Pregnancy is an anabolic state as attested to by the expected growth of maternal tissues, to say nothing of the fetus and placenta.

• The net caloric cost of carrying a singleton pregnancy is 80,000 kcal.
• Amino acid, vitamin and mineral needs are also substantially increased.

What are the basic nutritional objectives?

• Meet the increased needs of maternal and fetal tissues, but at the same time prevent hyperglycemia and hypoglycemia and associated ketosis.
• Provide adequate amino acids and minerals.
  • Approximately 1 kg of protein will be made by the fetus and placenta.
  • Adequate iodine is critical for both maternal fetal thyroid function.
• Increase vitamin intake, especially folic acid.
  • Folic acid and iron deficiency occurs in 50-75% of pregnancies.
    • Folic acid deficiency and neural tube defects, click image.
  • Vitamin D deficiency is associated with low infant birth weight.
• Encourage proper rate of weight gain during pregnancy. For the average woman.
  • 1st trimester, 2-4 pounds
  • 2nd trimester, 10-11 pounds
  • 3rd trimester, 12-13 pounds
• Avoid alcohol and tobacco, moderate caffeine intake only.
• Be cautious of excess salt intake and maternal hypertension.

Mrs. Franklin's history of bulimia greatly complicates things.