At The Root, Kirsten West Savali brings up (rightly) that this imagery hearkens back to another image we saw in 2014 of a Black woman being used as a chair by Garage editor-in-chief Dasha Zhukova. Perhaps what is even more critically necessary is the question of switching the races of the children.
Switching the races of the children in the ad does not switch their ethnic and genealogical histories.
In the same ways that Black mothers in the Slave Era and in the post-bellum period were seen less as women with intellect and agency and more as objects for public consumption by Whites, the image of a little Black girl in the armpit of a White girl (under the guise that girls can be anything) is reminiscent of the diminished status of Black women throughout this country’s history. Let’s be clear, White women have always played an integral role in the exploitation, oppression, and exclusion of Black women and girls. I say all this to say that there is no counter image that would make the new GapKids ad okay. Black women and girls being used as props links back to a long history that one image simply can’t erase or reset. Want More Convos Like This One?May 23, 2014 Hashtag Activism, Silencing, and Sacrificial Lambs of the New Media MovementJuly 2, 2014 Dr. In 1889, Prochownick performed the first serious study of diet in pregnancy.1 He restricted calories, reduced sodium intake, and encouraged minimal weight gain with the goal of reducing infant size in women with contracted pelves to avoid preterm induction of labor. PRECONCEPTION COUNSELINGWhat a woman eats before pregnancy is as important as intake during pregnancy. This review is based on a presentation given by Leonard Glassman and adapted for the Radiology Assistant by Robin Smithuis. So, first we're going to give you a couple of examples of the normal male breast, just to get used to what normal looks like.
Obviously, the lesions in this last category will need a biopsy, unless you are sure that it is classically benign, like for instance a lymph node or lipoma. The left image shows normal skin, a nipple and a small amount of connective tissue behind the nipple.
There is a small amount of fibrous connective tissue, but basically most of this breast is just fat.
It may be more prominent in the upper outer quadrant and, more importantly, it blends into the surrounding fat. If you think about the mammogram on the left as the breast of a woman instead of a man, than you might say that there is an ill-defined mass and you might conclude that this is a malignancy . Gynecomastia is simultaneous proliferation of ducts and stroma without encapsulation, so it must blend into the surrounding fat tissue. So you will not see tumors that start in the lobuli, for example lactating adenomas, fibroadenomas, phyllodes tumors, and also invasive lobular carcinomas are extremely rare.
On the far left a mammogram of a male with gynecomastia and next to it a mammogram of an eight year old girl with juvenile hypertrophy.
It begins as an increased number of ducts and epithelial proliferation with edema and cellular fibroblastic stroma. On the left a mammogram and an ultrasound image of a patient with a nodular glandular pattern of gynecomastia. The ultrasound image shows the typical appearance of gynecomastia: a hypoechoic mass with lobulation or even spiculation. If this was seen in a woman, you would say that this is a mass with microlobulation and spiculation, i.e.
A radiologist who was not used to looking at 'male' mammograms ordered the MR for problem solving. On the left a mammogram showing a subareolar density with prominent extensions into the fat. On the mammogram on the left we can imagine, that there is fibrosis with extension into the fat.
This is different from the glandular edema-like appearance in the acute phase of gynecomastia. These cases clearly demonstrate that gynecomastia can have an appearance which we would call malignant in a woman. Unfortunately some of the malignant lesions in a man can look benign and we will show some examples in the next chapter. There is a higher incidence in people from China and Africa due to hyperestrogenism secondary to parasitic liver disease. This subareolar location is just like in gynecomastia, but usually it is eccentric to the nipple.
Also DCIS is rare because there is no screening program for men, so they will present when there is a palpable mass.
On the left a huge invasive ductal carcinoma with some coarse benign looking calcifications. It results from hematogenous spread and is usually seen in patients with widespread disease.
On the CT on the left you can see the density of the lesion that proved to be a liposarcoma. In conclusion we can say, that male breast disease either presents as mass, pain or nipple discharge. Gynecomastia and invasive ductal cancer are the most common lesions in the male breast, but there are other rarer benign and malignant lesions. Gynecomastia and carcinoma can usually be differentiated, but biopsy is sometimes necessary to separate them.
Both gynecomastia and carcinoma occur mostly at the age of 60 and can be soft, mobile, subareolar and unilateral.
Actually we call it extension into the fat, if we think it is gynecomastia and spiculation, if we think it is a carcinoma. On the left two cases, that demonstrate, that it can be difficult to differentiate gynecomastia from carcinoma on a mammogram. The carcinoma on the right is a little bit more encapsulated than the gynecomastia on the right.
In addition to that explication, she discusses how race and gender work together to criminalize and marginalize Black women and girls each day meanwhile, they are commodified in ads like this. While she saw the pose as harmless, she validates the frustration many on social media have expressed with the picture. They are the byproducts of generations of rules, norms, and other expectations of human individuals due to their externally applied identities as one race or another or as one gender or another. It doesn’t switch the social narratives and norms which inform the concerns which have emerged following the publication of the ad. Not only that, it objectifies Black women and girls for the purpose of selling culture to Gap’s core audience (White, middle- to upper-class shoppers). In many ways, White womanhood has been historically and contemporarily shaped by the limited definitions of Black women’s agency and self-identity in the mainstream. There is no picture that instantly transports us all back in time, to a moment before the social construction of Black womanhood and girlhood as inherently less than White womanhood and girlhood existed. To suggest anything different is complicity in the racism and misogyny we continue to face.
Also, if you think the only form of oppression is denial of free speech, feel free to read a book.
The likelihood that a doctoral student at one of the best universities in the world who studies political science and race doesn’t know what oppression is is much higher than the likelihood that you are an incendiary, lazy troll who would rather spew non-facts than read books before engaging with said doctoral student.
For women of childbearing age, a gynecological visit should include a nutrition assessment. Recommendations should include information on weight gain, vitamin and mineral supplementation as needed, promotion of breastfeeding, and treatment of current problems associated with pregnancy, such as nausea, vomiting, heartburn, and constipation. What if being a “male” guaranteed that one would be deemed intellectually inferior? This means that the ways race and gender (and sexuality) intersect will have varying impacts on the ways raced, gendered, and sexed individuals are able to move throughout the world.
This isn’t simply a conversation about different color children leaning on one another in amicable ways.
Not only that, it minimizes the very real historical narratives which fuel much of our sociopolitical work today. She is a native of Oakland, CA, resided in sunny SoCal for a decade, and now lives in the Chicago suburbs.
Women found to be at nutritional risk (Table 1) should be referred to a registered dietitian for further assessment and treatment.Table 1.
These metaphors probably seem completely foreign given the very specific racial and gender histories of the United States. In essence, every human being brings into every situation with them their racial and ethnic histories, their gendered norms, their sexed performances, and whatever other socially inscribed ideals they have been bombarded with since their birth. Bringing the bourgie and good measure of the nerdy, she fearlessly writes about politics, pop culture, and whatever other topics in black America have firmly planted a bee in her bonnet.
If I had said Black instead of White and female instead of male, these scenarios would seem completely plausible. If we understand ourselves using this framework, we can then see why the new GapKids Ad is so problematic.
This is about confirmation of a concept that is deeply rooted in history and is already held in the minds of many. Just saying that the response was logical when couched in a larger framework of oppression in the US. Specific recommendations should be based on nutritional needs and individualized for each woman, taking into account cultural and ethnic background and views regarding diet and health.
Carbohydrates are important for energy production, and they spare protein from being used as energy.
So, how do we apply this conception of reality and social history to the new GapKids Ad that some are calling racist?
The cause of the low BMI should be evaluated; some common causes are disordered eating behaviors, drug use, excess exercise, or gastrointestinal disorders. Women with a history of a chronic illness requiring intervention with medical nutrition therapy should be evaluated to ensure good control of their diet and disease status.
The carbohydrate group provides much of the fiber necessary to help prevent constipation and hemorrhoids. Similar findings were seen in a study based on 70,000 men and women in the United States,26 and a study of 1200 men in South Wales.27 Birth weight has been inversely related to the development of adult disease such as hypertension, diabetes, and heart disease. Ketones are produced with low-carbohydrate diets, which may be contraindicated in pregnancy. Adolescents and women with multiple gestations have increased protein requirements.Fat Fat requirements are unchanged during pregnancy.


Eating behaviors are a personal issue, and how or why a person eats is determined by emotional, physical, and cultural beliefs. The four major components of a nutrition assessment are medical, nutrition, psychosocial, and obstetric histories. The medical history is used to determine preexisting conditions that required medical nutrition therapy like phenylketonuria or diabetes mellitus.
If a special diet was required before pregnancy, make an assessment to see if any changes are needed. Consequently, the LCPUFA status of the developing fetus depends on that of its mother, as confirmed by the positive relation between maternal PUFA consumption and neonatal PUFA status. A previous LBW infant or a large-for-gestational age (LGA) baby can indicate a nutrition problem requiring nutrition intervention.
This is particularly true for docosahexaenoic acid (DHA) because, on the basis of the current habitual diet, birth spacing appeared to be insufficient for the maternal DHA status to normalize completely.40 DHA accumulates in the fetal brain in the second half of pregnancy and is an important structural component of the retina lipids. A psychosocial assessment should include information on the patient's feelings about the pregnancy, her support system, emotional status, and body image.
The physiological importance of DHA is supported by its active and preferential maternal-fetal transfer, which is mediated by specific fatty acid transfer proteins and membranesbinding proteins that favor placental transport of DHA.41 Because of the decrease in PUFA status during pregnancy, the neonatal PUFA status may not be optimal. Whether the pregnancy was planned or unplanned may determine the motivation a woman has to improve her diet. Possible signs of an eating disorder include a fear of being weighed or refusing to be weighed, poor weight gain, multiple food aversions, ongoing nausea and vomiting, inappropriate body image, eroded tooth enamel, dehydration, enlarged salivary glands, and low prepregnancy weight. Five of the most commonly eaten fish that are low in mercury are shrimp, canned light tuna, salmon, pollock, and catfish. Information regarding vitamin, mineral, and herb use should be obtained, and food resources, such as cooking facilities and food availability, should be assessed.
The Women, Infants, and Children's Program (WIC) in th US, which provides milk, eggs, cheese, cereal, and juice throughout pregnancy and lactation, is available to low-income pregnant women based on medical need. When choosing your two meals of fish and shellfish, you may eat up to 6 ounces, one average meal, of albacore tuna per weekCheck to see if advisories exist concerning the safety of fish caught in local lakes, rivers, and coastal areas. Cultural and religious food practices and beliefs should be assessed because they may impact the nutritional intake of a pregnant woman. For example, fasting is required in some religions, and in pregnancy this would not be encouraged.
Dietary fish should be selected from a wide range of species without undue preference for large predatory fish, which are more likely to be contaminated with methylmercury.52, 53Vitamin A Vitamin A is required for its role in vision, cellular growth and differentiation, and immune function. Vitamin A deficiency in HIV-positive pregnant women has been shown to increase maternal-fetal transmission in parts of Africa. The diet history can be done by a 24-hour recall, where a person relates what they ate during the previous 24 hours. Further studies are underway to identify the role of vitamin A in this population.54 Vitamin A is readily available in the food supply of the United States. Other methods are a food frequency questionnaire, which lists foods and the frequency per day or per week, and a 2–3-day diet diary, which keeps track of actual intake for the specified time. The best food sources of vitamin A include leafy green and orange vegetables, such as spinach, dark green lettuce, carrots, sweet potato, acorn and butternut squash, cantaloupe, and apricots.
Vitamin A deficiency is rare in industrialized countries, but quite common in other parts of the world. A woman may say she drinks four glasses of milk a day, but further questioning may reveal that she buys only one gallon of milk a week.
In rat studies, vitamin A deficiency showed impaired lung development55 similar to that seen in premature babies with respiratory distress syndrome.
The vitamin A content of breast milk is associated with the vitamin A status of the mother during the third trimester of pregnancy.
Timing of meals and portions should be ascertained to properly assess the pregnant woman's intake.
Questioning a woman about her intended infant feeding practices can begin the process of encouraging breastfeeding.
Beef liver has more than three times the amount of preformed vitamin A than is currently recommended. Provitamin A beta-carotene sources includes dark green leafy and orange vegetables and fruits. When vitamin A supplements are prescribed, it is important to check the source of the vitamin A.
Some prenatal vitamins do not identify the source of vitamin A as either preformed vitamin A or beta-carotene. Due to its teratogenic effect women of childbearing age should use effective contraceptive methods, and different programs and precautions are instituted.
This is important, especially in pregnancy, in the synthesis of several amino acids involved in nucleic acid synthesis. A deficiency of folic acid in pregnancy may impair cell growth and replication and has been associated with poor pregnancy outcome.71 Three sources of folate are currently available. One report suggests the incidence of neural tube defects in the United States has decreased by 19% since the introduction of folate-fortified foods.74 The third source of folic acid is synthetic folate from vitamin supplements.
Dietary sources of folate include leafy green vegetables, orange juice, strawberries, dried peas, beans, and foods enriched with folate such as whole-grain breads, pasta, rice, and cereals. Women at risk for folic acid deficiency include those with low dietary intake, and those who use medications that are folate antagonists such as trimethoprim, triamterene, carbamazepine, phenytoin, phenobarbital, and primidone.Most pregnancies are unplanned, and even those that are planned often do not meet the recommendation for folate. At their gynecology visits, women of childbearing age should be advised to take a folic acid supplement and include good food sources of folic acid in their diets.Vitamin DVitamin D is essential for skeleton growth and bone health, and regulates calcium and phospate absorption and metabolism.
Nutrition that contains vitamin D is oily fish, egg, fortified margarines, and some breakfast cereals, but the main source is the synthesis following exposure of the skin to sunlight. Vitamin D deficiency can occur when the demand for it exceeds supply, as occurs in a period of rapid growth such as during pregnancy and lactation. Deficiency results in neonatal hypocalcemia, craniotabes, tetania, and severe deficiency of vitamin D results in rickets (in children) and osteomalacia (in children and adults). Two randomized trials with vitamin D supplementation versus placebo involving 232 women were included in a systematic review.77 In one trial the mothers had a higher mean daily weight gain and a lower number of LBW infants.
The rate of iron deficiency anemia is high among low-income pregnant women and in developing countries. Iron deficiency anemia, especially severe and chronic anemia, is associated with a higher incidence of LBW infants and a shorter length of gestation, a higher perinatal mortality and increased maternal mortality and morbidity. Trials have shown that when iron supplementation was provided, the incidence of LBW infants was decreased.79Iron absorption is increased during pregnancy and depends on maternal iron stores. Heme iron (iron from animal sources) is two to three times more absorbable than nonheme iron, plant-based foods, and iron-fortified foods. Compliance with iron supplementation is often poor because of associated gastrointestinal side effects. Calcium Calcium is important for bone and tooth formation and maintenance, and is required in nerve transmission and regulation of the heartbeat.
These changes are noticeable before fetal calcium demands are actually increased.89 Multiple studies have measured the changes in bone density in pregnant and lactating women.
Bone mineral losses are seen by 3 months of postpartum, and by 5 months after menses begin the bone mineral content returns to prepregnant status.90, 91 Lactating adolescents are the one group at risk for permanent bone loss. Bucher conducted a meta-analysis on 14 randomized controlled trials.94 In most of the studies, the usual calcium intakes were below the RDA for calcium. It was found that 375–2000 mg of supplemental calcium had a blood pressure-lowering effect. Almonds, broccoli, sardines and salmon with bones, soy milk, and calcium-fortified orange juice are also good sources of calcium, although portions vary.
Calcium citrate can be taken with or without meals.EATING RECOMMENDATIONSMeal frequency Women enter pregnancy with many different eating habits.
An investigation using the data from the Pregnancy, Infection, and Nutrition Study98 concluded that theistudy supports animal model work showing an association between decreased frequency of meals and preterm delivery.
If meals must be more than 5 hours apart, a snack including foods from the food guide pyramid is usually recommended. People who often skip meals or go a long time between meals choose more snacks with low nutrient density or overeat at the meals they do eat. A small bedtime snack (approximately 200 calories) is usually encouraged to avoid a long period overnight without eating and to avoid the possibility of ketosis.Translating nutrition requirements into diet recommendations After a nutrition assessment, a review of the food guide pyramid (Fig. Nutrition information provided to each woman should be based on her ethnic and cultural background. Serving sizes are defined as one-half cup rice, pasta, or cereals, or 1 oz or 1 slice of bread or bread product. Women of various ethnic groups may choose tortillas, naan, chapati, or pitta bread as other examples of grains. Many pregnant women increase their intake of fruit juices because they decrease diet soft drinks. Oranges, strawberries, melons, and other fruits can provide folic acid, vitamin C, and vitamin A in the form of beta-carotene. Vegetables are also recommended, three to five servings per day, from a variety of fresh or frozen vegetables. Vegetables are good sources of fiber, vitamins A and C, and folic acid, and some are high in nonheme iron. Two medium carrots can provide almost all the vitamin A needed for one day in the form of beta-carotene. Meat and meat substitutes are recommended, with two to three servings of 2–3 oz each per day. Incorporating beans, peas, nuts, and soy proteins can provide adequate protein intake for pregnant women who follow a vegetarian diet. Most pregnant women eat approximately 75–110 g of protein per day, exceeding their recommended protein requirement for pregnancy. Three or more servings each day are recommended from the milk group, which provides calcium, vitamin D, and protein. Chocolate milk, hot chocolate, using milk in soups, adding cheese to sandwiches, or eating yogurt as a snack are ways of increasing calcium intake. Women who follow the guidelines in the food guide pyramid should be able to meet the requirements for most nutrients.
Based on the evidence available today it is impossible to ascertain which component(s) of the prenatal multivitamin supplements are associated with these protective effects. Many herbs are contraindicated in pregnancy because of known adverse effects in pregnant women. John's wort, black cohosh, comfrey, and pennyroyal are some herbs that are not recommended in pregnancy because of their potential to either induce abortion or cause central nervous system disturbances or diarrhea.


Women often hesitate to tell their health care providers about use of herbs because they fear disapproval.
Currently, there is no regulation of herbs in the United States, and what the label says may not be what the bottle contains. Teas bought in health food stores or from herbalists should be avoided because they are not regulated as food or drug items. Mexican women often drink their coffee with at least 4–6 oz of milk, which adds more calcium to their diet. In a large prospective observational study, including 2635 women, the CARE group reported an association between caffeine consumption and the risk for fetal growth restriction. The association of caffeine with fetal growth restriction seemed to be stronger in women with faster caffeine clearance.111 The current body of evidence is limited concerning the maximum daily intake. Sensible advice would be to reduce caffeine intake during pregnancy, but not replace caffeine containing beverages with drinks containing alcohol or soft drinks loaded with sugar. Spontaneous abortions are twice as likely with moderate alcohol intake (more than 1 oz of alcohol twice a week) and four times more likely with heavy drinking (one to five drinks per day, four times a week).
Alcohol is associated with an increase in perinatal mortality, a decrease in birth weights, and an increase in LBW infants and congenital malformations. The fetal alcohol syndrome is characterized by LBW and length, low head circumference, congenital and intellectual anomalies, and certain facial features, and is associated with alcohol intake during pregnancy. The sensitivity of the pregnancy to the adverse effects of alcohol varies between women and between the different stages of gestation. The minimum or threshold level at which alcohol begins to pose a significant threat to pregnancy is not known. Studies have been performed showing that intake of aspartame levels at least three times the 99th centile pose no risk to the mother or the developing fetus.115, 116 Of the three components of aspartame, aspartate does not cross the placenta.
Women without PKU have phenylalanine hydroxylase activity to prevent any substantial or sustained rise in serum phenylalanine. Acesulfame K is safe for use in pregnancy.117 Sucralose is another nonnutritive sweetener approved for use in 1998. A related consideration to nutrition and exercise during pregnancy is adequate carbohydrate intake. Pregnant women use carbohydrates at a greater rate both at rest and during exercise than do nonpregnant women.121 Pregnant women who exercise should be sure to drink plenty of fluids before, during, and after exercise to prevent dehydration.
A small snack containing some carbohydrates should be eaten at least 1 hour before exercise to prevent hypoglycemia. A small snack may also be required after exercise based on the length of time and intensity of the workout.
For women with poor weight gain, exercise should be limited or more snacks before and after exercise should be encouraged to meet weight gain goals. WEIGHT GAIN RECOMMENDATIONSIn 1990, the Institute of Medicine of the National Academy of Sciences reviewed the literature and published their report confirming the association previously made regarding pregnancy weight gain and birth weights.
Table 4 shows the recommended weight gains based on the BMI and the rate of weight gain recommended by the IOM.8Table 4. Washington, DC, National Academy Press, 1990) Recently weight gain charts have been published including accurate estimated gestational age and differentiation between ethnic populations.123 The weight and BMI centile curves have the advantage in that they consider height during the whole course of pregnancy.
Regarding outcomes of weight gain within or outside 1990 IOM guidelines, moderate to strong evidence suggests an association between weight gain below IOM recommendations and preterm birth, LBW, SGA birth weights, and failure to initiate breastfeeding, and strong evidence for the association between weight gain above IOM recommendations and high birth weight, macrosomia, and LGA birth weights. Pregnant women and physicians have expressed concern associated with the increased weight gain ranges established by the IOM and postpartum weight retention. The National Maternal and Infant Health Survey examined the association between pregnancy weight gain and weight retention at 10–18 months of postpartum.
The women who gained above the IOM guidelines of 16 kg were more likely to have weight gain retention of more than 6 kg. The group of women in or below the normal range for weight gain had retained about the same amount of weight.
The National Maternal and Infant Health Survey showed that weight gain retention was less than 1 kg for white women and less than 3 kg for black women gaining weight within the IOM guidelines. Black women are at higher risk for weight gain retention of more than 6 kg at any weight gain. A Canadian study showed that women who gained more weight in the first 20 weeks of pregnancy were more likely to retain more weight postpartum.126Weight gain recommendations continue to be an important factor in pregnancy outcome. A woman with a BMI before pregnancy of less than 19.8 is considered in the underweight range based on the IOM weight gain guidelines. An assessment should include history of drug use, food availability, and a diet history to determine caloric intake, meal frequency, portions, and adequacy of nutritional intake. The goal of nutrition counseling for the overweight patient is to individualize her diet to meet her calorie and nutrient requirements and maintain weight gain according to the IOM guidelines. Weight gain should be monitored at each visit to ensure weight gain within the normal IOM weight gain range. Any excess weight gain or loss should be evaluated and a referral to a dietitian should be made.Excess weight gain Excess weight gain can be defined as a weight gain greater than the rate recommended by the IOM guidelines for each BMI group. The IOM recommends a further evaluation of weight gains of more than 6.5 lb per month for all pregnant women. If a woman is gaining too much weight, the possible cause should be assessed and recommendations made to improve the weight gain rates.
It may help to remind them that excess weight gain needs to be lost eventually, and to encourage regular exercise. In the first trimester, many women find they are more fatigued and exercise routines become less frequent.
Women also decrease their use of artificial sweeteners and increase caloric soft drinks and fruit juices, which can easily lead to excess weight gain. Nutritional assessments of many women have revealed that an increased intake of fruit juices is a main contributor to excess weight.
Once the possible causes of excess weight gain are assessed, suggestions for change should be discussed with the woman. A dietitian should be consulted to assess the possible causes and recommend the necessary changes to improve weight gain. After gaining too much weight one month, many women may restrict their intake too much in order to limit weight gain the next month. If a psychosocial issue has been identified, a referral to a social worker or other psychologist should be initiated.Table 5.
If her weight gain was poor on the previous visit, greater weight gain may be expected with improved intake3. Has she recently left her job, is she on bed rest, is she experiencing depression, stress, or boredom? Washington, DC, National Academy Press, 1992.)Once the causes for excess weight gain are identified, recommendations should be made and discussed with the patient.
A woman in the normal BMI range should have a weight gain of 10 lb by 20 weeks of gestation, and a woman in the overweight range should have a weight gain of 5–7 lb by 20 weeks. A woman with a BMI in the underweight range should have a weight gain of approximately 15 lb by 20 weeks.
In 11 of the 14 studies, they showed an association between a low rate of pregnancy weight gain and an increased risk of preterm deliveries. If weight gain was excessive on the previous visit and the woman made adjustments in her diet, her weight gain may be lower on the next visit. If this poor weight gain pattern persists, re-evaluate the diet history and increase the calories as needed2. Common causes are an increase in anxiety about the pregnancy, lack of support from significant other or family members, unwanted pregnancy, financial concerns, loss of job8.
Is the woman using street drugs such as cocaine or heroin, which can cause a loss of appetite?9. Washington, DC, National Academy Press, 1992) Common causes of poor weight gain are skipped meals, fear of gaining too much weight, an unwanted, unplanned pregnancy, and lack of support by the partner or family members.
Women with multiples present many nutrition-related problems, including increased needs for calories, protein, vitamins, and minerals. Many women are told to increase their fluid intake, which causes early satiety and decreased intake at meals. Data have shown that when twin birth weights are similar to that of a singleton birth weight, perinatal mortality declines.8 A study by Luke and colleagues concluded that maternal weight gain and pregravid BMI were predictors of fetal birth weight in twin gestations. They also found that women who were seen by a registered dietitian had the highest weight gains and the lowest incidence of babies weighing less than 1500 g.133Women pregnant with twins should be encouraged to eat small frequent meals accompanied by small amounts of fluids, and to spread between-meal fluid consumption throughout the day.
Calcium intake should be increased, though no exact recommendations have been made for multiples.
General nutrition guidelines include eating regular meals, using snacks to add foods missed at regular mealtimes, and adding fluids between meals.
Assessment of iron status is important for optimal perinatal care due to the high incidence of anemia in multiple pregnancies.
The need for calcium and vitamin D seems higher in multifetal than in singleton gestations.137 It is recommended that women with multiples take a calcium supplement and consume two to three servings of dairy food each day. Increased growth increases the demand for iron, zinc, folate, calcium, protein, and calories.138 However, the adolescents most likely to become pregnant are often those with inadequate nutritional status and unfavorable socioeconomic background. Research indicates that pregnant adolescents may be competing for nutrients with their fetus.139Due to peer pressure, teens often are more concerned about body image. They may skip meals and eat more foods with low nutrient density; however, intake of fast foods with high fat and saturated fat content often increases. Soft drinks replace milk products, so calcium intakes are below the RDA.Adolescents, especially those younger than 15 years of age, are at higher risk for medical complications of pregnancy than adult mothers. These problems include abnormal maternal weight gain, pregnancy-induced hypertension, anemia, lung disease, and renal disease.
Teens who gained less than 20 lb had babies weighing 400 g less than teens who gained more than 20 lb.
The incidence of LBW babies was 13% for the adolescents gaining less than 20 lb and 1% for those gaining more.141 Pregnant adolescents should be advised to choose foods from the food guide pyramid, and fruits and vegetables should be encouraged. For the adolescent, 1300 mg of calcium are recommended, which would include four servings of milk per day.



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