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NUTRITIONAL PROFILE:
Fill out the following form to gain a picture of your own eating habits; show it to your birth attendant for further nutritional counseling.
Nutritional Analysis Almost every day 3-4 times Once or twice a week Almost Never I usually eat: Breakfast
In a typical day, I eat:
Canned vegetables
Frozen vegetables
Fresh vegetablesLeafy green
Fresh fruit
Yellow or Orange
Cheese
Eggs
Red meat
Liver
Fish
Chicken
Cooked soybeans
Tofu
Nuts, peanut butter, tahini, etc.
Other sources of protein?
Whole grains, whole wheat noodles, corn tortillas
White rice, spaghetti, noodles
Items with refined sugar (candy, cake, cookies, etc.)
Carbonated beverages
Pieces of white bread
Pieces of whole wheat bread
Glasses of milk (include milk in cooking, on cereal, yogurt). At least one of the following (circle):
Orange, orange juice, cantaloupe, tomato, sprouts
Cups of (circle):
Coffee, black tea, herbal tea
Other
I am taking the following nutritional supplements:
Prenatal vitamins (do they include folic acid?)
Iron (type and dosage)
Calcium (amount)
Protein (amount & brand)
Nutritional Yeast (with vitamin B12 if complete vegetarian?)
Other foods that I usually like to eat during the week that are not already included are:
I smoke about ___________ cigarettes a day.
NUTRITIONAL PROFILE: PROTEIN
Write down everything that you have eaten for the last three meals, including snacks. When you are finished, do the same for yesterday. Tomorrow, again record everything.
MEAL TODAY YESTERDAY THIRD DAY Snack
Breakfast
Snack
Lunch
Snack
Dinner
Snack
Now look up the protein values of the foods in the tables which follow, and write them next to the item. What are your protein totals?
Day 1: grams
Day 2: grams
Day 3: grams
How can you improve the amount of protein you eat? Pregnant women need 75-100 grams of protein every day.
NUTRITIONAL HANDOUTS FOR CLIENTS
Food Groups
Vegetable and animal protein foods, serving sizes, and food groups used to assist pregnant clients and their midwives in planning a balanced daily dietary intake of sufficient protein to prevent potential complications of pregnancy.
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MoonDragon's Nutrition Index: Guidelines, Food Chart, Diets & Therapy
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