Obesity and Pregnancy Quiz

Obesity and Pregnancy

• Obesity before and during pregnancy leads to unfavorable metabolic changes.
  • These changes include increased blood glucose levels, increased blood concentration of insulin, insulin resistance, increased blood pressure, high C-reactive protein levels, and low HDL-cholesterol.
• Maternal obesity can have detrimental effects on both the mother and the baby.
  • In mothers, it can lead to hypertension, gestational diabetes, thrombo-embolism, obstructive sleep apnea, hemorrhage, labor problems, and pregnancy loss.
  • In babies, it can lead to malformation, macrosomia, birth injury, perinatal death, and later diabetes & obesity..
• Obese babies are nine times more likely to grow into obese adults.
• Nutritional recommendations and interventions for obesity in pregnancy include:
  • Meeting nutrient needs.
  • Consuming a variety of basic foods.
  • Participating in physical activity.
  • Maintaining appropriate rates of weight gain, but weight loss is not recommended during pregnancy.
• Bariatric surgery weight loss has increased for weight loss.
  • Weight loss is rapid following surgery due to limited food intake, fat malabsorption, decreased appetite, and dumping syndrome.
• Pregnancy after bariatric surgery can lead to deficiencies in many nutrient stores such as thiamine, vitamins D, B12, folate, iron, and calcium.
• Nutrition care for pregnant women post-bariatric surgery includes:
  • Assessment of dietary intake.
  • Supplement use.
  • Nutrient biomarker status.
  • Weight gain and physical activity monitoring.
  • Monitoring for gastrointestinal symptoms.
• Nutrient deficiencies will vary depending on the bariatric surgery performed.
• It is possible to reduce the risk of offspring obesity by weight loss before pregnancy.

Pregnancy Weight Gain Recommendations

• Underweight (BMI < 18.5 kg/m²): Recommended weight gain is 28-40 lb (12.7-18.2 kg).
• Normal weight (BMI 18.5-24.9 kg/m²): Recommended weight gain is 25-35 lb (11.4-15.9 kg).
• Overweight (BMI 25-29.9 kg/m²): Recommended weight gain is 15-25 lb (6.8-11.4 kg).
• Obese (BMI 30 kg/m² or higher): Recommended weight gain is 11-20 lb (5.0-9.1 kg).
• Twin pregnancy: Recommended weight gain is 25-54 lb (11.4-24.5 kg).

Inadequate Weight Gain During Pregnancy

• Inadequate weight gain during pregnancy and entering pregnancy underweight may have impact to mother and baby's health.
• Underweight individuals should aim to gain more weight during pregnancy.
  • Approximately 20% of women do not gain enough weight during pregnancy.
• Goal: balanced diet of meals and snacks, listen to hunger and fullness cues, and engage in physical activity on a regular basis.
• Tips for Healthy Weight Gain During Pregnancy:
  • Do not skip meals and aim for five to six small meals each day.
  • Include snacks throughout the day, consuming something every 3-4 hours. Examples: nuts, cheese and crackers, peanut butter sandwich, yogurt, dried fruit and nuts.
  • Add healthy oils, butter, cream cheese, sour cream, cheese, or gravy to your meals.
  • Consume more healthy fats, including nuts, avocado, olive oil, and coldwater fish.

Diabetes in Pregnancy

• Diabetes is a leading complication in pregnancy and has three main forms: Type 1, Type 2, and Gestational.
• Women developing gestational diabetes are predisposed to insulin resistance and impaired insulin production.
  • Prevalence is between two to twelve percent.
  • Accounts for 88 percent of all cases of diabetes in pregnancy.
• Risks related to gestational diabetes include increased risk of spontaneous abortion, stillbirth, congenital anomalies, and neonatal death.
• Risk factors for gestational diabetes:
  • Linked to multiple genetic factors and their environmental triggers, such as excess body fat, unhealthful diets, and low physical activity levels.
• All pregnant women without diabetes should be tested by a 75-gm oral glucose tolerance test at 24-28 weeks.
  • Diagnosis cutpoints: Fasting plasma glucose ≥ 92 mg/dL, 1-hr plasma glucose > 180 mg/dL, and 2-hr plasma glucose ≥ 153 mg/dL.
• All pregnant women should be screened at the first prenatal visit
  • Those with preexisting diabetes: Hemoglobin A1c (A1c) ≥ 6.5%, Fasting plasma glucose > 126 mg/dL, Two-hour glucose > 200 mg/dL after 75-gram oral glucose load, Classic symptoms of hyperglycemia present, and/or Random plasma glucose > 200 mg/dL.
• Gestational Diabetes Mellitus (GDM) is a significant cause of mother and fetal morbidity and results in adverse pregnancy outcomes like stillbirth, birth trauma, cesarean section, pre-eclampsia, respiratory distress, hypoglycemia, and hyperbilirubinemia.
• GDM can lead to neonatal adiposity with long-term sequelae including childhood obesity and diabetes.
• Medical nutrition therapy to normalize blood glucose levels with diet and exercise is the primary strategy for managing gestational diabetes.
  • Blood glucose levels can be improved with a low calorie intake; avoid elevated ketones.
  • Oral medication metformin (glyburide) is used to decrease insulin resistance.
• Exercise Recommendations: Regular aerobic exercise.
• Nutritional management for women with gestational diabetes:
  • Assess dietary and exercise habits.
  • Develop a diet and exercise plan.
  • Monitor weight gain.
  • Interpret blood glucose and urinary ketone results.
  • Ensure follow-up during and after pregnancy.
• Dietary pattern plan involves:
  • Whole-grain breads and cereals, vegetables, fruits, and high-fiber foods.
  • Minimally processed, nutrient-dense foods.
  • Limited intake of sugars.
  • Low-glycemic index foods.
  • Unsaturated fats.
  • Three regular meals and snacks daily.
• Caloric needs for women with gestational diabetes, based on BMI:
  • Underweight (≤ 18.5 kg/m²): 35-40 kcal/kg of body weight.
  • Normal weight (18.5-24.9 kg/m²): 30-35 kcal/kg of body weight.
  • Overweight (25-29.9 kg/m²): 25-30 kcal/kg of body weight.
  • Obese (≥ 30 kg/m²): 23-25 kcal/kg of body weight.
• To prevent gestational diabetes:
  • Reduce excessive weight and obesity.
  • Increase physical activity.
  • Decrease insulin resistance prior to pregnancy.
• Postpartum management of gestational diabetes:
  • Be tested for diabetes six weeks after delivery via fasting blood glucose measurements on two occasions or a two-hour oral 75-g glucose tolerance test.
    • Normal: <140 mg per dL on a two-hour glucose tolerance test.
    • Impaired glucose tolerance: >140 but <200 mg per dL.
    • Diabetes: >200 mg per dL.
• Care for type 2 diabetes in pregnancy should be individualized and follow protocol
  • Primary goal: maintain normal blood glucose
• Management of type 2 diabetes in pregnancy involves addressing the threats caused by hyperglycemia and hypoglycemia.
• Type 1 diabetes during pregnancy:
  • Potentially, a more hazardous condition than gestational or type 2 diabetes
    • Mother is at risk for kidney disease, hypertension, and preclampsia, etc.
    • Newborn is at risk for mortality, being SGA or LGA, and hypoglycemia within 12 hours after birth
• Nutritional management of type 1 diabetes during pregnancy involves:
  • Control of blood glucose levels
  • Caloric and nutritional adequacy of diet
  • Achieve recommended weight gain
  • Careful home monitoring of glucose levels and dietary intake, exercise, and insulin dose

Hypertensive Disorders of Pregnancy

• Affects five to ten percent of pregnancies and contributes to stillbirths, fetal/newborn deaths, and other adverse conditions.
  • Causes of most cases remain unknown, and cures remain elusive
• Hypertension in pregnancy relates to chronic inflammation, oxidative stress, and damage to endothelium of blood vessels results in impaired blood flow, increased tendency to clot, and plaque formation
• Chronic hypertension:
  • Present prior to pregnancy or diagnosed before 20 weeks.
  • Estimated incidence is three percent.
  • More common in those who are non-Hispanic Black Americans, obese, over 35 years of age, or who have had prior pregnancy high blood pressure.
• For women with chronic hypertension in pregnancy, diets should be monitored nutritionally.
• Gestational hypertension: Hypertension that first occurs during pregnancy.
  • Increases the risk for developing preeclampsia later in pregnancy or during the first week postpartum, and chronic hypertension later in life.
• Preeclampsia-eclampsia: Pregnancy-specific syndrome
  • Signs and symptoms range from mild to severe, as do the health consequences.
  • Cause is unknown.
• Main characteristics of preeclampsia:
  • Oxidative stress, inflammation, and endothelial dysfunction
  • Platelet aggregation and blood coagulation
  • Blood vessel spasms and constriction
  • Increased blood pressure
  • Insulin resistance
  • Adverse maternal immune system responses to the placenta
  • Elevated blood levels of triglycerides, free fatty acids, and cholesterol
• Nutritional recommendations and interventions for preeclampsia:
  • Adequate calcium and vitamin D status
  • Use of multi-vitamin/minerals if needed
  • Five or more servings of colorful vegetables and fruits daily
  • Adequate fiber intake
  • Consumption of basic food recommendations
  • Moderate-intensity exercise
  • Recommended weight gain
• Calcium associates with hypertension because it is efficient with pumping blood.
  • In kidney: regulate the blood pressure through renin-angiotension-aldosterone system
  • In pituitary gland, regulate Antidiuretic Hormone (ADH) secretion for water secretion.