Nutrition case study due in 16 hours

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Chapter 5
Nutrition during Pregnancy:
Conditions & Interventions

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Overview

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

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Health Conditions, Pregnancy, & Nutrition

  • Hypertensive disorders of pregnancy
  • Preexisting & gestational diabetes
  • Multifetal pregnancies
  • HIV/AIDS
  • Eating disorders
  • Obesity
  • Fetal alcohol spectrum
  • Adolescent pregnancy

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Hypertensive Disorders of Pregnancy

  • BP ≥140 mm Hg systolic or ≥90 mm Hg diastolic BP
  • Contributes to stillbirths, fetal & newborn deaths, & other complications

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Hypertensive Disorders of Pregnancy, Oxidative Stress, and Nutrition

  • R/T:
  • Inflammation
  • Oxidative stress
  • Damage to the

endothelium

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Hypertensive Disorders of Pregnancy, Oxidative Stress, and Nutrition

  • Consequences:
  • Impaired blood flow
  • Increased tendency to clot
  • Plaque

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Environmental Factors that Increase Oxidative Stress

  • Trans fat
  • Inadequate intake of antioxidants
  • High intake of simple sugars
  • Elevated BG
  • Excess body fat
  • Sedentary
  • Smoking

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Hypertensive Disorders of Pregnancy

  • Chronic Hypertension, Preexisting
  • Gestational HTN
  • Preeclampsia, Eclampsia
  • Preeclampsia Superimposed on Chronic HTN

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Chronic Hypertension

  • present before pregnancy or diagnosed <20W

  • Blood pressure ≥ 160/110 mm Hg increased risk of:
  • fetal death, preterm delivery, & fetal growth retardation

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Nutritional Interventions for Women with Chronic HTN in Pregnancy

adequate & balanced diet

If salt-sensitive, Na restriction req. for BP control

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Gestational Hypertension

HTN diagnosed for first time after 20W

If BP returns to normal by 12 weeks postpartum

  • transient HTN of pregnancy

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Preeclampsia-Eclampsia

>20 weeks gestation

**Proteinuria—urinary excretion of protein

  • Eclampsia—occurrence of seizures not attributed to other causes

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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

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Outcomes related to the existence of preeclampsia during pregnancy

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Risk Factors for
Preeclampsia

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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

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Diabetes in Pregnancy

  • Type 1 diabetes

  • Type 2 diabetes

  • Gestational

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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

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Risk Factors for Gestational Diabetes

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Adverse Outcomes Associated
with
Gestational Diabetes

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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

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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

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DIET for Gestational Diabetes

  • What would you recommend

?

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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

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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

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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!

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Background Information
About 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

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Risks Associated with Multifetal Pregnancy

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Complications Increase as Number of Fetuses Increases

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Median Birthweight for Gestational Age at Delivery of Twins

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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

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Nutrition & Outcome of Multifetal Pregnancy

  • Dietary intake
  • essential fatty

acids, Fe & Ca

  • V & M/ PNV

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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

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ED in Pregnancy

  • Rare
  • Most subfertile or infertile
  • Bulimics more likely

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Eating Disorders in Pregnancy

  • Higher risk for
  • Miscarriage
  • HTN
  • difficult deliveries
  • LBW

  • Refer to ED clinic or specialist
  • Counseling
  • Behavior modification

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Obesity & Excess Weight Gain

  • risk :
  • Cesarean delivery
  • Hypertensive disorders of pregnancy
  • Gestational DM
  • Macrosomic Babies

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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

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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

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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

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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

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Fetal Alcohol Syndrome

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

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Nutrition & Teen Pregnancy

  • Growth of Mom!
  • Infants average 155g less than those born to older adults

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Risks Associated with Adolescent Pregnancy

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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

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