Nutrition During Pregnancy: Conditions and Interventions PDF

Chapter 5 Nutrition During Pregnancy: Conditions and Interventions Copyright © 2017 Cengage Learning. All Rights Reserved. ...

Chapter 5 Nutrition During Pregnancy: Conditions and Interventions Copyright © 2017 Cengage Learning. All Rights Reserved.  Obesity and Pregnancy Obesity before and during pregnancy – Several unfavorable metabolic changes Increased blood glucose levels blood concentration of insulin insulin resistance blood pressure high C-reactive protein levels Low HDL-cholesterol Copyright © 2017 Cengage Learning. All Rights Reserved. MRI: Obese vs. normal Copyright © 2017 Cengage Learning. All Rights Reserved.  Recent Studies Have Focused On The Detrimental Effects Of Maternal Obesity Mother Baby 1. Hypertension 1. Malformation 2. Gestational Diabetes 2. Macrosomia 3. Thrombo-embolism 3. Birth Injury 4. Obstructive sleep 4. Perinatal death apnea. 5. Later diabetes 5. Hemorrhage &Obesity 6. Labor problems 7. Pregnancy loss. Obese babies are NINE TIMES more likely to grow into obese adults The Effects of Developmental Programming on Offspring Phenotype Resulting in Insulin Resistance and Obesity Maria et al.,  Obesity and Pregnancy (cont’d.) Nutritional recommendations and interventions for obesity in pregnancy – Meet nutrient needs – Consume a variety of basic foods – Participate in physical activity – Maintain appropriate rates of weight gain Weight loss is not recommended Copyright © 2017 Cengage Learning. All Rights Reserved.  Pregnancy Weight Gain (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Obesity and Pregnancy (cont’d.) Pregnancy after bariatric surgery – Use of bariatric surgery for weight loss has increased – Weight rapidly lost after the surgery due to limited food intake, fat malabsorption, decreased appetite, and dumping syndrome Copyright © 2017 Cengage Learning. All Rights Reserved.  Obesity and Pregnancy (cont’d.) Pregnancy after bariatric surgery – Deficiencies of many nutrient stores Thiamine, vitamins D, B12, folate, iron, and calcium Copyright © 2017 Cengage Learning. All Rights Reserved.  Obesity and Pregnancy (cont’d.) Nutrition care for pregnant women post-bariatric surgery includes: – Assessment of dietary intake – Supplement use – Nutrient biomarker status – Weight gain and physical activity – Gastrointestinal symptoms Nutrient deficiencies vary depending on type of bariatric surgery performed Copyright © 2017 Cengage Learning. All Rights Reserved. It is Possible to Reduce the Risk of Offspring Obesity by Weight Loss before Pregnancy. Inadequate weight gain during pregnancy Inadequate weight gain during pregnancy and entering pregnancy underweight – Underweight individuals should gain more weight during pregnancy – ~20% of women don’t gain enough weight Can impact mother’s and baby’s health – Goal: balanced diet of meals and snacks, listen to hunger and fullness cues, and engage in physical activity on a regular basis Inadequate weight gain during pregnancy  Diabetes in Pregnancy Diabetes is a leading complication in pregnancy and has three main forms – Type 1 – Type 2 – Gestational Copyright © 2017 Cengage Learning. All Rights Reserved.  Gestational Diabetes Women developing gestational diabetes appear to be predisposed to insulin resistance, and have impaired insulin production – Prevalence: two to twelve percent – Accounts for 88 percent of all cases of diabetes in pregnancy Copyright © 2017 Cengage Learning. All Rights Reserved.  Gestational Diabetes (cont’d.) Risks related to gestational diabetes – 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 Excess body fat Unhealthful diets Low physical activity levels Copyright © 2017 Cengage Learning. All Rights Reserved.  Gestational Diabetes (cont’d.) Diagnosis of gestational diabetes – 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 – 2-hr plasma glucose > 153 mg/dL Copyright © 2017 Cengage Learning. All Rights Reserved.  Gestational Diabetes (cont’d.) Diagnosis of gestational diabetes – All pregnant women should be screened at the first prenatal visit 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 – Random plasma glucose > 200 mg/dL Copyright © 2017 Cengage Learning. All Rights Reserved.  Impacts of GDM on mother and child a major cause of mother and fetal morbidity. an adverse pregnancy outcome: stillbirth, birth trauma, cesarean section, pre-eclampsia, respiratory distress, hypoglycemia, hyperbilirubinemia, etc. neonatal adiposity with its long-term sequelae including childhood obesity and diabetes Copyright © 2017 Cengage Learning. All Rights Reserved.  Gestational Diabetes (cont’d.) Management of gestational diabetes – Mainstay: medical nutrition therapy to normalize blood glucose levels with diet and exercise Blood glucose levels can be brought down with low calorie intake; avoid elevated ketones Oral medication metformin (glyburide) is used to decrease insulin resistance Copyright © 2017 Cengage Learning. All Rights Reserved.  Gestational Diabetes (cont’d.) Exercise benefits and recommendations – Regular aerobic exercise Nutritional management of 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 Copyright © 2017 Cengage Learning. All Rights Reserved.  Gestational Diabetes (cont’d.) The dietary pattern plan – Whole-grain breads and cereals, vegetables, fruits, and high-fiber foods – Minimally processed, nutrient-dense foods – Limited intake sugars – Low-glycemic index foods – Unsaturated fats – Three regular meals and snacks daily Copyright © 2017 Cengage Learning. All Rights Reserved.  Gestational Diabetes (cont’d.) Copyright © 2017 Cengage Learning. All Rights Reserved.  Gestational Diabetes (cont’d.) Prevention of gestational diabetes – Reduce excessive weight and obesity – Increase physical activity – Decrease insulin resistance prior to pregnancy Copyright © 2017 Cengage Learning. All Rights Reserved. Gestational Diabetes (cont’d.) Postpartum Management – 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. – a two-hour glucose tolerance test: Normal140 but 200 mg per dL. Type 2 Diabetes in Pregnancy Care should be individualized and follow protocol – Primary goal: maintain normal blood glucose Management of type 2 diabetes in pregnancy – Hyperglycemia and hypoglycemia pose threats  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 Copyright © 2017 Cengage Learning. All Rights Reserved.  Type 1 Diabetes During Pregnancy (cont’d.) Nutritional management of type 1 diabetes during pregnancy – 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 Copyright © 2017 Cengage Learning. All Rights Reserved.  Hypertensive Disorders of Pregnancy Affects five to ten percent of pregnancies – Contributes to stillbirths, fetal and newborn deaths, and other adverse conditions Causes of most cases remain unknown – Cures remain elusive Copyright © 2017 Cengage Learning. All Rights Reserved.  Hypertensive Disorders of Pregnancy (cont’d.) Hypertensive disorders of pregnancy, oxidative stress, and nutrition – Hypertension in pregnancy is related to: Chronic inflammation, oxidative stress, and damage to endothelium of blood vessels – Consequences of endothelial dysfunction: Impaired blood flow, increased tendency to clot, and plaque formation Copyright © 2017 Cengage Learning. All Rights Reserved.  Hypertensive Disorders of Pregnancy (cont’d.) 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 Nutritional interventions for women with chronic hypertension in pregnancy – Diets should be monitored Copyright © 2017 Cengage Learning. All Rights Reserved.  Hypertensive Disorders of Pregnancy (cont’d.) Gestational hypertension – Hypertension that first occurs during pregnancy – Increased 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 Copyright © 2017 Cengage Learning. All Rights Reserved. Preeclampsia and fetal development retardation Copyright © 2017 Cengage Learning. All Rights Reserved.  Hypertensive Disorders of Pregnancy (cont’d.) 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 Copyright © 2017 Cengage Learning. All Rights Reserved.  Hypertensive Disorders of Pregnancy (cont’d.) 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 Copyright © 2017 Cengage Learning. All Rights Reserved. Why calcium is associated with hypertension? In heart: how efficient the heart can pump the blood In kidney: regulate the blood pressure through renin-angiotension-aldosterone system In pituitary gland, regulate Antidiuretic Hormone (ADH) secretion for water secretion