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, 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 risk of: –Kidney disease –HTN 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 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

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 1 st trimester –1.5 lbs/W 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