The specific concern June may be facing is ensuring adequate intake of the essential nutrients her changing body and growing fetus require. An additional protein intake of twenty five grams per day is needed to support the formation and growth of new cells. A carbohydrate intake of at least one hundred and seventy five grams is necessary to provide glucose to fuel the fetal and maternal brains. June would not need to increase her intake of total fats, but it would be beneficial to ensure intake of omega 3 and 6 fatty acids. These fatty acids play a key role in the development of the mostly lipid fetal brain.
June should also be concerned about meeting the adequate intake of micronutrients as well as macronutrients. Vitamins such as B12, folate, iron, vitamin C, and zinc are especially important because of the role they play in the synthesis of DNA and new cell development as well as supporting increasing maternal blood volume, activation of the folate enzyme and formation of connective tissue. Vitamins such as calcium, vitamin D, phosphorus, magnesium and fluoride are also important for ensuring healthy bone growth for the fetus. To ensure she meets all the required macronutrients June should eat a well balanced diet of a variety of foods, focusing on nutrient dense choices. She should include foods from all groups such as protein, whole grain, fruit, dairy and vegetables. June should also consider taking a prenatal vitamin to ensure she receives the proper vitamin nutrition. A prenatal supplement containing iron will help June to meet her iron needs; this is often an issue for pregnant women even when a well planned diet is consumed. The supplement will also ensure adequate intake of folate, iron and calcium.
Additionally, June may have a concern about nutrition because of her vegetarianism. A well planned vegetarian diet containing a variety of legumes, fruits, nuts, vegetables and seeds may provide adequate nutrition. June will still have to ensure the supplement she chooses contains adequate calcium, vitamin D, B12 and folate. Because June does not like beans or tofu she must also ensure she finds an adequate source of protein and is consuming enough. Undoubtedly, June’s idea of adding fish back into her diet may be a solution to allowing her to include a good protein source into her diet as well ensuring intake of omega fatty acids. June should be mindful of the mercury content in her choices and avoid shark, swordfish, king mackerel, and tilefish. These fish contain high levels of mercury that can cause developmental delays. Refrigerated smoked seafood, raw or undercooked shellfish such as mussels and oysters should also be avoided; they may carry bacteria such as listeria or from algae in red tide. Safe bets for including fish in the diet would be flounder, salmon, catfish, sardines, tilapia and trout for low mercury choices. Another nutritional dilemma June may be facing is her caffeine intake; she should not consume more than 200mg of caffeine per day. This is the equivalent of one twelve ounce cup of coffee. June should try to replace her four cup per day intake to decaffeinated coffee or tea to avoid any risks that high caffeine intake may have on her pregnancy. Nutritional status is important during pregnancy, some advice June should consider for improving her nutritional status would be including two six ounce servings of fish per week of the lowest mercury content. She should also take a prenatal supplement and replace her coffee to decaffeinate. She should also be sure to have adequate fluid intake she should increase to three liters per day and eat a variety of foods including fruits, vegetables, dairy and grains. June should also discontinue her eating habits and be sure to have three nutritious meals per day. This will allow her to manage her weight better and stay healthier during her pregnancy. A complication of pregnancy some women may face is hyperemesis gravidum. This condition is characterized by severe nausea, vomiting, weight loss, electrolyte and acid base imbalance. Ways to treat this condition may vary, for severe cases IV rehydration and medication may be used to treat. Treatment of a mild case may include drinking carbonated beverages, sucking hard candy and eating small meals frequently. June should be aware of the risk factors for pregnant woman her age. These include gestational diabetes, pre eclampsia, Down's syndrome and cesarean section. June’s current weight is an issue, with a pre pregnancy BMI of thirty two; she should only gain eleven to twenty pounds total in the pregnancy. June's weight gain of five pounds in ten weeks is over the recommendation. Little gain is expected in the first trimester, two to four pounds should be adequate. Excessive weight gain can put June’s baby at risk for big a large for gestational age baby, having neural tube defects and fetal death, and for a complicated delivery resulting in cesarean section. June should try to engage in at least one hundred and fifty minutes of exercise per week. She should restart her walking as this is a safe and beneficial form of exercise during pregnancy. Exercise in water is recommended because the buoyancy compensates for changes in weight distribution. Activities that have initial risk of fall are the most adequate for pregnant women. After delivery, June should consider the benefits of breast feeding, not only does it provide the baby with important antibodies needed for fighting infection it also benefit her baby throughout its life span. Breastfeeding reduces the risk of allergy development, asthma, diabetes and obesity. Some benefits of breastfeeding to June is helping her lose pregnancy weight, reduced risk of breast cancer, more convenient, inexpensive and a way to promote bonding with baby.
References

America Pregnay Asociation. (2014). Mercury levels in fish. Retrieved from http://americanpregnancy.org/pregnancyhealth/fishmercury.htm Baby Center. (2014). Benefits of breastfeeding to you and your baby. Retrieved from http://www.babycenter.com/0_how-breastfeeding-benefits-you-and-your-baby Smolin, L. (2010). Nutrition science an applications. (2nd ed.). Hoboken, New Jersey: John Wiley and Sons. Whitney, E.Rolfes,S. (2011). Understandng nutrition. (12th ed.). Belmont,California: Nelson Education.