Pregnancy and High Risk Pregnancy
Kim, a 24-year-old female, is 28 weeks pregnant with her first baby. She is 5’7” tall and currently weighs 173 pounds. She walks 30 minutes per day, but it is getting harder. Thus, she walks quite slowly. She had a 3-hour oral glucose tolerance test in which she was diagnosed with gestational diabetes. She is in your office and informs you her blood sugars need to be less than 90 mg/dL fasting and less than 120 mg/dL 2 hours post meals. She is having a hard time keeping her blood sugars down 2 hours after a meal. She currently is consuming 3 meals a day, in which she consumes 60-75 grams of carbohydrates. She also has about 4-5 oz. of meat at these meals and a relatively low amount of fat (about 30 grams per day).

1.Based on the fact her blood sugars are higher than 120 mg/dL 2 hours post meals, what recommendations would you have? (Consider the amount of carbohydrates per each meal, protein, and fat, and if you would recommend snacks)
2.Since she is pregnant, what at least 2 micronutrients, include the RDAs, she needs to consume on a daily basis?
3.Would you recommend she continue with her exercise? If so, what alternatives can she do since she has trouble walking?

Nutrition Needs During Lactation

Kim, a 24-year-old female, had her baby and currently is breastfeeding. She worries her baby is not receiving enough milk. She does not want to pump because she heard this may reduce the amount of milk that comes out of the breast and it may confuse the baby when exposed to a bottle and then a breast. She knows she needs to eat more, but wants to lose her pregnancy weight within 6 months; a reasonable goal in her view. She gained 34 pounds during this pregnancy, but was 14 pounds overweight prior to pregnancy. She also was a gestational diabetic, but so far her blood sugars are within normal limits. She continues to take her pre-natal vitamins, but does not know what more she needs to eat to keep her milk up.

1.What nutrients will she need to consume more of during lactation than she did during pregnancy (include the RDAs)?
2.What advice would you have for her to lose the weight, but also keep up her milk with proper diet?