Info

Obese (BMI >29.0)

>15 >7.0

Figures are for single pregnancies. The range for women carrying twins is 35 to 45 lb (16 to 20 kg). Young adolescents (<2 years after menarche) should strive for gains at the upper end of the range. Short women (<62 in. or <157 cm) should strive for gains at the lower end of the range.

Institute of Medicine. Nutrition During Pregnancy. Part I, Weight Gain. Committee on Nutritional Status During Pregnancy and Lactation, Food and Nutrition Board, National Academy Press, Washington, DC, 1990.

Institute of Medicine. Nutrition During Pregnancy. Part I, Weight Gain. Committee on Nutritional Status During Pregnancy and Lactation, Food and Nutrition Board, National Academy Press, Washington, DC, 1990.

Exercise is an important part of the lifestyle of many women. Guidelines are contradictory, but the recommendations of the American College of Obstetrics and Gynecology (1994) suggest that in the absence of either obstetric or medical complications, most women can perform moderate exercise to maintain cardiorespiratory and muscular fitness throughout pregnancy and the postpartum period. Women exercising regularly prior to pregnancy can continue mild to moderate exercise, preferably for short periods three times a week. Women initiating exercise during pregnancy should be more cautious, and consider programs developed specifically for pregnant women. After the first trimester, women should avoid exercise in the supine position, which can compress the inferior vena cava and decrease blood flow to the placenta. The pregnant woman should stop exercise when she feels fatigued or uncomfortable and avoid overheating and dehydration. Since the center of gravity shifts in the third trimester, advise her that exercises that could cause loss of balance are unwise.

Pregnancy may be a time when women are more likely to be abused by an intimate partner or when patterns of abuse may intensify, increasing the risk of miscarriage and low-birthweight babies, as well as late prenatal care. Abuse in pregnancy ranges from 8% to 22%, and may result in femicide. Because violence survivors often disclose their experiences to their health care provider before confiding in their family, clergy, or friends, many experts consider universal screening an ethical imperative. No woman deserves to be hurt. Safety and legal concerns also surround domestic violence, but the woman needs to be supported and offered multiple opportunities to talk about any form of abuse or violence in the safety and privacy of a prenatal visit. When to ask, how to bring up the subject, and how to respond when the woman reveals that she is or has been abused are important questions to consider before screening for violence and abuse. Direct questioning in a nonjudgmental manner in a private setting is recommended at each prenatal visit. Validation of positive responses and marking the area of any injury on a body map is suggested. Above all, in situations of admitted abuse, ask the woman how you might help her. Offer information on safe shelters, counseling centers, hotline telephone numbers to call*, and other sources of help when she is ready to take advantage of these. Clues to physical violence may also arise from behavior during the interview or from frequent changes in appointments at the last minute to avoid detection of bruises or other signs of injury.

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