Textbook Problem

This case study involves use of the American Dietetic Association’s Nutrition Care Process.

  At 37 years of age, Señora Mendez was in her 23rd week of pregnancy and expecting her second child. Or so she thought, until an ultrasound scan detected twins. Her prepregnancy weight was 142 lb (64.5 kg) and her BMI 23 kg/m². Señora Mendez’s weight-gain progress has been poor due to nausea and vomiting experienced in the first half of pregnancy. Otherwise, Sra. Mendez was experiencing a normal pregnancy for women expecting twins. Concerns about her weight-gain progress and the nutritional needs of women with twin gestation prompted her certified–nurse-midwife to prescribe a prenatal vitamin and mineral supplement and to refer her to a registered dietitian/certified diabetes educator.

  A nutritional assessment completed during week 25 of pregnancy identified that Sra. Mendez had gained 14 pounds since conception, and that her typical dietary intake excluded fish or other sources of omega-3 fatty acids. Her plasma 25-hydroxyvitamin D level was below 24 nmol/L, indicating low vitamin D status. No other nutrition-related problems were identified.

1.    Assume Sra. Mendez will deliver toward the end of week 37 and is now in the beginning of week 25. How many pounds (or kilograms) should be set as a goal for weekly weight gain if a total pregnancy gain at the midpoint of the provisionally recommended range for weight gain in twin pregnancy is to be achieved?