Linda is an African-American woman who has been taking hormonal contraceptive pi

Question

Linda is an African-American woman who has been taking hormonal contraceptive pills for 10 years. At the age of 35 years, she thinks she is ready to have children and fortunately has had no problems conceiving. However, she has had 4 miscarriages between the ages of 35-38 years. Her blood work during these 3 years showed triglycerides at 172 mg/dL, blood pressure at 135/100 mm Hg, LDL at 175 mg/dL and total cholesterol at 242 mg/dL. At 38 years of age, she is 5 feet 5 inches and weighs 180 lbs (pre-pregnancy). She is pregnant for the 5th time and is elated that she has crossed the 20 weeks mark (the cut off period for a miscarriage). She is currently 27 weeks pregnant, weighs 185 lbs. She lives in a one-room studio, with very little physical activity and seldom ventures outdoors. Based on a recent magazine article that advocated a strict vegan diet for optimal growth and development of the fetus, Linda becomes a vegan. However, she occasionally indulges in her love for yogurt. She decides not to take any vitamin supplements as she believes that her own over-weight body has enough nutrient stores for the baby. She has read of the potential complications that can arise from being overweight and she decides to “eat healthy”. Her goal is to deliver a full term baby as well as use the pregnancy period to lose her excess body weight. Her rationale is that if she eats healthy and does not gain any weight, she will be successful in transferring her “extra weight” to the baby. Other than a family history of hypertension, she thinks that she and her baby are on their way to good health.

1. What may have been the reasons for Linda’s recurrent miscarriages?

2. Comment on her blood work during the period of miscarriages? From the case study, what could be the most likely reason for these values?

3. Irrespective of her pregnancy status, does Anna have any increased risk for chronic disease? Why?

4. Based on Linda’s pre-pregnancy weight, determine her IBW, BMI and EER. Would you classify her as underweight, normal weight, overweight, obese?

5. Comment on Linda’s weight gain during the

second trimester of her pregnancy. What may be the implications for these trends on the pregnancy outcomes?

Explanation / Answer

Based on Chegg's policy a maximim of 4 answers can be done at a stretch and hence provided for first 4 questions only.

What may have been the reasons for Linda’s recurrent miscarriages?

The reasons for Linda’s recurrent miscarriages are:

Major risk factor: Use of hormonal contraceptive methods

Predisposing factors:

Comment on her blood work during the period of miscarriages? From the case study, what could be the most likely reason for these values?

Report

Linda’s value

Normal value

Comments

Triglyceride

172 mg/dL

< 100 mg/dL

Borderline High

LDL

175 mg/dL

65-70 mg/dL

High

Total cholesterol

242 mg/dL

< 200 mg/dL

High

Reason for elevated lipid profile report is due to

Irrespective of her pregnancy status, does Anna have any increased risk for chronic disease? Why?

If Linda’s problems are not addressed then, she develops long-term consequences of many diseases related to elevated lipid profile like cardiovascular disease, atherosclerosis, stroke, etc.

Additionally, as she has been in hormonal contraceptive methods for last years, she is at risk for developing liver-related diseases since the pills are metabolized in the liver.

4. Based on Linda’s pre-pregnancy weight, determine her IBW, BMI, and EER. Would you classify her as underweight, normal weight, overweight, obese?

Based on her profile height 5”5’ and weight 185 lbs her BMI is 30.8 kg/m2 which puts her in the category of obesity.

Ideal Body Weight (IBW): 125.4 lb. Formula: For females: IBW = 45.5 kg for 5 feet + 2.3 kg for each inch over 5 feet.

Estimated Energy Requirement [EER]: 2077 calories/day.

Report

Linda’s value

Normal value

Comments

Triglyceride

172 mg/dL

< 100 mg/dL

Borderline High

LDL

175 mg/dL

65-70 mg/dL

High

Total cholesterol

242 mg/dL

< 200 mg/dL

High

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