Nutrition and supplementation in the woman of reproductive age can have profound and lasting effects on her child’s health. Preconceptional planning for all women should include advice to begin folic acid supplementation at 400 μg/d as a means to prevent neural tube defects. Under some circumstances, it is recommended that a woman take a higher dose. Lifestyle interventions include reaching a healthy body weight before conception. The focus of preconceptional weight loss should be on cutting empty-calorie foods and increasing nutrient-dense foods such as fruits and vegetables, whole grains, dairy and lean meats, poultry, and fish. Increasing physical activity before becoming pregnant will have benefits in helping cope with some of the unpleasant side effects associated with pregnancy. Some women require physician assessment to determine the appropriate program. One of the most common side effects of pregnancy is “morning sickness,” with up to 80% of women experiencing nausea and vomiting at some point, usually beginning between the 4th and 7th weeks after their last menses and ending for most by the 20th week. For 10% of those women, it remains an ongoing battle throughout the pregnancy. Some women self-treat with herbs. Healthcare professionals should become skilled in patient activation and culturally appropriate counseling skills. We present a case from our Family Medicine practice to demonstrate an approach to the issues of prevention of neural tube defects and treatment of morning sickness in an overweight Hispanic woman living in a rural area of the United States.
David Glenn Weismiller, MD, ScM, FAAFP, is an attending physician with the Rural Health Group, Inc, of North Carolina. An active practicing clinician and educator, Dr Weismiller has been providing maternity care for more than 25 years.
Kathryn M. Kolasa, PhD, RDN, LDN, is professor emeritus at the Departments of Family Medicine and Pediatrics, Brody School of Medicine, East Carolina University, Greenville, North Carolina, and a contributing author to Nutrition Today.
The authors have no conflicts of interest to disclose.
Correspondence: Kathryn M. Kolasa, PhD, RDN, LDN, 3080 Dartmouth Dr, Greenville NC 27858 (firstname.lastname@example.org).