Certain medical conditions are managed to a large extent by diet modifications or other special forms of nutritional support, and frequent monitoring and revision of the care plan may be needed when the woman is pregnant or lactating. Such conditions usually require specialized nutritional care management by a registered dietitian with experience in pregnancy and lactation as well as in the health problem in question.

High-risk conditions that indicate the need for specific diet therapies include the following:

• hyperemesis gravidarum;

• preexisting diabetes mellitus and gestational diabetes (if insulin is required);

• serious liver or renal disease;

• acquired immune deficiency syndrome (AIDS) or other severe unresponding infection;

• serious gastrointestinal disorders (such as those caused by Crohn's disease or gastric bypass surgery) that lead to inadequate intake or malabsorption;

• genetic disorders that affect nutrition, such as cystic fibrosis and inborn errors of metabolism; and

• serious eating disorders.

Conditions that sometimes entail complicated management include gestational diabetes mellitus treated with diet and exercise, high risk of preterm birth, suspected fetal growth restriction, substance abuse, multifetal gestations, and hypertension. The assessment, planning, and counseling skills of the experienced dietitian may be quite helpful in the care of women with these conditions.

In addition to providing the basic services listed in Chart 3-1, facilities that serve women who have complex nutritional problems should provide the services listed in Chart 3-3.

Treatment of many of the disorders listed in the chart involves frequent calculation of the need for and intake of specific nutrients and development and implementation of an individualized nutritional care plan. The plan should be coordinated with the mother's total care and updated frequently.