monitoring, and patient education.50 So far, studies have not identified which elements of prenatal care are more powerful in preventing preterm birth.

As a part of comprehensive care, women found to be at high risk for preterm birth should be the beneficiaries of intensive evaluation, diet counseling, and, if necessary, food and vitamin-mineral supplementation. Because cigarette smoking, excessive alcohol intake, and illegal substance use all lead to an increased likelihood of preterm birth, the entire health care team needs to assist the woman who uses these substances to quit and to obtain outside help.

If preterm labor occurs and is treated with bedrest and tocolytic therapy, the woman may need extra nutritional care to deal with problems (e.g., decreased appetite, increasing constipation, glucose intolerance) associated with one or both of these treatments.

Multiple Pregnancy. The presence of more than one fetus in a gestation imparts added risk for preterm labor, preeclampsia, and diabetes mellitus. The mother will benefit from nutritional counseling to help her meet her increased nutritional demands comfortably and within any limits that may be imposed on her physical activity. Vitamin-mineral supplementation is advisable in combination with a well-balanced diet.10 One study52 indicates that nutritional intervention may reduce the occurrence of low birth weight and of very low birth weight among twins.

Fetal Growth Restriction. The term fetal growth restriction, formerly called intrauterine growth retardation, refers to infants born at an abnormally low weight for their gestational age. Among the nutrition-related factors associated with fetal growth restriction are the abuse of many kinds of substances,5357 low weight for height, low weight gain during the second and third trimesters,10 and serious maternal infectious diseases such as acquired immune deficiency syndrome (AIDS). Prenatal participation in WIC (which includes food supplementation and nutrition education) is associated with higher birth weight even among infants born before 37 weeks of gestation.58 Women who are suspected of having a growth-restricted fetus may need expert and intensive nutritional management.

Systemic Health Problems

Diabetes Mellitus. A primary aim of pregnancy management for the woman with diabetes mellitus is the maintenance of normal blood



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