Chapter 5 Nutrition during Pregnancy: Conditions

1
Chapter 5 Nutrition during PregnancyConditions
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 lt20W
• 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

• gt20 weeks gestation
• Proteinuriaurinary excretion of protein
• Eclampsiaoccurrence 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

19
(No Transcript)
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 _at_ risk of
• Kidney disease
• HTN
• Newborn _at_ 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!

28
(No Transcript)
29
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

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
Fetal Alcohol Syndrome

• 1973
• Characteristics
• anomalies of eyes, nose, heart CNS
• growth retardation
• small head
• mental retardation

44
(No Transcript)
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