essential amino acids she needs while
avoiding any upsetting foods. Continuing with her supplement, there should be no
problems with iron levels. Whole grains were added to increase her dietary fiber. Being
exclusive to refined white bread and white rice was not doing her much good. The slow
transition to whole grains can be achieved with mild products containing only whole
grain.

Sample diet plan based on Tiffanys food preferences.


Breakfast:
2 Egg omelet with: any color bell pepper, cup spinach, 1 oz. Cheese
(Not a fan of veggies so they are slightly disguised in the omelet)
1 Cup milk
1 Slice ( whole grain) bread toasted
1 Tbsp. Fiber rich jam
Snack:
1 Slice ( whole grain) bread toasted
1 Tbsp. Peanut butter
banana sliced on top
Lunch: Sandwich with any condiments of choice.
3 oz. Lean turkey breast
2 lettuce leafs
1 tomato slice
2 slices ( whole grain) bread
1 oz. Cheese
1 cup milk

grapefruit
Snack:
FAGE 2% plain yogurt
Strawberries (4-6 whole berries)
cup cashews
Dinner:
1 cups steamed veggie mix (broccoli, green beans, carrots)
cup brown rice
cup beans
(complementary protein during most sensitive time of day to foods like meat)
1 Tbsp. Margarine
Snack:
1 cup baby carrots
3 Tbsp. Hummus