Nutrition Through the Life

Cycle 6th Edition Brown

Solutions Manual
Full download at link:

Solution Manual:
https://testbankpack.com/p/solution-manual-for-
nutrition-through-the-life-cycle-6th-edition-brown-
1305628004-9781305628007/

Test Bank: https://testbankpack.com/p/test-bank-for-

nutrition-through-the-life-cycle-6th-edition-brown-
1305628004-9781305628007/

Instructor’s Manual1 for Chapter 5 – Nutrition During

Pregnancy: Conditions and Interventions
Resources Included in This Document
1. Lists of chapter learning objectives and key terms
2. “Lecture launcher”: Stephen Paget quote
3. Assignment worksheets with answer keys: type 1 diabetes, gestational diabetes
4. Answer keys for textbook case studies 5.1, 5.2, and 5.3
5. Chapter outline/summary
6. List of relevant websites organized by topic
7. Internet activities: (A) Canadian recommendations, (B) HIV/AIDS, (C) preeclampsia, (D) IFIC
site evaluation
8. Discussion questions
9. Classroom activities: (A) gestational diabetes assessment tool, (B) low-glycemic index diet
planning

Learning Objectives

5.1 Cite three specific examples of nutrition-related recommendations intended for women who
enter pregnancy obese.
5.2 Distinguish the different types of hypertensive disorders that occur during pregnancy, and
connect two components of nutrition care recommended for women with each type.
5.3 Connect the different, major types of disorders in carbohydrate metabolism that occur
during pregnancy and the key components of the nutritional management of each type.

1revised by Nadine Kirkpatrick, Sacramento City College, and Carrie King, University of Alaska
at Anchorage; originally by U. Beate Krinke, University of Minnesota

© 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly
accessible website, in whole or in part.
5.4 Explain three differences in nutrient needs and cite two specific considerations for delivery
of effective nutritional care for women with multifetal pregnancy.
5.5 Identify the components of nutritional care for women with HIV during pregnancy.
5.6 Identify two primary components of the nutritional care of women with eating disorders
during pregnancy.
5.7 Summarize the consequences of excess alcohol intake during pregnancy, and list four
factors that affect the relationship between alcohol intake and the outcome of pregnancy.
5.7 Distinguish three ways in which energy and nutrient needs differ between adults and
adolescents during pregnancy.

Key Terms
dumping syndrome prostacyclin macrosomia
gestational diabetes thromboxane assisted reproductive
oxidative stress congenital anomalies technology (ART)
endothelium hemoglobin A1c cephalopelvic disproportion
placenta abruption ketones

Lecture Launchers

• In his book Confessio Medici, Stephen Paget wrote: “Practice is science touched with
emotion” (1908; available online from
http://archive.org/details/confessiomedici01pagegoog). Think of an example in your own
experience where treatment involved “science touched with emotion.” What does this
quotation mean to you? How does it apply to providing nutrition counsel or education to
pregnant women with one of the health conditions discussed in this chapter?

Answers to Global Nutrition Watch Activities

1. a
2. seven
3. c

Worksheet Answer Key (worksheets appear at the end of this document)

Worksheet 5-1: Type 1 Diabetes prior to Pregnancy

1. Based on her most recent A1c level being in the normal range, Nan had good blood glucose
control in the 120 days prior to the start of her pregnancy (p. 147).
2. Yes: acesulfame potassium, aspartame, neotame, saccharin, and sucralose (ADA).
3. Fiber intake of 25-35 grams/day may decrease her need for insulin during pregnancy (p.
148). She might also consider the application of the glycemic index in meal planning (p.
146, Table 5.11). Regular meal and snack consumption will be important to help her avoid
hypoglycemia and she might need slightly less carbohydrate at her morning meal than the
other meals throughout the day due to the possibility of decreased carbohydrate tolerance
in the morning (ADA).
4. Yes: for kidney disease and hypertension (p. 147).

Worksheet 5-2: Distribution of Calories for Gestational Diabetes

Food Item Serving Carbohydrates Fat Protein Calories
Size (grams) (grams) (grams)
Breakfast
Complete Wheat Bran Flakes ¾ cup 23 0.58 2.90 90
2% Milk ½ cup 6 2.42 4.03 61
Egg 1 1 10.61 12.58 74

© 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly
accessible website, in whole or in part.
 Black coffee, tea
Morning Snack
Peanuts 2 oz 10 28.16 13.43 326
Carrot 1 7 0.15 0.57 31
Graham crackers 4 small 1.41 0.97 59
Lunch
Beef or chicken burrito 1 33 9.46 12.09 255
Salsa ½ cup 7 0.22 1.99 33
Black beans 1 cup 40 0.93 15.24 228
Apple 1 21 0.31 0.47 81
Black coffee, tea, diet soda
Midday Snack
Banana ½ 28 0.39 1.29 55
2% milk 1 cup 12 4.83 8.05 121
Dinner
Lean pork chop 4 oz 0 12.53 29.02 263
Pinto beans 1 cup 22 1.11 15.41 116
Corn bread 1 oz 12 2.72 1.87 92
Margarine 1 tsp 1 3.78 0.04 33
Garden salad 2 cups 0 0.19 3.45 10
Feta cheese 1 oz 1 6.03 4.03 74
Salad dressing 2 Tbsp 3 10.52 0.33 104
Black coffee, tea, diet soda
Bedtime Snack
Peanut butter 2 Tbsp 12 16.12 8.03 190
Rice cake 1 8 0.25 0.74 35
2% milk 1 cup 12 4.83 8.05 121
Totals: --- 270 2442
Calories: --- 1080 117.55 144.58 2442
% of Total Calories: --- 44% 43% 24% ---
Recommendation 40-50% 30- 20% ---
40%

Textbook Case Study Answer Key2

Case Study 5.1: A Case of Preeclampsia

1. Susan’s diet provides low amounts of vitamins E and C, folate, carotenoids, and
antioxidant-rich vegetables and fruit. Her regular consumption of sweetened tea and high-
glycemic index carbohydrates contribute to oxidative stress, too. (A table of the glycemic
index of carbohydrates is given in Chapter 1 on page 6.)
2. Restriction of weight gain below recommended levels and salt restriction.
3. Preeclampsia in a subsequent pregnancy, gestational diabetes, type 2 diabetes, heart
disease, hypertension, and stroke.

Case Study 5.2: Elizabeth’s Story: Gestational Diabetes

1. Yes, based on her 1- and 2-hour blood glucose values.
2. Yes.

2 Contributed by Judith E. Brown

© 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly
accessible website, in whole or in part.
3. High blood glucose levels during pregnancy are strongly associated with the delivery of
excessively large newborns.
4. The nutritional management of gestational diabetes does not include no-sugar, low-
carbohydrate diets, or a low weight gain.
5. Dietary recommendations for women with gestational diabetes are individualized and
emphasize whole grains, vegetables, fruits, high-fiber foods, and limited intake of simple
sugars; they also encourage intake of low-glycemic index carbohydrate foods,
monounsaturated fats, and regular meals and snacks. Dietary intake and exercise levels
should not only help control blood glucose levels but also promote adequate weight gain.

Case Study 5.3: Twin Pregnancy and the Nutrition Care Process
1. The midpoint of the provisionally recommended weight gain range for normal weight women
with a twin pregnancy is 45.5 lbs (20.7 kg). She has 13 weeks left before delivery and an
additional 31.5 pounds (14.3 kg) to gain. Her weekly weight gain goal would be set at
approximately 2-2.5 pounds (0.9-1.1 kg) per week.
2. Examples of appropriate nutrition diagnoses for this case are:
- Inadequate energy intake due to nausea and vomiting.
- Inadequate vitamin D intake due to lack of vitamin D intake or sun exposure.
- Inadequate intake of the omega-3 fatty acids EPA and DHA due to lack of fish and
seafood consumption.
- Altered nutrition-related value for plasma 25-hydroxyvitamin D due to insufficient
vitamin D from foods/sun exposure.
- Increased nutrient needs related to twin pregnancy.
3. Students should cite evidence-based methods for achieving weight gain, increasing EPA
and DHA intake, and improving vitamin D status.
Examples of interventions are:
- Increased calorie intake by 1,000 calories per day according to an eating plan jointly
developed by the dietitian and Sra. Mendez.
- Sun bathing in direct sunlight while wearing shorts and a short-sleeve top for 10
minutes three times a week. Or, taking a vitamin D supplement providing
approximately 800 IU vitamin D daily.
4. Examples of nutrition-related indicators that could be used to monitor and evaluate the
interventions are:
- Weight gain per week
- Rate of weight gain per week
- Total pregnancy weight gain
- EPA+DHA intake
- Fish intake as recommended
- Sunbathing duration, frequency
- Ingestion of the recommended vitamin D supplement
- Improvement in plasma 25-hydroxyvitamin D level

Chapter Outline

I. Introduction
The expectation of a healthy newborn is fulfilled for “the vast majority of pregnancies” (p.
136). Chapter 5 deals with special conditions of pregnancy and with corresponding
interventions.

II. Obesity and Pregnancy

Obesity prior to pregnancy is associated with higher rates of gestational diabetes and

© 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly
accessible website, in whole or in part.
 hypertensive disorders of pregnancy. Excessive visceral fat increases disease risk as
compared to subcutaneous fat. Nutritional as well as surgical interventions for obesity
treatment are discussed.

III. Hypertensive Disorders of Pregnancy

Affecting 5-10% of pregnancies, hypertensive disorders of pregnancy (see Table 5.2) stem
largely from unknown causes; cures are elusive for affected women. Weight gain
recommendations match those for women without hypertension. The importance of this
topic is emphasized by the number of tables (#5.3, 5.4, 5.5, and 5.6) that deal with issues
related to preeclampsia. Susan’s story in Case Study 5.1 facilitates application of nutrition
recommendations to preeclampsia, one of the hypertensive disorders of pregnancy.

IV. Diabetes in Pregnancy

Allow the student to describe the role of insulin resistance and to distinguish between type
1 and type 2 diabetes’s effects on maternal health and on the developing fetus. Students
will also discover, and should be able to discuss, the close relationship between gestational
diabetes and type 2 diabetes. The role of the glycemic index in the management of diabetes
in pregnancy is discussed plus a sample meal plan is provided (using low-glycemic index
foods) in Table 5.11.

V. Multifetal Pregnancies
Twin and triplet pregnancy rates have increased, especially in older women and in women
achieving pregnancy with assistive reproductive technologies. Prepregnancy weight affects
weight gain recommendations for a pregnancy with multiples (Table 5.16; heavier women
need to gain proportionately less weight). Best practices for healthy outcomes are
summarized in Table 5.17. Multifetal pregnancies pose greater risks than singleton
pregnancies.
The 3% of newborns resulting from multifetal pregnancies “account for disproportionally
high percentages of all low-birthweight newborns, preterm births, and infant deaths” (p.
148).

VI. HIV/AIDS during Pregnancy

Roughly 20% of infections in children occur during pregnancy, but treatment can reduce
risk of viral transmission to the fetus and subsequently to the newborn. Nutritional
management for women with HIV/AIDS is discussed on page 154 and in Table 5.18. It is
possible for a mother with HIV/AIDS to deliver a healthy infant.

VII. Eating Disorders in Pregnancy

Referral to a program that uses a team approach can support maternal and fetal health.
Because eating disorders are associated with sub- or infertility, pregnancy in women with
diagnosed eating disorders is uncommon.

VIII. Fetal Alcohol Spectrum Disorders

Fetal alcohol spectrum disorders is the term used to describe the range of effects of alcohol
consumed during pregnancy on fetal development. Abstinence from alcohol is
recommended during pregnancy because alcohol that a pregnant woman consumes can
easily cross the placenta and reach the fetus.

IX. Nutrition and Adolescent Pregnancy

Despite declining teen pregnancy rates, the U. S. has one of the highest adolescent
pregnancy rates of developed countries. The risks of poor outcome may be due more to
lifestyle factors than biological immaturity. The high potential for detrimental, long-term
consequences is balanced by treatment that supports teen, as well as fetal, growth and
development.

© 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly
accessible website, in whole or in part.
 Evidence-Based Practice. Research-based and “best-practice” protocols can enhance the
outcomes of problematic pregnancies; continually striving to evaluate and update current
practices will foster public health.

Internet Resources At-a-Glance

• Science of Nutrition
• National Library of Medicine (PubMed): www.ncbi.nlm.nih.gov/pubmed
• Academy of Nutrition and Dietetics Evidence Analysis Library: http://www.andeal.org/

• Nutrition during Pregnancy: Conditions & Interventions

• American Diabetes Association: www.diabetes.org. Point to “Diabetes Basics,” then
select “Gestational.”
• Canadian Diabetes Association: www.diabetes.ca. Click on “Diabetes & You” and then
scroll down to select “Gestational Diabetes” under the heading “What Is Diabetes?”

• Public Food & Nutrition Programs

• United States – National Institutes of Health National Institute of Child Health and
Human Development: http://www.nichd.nih.gov. Search for information on gestational
diabetes.

• Nationwide Priorities & Nutritional Health

• United States – Centers for Disease Control, Pediatric and Pregnancy Nutrition
Surveillance System (PedNSS): http://www.cdc.gov/pednss/index.htm

Exploring the Internet: E-Trips

A. Go to the Canadian Diabetes Association web site at www.diabetes.ca. Click on “Diabetes &
You” and then scroll down to select “Gestational Diabetes” under the heading “What Is
Diabetes?” Compare Canadian information on gestational diabetes with information from
the U.S. Government source (NIH or Ask-HRSA). How are weight gain recommendations
similar or different?

B. Use a search engine and identify three web sites that provide support, encouragement, and
accurate information for women testing positive for HIV/AIDS. Rate the nutrition advice
given. Be prepared to discuss the process used for searching addresses as well as the
criteria used to rate nutrition information accuracy.

C. Visit the Geneva Foundation for Medical Education and Research website. Locate the
obstetrics, gynecology, and reproductive medicine guidelines (under “Databases, links”).
Then select the topic “Pre-eclampsia, eclampsia, hypertension in pregnancy.” Scroll down to
the subheading “Articles in journals.” Browse these articles to find one that includes
nutrition-related information and then review that article. Does the information agree with
the information presented in this chapter? Prepare a brief summary report that you would
be able to submit to an obstetrician regarding the role of nutrients in this pregnancy
condition. (Note: a direct link is
http://www.gfmer.ch/Guidelines/Pregnancy_newborn/Preeclampsia_eclampsia_hypertensi
on_in_pregnancy.htm.)

D. The text states “any advice that strays from current scientifically based wisdom about
nutritional needs of women during pregnancy should be sidestepped.” Visit the
International Food Information Council’s brochure on “Healthy Eating During Pregnancy:”
www.foodinsight.org/Content/3651/RevisedHealthyEatingPregnancy809.pdf. Compare the
brochure recommendations to the recommendations given for multifetal pregnancies.

© 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly
accessible website, in whole or in part.
 Would you be able to use the brochure with a woman sustaining a multifetal pregnancy?
Why or why not? Can you find the evidence underlying the recommendations in the
brochure? Which are common sense recommendations? Which have research to support
them?

Discussion Questions

A. Hypertensive disorders of pregnancy are the second leading cause of maternal mortality in
the United States. Discuss the relationship between hypertensive disorders of pregnancy
(Table 5.2), chronic hypertension, and outcomes related to preeclampsia (see Table 5.5).
Begin by defining hypertension.

B. What are preventive measures and nutritional interventions associated with preeclampsia?
How would you prioritize this long list of potentially helpful nutrition interventions?

C. In Case Study 5.1, what are the critical pieces of information [for example, proteinuria
levels, insulin resistance, infant’s weight, and delivery at 36 weeks]? What other questions
would you ask if you were the dietitian in this scenario? What sort of dietary advice would
you give to Susan to treat her preeclampsia?

D. Describe an oral glucose tolerance test (OGTT). Discuss the pros and cons of using the
OGTT in the diagnosis of gestational diabetes. How does the determination of glucose
tolerance during pregnancy differ from the process used for non-pregnant women?

E. Potential consequences of poorly controlled gestational diabetes (see Table 5.7) include
increased risk of chronic disease later in life. What aspects of the meal plan found in Table
5.11 would make it suitable for a pregnant woman with gestational diabetes?

F. Assume that you are developing a health promotion campaign aimed at Pima women of
conceptual age. What nutritional and exercise considerations might such a campaign
include? What, if anything, would you do about the young males of this age?

G. How would you explain to a young woman that it is a good idea to eat a higher percentage
of calories from fat during her pregnancy?

H. Why not just “eat double” for a twin pregnancy? [Tables 5.13 through 5.17 and Illustrations
5.5 and 5.6 deal with aspects of a multifetal pregnancy.]

I. What are strategies to maintain nitrogen balance while minimizing insulin resistance in a
pregnant woman with HIV/AIDS?

J. Describe examples of potentially supportive community food and nutrition programs for a
pregnant woman with HIV/AIDS. [WIC, SNAP, food pantries, Open Arms, etc.]

K. What are risks associated with an adolescent pregnancy? What messages could you develop
to reach adolescents regarding each of these risks of pregnancy?

Classroom Activities

A. Develop an assessment tool for gestational diabetes. What would you need to include?
[Weight status or overweight, physical activity levels, insulin resistance.]

B. Modify one day’s intake to lower the glycemic index. Have teams of two students
interview each other about what was eaten in the last 24 hours. Pick one of the intakes to

© 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly
accessible website, in whole or in part.
 modify so that it includes more low- and moderate-glycemic index foods. Use foods that
team members would actually eat.

© 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly
accessible website, in whole or in part.
 Worksheet 5-1: Type 1 Diabetes prior to Pregnancy
Nan has had type 1 diabetes for 15 years. Currently 29 years old and in the sixth week
of her first pregnancy, she is referred to a registered dietitian for a review of nutrition
recommendations for a healthy pregnancy. She brings her lab work with her and it
shows her last A1c level was obtained one month ago and it was 5.5%. Nan is
concerned that she won’t be able to use artificial sweeteners and she asks if any have
been found to be safe during pregnancy. A diet history shows a fairly high intake of
processed foods.

Her preferred meal planning method is carbohydrate counting and she feels
comfortable doing this already. Nan asks you for feedback on how she might be able to
improve her diet.

Questions:
(To answer these questions, use the textbook and refer to the 2008 article “Nutrition
Recommendations and Interventions for Diabetes: A Statement of the American
Diabetes Association.” The reference is doi: 10.2337/dc08-S061; Diabetes Care,
January 2008, vol. 31, no. Supplement 1, S61-S78; it is available at:
http://care.diabetesjournals.org/content/31/Supplement_1/S61.full?ijkey=9125024b
eb66755222a5f68f5a43ed6badcccc52&keytype2=tf_ipsecsha.)

1. How was Nan’s blood sugar control prior to pregnancy? How are you able to assess
this?

2. Are there any artificial sweeteners that may be used safely during pregnancy?

3. What nutrition recommendations do you have for Nan during her pregnancy?

4. Is there a higher risk for complications due to having type 1 diabetes prior to
pregnancy?

© 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly
accessible website, in whole or in part.
Worksheet 5-2: Distribution of Calories for Gestational Diabetes
Use a food composition database (e.g., http://ndb.nal.usda.gov/ndb/search/list) to determine
the amount of protein and fat in the 2400-calorie meal plan provided in Table 5.11, then
determine how this compares to the recommendations on p. 149 for calorie distribution for
gestational diabetes.

Food Item Serving Carbohydrates Fat Protein Calories

Size (grams) (grams) (grams)
Breakfast
Complete Wheat Bran Flakes ¾ cup 23 90
2% Milk ½ cup 6 61
Egg 1 1 74
Black coffee, tea
Morning Snack
Peanuts 2 oz 10 326
Carrot 1 7 31
Graham crackers 4 small 59
Lunch
Beef or chicken burrito 1 33 255
Salsa ½ cup 7 33
Black beans 1 cup 40 228
Apple 1 21 81
Black coffee, tea, diet soda
Midday Snack
Banana ½ 28 55
2% milk 1 cup 12 121
Dinner
Lean pork chop 4 oz 0 263
Pinto beans 1 cup 22 116
Corn bread 1 oz 12 92
Margarine 1 tsp 1 33
Garden salad 2 cups 0 10
Feta cheese 1 oz 1 74
Salad dressing 2 Tbsp 3 104
Black coffee, tea, diet soda
Bedtime Snack
Peanut butter 2 Tbsp 12 190
Rice cake 1 8 35
2% milk 1 cup 12 121
Totals: --- 270 2442
Calories: --- 2442
% of Total Calories: --- ---
Recommendation 40-50% 30- 20% ---
40%

© 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly
accessible website, in whole or in part.