• Conduct detailed assessments as needed to develop strategies for adjusting nutrient or energy intake or for following up on undesirable changes in weight.

• Provide nutritional counseling for women with commonly occurring conditions such as lactose intolerance, gestational diabetes mellitus controlled by diet and exercise, iron-deficiency anemia, mild gastrointestinal disorders, obesity, low weight for height, and inadequate prenatal weight gain; or, if possible, refer the woman to a dietitian for this service.

• Recommend nutrient supplements if indicated by the assessment.

• Monitor the woman's progress, and revise the plan of care as indicated.

• Refer the woman, as necessary, to community resources (see Chart 3-2 for federal food and nutrition programs).

• Provide or refer the woman for special nutrition services if she has a health condition that requires complex nutritional care. Such conditions include insulin-requiring diabetes mellitus, certain gastrointestinal diseases, chronic renal failure, and phenylketonuria. For the treatment of eating disorders, the involvement of an experienced eating disorders team is advisable. Follow up on recommendations from nutrition specialists, and confer with them as needed.

• Assist the woman in quitting substance use, or refer her to a special treatment program and follow up as needed.

• Provide special assistance with breastfeeding if the woman wants to breastfeed and has twins, triplets, a premature infant, an infant with a congenital anomaly, or other circumstances that affect feeding or nutrient requirements; or help her obtain this assistance from a lactation specialist.

a This includes alerting women to advisories regarding environmental contaminants in the food supply.

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