breastfeeding. Liquid diets and weight loss medications are not recommended.

Conditions Warranting Special Nutrition Services

Most women have no need for special nutrition services immediately after delivery. Those who have delivered by cesarean section may require temporary diet modifications that consider the effects of the surgery and anesthesia on their gastrointestinal function. Women with chronic disorders that call for modified diets require postpartum modifications to adjust for their changing physiologic status and nutrient needs, especially if they are breastfeeding. For example, breastfeeding women who require insulin are at increased risk for hypoglycemia and thus need adequate monitoring and diet counseling. 115

Special Considerations at the Postpartum Visit

The postpartum visit (usually 4 to 6 weeks following delivery) offers an opportunity to address new or continuing nutritional problems or breastfeeding concerns (see Chapter 4 for information about breastfeeding support). Many women experience some emotional lability (especially symptoms of mild depression) during the postpartum period; some families find it difficult to adapt to the newborn; and families with twins or multiple offspring are confronted with special challenges. Consequently, it is advisable for the primary care provider to determine whether any such stresses are present and whether they are adversely affecting the mother's appetite, access to food, and sleeping or eating habits. In addition, it is recommended that care be taken to identify cases of substance abuse or addiction (including cigarette smoking, alcohol consumption, or illicit use of other mood-altering drugs).

The health status of women who experienced complications during pregnancy should be reassessed at the postpartum visit. For example, assessment of blood glucose status is appropriate for women who experienced gestational diabetes, assessment of blood pressure and of renal status may be indicated for women who experienced preeclampsia, and monitoring of iron status is desirable for women at increased risk of anemia because of hemorrhage associated with delivery. If any abnormal findings are observed, special nutrition services may be initiated.

The postpartum visit also offers an opportunity to promote healthful eating for the entire family and to verify that the infant is receiving well

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