Chapter 5 Nutrition during Pregnancy: Conditions & Interventions

1. Chapter 5Nutrition during Pregnancy:Conditions & Interventions

2. Overview • Nutritional interventions • improve outcomes • based on scientific evidence • safety, effectiveness, and affordability

3. Health Conditions, Pregnancy, & Nutrition • Hypertensive disorders of pregnancy • Preexisting & gestational diabetes • Multifetal pregnancies • HIV/AIDS • Eating disorders • Obesity • Fetal alcohol spectrum • Adolescent pregnancy

4. Hypertensive Disorders of Pregnancy • BP ≥140 mm Hg systolic or ≥90 mm Hg diastolic BP • Contributes to stillbirths, fetal & newborn deaths, & other complications

5. Hypertensive Disorders of Pregnancy, Oxidative Stress, and Nutrition • R/T: • Inflammation • Oxidative stress • Damage to the endothelium

6. Hypertensive Disorders of Pregnancy, Oxidative Stress, and Nutrition • Consequences: • Impaired blood flow • Increased tendency to clot • Plaque

7. Environmental Factors that Increase Oxidative Stress • Trans fat • Inadequate intake of antioxidants • High intake of simple sugars • Elevated BG • Excess body fat • Sedentary • Smoking

8. Hypertensive Disorders of Pregnancy • Chronic Hypertension, Preexisting • Gestational HTN • Preeclampsia, Eclampsia • Preeclampsia Superimposed on Chronic HTN

9. Chronic Hypertension • present before pregnancy or diagnosed <20W • Blood pressure ≥ 160/110 mm Hg increased risk of: • fetal death, preterm delivery, & fetal growth retardation

10. Nutritional Interventions for Women with Chronic HTN in Pregnancy • adequate & balanced diet • If salt-sensitive, Na restriction req. for BP control

11. Gestational Hypertension • HTN diagnosed for first time after 20W • If BP returns to normal by 12 weeks postpartum • transient HTN of pregnancy

12. Preeclampsia-Eclampsia • >20 weeks gestation **Proteinuria—urinary excretion of protein • Eclampsia—occurrence of seizures not attributed to other causes

13. 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

14. Outcomes related to the existence of preeclampsia during pregnancy

15. Risk Factors for Preeclampsia

16. 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

17. Diabetes in Pregnancy • Type 1 diabetes • Type 2 diabetes • Gestational

18. 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

20. Risk Factors for Gestational Diabetes

21. Adverse Outcomes Associated with Gestational Diabetes

22. 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

23. 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

24. DIET for Gestational Diabetes • What would you recommend ?

25. 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

26. 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

27. 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!

29. 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 Background InformationAbout Multifetal Pregnancies

30. Risks Associated with Multifetal Pregnancy

31. Complications Increase as Number of Fetuses Increases

32. Median Birthweight for Gestational Age at Delivery of Twins

33. 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

34. Nutrition & Outcome of Multifetal Pregnancy • Dietary intake • essential fatty acids, Fe & Ca • V & M/ PNV

35. 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

36. ED in Pregnancy • Rare • Most subfertile or infertile • Bulimics more likely

37. Eating Disorders in Pregnancy • Higher risk for • Miscarriage • HTN • difficult deliveries • LBW • Refer to ED clinic or specialist • Counseling • Behavior modification

38. Obesity & Excess Weight Gain • risk : • Cesarean delivery • Hypertensive disorders of pregnancy • Gestational DM • Macrosomic Babies

39.  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

40.  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

41.  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

42.  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

43. 1973 Characteristics: anomalies of eyes, nose, heart & CNS growth retardation small head mental retardation Fetal Alcohol Syndrome

45. Nutrition & Teen Pregnancy • Growth of Mom! • Infants average 155g less than those born to older adults

46. Risks Associated with Adolescent Pregnancy

47. 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