Your patient is a healthy 28-year-old G2P1001 at 20 weeks gestational age. Two years ago, she vaginally delivered at term a healthy baby boy weighing 6 lb 8 oz. This pregnancy, she had a prepregnancy weight of 130 lb. She is 5 ft 4 in tall. She now weighs 140 lb and is extremely nervous that she is gaining too much weight. She is worried that the baby will be too big and require her to have a cesarean section. What is the best counsel for this patient?
a. Her weight gain is excessive, and she needs to be referred for nutritional counseling to slow down her rate of weight gain.
b. Her weight gain is excessive, and you recommend that she undergo early glucola screening to rule out gestational diabetes.
c. She is gaining weight at a less than normal rate, and, with her history of a smallfor-gestational-age baby, she should supplement her diet with extra calories.
d. During the pregnancy, she should consume an additional 300 kcal/day versus prepregnancy, and her weight gain so far is appropriate for her gestational age.
e. During the pregnancy she should consume an additional 600 kcal/day versus prepregnancy, and her weight gain is appropriate for her gestational age.
The correct answer and explanation is :
The correct answer is:
d. During the pregnancy, she should consume an additional 300 kcal/day versus prepregnancy, and her weight gain so far is appropriate for her gestational age.
Explanation:
This patient is a healthy 28-year-old woman who is currently at 20 weeks gestation and has gained 10 pounds from her prepregnancy weight of 130 lbs. Given her height of 5 ft 4 in, her prepregnancy BMI is 22.3 kg/m², which falls within the normal BMI range (18.5–24.9 kg/m²).
For women with a normal BMI, the recommended total weight gain during pregnancy is 25–35 lbs. The expected rate of weight gain is about 1 pound per week during the second and third trimesters after an initial 1–5 lbs gain in the first trimester. At 20 weeks, she has gained 10 lbs, which is within the expected range, suggesting that her weight gain is appropriate.
Additionally, pregnant women with a normal BMI should increase their caloric intake by approximately 300 kcal/day during the second and third trimesters to support fetal growth. This is a modest increase that helps ensure optimal fetal development without excessive weight gain.
Her concern about having a large baby and the risk of cesarean delivery is understandable, but excessive fetal growth is more commonly linked to gestational diabetes or maternal obesity, neither of which she currently has. Her previous baby was born at term and was of average weight (6 lb 8 oz), which does not indicate a history of fetal macrosomia.
Why the Other Choices Are Incorrect:
- (a) & (b): Her weight gain is not excessive, so she does not need nutritional counseling or early diabetes screening.
- (c): Her weight gain is not below normal, and there is no clear history of small-for-gestational-age (SGA) infants.
- (e): A 600 kcal/day increase is excessive for a normal-weight woman; this recommendation is more applicable to underweight or multiple-gestation pregnancies.
Thus, her weight gain is appropriate, and she should continue a balanced diet with an additional 300 kcal/day to maintain a healthy pregnancy.