Prenatal Nutrition Screening

I eat fewer than 2 meals a day.

3

I eat fewer than 4 servings of fruit and vegetables a day.

2

I have less than 2 cups of milk or yogurt a day.

2

I eat more than 2 or 3 servings of candy, chips, doughnuts, or other snack foods a day.

2

I drink more than 3 glasses of soft drinks or Kool-aid a day.

2

I drink beer, liquor, or wine.

2

I have gained more than 1 pound a week since I became pregnant.

2

I have been feeling sick since I found out I'm pregnant and have lost weight.

2

My last pregnancy was less than 2 years ago.

3

I have diabetes or had gestational diabetes during a past pregnancy.

3

I have or had in the past an eating disorder (anorexia or bulimia).

3

I don't always have enough money to buy the food I need.

3

Total

0 - 2 =

Healthy Eating

3 - 4 =

Consider contacting Glens Falls Hospital for an evaluation by a Registered Dietitian

6 or greater =

High risk. Please contact Glens Falls Hospital for an evaluation by a Registered Dietician.