Nutrition During Pregnancy PDF

I.1 Nutrition Before Pregnancy Becoming healthy before becoming pregnant Pre-conception nutrition is a vital part of preparing for pregnancy. Factors such as a woman's weight compared with her height and what she eats can play an important role in a mother's health during pregnancy and t...

I.1 Nutrition Before Pregnancy Becoming healthy before becoming pregnant Pre-conception nutrition is a vital part of preparing for pregnancy. Factors such as a woman's weight compared with her height and what she eats can play an important role in a mother's health during pregnancy and the health of her developing fetus. Implantation of zygote and development of the placenta depends on good nutritional status – prior to conception. Placenta is the connection between the baby’s and the mother’s blood, Provides nutrients, hormones & antibodies to the fetus, also removes waste products from the fetus I.1 Nutrition Before Pregnancy Pre-pregnancy nutrition Many women do not eat a well-balanced diet before pregnancy and may not have the proper nutritional status for the demands of pregnancy Mothers should establish good eating habits prior to becoming pregnant. Nutrient stores are especially important for early development – even before the mother learns she is pregnant. I.1 Nutrition Before Pregnancy important An undernourished mother is more likely to give birth to a low- birth weight baby. Low-birth weight: any baby born weighing less than 2500 g Increased risk of infections, learning disabilities, impaired physical development, and death in the first year Preterm babies are born before 38 weeks and may be low-birth weight babies. Small for gestational age are babies born at term but weigh less than would be expected for their gestational age. Nutrition plays a major role in these conditions. I.1 Nutrition Before Pregnancy very important Pre-pregnancy weight v imp Under weight An underweight women has a high risk of having a low birth weight infant especially if she is malnourished and / or unable to gain appropriate weight during pregnancy The rates of preterm infants and infant deaths are higher for underweight women Complications may also include: Low IQ, other brain impairments & learning difficulties Short stature Babies under 5 ½ lbs. are 40X more likely to die in the 1st year. An underweight woman may improve her chances of having a healthy infant by gaining some pounds prior to pregnancy, or during pregnancy. I.1 Nutrition Before Pregnancy very important Pre-pregnancy weight vv imp Overweight and obese women Overweight and obesity are associated with an increased risk of several complications, including Gestational diabetes, Pregnancy- induced hypertension, Pre-eclampsia and Congenital defects. Obesity is also linked to a greater risk of abnormal labour and an increased likelihood of needing an emergency caesarean operation. I.1 Nutrition Before Pregnancy Pre-pregnancy weight vv imp Overweight and obese women Infants born preterm to a mother who is obese, are also less likely to survive Heart defects Neural tube defects Moreover, the incidence of these complications appears to increase as the pre-pregnancy BMI increases, so women who are severely obese are at the greatest risk of experiencing such complications I.1 Nutrition Before Pregnancy A healthful diet before conception includes Avoiding teratogens: substances that cause birth defects Includes alcohol and illegal drugs Avoiding other possible hazards Smoking, caffeine, medications, some herbs and supplements BMI between 19.8 and 26.0 kg/m2 and appropriate level of physical activity  I.1 Nutrition Before Pregnancy Special Recommendations for Women Before Pregnancy Maintain a healthy weight. Vvv imp Engage in physical activity regularly. gain or lose weight, gradually (no more than 1–2 pounds/week). stop drinking If smoker, quit smoking To minimize the risk of having an infant with a neural tube defect, eat a highly fortified breakfast cereal that provides 100 percent of the Daily Value (DV) for folate , increase the dietary intake of dark green leafy vegetables or take a vitamin supplement that provides 400 μg/day of folic acid.  I.2 Nutrition during Pregnancy Events of Pregnancy A full term pregnancy lasts 38 to 42 weeks. First trimester: conception to week 13 Second trimester: week 14 to week 27 Third trimester: week 28 to week 40 Embryonic stage: approximately day 15 to week 8. After week 8, the developing baby is called a fetus. Critical periods Times during which tissues and organs differentiate and mature. If proper “building” blocks (proteins, carbohydrates, lipids) are not present the tissue/organ does not develop properly and cannot catch up. I.1 Nutrition Before Pregnancy Nutrition related components of preconception care Risk assessment: Age, Diet, Substance use, existing medical condition, Barriers to prenatal care and PHC. Health Promotion: Healthful diet and refraining from substance use. Compliance with prenatal care. Interventions: Referral to hospitals with highly equipped and trained staff. Nutrition counseling, supplementation or referral to improve diet as needed. I.2. a Maternal physiological changes in pregnancy The body must change its physiological and homeostatic mechanisms in pregnancy to ensure the fetus is provided with all the requirements of appropriate growth. Increases in blood sugar, breathing and cardiac output are all required. Levels of progesterone and estrogens rise continually throughout pregnancy, suppressing the hypothalamic axis and subsequently the menstrual cycle. The placenta also produce many hormones  I.2. a Maternal physiological changes in pregnancy The major maternal physiological adaptation to pregnancy 1-Systemic changes: -volume homeostasis. -blood -cardio vascular system. 2-respiratory changes. 3-urinary tract and renal function. 4-Alimentary tract. 5-Reproductive organs. 6-endocrinological changes.  I.2. a Maternal physiological changes in pregnancy 1- Systemic changes very important volume homeostasis:  fluid retention is the most fundamental systemic changes of normal pregnancy.  the total blood volume is increased during pregnancy 30%. The factors contributing include: very important Increase sodium retention. Decrease in plasma osmotic pressure. Decrease in thirst threshold. Resetting of osmostate. The marked increase in plasma volume associated with normal pregnancy causes dilution of many circulating factors.  I.2. a Maternal physiological changes in pregnancy vvv imp B-Hematological changes Decrease in: Increase in: Red cell count. Hemoglobin concentration. White cell count. Haematocrit. Fibrinogen Plasma folate concentration. concentration Concentrations of albumin, Plasma concentrations Most amino acids, of lipids, fat-soluble many minerals vitamins Water soluble vitamins. certain carrier proteins I.2. a Maternal physiological changes in pregnancy B-Hematological changes very important Increase in: White cell count. Fibrinogen concentration Plasma concentrations of lipids, fat-soluble vitamins certain carrier proteins  I.2. a Maternal physiological changes in pregnancy Cardio vascular changes: Earliest changes is peripheral vasodilatation Results in decreased systemic vascular resistance→ ↑co 6 l/ min. Max. (22-28)wks. heart rate increase (10-20%). cardiac output increase (30-50%). Mean arterial blood pressure decrease (10%).- Respiratory changes increase O2 demand by 20 %. Breathlessness due to hyperventilation and elevation of diaphragm. tissue and oxygen availability to placenta improves.  I.2. a Maternal physiological changes in pregnancy The urinary tract and renal function Blood flow increase (60-70%). Glomerular filtration increased (50%). Clearance of most substances is enhanced. Plasma creatinine ,urea,urate are reduced. Glycoseuria is normal.  I.2. a Maternal physiological changes in pregnancy Gastrointestinal system changes very important The gums becomes spongy. The lower oesophageal sphincter is relaxed (heart burn). Gastric secretion is reduced. Delayed gastric emptying Nausea and vomiting Increases in the appetite Changes in the taste Intestinal secretions are reduced Decreased intestinal motility Decrease emptying time of the gall bladder The intestinal musculature is relaxed (constipation).  I.2. a Maternal physiological changes in pregnancy Endocrinological changes very important Prolactine concentration increases markedly but act after delivery. Insulin resistance develop. Thyroid function changes little. Trans placental calcium transport is enhanced. Corticosteroid concentration increased. Aldesterone concentration increased. Angiotensin and renine increased  I.2. a Maternal physiological changes in pregnancy Metabolic changes and adaptive responses Changes in maternal hormone secretions lead to changes in the utilisation of carbohydrate, fat and protein during pregnancy. The fetus requires a continual supply of glucose and amino acids for growth, hormone produced by the placenta, human chorionic somatomammotropin, is thought to encourage maternal tissues to make greater use of lipids for energy production, increasing the availability of glucose and amino acids for the fetus. Changes in hormone levels also help to ensure that maternal lean tissues are conserved, and are not used to provide energy or amino acids for the fetus.  I.2. a Maternal physiological changes in pregnancy Metabolic changes and adaptive responses Adaptive responses help to meet the increased demands for nutrients, irrespective of the nutritional status of the mother. Such homeostatic responses include increased absorption of iron and calcium. Other minerals, such as copper and zinc, may also show improved absorption. There is reduced urinary excretion of some nutrients including riboflavin and the amino acid taurine Increased secretion of the hormone aldosterone, particularly towards the end of pregnancy, may lead to increased reabsorption of sodium from the renal tubules which may encourage fluid retention. Exercise during pregnancy A regular schedule of physical activity is not only healthy for mom and baby, it helps to prevent excessive weight gain and helps alleviate many of the discomforts of pregnancy such as constipation, water retention, and fatigue. A good goal for most pregnant women is to get 30 minutes of moderate intensity activity on most days of the week. Activities such as walking, swimming, low-impact aerobics, and stationary bicycling are considered safe and appropriate for the pregnant woman with an altered center of gravity. Contact sports and activities that result in sudden jerking or bouncing movements should be avoided. Weight gain during pregnancy: Appropriate weight gain in pregnancy is critical to maternal and infant outcomes of pregnancy. Optimal weight gains are different for women who begin pregnancy at different nutritional levels. Weight gain during pregnancy includes the weight of the fetus, placenta, amniotic fluid, uterus, breast and expanded blood volume. Any additional gestational weight gain is an energy reserve for the mother to nourish her child. Weight gain during pregnancy very imp Women of normal pre-pregnancy BMI (18.5-24.9) carrying a single fetus should aim for a weight gain range between 11.5 to 16 kg. A slightly higher target range of 12.5-18 kg is recommended for women with a low pre-pregnancy BMI ( 30) had to gain only from 5-9 kg. Weight gain during pregnancy Determinants of gestational weight gain: Determinants of gestational weight gain are mainly of maternal origin including: Sociodemographic (age, parity, ethnic background, & socioeconomic status), Nutritional (BMI, lean body mass & body fat), Genetic, health/illness (diabetes, hypertension, chronic disease, systemic or genital tract infection), Environmental (geography, climate), Behavioral (attitudes, stress, anxiety, cigarette smoking, alcohol and illicit drug use) in addition to received prenatal care. Weight gain during pregnancy Assessment of gestational weight gain: Clinical data relevant to gestational weight gain include weight, height and gestational age. Pre-pregnancy BMI and serial weight measurements are the anthropometric measurements with documented clinical value for assessment of gestational weight gain. Weight gain during pregnancy The complications of excessive weight gain during pregnancy include: vv imp Maternal complications that affect the course of pregnancy such as hypertension and diabetes complications related to the Delivery process complications such as cephalopelvic disproportion and increased risk for Cesarean section complications related to Infant health complications like macrosomia and increased rates of birth injuries. Lactational performance as it was reported that excessive weight gain is inversely related to breast feeding duration Post partum Excessive weight gainers during pregnancy are more prone to higher post partum weight retention after 1 year and later in life. Weight gain during pregnancy Consequences of low weight gain and maternal malnutrition during pregnancy: Low gestational weight gain is associated with an increased risk of having a low birth weight (LBW ) baby. Weight gain during pregnancy Rate of Weight Gain In the 1st trimester, weight gain is usually low, averaging a total of 3-4 lbs. In the 2nd and 3rd trimesters, when the majority of fetal growth occurs, the typical pattern of weight gain is one of smooth, steady increments. Personalized approach is best depending on patient’s height, pre-pregnancy weight, bone structure, activity level. Weight gain during pregnancy Distribution of weight gain in pregnancy Usual 25-35 pound weight gain Fetus 7.5-8.5 lbs Blood 4.0 lbs Placenta 1.5 lbs. Amniotic fluid 1.8 lbs. Uterus 2.0 lbs Breasts 1.0 lbs Maternal Stored Fat and proteins 7.5lbs Total weight gain 28-29 lbs Weight gain during pregnancy Monitoring Weight Gain Smooth, progressive weight gain generally represents a normal gain of lean and fat tissue. Deviations from the expected weight gain pattern result from changes in physical activity, food intake and/or excess water retention. Erratically high weight gain is likely to reflect excessive water retention – one of the symptoms of pre-eclampsia or pregnancy- induced hypertension. Weight gain grids are useful in tracking weight gain by week of gestation and allow individualized monitoring for women of varying pre-pregnancy BMIs. If women are gaining too little weight or gaining too slowly, they should be encouraged to eat 5 or 6 small meals throughout the day instead of 3 larger meals. Weight gain during pregnancy Weight gain during pregnancy I.2.d Dietary Assessment Dietary assessment early in pregnancy, using a food history or frequency questionnaire, is important. It is now recognised that pregnant women do not actually have to ‘eat for two’; however, a healthy and varied diet, which is rich in nutrients, is important for both the mother and the baby. The developing fetus obtains all of its nutrients through the placenta, so dietary intake has to meet the needs of the mother as well as the products of conception, and enable the mother to lay down stores of nutrients required for the development of the fetus and lactation after the birth.  Nutritional Requirements Of Pregnancy Energy v important The maternal diet during pregnancy must provide sufficient energy to ensure the delivery of a full-term, healthy infant of adequate size and appropriate body composition. The additional energy requirements of pregnancy which are 340 k cal/day during the second trimester and 450 kcal/ day during the third trimester The increase in energy requirements result from the following: Increased basal metabolic rate the need to deposit energy in the form of new tissue; this includes the fetus, placenta and amniotic fluid; the growth of existing maternal tissues, including breast and uterus; extra maternal fat deposition;  Nutritional Requirements Of Pregnancy Proteins The protein RDA for pregnancy is 71g/ day( an additional 25 g/day higher than non pregnant women). Pregnant women can easily meet their increased needs by selecting meats. milk products, and protein containing plant foods such as legumes, nuts, whole grains and seeds. The use of protein supplements during pregnancy should be discouraged as it may be harmful for the developing fetus.  Nutritional Requirements Of Pregnancy Essential fatty acids Essential long chain fatty acids are particularly important to the growth and development of the fetus. The brain is largely made of lipid material and it depend heavily on the long chain omega 3 and omega 6 fatty acids for its growth, functioning and structure. Carbohydrate EAR for starch, sugar and non-starch polysaccharides (dietary fibre) during pregnancy are 135g/day and the AI ARE 175g/d.  Nutritional Requirements Of Pregnancy Fiber Daily consumption of whole grain breads and cereals, leafy green and yellow vegetables and fresh and dried fruits should be encouraged to increase nutrients intake and avoid constipation, Women with low intakes of non-starch polysaccharides may increase intakes, during pregnancy to 28g per day, along with increased fluid intakes to encourage regular bowel movement.  Nutritional Requirements Of Pregnancy Nutrients for blood production and cell growth Folate: The requirement for folate increases to 600 mg/day. during pregnancy so much because of its role in DNA synthesis and new cell formation, increased erythropoiesis, fetal and placental growth and most important is for the prevention of neural tube defects. Vitamin B12 : RDA during pregnancy are 26µg/ day Vegans who exclude all foods of animal origin need daily supplements of VitaminB12 or Vitamin B12 fortified foods to avoid the neurological complications of a deficiency.  Nutritional Requirements Of Pregnancy Iron vv imp Iron requirements are increased during pregnancy to supply the growing fetus and placenta and for the production of increased numbers of maternal RBCs. The RDA for pregnant women is 27 mg/d which represent an increase of 12 mg/day over that of non- pregnant women. Zinc The RDA for pregnant women is 11-13 mg/day 3-5 g higher than that of non pregnant women. Zinc is needed for RNA and DNA synthesis and protein synthesis Maternal zinc status may be negatively affected by prenatal iron supplementation since excess iron ingestion inhibits zinc absorption  Nutritional Requirements Of Pregnancy Vitamin C An additional 10 mg per day of vitamin C intake is recommended (to a total of 50 mg per day) The rapidly growing fetus places a moderate extra drain as it is able to concentrate the vitamin at the expense of circulating vitamin levels. Vitamin C also has an important role in enhancing the absorption of non-haem sources of iron. Pregnant women are therefore encouraged to consume foods or drinks containing vitamin C, together with iron-rich meals, in order to help with iron absorption  Nutritional Requirements Of Pregnancy Nutrients for bone development Calcium Babies born at full term contain approximately 25 g of calcium, most f which is laid down during the last trimester and about 5 grams are laid in the maternal skeleton. Although calcium demands on the mother are high, particularly during the latter stages of pregnancy, physiological adaptations take place to enable more efficient uptake and utilisation of calcium These adaptations include: Enhanced calcium retention, due to an increase in reabsorption in the kidney tubules. Demineralisation of maternal bone may be detrimental in adolescence, when the skeleton is still increasing in density.  Nutritional Requirements Of Pregnancy Other groups that may have inadequate calcium intakes include: women who consume little or no milk or dairy products; vegan women The RDA for calcium during pregnancy is 1000 mg/ day for women 19 years and older, and 1300mg/ day for women less than 18 years Phosphorous: The RDA for phosphorous is the same for pregnant and non pregnant women: 700 mg/day for women more than 19 years, and 1250 mg/day for women younger than 19 years  Nutritional Requirements Of Pregnancy Vitamin D Vitamin D is important for the absorption and utilisation of calcium, needed for the calcification of the fetal skeleton, particularly during the later stages of pregnancy Also vitamin D is suggested to have additional role in enhancing the immune function and brain development. Low vitamin D status can be detrimental to both the mother and the fetus. poor maternal vitamin D status ( deficiency) is associated with vvvimp: Reduced bone mass in the developing fetus and may also increase the risk of osteoporosis in later life. Neonatal hypocalcemia Poor tooth enamel  Nutritional Requirements Of Pregnancy For the mother , maternal vitamin D deficiency is associated with increased predisposition of preeclampsia. Pregnant women therefore need a good supply of vitamin D of 5 micro gram ( 200 IU) / day which are currently recommended for all pregnant women Other nutrients Thiamin(B1) and riboflavin (B2), are needed for the release of energy in the body’s cells. Requirements for thiamin parallel the requirements for energy and are subsequently higher.  Nutritional Requirements Of Pregnancy Vitamin A Extra vitamin A is required during pregnancy for growth and maintenance of the fetus, for fetal stores of vitamin A and for maternal tissue growth. Requirements are highest during the third trimester, when fetal growth is most rapid. The RDA of vitamin A IS 770 mcg of retinol equivalents is most rapid. It is well known that excessive intakes of vitamin A in the form of retinol may be toxic to the developing fetus.  Nutritional Requirements Of Pregnancy Iodine It is important to ensure adequate iodine intake during pregnancy to ensure optimal development of the foetus. An additional 70 mcg of iodine has been added for PREGNANT females to make it 220 mcg/day. Sodium Moderation in the use of salt and other sodium-rich foods is appropriate for everyone. Aggressive restriction is usually unwarranted in pregnancy and consumption of sodium should remain above 2 to 3g/day (iodised salt is preferred) Food safety issues and practices during pregnancy Pregnant women are advised to pay particular attention to food hygiene during pregnancy and also to avoid certain foods, harmful substances include food pathogens (e.g. listeria and salmonella) and toxic food components [e.g. dioxins and polychlorinated biphenyls (PCBs)], alcohol and high doses of some dietary supplements. Food safety issues and practices during pregnancy Potentially harmful substances include food pathogens (e.g. listeria and salmonella) and toxic food components [e.g. dioxins and polychlorinated biphenyls (PCBs)], as well as alcohol and high doses of some dietary supplements. Food safety issues and practices during pregnancy Caffeine imp There is evidence of an association between caffeine intakes above 300 mg per day and LBW as well as spontaneous abortion. it is possible that other constituents in coffee, not necessarily caffeine per se, may pose a risk, The FSA currently advises that women who are pregnant, or intend to become pregnant, should limit their caffeine intake to 300 mg per day (around four cups of coffee). Caffeine is present in a variety of foods and beverages, including cocoa, colas, energy drinks and chocolate, as well as tea and coffee. Caffeine is also found in a number of prescription and over-the-counter medicines, e.g. headache pills, cold and flu remedies, diuretics and stimulants. Food safety issues and practices during pregnancy Food borne illness Pregnant women are advised to pay particular attention to food hygiene and to avoid certain foods during pregnancy in order to minimise the risk of food poisoning from potentially harmful pathogens, such as listeria, salmonella, campbylobacter,and toxoplasmosis. The following food pathogens can cause potential harm to the developing fetus Food safety issues and practices during pregnancy Fish Pregnant women, and those who may become pregnant, are also advised to avoid marlin, shark and swordfish due to the risk of exposure to methyl mercury, which at high levels can be harmful to the developing nervous system of the fetus. For the same reason, the FSA also advises pregnant women to limit their intake of tuna to no more than two portions of fresh tuna per week or four medium-sized tins of tuna / week. Food safety issues and practices during pregnancy Smoking cigarettes and chewing tobacco: Smoking restricts the blood supply to the growing fetus and thus limits oxygen and nutrient delivery and waste removal. A mother who smokes is more likely to have complications including: Fetal growth retardation Low birth weight Complications at birth (prolonged final stage of labor) Mislocation of the placenta Diet-related conditions during pregnancy Nausea and vomiting and changes in taste and appetite Symptoms of morning sickness, nausea and vomiting (particularly in the first trimester) are reported to occur in around half to three-quarters of pregnant women. Severe and continued vomiting may require hospitalization if it results in acidosis, dehydration, or excessive weight loss. The hormonal changes of early pregnancy seem to be responsible for a woman's sensitivities to the appearance, texture, or smell of foods. The causes of these symptoms are unknown, but a variety of triggers have been documented, including smells of foods, perfume and cigarette smoke. Diet-related conditions during pregnancy Recommendations to Alleviate the Nausea of Pregnancy imp On awaking, arise slowly. Eat dry toast or crackers. Chew gum or suck hard candies. Eat small, frequent meals. Avoid foods with offensive odors. When nauseated, drink carbonated beverages instead of citrus juice, water, milk, coffee, or tea Diet-related conditions during pregnancy Changes in taste and appetite are also common in pregnancy. Some women experience increases in appetite which may be caused by hormonal changes The development of cravings or aversions to foods is also often reported, with the most common cravings being for dairy products and sweet foods. Common aversions include tea and coffee, alcohol, fried foods and eggs and, in later pregnancy, sweet foods. Pica is a condition where non-food substances such as soap, coal and chalk are craved and consumed. The reasons for the development of this condition are unknown, but there is no clear evidence that it has any link with mineral deficiencies. Diet-related conditions during pregnancy Heartburn Heartburn is another common complaint during pregnancy. The hormones of pregnancy relax the digestive muscles, and the growing fetus puts increasing pressure on the mother's stomach.This combination allows stomach acid to back up into the lower esophagus, creating a burning sensation To Prevent or Relieve Heartburn very important Relax and eat slowly. Chew food thoroughly. Eat small, frequent meals. Drink liquids between meals. Avoid spicy or greasy foods. Sit up while eating; elevate the head while sleeping. Wait an hour after eating before lying down. Wait two hours after eating before exercising. Diet-related conditions during pregnancy ConstipationIt is common for women to suffer from constipation during pregnancy. The causes are probably due to physiological effects on gastrointestinal function caused by pregnancy, as well as a decline in activity and changes in the diet To Prevent or Alleviate Constipation very important Eat foods high in fiber (fruits, vegetables, and whole-grain cereals). Exercise regularly. Drink at least eight glasses of liquids a day. Respond promptly to the urge to defecate. Use laxatives only as prescribed by a physician;. Other considerations include changing the type of iron supplement used, as iron supplements may sometimes aggravate the symptoms of constipation.  Diet-related conditions during pregnancy Anaemia during pregnancy imp Most cases of anaemia are caused by iron deficiency; also associated with folate deficiency, blood loss and inherited conditions Complications In the mother, imp breathing difficulties, fainting, fatigue, tachycardia (excessive heartbeat rate) and palpitations. It may also lead to reduced resistance to infection and the risk of haemorrhage before or after the birth. Complications In the fetus, imp can cause growth retardation. is a risk factor for pre-term delivery and LBW. reduced fetal iron stores that may lead to IDA in infancy which could have adverse consequences on infant development. Diet-related conditions during pregnancy Anaemia IDA is usually treated with oral iron supplements, Iron supplements should be prescribed with caution, however, as they may cause side effects such as nausea and constipation and nutrient interactions (calcium, zinc, copper). Intake of iron rich foods with right dose of iron supplements can make best results Leg Cramps Magnesium supplementation may relieve leg cramps because pregnancy and lactation can lead to a secondary magnesium deficiency as evidenced by low serum magnesium levels. High risk pregnancies High-risk pregnancy: a pregnancy characterized by indicators that make it likely the birth will be surrounded by problems such as premature delivery, difficult birth, retarded growth, birth defects, and early infant death. Low-risk pregnancy: a pregnancy characterized by indicators that make a normal outcome likely. High risk pregnancies include Diabetes Hypertensive disorders. High risk pregnancies 1-Diabetes Pre-existing Diabetes Whether diabetes depends on how well it is controlled before and during pregnancy. Complications If not properly managed may result in imp severe hypoglycemia hyperglycemia, spontaneous abortions, COMPLICATIONS TO INFANTS MACROSOMIA large size baby Congenital defects Hypoglycemia and respiratory distress after delivery High risk pregnancies Risk factors for gestational diabetes: vv imp Age 25 or older BMI > 25 or excessive weight gain Complications in previous pregnancies, including gestational diabetes or high birth weight infant Pre-diabetes or symptoms of diabetes Family history of diabetes Complications complications during delivery high infant birth weight." Birth defects associated with gestational diabetes include heart damage, limb deformities, and neural tube defects High risk pregnancies Dietary interventions for gestational diabetes Dietary recommendations include consuming regular meals and snacks that contain higher levels of slowly digestible carbohydrate. As many women with GDM are overweight or obese, the diet must also avoid excessive weight gain, which can further compromise pregnancy outcomes Dietary recommendations should meet the needs of pregnancy and maternal blood glucose goals. To maintain normal blood glucose levels, carbohydrates should be restricted to 35 to 40 percent of energy intake. To limit excessive weight gain, obese women should limit energy intake to about 25 k calories per kilogram body weight. Diet and moderate exercise may control gestational diabetes, but if blood glucose fails to normalize, insulin or other drugs may be required. High risk pregnancies Pregnancy-induced hypertension (PIH) is a common condition specific to pregnancy that mainly occurs after the 28th week of gestation and disappears after delivery. PIH includes: Transient hypertension of pregnancy Pre-eclampsia condition characterized by hypertension, fluid retention, and protein in the urine; Pre-eclampsia usually occurs towards the end of pregnancy Eclampsia: a severe stage of preeclampsia characterized by convulsions. High risk pregnancies Dietary interventions exercise may protect against preeclampsia by stimulating placenta growth and vascularity and reducing oxidative stress supplementation with antioxidants (e.g. vitamins C and E) may reduce the risk of pre-eclampsia calcium supplementation Appropriate weight gain during pregnancy and limitation of excessive weight gain may reduce the risk of preeclampsia especially in overweight and obese women  High risk pregnancies Teenage pregnancy Risk Factors for Poor Pregnancy Outcome in Teenagers imp Maternal age, especially younger than age 16 Poor nutrition and low pre-pregnancy weight Poor weight gain Infection Preexisting anemia Poverty, Lack of social support, Lack of education Rapid repeated pregnancies Late entry into the health system  High risk pregnancies Common complications among adolescent mothers include Iron-deficiency anemia (which may reflect poor diet and inadequate prenatal care) Prolonged labor (which reflects the mother's physical immaturity). Pregnant teenagers have higher rates of stillbirths, preterm births, and low-birth weight infants Many of these infants suffer physical problems, require intensive care, and die within the first year. Dietary interventions For a teenage women who enters pregnancy at a healthy body weight, a weight gain of approximately 16 Kg is recommended; this lowers the risk of delivering a low-birth weight infant. Gaining less weight may limit fetal growth. High risk pregnancies Pregnancy in Older Women The complications associated with later pregnancy include Hypertension and diabetes,. Cesarean section, is twice as common in women over 35 as among younger women. Maternal death rates are higher in women over 35 than in younger women. The complications associated with later pregnancy include The babies of older mothers face problems of their own including higher rates of preterm births and low birth weight Their rates of birth defects and congenital abnormalities (Down syndrome) are also big High risk pregnancies Summary of Nutritional Care During Pregnanc vvimpy Energy intake to meet nutritional needs and allow for about a 0.4-kg (14-oz) weight gain per week during the last 30 weeks of pregnancy Protein intake to meet nutritional needs, about an additional 25 g/day additional 25 g/day/fetus if more than one fetus Sodium intake that is not excessive 2-3 g/day Mineral and vitamin intakes to meet the recommended daily allowances (folic acid and possibly iron supplementation is required) Caffeine in moderation: less than 200 mg/day equivalent of 2 cups of coffee