Determine the hemoglobin or hematocrit value. If applicable, correct the cutoff value for smoking (Tab 1, page 16) or altitude (Tab 9, page 110) or both.
Perform additional tests if appropriate. According to the history, physical examination, and stage of gestation, it may be advisable to do a glucose screen or other indicated blood or urine analyses.
Nondietary factors may influence a woman's nutrient requirements, affect her ability to achieve adequate nutrition, signal previous problems with nutrition during pregnancy or lactation, or indicate the need for special approaches to care.
Excessive use of vitamin and mineral supplements is to be avoided. Vitamin A at high levels is a documented teratogen, and pregnant women should avoid unprescribed supplements that contain vitamin A, especially at dosages exceeding 800 RE (-4,000 IU). Very early in pregnancy, supplemental folate may help prevent neural tube defects among women who have had a pregnancy affected by such a defect. Preventing or resolving anemia is encouraged as part of general health promotion. A pregnant woman who is currently breastfeeding has increased nutritional requirements.