NU682 Unit 5 Weight Gain Counseling Plan Example

Fifty-Two Pounds Last Time: A Unit 5 Weight Gain Counseling Plan Built Around Night Shifts and a Mother Who Cooks

[Student Name]

Purdue University Global

NU682: Childbearing Family

Unit 5 Weight Gain Counseling Plan

[Instructor Name]

[Date]

The patient and family are composite and illustrative; the sources cited are real.

Her Starting Point

Ms. Delgado is 5 feet 4 inches tall and weighed 162 pounds at her first prenatal visit, which she confirms was her weight before this pregnancy. Her prepregnancy body mass index is 27.8, in the overweight category. In her first pregnancy, which began at 144 pounds, she gained 52 pounds. Her son was large for gestational age, and labor ended in a cesarean for arrest of descent. She works four ten-hour night shifts a week, sleeps in the late morning and eats her main meal at about 4 p.m., cooked by her mother, who lives with her, her husband and her son.

The Target

For a pregnancy that begins in the overweight range, the recommended total gain is 15 to 25 pounds, about 0.6 pounds a week after the first trimester (Institute of Medicine [IOM], 2009). That is the target the plan uses. She has gained 2 pounds so far, which is within the expected small first-trimester gain.

Why It Matters for Her

A large review of more than a million pregnancies found that nearly half gained above the recommended range, and that gaining above it was associated with higher odds of a large-for-gestational-age baby, a birth weight above about 8 pounds 13 ounces and cesarean delivery (Goldstein et al., 2017). Gaining too little carried its own risks, including a small baby and preterm birth. She has already experienced two of the outcomes linked to excess gain. The plan presents that as information, not blame: her first pregnancy is one reason to aim for the range this time, and gaining within it also lowers the weight she would carry into a third pregnancy if she has one.

The goal is not to diet in pregnancy; it is to gain about half of what she gained last time.

What the Counseling Includes

Pregnant people should be offered behavioral counseling aimed at healthy weight gain, because such programs modestly reduce both excess gain and gestational diabetes (US Preventive Services Task Force [USPSTF], 2021). The plan uses the elements those interventions share: a clear target, regular self-monitoring, specific changes to eating and activity, and follow-up at each visit.

Self-monitoring. She will weigh herself once a week, on her day off, on the same scale, and record it on a chart that shows her target range by week. The chart is reviewed at each prenatal visit.

Eating around night shifts. The plan does not ask her to cook separately. It asks for three changes. First, the 4 p.m. family meal stays, with a smaller second portion of rice or tortillas and a larger serving of the vegetables her mother already makes. Second, the vending machine snacks she buys at 2 a.m. are replaced by food she packs: fruit, yogurt, a peanut butter sandwich. Third, sweetened coffee drinks during her shift become unsweetened coffee or water. Her mother is invited to the next visit, at Ms. Delgado's suggestion, to hear the plan directly.

Activity. ACOG's target for an uncomplicated pregnancy is moderate activity adding up to at least 150 minutes across each week (American College of Obstetricians and Gynecologists [ACOG], 2020). Her job already involves several miles of walking a shift, which counts. On her days off, a 30-minute walk with her son in the stroller adds to it. She is told to stop and call if she has bleeding, fluid leakage, regular contractions, chest pain or dizziness.

Referral. A registered dietitian visit is offered and accepted; her insurance covers two visits.

Screening That Follows From Her History

Her body mass index above 25 and a previous baby weighing more than 9 pounds are risk factors for diabetes, so early glucose screening is ordered now rather than waiting until 24 to 28 weeks. If it is normal, standard screening is repeated at 24 to 28 weeks. Her previous cesarean also means a conversation about trial of labor after cesarean will begin in the second trimester.

Follow-Up Plan

At each visit her weight is plotted against the target. If she is above the weekly range for two consecutive visits, the plan is reviewed with her, not lectured: which of the three changes is hardest, and what would make it easier. If she gains less than the minimum, the plan checks whether night-shift fatigue or nausea is limiting her eating. At 28 weeks, total gain should be roughly 10 pounds.

Documentation

The chart records her prepregnancy weight and body mass index, the target range, the counseling provided, the changes she agreed to, the dietitian referral and the early glucose screen.

Conclusion

Ms. Delgado's target of 15 to 25 pounds comes from her prepregnancy weight, and her history gives her a personal reason to aim for it. The plan turns that target into three food changes that fit her night shifts and her mother's kitchen, walking she already does, a weekly weigh-in and support from a dietitian and her family.

References

American College of Obstetricians and Gynecologists. (2020). Physical activity and exercise during pregnancy and the postpartum period: ACOG committee opinion, number 804. Obstetrics & Gynecology, 135(4), e178-e188. https://doi.org/10.1097/AOG.0000000000003772

Goldstein, R. F., Abell, S. K., Ranasinha, S., Misso, M., Boyle, J. A., Black, M. H., Li, N., Hu, G., Corrado, F., Rode, L., Kim, Y. J., Haugen, M., Song, W. O., Kim, M. H., Bogaerts, A., Devlieger, R., Chung, J. H., & Teede, H. J. (2017). Association of gestational weight gain with maternal and infant outcomes: A systematic review and meta-analysis. JAMA, 317(21), 2207-2225. https://doi.org/10.1001/jama.2017.3635

Institute of Medicine. (2009). Weight gain during pregnancy: Reexamining the guidelines. The National Academies Press. https://doi.org/10.17226/12584

US Preventive Services Task Force. (2021). Behavioral counseling interventions for healthy weight and weight gain in pregnancy: US Preventive Services Task Force recommendation statement. JAMA, 325(20), 2087-2093. https://doi.org/10.1001/jama.2021.6949