Chapter 5 Nutrition during Pregnancy:Conditions & Interventions
Overview
• Nutritional interventions – improve outcomes– based on scientific evidence
• safety, effectiveness, and affordability
Health Conditions, Pregnancy, & Nutrition
– Hypertensive disorders of pregnancy– Preexisting & gestational diabetes– Multifetal pregnancies– HIV/AIDS– Eating disorders– Obesity– Fetal alcohol spectrum– Adolescent pregnancy
Hypertensive Disorders of Pregnancy
• BP ≥140 mm Hg systolic or ≥90 mm Hg diastolic BP– Contributes to stillbirths, fetal & newborn
deaths, & other complications
Hypertensive Disorders of Pregnancy, Oxidative Stress, and Nutrition
• R/T: – Inflammation– Oxidative stress – Damage to the endothelium
Hypertensive Disorders of Pregnancy, Oxidative Stress, and Nutrition
• Consequences:– Impaired blood flow– Increased tendency to clot– Plaque
Environmental Factors that Increase Oxidative Stress
• Trans fat
• Inadequate intake of antioxidants
• High intake of simple sugars
• Elevated BG
• Excess body fat
• Sedentary
• Smoking
Hypertensive Disorders of Pregnancy
• Chronic Hypertension, Preexisting
• Gestational HTN
• Preeclampsia, Eclampsia
• Preeclampsia Superimposed on Chronic HTN
Chronic Hypertension
• present before pregnancy or diagnosed <20W
• Blood pressure ≥ 160/110 mm Hg increased risk of:– fetal death, preterm delivery, & fetal growth
retardation
Nutritional Interventions for Women with Chronic HTN in Pregnancy
• adequate & balanced diet
• If salt-sensitive, Na restriction req. for BP control
Gestational Hypertension
• HTN diagnosed for first time after 20W
• If BP returns to normal by 12 weeks postpartum• transient HTN of pregnancy
Preeclampsia-Eclampsia• >20 weeks gestation
**Proteinuria—urinary excretion of protein
•Eclampsia—occurrence of seizures not attributed to other causes
S/S of Preeclampsia• HTN• urinary PRO • plasma volume expansion• Low urine output• H/A• Sensitivity to light• Blurred vision• Abd pain• Nausea• platelet aggregation, vasoconstriction
Outcomes related to the existence of preeclampsia
during pregnancy
Risk Factors for
Preeclampsia
Recommendations for Preeclampsia
• Antihypertensive meds
• Low dose aspirin
• Calcium, 1000-2000 mg
• Vitamins C, 200 mg & E, 400 IU
• 5-9 fruits & vegetables
• 3 Regular meals + snacks
• Appropriate weight gain, physical activity
Diabetes in Pregnancy
• Type 1 diabetes
• Type 2 diabetes
• Gestational
Potential Consequences of Gestational Diabetes-Fetus
• BG from mother reaches fetus– insulin glucose uptake & TG in fetus
• Fetal changes, risk later in life– Insulin resistance– Type 2 DM– HTN
Risk Factors for
Gestational Diabetes
Adverse Outcomes
Associated with
Gestational Diabetes
Glucose Screening
• First screen – oral glucose challenge test (GTT)
• If elevated– oral GTT is given
• ≥2 of the following levels are exceeded:– Overnight fast 95 mg/dL– 1-hour after glucose load 180 mg/dL– 2-hours after glucose load 155 mg/dL– 3-hours after glucose load 140 mg/dL
TX of Gestational Diabetes• First approach
– normalize BG with diet & exercise
• After 2 weeks, if BG high– Insulin
• MNT adverse perinatal outcomes• Appropriate weight gain• Postpartum F/U
DIET for Gestational Diabetes
• What would you recommend
?
Type 1 Diabetes during Pregnancy
• Mother @ risk of:– Kidney disease– HTN
• Newborn @ risk of:– Mortality– Being SGA or LGA– Hypoglycemia within 12 hours after birth
Nutritional Mgmt of Type 1 DM during Pregnancy
• Control of BG!
• Nutritional adequacy of diet
• Rec. weight gain
• Careful home monitoring:– BG– dietary intake– Exercise– Insulin– urinary ketone levels
Multifetal Pregnancies
• Twin births – in 1980 = 1 in 56– in 2005 = 1 in 32
• Triplet & higher order – in 1980 = 1 in 2941 – in 2005= 1 in 558 WOW!
Background InformationAbout Multifetal Pregnancies
• Dizygotic– 2 eggs fertilized– AKA Fraternal– ~70% of twins– Different genetic
“fingerprints”– Incidence increased
by perinatal nutrient supplements
• Monozygotic– 1 egg is fertilized – AKA Identical– Always same sex– ~30% of twins– Rates appear not to
be influenced by heredity
Risks Associated
with Multifetal Pregnancy
Complications Increase as Number of Fetuses Increases
Median Birthweight
for Gestational
Age at Delivery of
Twins
Nutrition & Outcome of Multifetal Pregnancy
• Weight gain c twin– 35-45 lbs– 0.5 lbs/W 1st trimester– 1.5 lbs/W 2-3 trimesters
• Weight gain c triplets– ~45-55 lbs or 1.5 lbs/W
Nutrition & Outcome of Multifetal Pregnancy
• Dietary intake– essential fatty acids, Fe & Ca
• V & M/ PNV
HIV/AIDS during Pregnancy• Primary Goal-prevent transmission to baby
– Meds, c-section
• TX• Consequences• Nutritional factors
– increase the most in advanced stages– no standards of care during pregnancy exist
ED in Pregnancy
• Rare– Most subfertile or infertile – Bulimics more likely
Eating Disorders in Pregnancy
• Higher risk for– Miscarriage– HTN– difficult deliveries– LBW
• Refer to ED clinic or specialist– Counseling
• Behavior modification
Obesity & Excess Weight Gain
• risk :– Cesarean delivery– Hypertensive disorders of pregnancy– Gestational DM– Macrosomic Babies
Fetal Alcohol Spectrum• range of effects
– fetal alcohol exposure– mental & physical
• Effects:– Behavioral problems– Mental retardation– Aggressiveness– Nervousness & short attention span– Stunting growth & birth defects
Fetal Alcohol Spectrum Stats
• One of the leading preventable cause of birth defects
~1 in 12 American pregnant women drink alcohol
1 in 30 consume ≥5 drinks on 1 occasion at least monthly
1 in 1000 newborns are affected by FAS
Effects of Alcohol on Pregnancy Outcome
• easily crosses placenta
• remains in fetal circulation – lacks enzymes to break down alcohol
• Exposure during critical periods of growth & development – permanently impair organ & tissue
Effects of Alcohol on Pregnancy Outcome
• Heavy drinking (4-5 drinks/D) – Miscarriage– Stillbirth– infant death– ~40% of fetuses will have FAS
• No “safe” dose so no alcohol at all
Fetal Alcohol Syndrome
• 1973• Characteristics:
– anomalies of eyes, nose, heart & CNS
– growth retardation– small head– mental retardation
Nutrition & Teen Pregnancy• Growth of Mom!• Infants average 155g less than those
born to older adults
Risks Associated with Adolescent Pregnancy
Dietary Recommendations for Pregnant Teens
• more kcals to support own growth + fetus• Caloric need from nutrient-dense diet• Calcium DRI pregnant teens is 1300 mg