A nurse is reinforcing teaching about nutritional needs with a client who is pregnant. Which of the following nutrients should the nurse instruct the client to increase during pregnancy?

Choice A rationale Iron (normal adult range: 60-170 µg/dL) is crucial during pregnancy to support the increased maternal blood volume and fetal red blood cell production. Iron deficiency anemia is common in pregnancy and can lead to fatigue, shortness of breath, and adverse pregnancy outcomes like preterm birth or low birth weight. Choice B rationale Calcium (normal range: 8.5-10.5 mg/dL) intake is vital for fetal skeletal development and maintaining maternal bone density. If maternal calcium intake is insufficient, the fetus will draw calcium from the mother's bones, potentially leading to maternal bone demineralization and increased risk of osteoporosis later in life. Choice C rationale Vitamin D (normal range: 30-100 ng/mL) is essential for calcium absorption and utilization, which is critical for fetal bone and tooth development. Adequate vitamin D levels also support maternal immune function and may play a role in preventing preeclampsia and gestational diabetes. Choice D rationale While Vitamin E (normal range: 5.5-17 µg/mL) is an important antioxidant, there is no strong evidence to recommend a significant increase in its intake during pregnancy. Excessive intake of some vitamins can be harmful; therefore, general nutritional guidelines emphasize a balanced diet to meet vitamin E needs.