A 24-year-old primigravida weighing 57 kg, hemoglobin 11 gm/dl, visits an antenatal clinic during the second trimester of pregnancy seeking advice on dietary intake. She should be advised to take?

1. A

   Additional intake of 300 kcal

2. B

   Additional intake of 500 kcal

3. C

   Additional intake of 650 kcal

4. D

   No extra kcal

Appeared in: DSSSB Public Health Nurse - 2015

Explanation

• During the second trimester, energy needs increase to support the rapid growth of the fetus and the development of the placenta and maternal tissues.
• The Indian Council of Medical Research (ICMR) and other health bodies recommend an additional intake of approximately 300-350 kcal per day during this period.
• This extra energy prevents the breakdown of the mother's own tissues for fuel and ensures the fetus receives adequate nutrients for healthy development.
• Among the given choices, 300 kcal is the standard and correct recommendation.

Why Other Options Were Wrong

• Option B: This amount is too high for the second trimester of pregnancy.
• Option C: This is an excessive amount of additional calories for any stage of pregnancy.
• Option D: This is insufficient for the second trimester, a period of accelerated fetal growth.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Nutritional requirements during pregnancy as background academic context rather than a clinical decision trigger.
• Nurses play a crucial role in antenatal counseling, educating pregnant women about appropriate nutrition to ensure positive maternal and fetal outcomes.
• Inadequate caloric intake can lead to low birth weight (LBW) and Intrauterine Growth Restriction (IUGR), while excessive intake can cause macrosomia and increase delivery complications.
• What if the woman was in her first trimester? The advice would change. No additional calories are typically needed, and the focus would be on nutrient-dense foods and folic acid supplementation to prevent neural tube defects.

How to Approach the Question

• First, identify the key information in the clinical scenario: the patient is in the second trimester of pregnancy.
• Next, understand the question: it asks for the correct dietary advice regarding additional calorie intake.
• Recall the standard nutritional guidelines for pregnancy. Remember that energy needs change with each trimester.
• Differentiate the caloric requirements for the first, second, and third trimesters, as well as for lactation.
• Evaluate the given options based on these guidelines. Eliminate the option for the first trimester ('No extra kcal') and the option for lactation ('500 kcal').
• Select the option that correctly matches the recommendation for the second trimester, which is approximately 300-350 kcal.

Concept Tested & Keywords

• Concept Tested: Nutritional requirements during pregnancy
• Stem keywords: primigravida, second trimester, dietary intake, kcal
• Lead-in keywords: advise to take
• Clinical cues: Patient is in the second trimester, a period of significant fetal growth and increased maternal metabolism.
• Negative lead-in flag: false

Question ID

Q3xPbd43O8UtC86n6bYa0B

Copy ID

Reference Book

E6 Nutrition Kumud Khanna 2e p. 88-90

E6 Textbook of Biochemistry for medical StudentsDM Vasudevan Part 2 — Subpart A (pp 1-239 of 478) p. 196-198