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