It is important to understand how the woman currently eats to establish an appropriate diet plan. The nurse should take a diet history, asking about a typical breakfast, lunch, dinner, and snack. Once established, specific recommendations can be given. It is not useful to recommend overly restrictive diets that try to eliminate macronutrients. Patients who request guidance on specific diets should be referred to a registered dietician. Weight gain is not the first thing to bring up during this visit. Also, weight gain recommendations during pregnancy are tailored to the individual based on starting weight. For one fetus, the Institute of Medicine recommends the following: