Nutritional Assessment

A baseline assessment should be made at the first prenatal visit and follow-up care should be provided at subsequent visits. The initial nutritional assessment should include baseline anthropometric measurement such as weight, height, BMI (height [cm]/kg [m2]), and mid-upper arm circumference (MUAC) [23]. The BMI will indicate whether the woman is at an appropriate weight or is underweight or overweight at onset of pregnancy. This information will enable the provider to make specific weight gain recommendations and allow for tracking of weight gain during pregnancy. Additionally, women who have a MUAC of <23 cm are at even greater nutritional risk [96, 97]; thus, this anthropometric marker may indicate the need for more aggressive nutritional intervention. Biochemical assessment measures including serum albumin, transferrin, hematocrit, creatinine, urea nitrogen, lipids, and micronutrients indicate disease prognosis and potential complications [98, 99]. These markers should be included in the initial assessment and followed throughout pregnancy.

The initial assessment takes into account the diet history of the woman as well as any symptoms or problems that might hinder adequate intake. Typical dietary, appetite, gastrointestinal symptoms (i.e., nausea, vomiting, diarrhea, and constipation), difficulty with chewing and swallowing, food allergies, ethnic and cultural food practices, and household food security should be considered and included in the assessment. Furthermore, all medications and supplements as well as complementary therapies should be investigated in order to determine possible drug-nutrient interactions.

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