Nutrition During Pregnancy: Conditions and Interventions PDF

Chapter 5 Nutrition during Pregnancy: Conditions and Interventions Sofyan Maghaydah  Definitions and Features of Hypertensive Disorders of Pregnancy Hypertensive Disorders of Pregnancy, Oxidative Stress, and Nutrition HTN in pregnancy is related to: – Inflammation – Oxidative st...

Chapter 5 Nutrition during Pregnancy: Conditions and Interventions Sofyan Maghaydah  Definitions and Features of Hypertensive Disorders of Pregnancy Hypertensive Disorders of Pregnancy, Oxidative Stress, and Nutrition HTN in pregnancy is related to: – Inflammation – Oxidative stress – Damage to the endothelium (cells lining the inside of blood vessels) Consequences of endothelial dysfunction: – Impaired blood flow – Increased tendency to clot – Plaque formation Environmental Factors that Increase Oxidative Stress Ways to Reduce Oxidative Stress Exclude trans fats from diet Adequate intake of vitamins C & E, the carotenoids, & antioxidants from plants Ample physical activity Weight loss if overweight (not recommended during pregnancy) Consume low-glycemic index foods  Chronic Hypertension HTN present before pregnancy or diagnosed 35 years of age, or history of HTN with previous pregnancy Blood pressure ≥ 160/110 mm Hg associated with increased risk of: – fetal death, preterm delivery, & fetal growth retardation Nutritional Interventions for Women with Chronic Hypertension in Pregnancy Intervention should aim to achieve adequate & balanced diets for pregnancy Weight gain is same as for other pregnant women If salt-sensitive, Na restriction required for blood pressure control without too little that could impair fetal growth  Gestational Hypertension Hypertension diagnosed for first time after 20 weeks of pregnancy If blood pressure returns to normal by 12 weeks postpartum, it’s called transient hypertention of pregnancy  Preeclampsia-Eclampsia A pregnancy-specific syndrome occurring >20 weeks gestation accompanied by proteinuria Proteinuria—urinary excretion of ≥0.3 gram protein in 24-hour urine sample (or >30 mg/dL protein or ≥2 on dipstick reading) Eclampsia—occurrence of seizures not attributed to other causes  Outcomes related to the existence of preeclampsia during pregnancy  Nutrient Intake and Preeclampsia  Diabetes in Pregnancy Diabetes: the 2nd leading complication in pregnancy Forms of diabetes include: – Type 1 diabetes—Results from destruction of insulin-producing cells of pancreas – Type 2 diabetes—Due to body’s inability to use insulin normally, or produce enough insulin – Gestational—CHO intolerance with 1st onset during pregnancy  Gestational Diabetes Seen in ~3-7% of pregnant women Women who develop gestational diabetes appear to be predisposed to insulin resistance & type 2 diabetes Associated with increased levels of blood glucose, tryglycerides, fatty acids & blood pressure  Potential Consequences of Gestational Diabetes Elevated glucose from mother reaches fetus resulting in increased insulin production – Increased insulin leads to increased glucose uptake & triglyceride formation in fetus Fetal changes may increase likelihood of complications later in life such as: – Insulin resistance – Type 2 diabetes – High blood pressure  Adverse Outcomes Associated with Gestational Diabetes Risk Factors for Gestational Diabetes  Glucose Screening First screen is a 50-g oral glucose challenge test If elevated, 3-hour, 100-g oral glucose tolerance test is given Gestational diabetes diagnosed if ≥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  Treatment of Gestational Diabetes First approach is to normalize blood glucose levels with diet & exercise If postprandial glucose remains high 2 weeks after adhering to diet & exercise, insulin injections are added Medical nutrition therapy decreases risk of adverse perinatal outcomes  Exercise Benefits & Recommendations Regular aerobic exercise decreases insulin resistance & blood glucose in gestational diabetes Exercise should approximate 50- 60% of VO2 max  Nutritional Management of Women with Gestational Diabetes 1. Assess dietary & exercise habits 2. Develop individualized diet & exercise plan 3. Monitor weight gain 4. Interpret blood glucose & urinary ketone results 5. Ensure follow-up during & after pregnancy  THE DIET PLAN 1. Whole-grain breads & cereals, vegetables, fruits, & high-fiber foods 2. Limited intake of simple sugars 3. Low-GI foods, or carbohydrate foods that do not greatly raise glucose levels 4. Monounsaturated fats 5. Three regular meals & snacks  Multifetal Pregnancies U.S. rates of multifetal pregnancies have increased – Linked to assisted reproductive technologies Only 1 in 5 triplets are spontaneously conceived Incidence highest in women 45 to 54 y/o (1 in 5 are multifetal) Multifetal Pregnancies Twin births – in 1980 = 1 in 56 – in 2001 = 1 in 31 Triplet & higher order – in 1980 = 1 in 2941 – in 2001 = 1 in 558  Background Information About Multifetal Pregnancies Dizygotic Monozygotic – 2 eggs are fertilized – 1 egg is fertilized – AKA Fraternal – AKA Identical – ~70% of twins (or almost identical) – Different genetic – Always same sex “fingerprints” – ~30% of twins – Incidence increased – Rates appear not to by perinatal be influenced by nutrient heredity supplements  Note the Differences in Placentas and Amniotic Sacs Twins with 2 amniotic Twins with 1 Twins with 2 sacs, 2 chorions, & 2 amniotic sac, 1 amniotic sacs, 1 placentas chorion, & 1 chorion, & fused placenta placentas Nutrition and the Outcome of Multifetal Pregnancy Weight gain in multifetal pregnancy – 35-45 pounds Rate of weight gain in twin pregnancy – 0.5 pounds per week in 1st trimester – 1.5 pounds per week in 2nd & 3rd trimesters Weight gain in triplet pregnancy – Gain of ~50 pounds or 1.5 pounds per week  Fetal Alcohol Spectrum “Fetal alcohol spectrum” describes range of effects that fetal alcohol exposure has on mental development & physical growth Effects include: – Behavioral problems – Mental retardation – Aggressiveness – Nervousness & short attention span – Stunting growth & birth defects  Fetal Alcohol Spectrum Fetal exposure to alcohol is a 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 fetal alcohol syndrome  Effects of Alcohol on Pregnancy Outcome Alcohol easily crosses placenta to fetus Alcohol remains in fetal circulation because fetus lacks enzymes to break down alcohol Alcohol exposure during critical periods of growth & development can permanently impair organ & tissue formation  Effects of Alcohol on  Pregnancy Outcome Heavy drinking (4-5 drinks/day) increases risk of miscarriage, stillbirth, & infant death ~40% of fetuses born to women who drink heavily will have fetal alcohol syndrome Because a “safe” dose of alcohol consumption during pregnancy has not been identified, it is recommended that women do not drink alcohol while pregnant  Fetal Alcohol Syndrome First identified in 1973 Characteristics include: – anomalies of eyes, nose, heart & CNS – growth retardation – small head – mental retardation Features of FAS in children  Nutrition and Adolescent Pregnancy Growth during adolescent pregnancy –Teen growth in height & weight at expense of fetus –Infants born to teens average 155g less than those born to older adults Risks Associated with Adolescent Pregnancy  Obesity, Excess Weight Gain and Adolescent Pregnancy Overweight & obese adolescents are at increased risk for: – Cesarean delivery – Hypertensive disorders of pregnancy – Gestational diabetes – Delivery of excessively large infants  Dietary Recommendations for Pregnant Adolescents Young adolescents may need more calories to support their own growth as well as that of fetus Caloric need should be from nutrient-dense diet Calcium DRI for pregnant teens is 1300 mg