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2. Given Mya’s present weight, what would your recommended weight gain for her pregnancy be? Do you have
any recommendations or suggestions for altering or changing her exercise regime?
Answer: The normal weight gain for pregnancy is approximately 25 to 30 pounds, which includes the baby, all
accompanying fluids, and some extra body fat. Therefore, at the high end, Mya would have a final weight of
3. Because Mya is having difficulty eating, what suggestions might you offer her? If, in her past pregnancy, her
nausea only lasted for the first trimester, can you offer the hope that the nausea will be short lived? If it is,
should she continue on the vegetarian diet with her daughter or resume to another type of diet?
Answer: In general, morning sickness or pregnancy nausea only lasts through the first trimester. Comparing
one pregnancy to another is rarely applicable as each pregnancy tends to be as different as each child is. For the
most part, the nausea does quiet down after the first trimester in the majority of women, with some women
4. Do you consider Mya’s diet a high-risk pregnancy? If so, for what reasons? What are factors that modulate her
risk?
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Answer: Mya’s pregnancy would be considered high risk given her age. She also had a miscarriage while
younger; it was in the beginning of the second trimester, which is somewhat concerning. Given the stress and
weight loss she has had leading up to her pregnancy, it is appropriate to keep an eye on her because of her age.
5. In the last weeks of pregnancy, what pieces of information can you provide to Mya that can begin to prepare her
for lactation?
Answer: Lactation is often more difficult than one would expect when trying to optimize its success. There are
many factors that can interfere with optimal lactation, such as the health of the baby or the mother or both. It
does take a while for the mother’s milk to come in and often mothers supplement with formula until their milk
is available. Sometimes the baby now prefers the formula and will not go back to the breast.
6. Clearly, as outlined in Highlight 15, alcohol for the unborn fetus is not a healthy situation. Think back to
Highlight 7, where you studied the absorption and elimination of alcohol in the adult body. As you recall how
the adult body processes alcohol, visualize and then discuss how this process would occur in the unborn fetus of
the mother that drinks alcohol without eating during trimesters one, two, and three.
What are some alternatives to alcoholic beverages for pregnant women when they might be out for a night with
friends? Be creative!
Answer: If you recall, the body puts a priority on alcohol absorption and clearance from the body because it is
essentially a toxin to the body. As it is absorbed in the stomach or in the intestine, it is sent directly to the
IM Worksheet Answer Key
Worksheet 15-1: Maternal Weight Gain Calculations
1. BMI = 26.6 = overweight: 15-25 lbs recommendation
Worksheet 15-2: Chapter 15 Crossword Puzzle
Worksheet 15-3: Food Safety for Pregnancy (Internet Exercise)
Canadian Information7
Under guidance from an Expert Advisory Group, and to align with the Dietary Reference Intakes and Eating Well
with Canada’s Food Guide, Health Canada has been revising select prenatal guidelines in the 1999 Nutrition for a
Healthy Pregnancy: National Guidelines for the Childbearing Years. Key guidelines from the revisions, include:8
• Encourage all women to eat at least 150 g of fish each week. Fish contains omega-3 fats and other important
nutrients for pregnancy.
• Women who could become pregnant and those who are pregnant should take a multivitamin containing 0.4 mg
of folic acid every day.
• Pregnant women should also ensure that their multivitamin contains 16-20 mg of iron.
In 2008, the PHAC published The Sensible Guide to a Healthy Pregnancy,10 a guide that provides tips, facts,
answers to frequently asked questions, recommendations for gestational weight gain ranges, and other key
information for ensuring a healthy pregnancy. The guide was written for any woman who is pregnant or is planning
on becoming pregnant. Key topics include: Prenatal Nutrition (e.g., folic acid and eating a healthy diet), Alcohol and
Pregnancy, Physical Activity, Smoking and Pregnancy, Oral Health, and Emotional Health. It features a 10-month
pregnancy calendar with information for each month and space for women to record their experiences during
pregnancy and shortly after birth. Recommendations for gestational weight gain ranges (similar to those found in
Table 15-1 on page 501) suggest the following general targets based on pre-pregnancy body mass index (BMI):
Table 15.1 Canadian Guidelines for Gestational Weight Gain11
BMI Category (Pre-Pregnancy)*
Recommended Total Gestational Weight
Gain
kg
lb
<20
12.5 – 18.0
28 – 40
20 – 27
11.5 – 16.0
25 – 35
>27
7.0 – 11.5
15 – 25
15.2 Perinatal Health Statistics in Canada
The Canadian Perinatal Surveillance System (CPSS) was established in 1995, in part to identify disparities in
perinatal health in Canada.14 The importance of systematically collecting perinatal data has helped to address and
implement appropriate responses to improve the health of mothers, fetuses and infants. Fifty-two perinatal health
9 Health Canada. Nutrients of Special Concern for a Healthy Pregnancy: Folate. Available at: www.hc-sc.gc.ca/fn-
15.3 Canadian Prenatal Programs
Although Canada does not have a single national nutrition program for pregnant women, supportive nutrition
programs are available to them. In 1995, through a community development approach, Health Canada (now under
the leadership of PHAC) launched the Canadian Prenatal Nutrition Program (CPNP) in communities across the
country. This program is aimed at reducing the incidence of unhealthy birth weights, improving the health of both
infant and mother, and encouraging breastfeeding.16 The program supports community–based services by funding
local community groups to establish and deliver services according to the local population needs and to build on
Many public health offices or community health centres offer prenatal and postnatal education programs to
interested members of the community. To find out about programs for pregnant women at nutritional risk in your
local area, contact your local or provincial public health office or community health centre.
15.4 Folic Acid and Pregnancy: The Canadian Situation
The public health initiative of folic acid food fortification began in Canada in 1996 as a way to reduce the risk of
certain birth defects. In 2002, Health Canada launched a folic acid awareness campaign (now under the leadership of
PHAC) to further support a reduction in the incidence of babies born with neural tube defects (NTD). These
strategies have contributed to an improved folic acid status of pregnant Canadian women and a decreased incidence
of neural tube defects similar to those reported for the United States and found in Figure 10-11, Chapter 10 on page
328 of the textbook. Between 1993 (pre-fortification) and 2002 (full fortification), a 46% reduction in the overall
rate of NTD was observed in a 7-province study and geographical differences almost disappeared across Canada.17
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In 2008, in response to inquiries received following release of an updated version of the Joint Society of
Obstetricians and Gynaecologists of Canada document titled, Motherisk Clinical Practice Guideline on
Preconceptional Vitamin/Folic Acid Supplementation,18 PHAC published an information update titled, Folic Acid
and Prevention of Neural Tube Defects,19 to clarify PHAC recommendations regarding folic acid supplementation.
Canadian Readings on Folic Acid Food Fortification and Pregnancy
• Sherwood KL, Houghton LA, Tarasuk V, O’Connor DL. 2006. One-third of pregnant and lactating women may
not be meeting their folate requirements from diet alone based on mandated levels of folic acid fortification.
Journal of Nutrition, 136(11):2820-2826.
• House JD, March SB, Ratnam MS, Crowley M, Friel JK. 2006. Improvements in the status of folate and
cobalamin in pregnant Newfoundland women are consistent with observed reductions in the incidence of neural
15.5 Canadian Recommendations for Consuming Fish During Pregnancy
Eating Well with Canada’s Food Guide recommends that Canadians eat at least two Food Guide servings (75 grams
each serving) of fish each week. The nutrients offered by fish are of particular benefit to pregnant and breastfeeding
women, and women who may become pregnant. For these women, shellfish such as clams, crab, mussels, oysters,
shrimp, and younger and smaller types of fish such as salmon, rainbow trout, sardines, herring, haddock, canned
light tuna, pollock (Boston bluefish), sole, flounder, anchovy, char, hake, mullet, smelt, Atlantic mackerel, and lake
white fish are recommended at intake levels of up to 150 g per week due to their relatively low levels of mercury,
high levels of long-chain omega-3 fatty acids, vitamin D, and trace minerals.20 Health Canada has identified larger
predatory fish species as being more of a concern due to mercury bioaccumulation and recommends a limited intake
up to 150 g per month of these species for women who are or may become pregnant and breastfeeding mothers.20
15.6 Canadian Recommendations for Lactation
Health Canada and PHAC support and promote breastfeeding, and recommend breastfeeding as the optimal method
of feeding infants and for providing immunological and emotional nurturing of infants. The primary
recommendation in the 2004 Exclusive Breastfeeding Duration document from Health Canada states:22
Exclusive breastfeeding* is recommended for the first six months of life for healthy term infants, as breast
milk is the best food for optimal growth. Infants should be introduced to nutrient-rich, solid foods with
particular attention to iron at six months with continued breastfeeding for up to two years and beyond.
Prepared for health professionals, a 2005 statement of the joint working group of Canadian Paediatric Society,
Dietitians of Canada, and Health Canada, titled Nutrition for Healthy Term Infants,25 presents national guidelines on
issues associated with breastfeeding, for example, the benefits of breastfeeding, vitamin and mineral
supplementation, use of alternate milks and other fluids, transitioning to solid foods, and safety issues around
feeding.
Eating Well with Canada’s Food Guide recommends adding two or three extra servings of food from any of the four
food groups each day to meet the nutritional needs of lactating women.26 In Canada, concern has been raised about
the nutritional adequacy of the food intake of lactating women in low-income communities.27
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Canadian Readings on Breastfeeding
• Groleau D, Soulière M, Kirmayer LJ. 2006. Breastfeeding and the cultural configuration of social space among
Vietnamese immigrant woman. Health & Place, 12(4):516-526.
• Coulibaly R, Séguin L, Zunzunegui M, Gauvin L. 2006. Links Between Maternal Breast-Feeding Duration and
Québec Infants’ Health: A Population-Based Study. Are the Effects Different for Poor Children? Maternal &
Child Health Journal, 10(6):537-543.
Highlight 15: Fetal Alcohol Syndrome
In 1996, Health Canada and the Canadian Paediatric Society released a joint statement on Fetal Alcohol Syndrome
and Fetal Alcohol Effects.28 The basis of the recommendations states “the prudent choice for women who are or may
become pregnant is to abstain from alcohol.” The statement also recommends health professionals inform pregnant
women who have consumed small amounts of alcohol occasionally that the risk is minimal, and should also tell the
mother that both she and the fetus will benefit if she stops drinking alcohol at any time during the pregnancy.
Education related to preventing fetal alcohol syndrome is part of the Canadian Prenatal Nutrition Program. In 2003,
PHAC released a resource for healthcare workers titled, Fetal Alcohol Spectrum Disorder (FASD): A Framework
for Action, which focused on building and maintaining a system of supports and services to prevent FASD and
improving outcomes for people living with FASD. Educational materials include a poster and a brochure. These and
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Worksheet 15-1: Maternal Weight Gain Calculations
For the following pregnant women listed below indicate whether they are within, below, or above the recommended
weight gain pattern. (Calculate BMI, then determine recommended prenatal weight gain based on prepregnancy
weight, using Table 15-1 and Figure 15-7 in the text.)
1. 22 year old, prepregnancy weight 155 lbs, 5’4”, 38 weeks gestation, weighing 200 lbs BMI = ________
4. 32 year old, prepregnancy weight 184 lbs, 5’6”, 8 weeks gestation, weighing 187 lbs BMI = ________
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Worksheet 15-2: Chapter 15 Crossword Puzzle
Across:
Down:
3. a condition characterized by hypertension, fluid
retention, and protein in the urine
6. production and secretion of breast milk for the
purpose of nourishing an infant
8. a hormone secreted from the anterior pituitary gland
that acts on the mammary glands to initiate and
sustain milk production
1. glands of the female breast that secrete milk
2. an uncommon and always fatal type of neural tube
defect in which the brain is absent
4. a birthweight of 5 ½ pounds (2,500 g) or less;
indicates probable poor health in the newborn and
poor nutrition status in the mother during
pregnancy, before pregnancy, or both
1
2 3 4
5
6
7
8
9
10
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Worksheet 15-3: Food Safety for Pregnancy (Internet Exercise)
Read this file in order to answer questions 1-8. Do not close the window until you have finished
answering the questions.
1. It is safe to eat feta cheese during pregnancy as long as it is made from unpasteurized milk products.
a. True
b. False
2. You can eat hot dogs when pregnant, provided they are hot and not lukewarm in temperature.
3. When pregnant, you can eat fruits and vegetables immediately once you purchase them from the
4. It is advised that pregnant woman should be cautious when eating any raw fish product such as
5. Listeria is a virus that is found in seafood products.
a. True
b. False
6. Toxoplasma is a bacterium found in cold refrigerators.
7. It is advisable to avoid eating mung bean sprouts when pregnant.
a. True
b. False
8. What are the three main dangers for pregnant women that are found in food?