This document provides information on prenatal care, including initial prenatal evaluation, definitions of common terms, assessment of gestational age, routine prenatal visits, laboratory tests, nutritional counseling, and dietary recommendations. The initial prenatal evaluation involves taking a medical history, physical exam, and laboratory tests to assess the health of the mother and fetus. Routine prenatal visits every 4 weeks until 28 weeks and every 2 weeks until delivery are recommended to monitor the pregnancy. Laboratory tests screen for infections and nutritional deficiencies. Nutritional counseling advises women on healthy diet and weight gain during pregnancy.
E. Atypical HUS (aHUS)
1. Epidemiology. aHUS is much less common than STEC-HUS.
2. Etiology
a. Drugs (e.g., oral contraceptives, cyclosporine, tacrolimus) or pregnancy may cause
aHUS.
b. Inherited aHUS occurs with both autosomal dominant and autosomal recessive
inheritance patterns, although not all patients have identifiable mutations. These
genetic mutations cause chronic, excessive activation of complement, which also
leads to platelet activation, endothelial cell damage, and systemic thrombotic
microangiopathy.
3. Clinical features. Clinical findings are similar to those of STEC-HUS. Diarrhea may also
be present, and severe proteinuria and hypertension are more consistently found. The
clinical course is generally more severe with multiorgan damage.
4. Management. Treatment is supportive. Inciting medications, if any, must be stopped
immediately.
5. Prognosis. Some patients have a chronic relapsing course (recurrent HUS). All patients
with aHUS have a higher risk of progression to ESRD than patients with STEC-HUS.
Antenatal care, also known as prenatal care, is the care that a woman receives during pregnancy to ensure the health of both the mother and the fetus. This care typically begins as soon as a woman suspects or confirms that she is pregnant and continues throughout the pregnancy.
The main goal of antenatal care is to detect and manage any potential problems or complications early on, in order to optimize the health of the mother and baby. This care includes regular check-ups with a healthcare provider, as well as laboratory tests and imaging studies to monitor the health of the fetus and mother.
During antenatal care, healthcare providers typically check for signs of conditions such as gestational diabetes, hypertension, and pre-eclampsia, as well as assess the baby's growth and development. They also provide guidance on nutrition, exercise, and lifestyle changes to support a healthy pregnancy.
Antenatal care also includes education on childbirth and postpartum care, as well as opportunities for the expectant mother to ask questions and discuss any concerns they may have.
It is important for women to receive adequate antenatal care to increase the chances of a healthy pregnancy and delivery, and to prevent any potential complications.
E. Atypical HUS (aHUS)
1. Epidemiology. aHUS is much less common than STEC-HUS.
2. Etiology
a. Drugs (e.g., oral contraceptives, cyclosporine, tacrolimus) or pregnancy may cause
aHUS.
b. Inherited aHUS occurs with both autosomal dominant and autosomal recessive
inheritance patterns, although not all patients have identifiable mutations. These
genetic mutations cause chronic, excessive activation of complement, which also
leads to platelet activation, endothelial cell damage, and systemic thrombotic
microangiopathy.
3. Clinical features. Clinical findings are similar to those of STEC-HUS. Diarrhea may also
be present, and severe proteinuria and hypertension are more consistently found. The
clinical course is generally more severe with multiorgan damage.
4. Management. Treatment is supportive. Inciting medications, if any, must be stopped
immediately.
5. Prognosis. Some patients have a chronic relapsing course (recurrent HUS). All patients
with aHUS have a higher risk of progression to ESRD than patients with STEC-HUS.
Antenatal care, also known as prenatal care, is the care that a woman receives during pregnancy to ensure the health of both the mother and the fetus. This care typically begins as soon as a woman suspects or confirms that she is pregnant and continues throughout the pregnancy.
The main goal of antenatal care is to detect and manage any potential problems or complications early on, in order to optimize the health of the mother and baby. This care includes regular check-ups with a healthcare provider, as well as laboratory tests and imaging studies to monitor the health of the fetus and mother.
During antenatal care, healthcare providers typically check for signs of conditions such as gestational diabetes, hypertension, and pre-eclampsia, as well as assess the baby's growth and development. They also provide guidance on nutrition, exercise, and lifestyle changes to support a healthy pregnancy.
Antenatal care also includes education on childbirth and postpartum care, as well as opportunities for the expectant mother to ask questions and discuss any concerns they may have.
It is important for women to receive adequate antenatal care to increase the chances of a healthy pregnancy and delivery, and to prevent any potential complications.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Initial Prenatal evaluation
Prenatal care should be initiated as soon as there
is a reasonable likelihood of pregnancy.
Major goals:
1. define the health status of the mother and
fetus
2. estimate the fetal gestational age
3. initiate a plan for continuing obstetrical care.
3. Definition of Terms
1. Nulligravida—a woman who currently is not
pregnant nor has ever been pregnant.
2. Gravida—a woman who currently is pregnant
or has been in the past, irrespective of the
pregnancy outcome.
• Primigravida- woman on her first pregnancy
• Multigravida – woman on her subsequent
pregnancies
3. Nullipara—a woman who has never completed
a pregnancy beyond 20 weeks’ gestation.
4. Definition of Terms
4. Primipara—a woman who has been delivered only
once of a fetus or fetuses born alive or dead with an
estimated length of gestation of 20 or more weeks.
5. Multipara—a woman who has completed two or
more pregnancies to 20 weeks’ gestation or more.
• Parity is determined by the number of
pregnancies reaching 20weeks. It is not
5. Normal Pregnancy Duration
mean duration of pregnancy calculated from the
first day of the last normal menstrual period is
very close to 280 days or 40 weeks.
Naegele rule- estimate the expected delivery
date by adding 7 days to the date of the first day
of the last normal menstrual period and
counting back 3 months
· For example:
· LMP September 10, 2017, EDD is expected date of delivery
will be June 17, 2019
6. Trimesters
It has become customary to divide pregnancy into
three parts of approximately 3 calendar months.
first trimester: 1 to 14 weeks
2nd trimester: 15 to 28 weeks
3rd trimester: 29 to 42 weeks
7. PrenatalVisit
Advise office visit at 8-10 weeks of pregnancy (or earlier if the
patient is at risk for ectopic pregnancy)
Every 4 weeks for first 28 weeks.
Every 2 – 3 weeks until 36 weeks gestation.
Every week after 36 weeks gestation.
Frequency of visits is determined by individual needs and
assessed risk factors.
Goal: Coordination of care for detected medical and psychosocial
risk factors.
9. INITIAL PRENATAL VISIT
Complete history-taking
□ Previous and current health status
□ Obstetric history
□ Menstrual history
□ Psychosocial screening, depression, intimate
partner violence
□ Cigarette, alcohol, illicit drug use
10. Psychosocial Screening
Previous and Current Health Status
define psychosocial
issues as
nonbiomedical factors
that affect mental and
physical well-being.
Women should be
screened for: barriers
to care, communication
obstacles, nutritional
status, unstable
housing, desire for
pregnancy, safety
concerns that include
intimate partner
violence, depression,
stress, and use of
substances such as
tobacco, alcohol, and
illicit drugs
• This screening should
be performed on a
regular basis, at least
once per trimester,
• to identify important
issues and reduce
adverse pregnancy
outcomes.
11. Cigarette
Smoking
twofold risk of placenta previa, placental abruption, and premature
membrane rupture
Pathophysiology: fetal hypoxia from increased carboxyhemoglobin, reduced
uteroplacental blood flow, and direct toxic effects of nicotine and other
compounds in smoke.
Previous and Current Health Status
12. Alcohol
Previous and Current Health Status
Ethyl alcohol or ethanol is
a potent teratogen that
causes a fetal syndrome
characterized by growth
restriction, facial
abnormalities, and central
nervous system
dysfunction
Women who are pregnant
or considering pregnancy
should abstain from using
any alcoholic beverages.
Illicit drugs Can cause -fetal-growth restriction, low birthweight,
and drug withdrawal soon after birth.
13. Intimate Partner Violence
Previous and Current Health Status
Screen at the first prenatal visit, then again at least once per trimester, and
again at the postpartum visit.
associated with an increased risk of several adverse perinatal outcomes including
preterm delivery, fetal- growth restriction, and perinatal death.
refers to a pattern of assaultive and coercive behaviors that may include physical
injury, psychological abuse, sexual assault, progressive isolation, stalking,
deprivation, intimidation, and reproductive coercion
16. Clinical
Evaluation
2. Based on ultrasound
first-trimester crown-rump
length is the most accurate tool
for gestational age assignment
Ultrasound done during 2nd and
3rd trimesters can also provide
an estimated gestational age,
but with declining accuracy.
Gestational Age Assessment
18. LABORATORY TESTS
To document blood typing should there be a need
for emergency blood transfusion during
pregnancy
To identify the Rh (-) woman who will need anti-
D immunoglobulin at 28 weeks
Blood type,
Rh factor
Recommended at initial visit to evaluate
for iron deficiency and anemias
Repeat at 28-32 weeks
Complete
blood count
19. Screen for asymptomatic bacteriuria If
positive, treat then do test of cure
Urine culture
Screen at initial visit; if high-risk, rescreen
in 3rd trimester
If positive, counsel regarding health risks,
administer Hepatitis B vaccine and
immunoglobulin to baby upon delivery
HBsAg
LABORATORY TESTS
20. If high-risk, rescreen in the third trimester
If reactive, confirm with FTA-ABS / TP-PA
Watch out for congenital syphilis
Recommended in all pregnant women but may be
done on opt-out basis
If high-risk, rescreen in the third trimester
HIV screen
RPR / VDRL
LABORATORY TESTS
21. Recommended for all pregnant women
Repeat in the third trimester if woman is at risk Test include
endocervical or vaginal swab NAAT
Recommended for pregnant women with risk factors Tests
include endocervical swab culture or NAAT
If left untreated, may cause gonococcal infection in
the neonate
Neisseria
gonorrhea
Chlamydia
trachomatis
Rubella IgG Screen all women
Non-immune pregnant women should be counselled to
avoid exposure, and seek immunization postpartum
LABORATORY TESTS
22. Screen for gestational diabetes mellitus and
overt diabetes mellitus
FBS / HBA1c /
RBS / 75g OGTT
OTHER TESTS
Obtained in all women at 35-37 weeks age of
gestation
If positive, intrapartum antibiotic prophylaxis is
given
Group B
Streptococcus
screen
23. POGS CPG ON DIABETES MELLITUS IN PREGNANCY PROTOCOL FOR
THE EVALUATION OF DIABETES IN PREGNANT WOMEN
FIRST PRENATAL VISIT
FBS, HBA1c or RBS
FBS < 92 mg/dl or
RBS <200 mg/dl or
HBA1c < 6.5 %
FBS > 92 g/dl or
but <126 mg/dl
FBS >126 mg/dl or
RBS ≥ 200 mg/dl or
HBA1c ≥ 6.5 %
NORMAL GDM
No further testing
OVERT DM
No further testing
24. POGS CPG ON DIABETES MELLITUS IN PREGNANCY PROTOCOL FOR THE
EVALUATION OF DIABETES IN PREGNANT WOMEN
If initial screening is NORMAL
WITH other risk factors
Proceed immediately to 2-
hour 75g OGTT
NORMAL
NO other risk factors
2-hour 75g OGTT at
24-28 weeks
NORMAL
Repeat 2-hour 75g OGTT at 32 weeks
or anytime with maternal / fetal signs of DM
25. First trimester “dating” ultrasound
• <14 weeks
• Second trimester “anatomy” ultrasound
• 18-24 weeks
• Third trimester “growth” ultrasound
• >28, 32-35 weeks
OTHER TESTS
Ultrasonography
Screen for pre-malignant cervical lesions,
treatable infections
Pap Smear
26. • Subsequent prenatal visits have been traditionally
• scheduled at
• 4-week intervals until 28 weeks,
• then every 2 weeks until 36 weeks,
• and weekly thereafter.
• Women with complicated pregnancies often require
return visits at 1-to 2-week intervals.
SUBSEQUENT PRENATAL VISITS
27. SUBSEQUENT PRENATAL VISITS
Prenatal Surveillance
□ Maternal weight, blood pressure
□ Fundal height measurement
□ Fetal heart sounds
□ Abdominal examination for fetal presentation
□ Cervical examination at term or as necessary
28. 1. Fundal/fundic Height
• Between 20 and 34 weeks, the height of the uterine
fundus measured in cm correlates closely with
gestational age in weeks
• measurement is used to monitor fetal growth
and amnionic fluid volume.
• It is measured as the distance along the abdominal
wall from the top of the symphysis pubis to the top
of the fundus.
Prenatal Surveillance
29. 2. Fetal Heart Sounds
• detectableby:
• 10weeks AOG using fetaldoppler
• 16weeks AOG by stethoscope
Prenatal Surveillance
3. Sonography
• Sonography provides invaluable information
regarding fetal anatomy, growth and developmental.
30. 1. Group B Strep (GBS) Infection
• Recommend that vaginal and rectal group B
streptococcal (GBS) cultures be obtained in all women
between 35 and 37 weeks’ gestation
• Intrapartum antimicrobial prophylaxis is given for
those whose cultures are positive.
SUBSEQUENT LAB TESTS
31. 2. Gestational Diabetes
• All pregnant women should be screened for gestational
diabetes mellitus, whether by history, clinical factors, or
routine laboratory testing.
• Done between 24 and 28 weeks’ age of gestation
• Can be done during the first trimester check-up for high
risk women.
SUBSEQUENT LAB TESTS
32. • Serum screening for neural-tube defects is offered at 15
to 20 weeks.
• Fetal aneuploidy screening may be performed at 11 to
14 week’s gestation and/or at 15 to 20 weeks
3.Neural-Tube Defect and Genetic Screening
SUBSEQUENT LAB TESTS
35. Recommended Dietary Allowance
CALORIES
Pregnancy requires an additional 80,000 kcal, mostly
during the last 20 weeks.
To meet this demand, a caloric increase of 100 to 300
kcal per day is recommended during pregnancy
0 kcal / day
340 kcal / day
450 kcal / day
first trimester
2nd trimester
3rd trimester
36. PROTEIN
RDA 5-6 g /day OR 1 g/kg/d
Function Growth and remodeling of fetus, placenta,
uterus
Notes • Preferably supplied from animal sources
such as meat, milk, eggs, cheese, poultry and
fish
Recommended Dietary Allowance
37. IRON
RDA 27 mg /day
60-100 mg / day if obese, twin gestation, late iron
supplementation, irregular intake of iron, or with
iron deficiency anemia
Inadequate intake Anemia
Notes • Diet alone insufficient
• Iron requirements are slight during first 4
months of pregnancy hence not necessary to
supplement during this time
• Ingestion of iron at bedtime or on an empty
stomach aids absorption
Recommended Dietary Allowance
38. FOLIC ACID
RDA 400 g /day (or 0.4 mg / day) throughout periconceptional
period and first trimester
4 mg / day if with prior child with neural-tube defect (69%
decrease in NTD)
Inadequate intake Neural tube defects
Notes • Diet alone is insufficient
• Women taking anti-seizure medications and other drugs that
interfere with folic acid metabolism, carrying multiple
gestation, and obese need higher doses
Recommended Dietary Allowance
39. VITAMIN B12
RDA 2.6 g /day
Inadequate intake Increased risk for neural tube defects
Notes • Occurs naturally only in foods of animal origin
• Strict vegetarians may give birth to infants deficient in
Vitamin B12
• Breastmilk of a vegetarian mother contains little Vitamin
B12
Recommended Dietary Allowance
40. VITAMIN D
RDA 15 g /day (600 IU/day)
Inadequate intake Disordered skeletal homeostasis, congenital
rickets and fractures in the newborn
Notes • Supplementation can be considered in
women with limited sun exposure
Recommended Dietary Allowance
41. IODINE
RDA 220 g /day
Inadequate intake Neonatal cretinism
Notes • Dietary sources may be sufficient (iodized salt,
bread products)
• Consider supplementation in areas where
iodine deficiency is common
Recommended Dietary Allowance
42. CALCIUM
RDA 1000 mg /day
Inadequate intake Demineralization of mother’s bones
Notes • Development of fetal skeleton increases demand for
calcium → maternal intestinal calcium absorption is
doubled → dietary intake of calcium is necessary
• Recommended for pregnant women with poor dietary
calcium intake
• Unclear if supplementation may prevent preeclampsia
Recommended Dietary Allowance
43. Vitamin A Beta-carotene, the precursor of vitamin A found in fruits
and vegetables, has not been shown to produce vitamin A
toxicity.
Most prenatal vitamins contain vitamin A in doses
considerably below the teratogenic threshold.
Vitamin A deficiency, whether overt or subclinical, was
associated with an increased risk of maternal anemia and
spontaneous preterm birth.
Recommended Dietary Allowance
44. Vitamin B6 (Pyridoxine)
For women at high risk for inadequate
nutrition- for substance abusers,
adolescents, and those with multifetal
gestations
a daily 2-mg supplement is recommended.
Vitamin C
recommended dietary allowance
for vitamin C duringpregnancy is 80
to 85 mg/day—approximately 20
percent more than when
nonpregnant
Recommended Dietary Allowance
45. Pragmatic Nutritional Surveillance
1. In general, advise the pregnant woman to eat what she wants in amounts she desires
and salted to taste.
2. Ensure that food is amply available for socioeconomically deprived
women.
3. Monitor weight gain, with a goal of approximately 25 to 35 lb in women with a
normal BMI.
4. Explore food intake by dietary recall periodically to discover the occasional
nutritionally errant diet.
5. Give tablets of simple iron salts that provide at least 27 mg of elemental iron daily.
Give folate supplementation before and in the early weeks of pregnancy. Provide
iodine supplementation in areas of known dietary insufficiency.
6. Recheck the hematocrit or hemoglobin concentration at 28 to 32 weeks’ gestation
to detect significant decreases.