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High Risk Nutrition Care Plan Guidelines 4

Assessment, counseling, and referral guidelines: • Complete nutritional assessment according to WIC protocol. Especially note information that may be risk factors for GDM, such as marked obesity, history of GDM or delivery of a previous large for gestational age infant, glycosuria, polycystic ovary syndrome, or a strong family history of diabetes. • Assess diet and physical activity level, including medications prescribed by HCP. • Counsel on a consistent carbohydrate-controlled meal plan, consistent mealtimes, and increased physical activity. • Make referrals according to Section 3.5 of the WIC Procedure Manual.

Documentation: • Check “High Risk Education” on the Nutrition Education screen under Nutrition Education Topics and enter “Gestational Diabetes” under Topic Status. • Document the specific details regarding the nutritional assessment and nutrition care plan in the Nutrition Assessment field on the Care Plan Summary. This includes documentation of any prescribed medications and current medical care plan.

Recommendations for the WIC CPA: • Learn about and reinforce the health care team’s plan of care and encourage participant to keep all appointments and take prescribed medications or continue meal plans (diet therapy) as directed. • Breastfeeding should be strongly encouraged as it is associated with maternal weight loss and reduced insulin resistance for both mother and baby. • For the postpartum participant, encourage modest weight loss and increased physical activity which can delay or prevent type 2 diabetes. Encourage a goal to reach pre- pregnancy weight 6 to 12 months postpartum. • Infants and children of women with GDM can lower risk of diabetes by eating healthy foods, being active, and not becoming overweight.

Risk 341 Nutrient Deficiency or Disease

Any currently treated or untreated nutrient deficiency or disease. These include, but are not limited to, Protein Energy Malnutrition, Scurvy, Rickets, Beriberi, Hypocalcemia, Osteomalacia, Vitamin K Deficiency, Pellagra, Xerophthalmia, and Iron Deficiency.

Nutrient deficiencies or diseases can be the result of poor nutritional intake, chronic health conditions, acute health conditions, medications, altered nutrient metabolism, or a combination of these factors, and can impact the levels of both macronutrients and micronutrients in the body. They can lead to alterations in energy metabolism, immune function, cognitive function, bone formation, and/or muscle function, as well as growth and development if the deficiency is present during fetal development and early childhood.