Assignment
Brenda is a 36 y/o female who is currently 24 weeks pregnant. She has two children ages 18 month and 3 years who are healthy. She lives with her husband and mother in-law who takes care of her older children while she is at work. They have limited discretionary income. She works full time as a cashier at a target. Lately she has been feeling tired and irritable and is anxious that the baby is getting too big.
Ht: 5'2" Current BP: 130/90
Weight hx: Urinalysis:
Pre-pregnancy wt 155 lbs Glucose: negative
6 weeks gestation: 165 lbs Protein: negative
12 weeks 172 lbs Ketones: 1+
16 weeks 180 lbs
20 weeks 190 lbs
24 weeks 198 lbs
Weight gain history: 1st pregnancy 45#, 2nd pregnancy 53#.
Her doctor is concerned about her rapid weight gain but indicates that the baby is doing well.
The next day Brenda goes to the lab and has her blood drawn and does a 1-hour glucose tolerance test.
Results:
Hgb (Hemoglobin) 10.3 gm/dL
Hct (Hematocrit) 31%
Fasting glucose: 94 mg/dL
1-hour GTT: 127 mg/dL
Upon getting the results of the 1-hour GTT the physician refers Brenda to a registered dietitian to help control her weight gain and improve her blood sugar control. Her physician is concerned about progression to gestational diabetes if weight gain continues at current rate.
The dietitian conducts a multi-pass 24-hour recall (results below):
1. 10:00 AM: 16 oz Starbucks Caffe Latte with whole milk
2. 12:30 PM: Fish sandwich from McDonalds, large fries, medium Sprite
3. 4:00 PM: 20 oz Orange juice, 3 ½ oz bag of potato chips
4. 7:00 PM: Sesame chicken (5 oz), vegetable fried rice (1 ½ servings)
5. 9:00 PM 1 cup of Blue Bell vanilla ice cream
Brenda reports this is a typical day and being pregnant has really made her hungry. She occasionally takes a multivitamin but doesn't always remember to do so. She also reports that she does not have time to exercise and her job requires sitting and standing most of the day.
A. What is Brenda's BMI and what is the recommended weight gain for Brenda during pregnancy? How much should she gain per trimesters (rate). How much should she have gained at this point (24 weeks)?
B. Is Brenda's weight gain appropriate? Explain your answer (how much weight has she gained compared to how much she should have gained? Consider recommended total or rate of weight gain for each trimester.)
C. What risks are associated with Brenda's weight classification during pregnancy? What would you recommend for managing Brenda's weight during the pregnancy?
D. What could be the reason for ketones in the urine?
E. What are the diagnostic criteria for gestational diabetes? Use laboratory diagnostic criteria
F. Does she have any risk factors for gestational diabetes?
G. Does Brenda have gestational diabetes now? Explain your answer
H. What do Brenda's hemoglobin and hematocrit levels indicate, how can this impact the pregnancy and what should be recommended?