At 37 years of age, Señora Mendez was in her 23rd week of pregnancy and expecting her second child. Or so she thought, until an ultrasound scan detected twins. Her prepregnancy weight was 142 pounds (64.5 kg) and her BMI. Señora Mendez’s weight-gain progress has been poor due to nausea and vomiting experienced in the first half of pregnancy. Otherwise, Sra. Mendez was experiencing a normal pregnancy for women expecting twins. Concerns about her weight-gain progress and the nutritional needs of women with twin gestation prompted her certified–nurse midwife to prescribe a prenatal vitamin and mineral supplement and to refer her to a registered dietitian/certified diabetes educator.   A nutritional assessment completed during week 25 of pregnancy identified that Sra. Mendez had gained 14 pounds since conception, and that her typical dietary intake excluded food sources of EPA and DHA. Her plasma 25-hydroxyvitamin D level was below 24 nmol/L, indicating low vitamin D status. No other nutrition-related problems were identified. Assume Sra. Mendez will deliver toward the end of week 37 and is now in the beginning of week 25. How many pounds (or kilograms) should be set as a goal for weekly weight gain if a total pregnancy gain at the midpoint of the provisionally recommended range for weight gain in twin pregnancy is to be achieved? State three appropriate nutrition diagnoses for this case. Name one potential nutrition intervention (one each for the three nutrition diagnosis you answer in #2) that would address each of the nutrition diagnoses stated.

At 37 years of age, Señora Mendez was in her 23rd week of pregnancy and expecting her second child. Or so she thought, until an ultrasound scan detected twins. Her prepregnancy weight was 142 pounds (64.5 kg) and her BMI. Señora Mendez’s weight-gain progress has been poor due to nausea and vomiting experienced in the first half of pregnancy. Otherwise, Sra. Mendez was experiencing a normal pregnancy for women expecting twins. Concerns about her weight-gain progress and the nutritional needs of women with twin gestation prompted her certified–nurse midwife to prescribe a prenatal vitamin and mineral supplement and to refer her to a registered dietitian/certified diabetes educator.

A nutritional assessment completed during week 25 of pregnancy identified that Sra. Mendez had gained 14 pounds since conception, and that her typical dietary intake excluded food sources of EPA and DHA. Her plasma 25-hydroxyvitamin D level was below 24 nmol/L, indicating low vitamin D status. No other nutrition-related problems were identified.

1. Assume Sra. Mendez will deliver toward the end of week 37 and is now in the beginning of week 25. How many pounds (or kilograms) should be set as a goal for weekly weight gain if a total pregnancy gain at the midpoint of the provisionally recommended range for weight gain in twin pregnancy is to be achieved?
2. State three appropriate nutrition diagnoses for this case.
3. Name one potential nutrition intervention (one each for the three nutrition diagnosis you answer in #2) that would address each of the nutrition diagnoses stated.
4. Cite a nutrition-related indicator of success (one each for the three interventions you answer in #3) that could be used to monitor and evaluate each of the nutrition interventions stated.
5. What type of multiple fetus pregnancy is Sra. Mendez most likely to have? What is the chance that the twins will be of the same sex/gender?