Nutritional Counseling

  • Weight gain goals should be set based on the woman's BMI at baseline. If underweight (BMI < 19.8 kg/m2), then she needs to gain 28-40 lb during pregnancy. If at appropriate weight (BMI 19.8 - 26 kg/m2), then she needs to gain 25-35 lb during pregnancy. If overweight (BMI > 26-29 kg/m2), then she needs to gain 15-25 lb during pregnancy. If obese (BMI > 29 kg/m2), then she needs to gain at least 15 lb during pregnancy (refer to Table 12.1).
  • Energy needs are dependent on whether the woman is asymptomatic or symptomatic at the time of assessment. If asymptomatic, then her calorie needs are increased by 10% plus an additional 300 kcal per day on average during pregnancy (500 kcal per day during lactation). (see Chaps. 1 and 18, "Nutrient Recommendations and Dietary Guidelines for Pregnanat Women" and "Nutrition Issues During Lactation"). If symptomatic, then her calorie needs are increased by 20-30% plus an additional 300 kcal per day during pregnancy (500 kcal per day during lactation).
  • Protein needs are estimated to be approximately 1 g/kg/day.
  • Encourage a diet that is nutritionally adequate and varied. Additional multivitamin and mineral supplementation is also encouraged. Specific nutrients of importance are iron and folate. The DRI for iron is 27 mg/day and for folate is 600 mcg per day. While prenatal vitamins vary, most provide approximately 800-1,000 mcg of folic acid and 30 mg of iron per dose.
  • Provide counseling regarding breastfeeding and risk of MTCT of HIV.
  • Address food safety with regard to proper hand washing, safe food handling and storage, and safe cooking temperatures.
  • Provide counseling for women on ARV treatment regarding meal planning, symptom management, and the metabolic changes associated with ARV therapy.
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