Food & Nutrition

1. COMPLICATI
ONS DURING
PREGNANCY
K R I T I K A G U P TA L O V E N E E T K A U R
K A M A L D E E P K A U R K A R A M J E E T K A U R

2. SYMPTOMS WHICH NEED
IMMEDIATE MEDICAL
ATTENTION1. Bleeding
2. Severe nausea and vomiting
3. Baby’s activity level severely declines

3. 1. Bleeding
Bleeding means different things throughout your pregnancy. Bleeding
heavily and severe abdominal pain and menstrual-like
cramps during first trimester, could be a sign of an ectopic pregnancy.
Heavy bleeding with cramping could also be a sign of miscarriage in
first or early second trimester.
By contrast, bleeding with abdominal pain in the third trimester may
indicate placental abruption, which occurs when the placenta
from the uterine lining.

4. 2. Severe Nausea and Vomiting
It's very common to have some nausea when you're pregnant. If it gets
to be severe, that may be more serious.
If the mother can’t eat or drink anything, she runs the risk of becoming
dehydrated. Being malnourished and dehydrated can harm your baby.

5. 3. Baby’s Activity Level Significantly Declines
If the baby's activity levels decrease significantly, then it is not a very
good sign. This can be due to the reason that baby is growing weaker
gradually. This is usually when babies do not get the nutrition they are
supposed to through their mother.

6. SOME COMMON PROBLEMS
• Anaemia
• Urinary Tract Infections (UTI)
• Mental Health Conditions
• Obesity and Weight Gain
• Hyperemesis Gravidarum
• Constipation and haemorrhoids

7. ANEMIA
• Anemia is having lower than the normal number of healthy
red blood cells.
• Women with pregnancy related anemia may feel tired and
weak.
• This can be helped by taking iron and folic acid supplements.

8. PREVALENCE
• According to World Health Organization estimates, up to 56% of all women living In
developing countries are anemic.
• In India, National Family Health Survey in 1998 to 99 shows that 54% of women in
rural and 46% women in urban areas are anemics.
• The relative prevalence of mild, moderate, and severe anemia are 13%, 57% and 12%
respectively in India (ICMR data).
• According to WHO, hemoglobin level below 11gm/dl in pregnant women constitutes
anemia and hemoglobin below 7gm/dl is severe anemia. The Center for Disease
Control and Prevention (1990) defines anemia as less than 11gm/dl in the first and
third trimester and less than 10.5gm/dl in second trimester.

9. URINARY TRACT INFECTIONS
A UTI is a bacterial infection in urinary tract.During pregnancy urine
becomes less acidic and more likely to contain glucose, both of which boost
the potential for bacterial growth.
Symptoms:
Feeling an urgent need to urinate and frequent urination.
Having difficulty in urination.
Having burning sensation or cramps in lower back or lower abdomen.
Having pain and burning sensation during urination.
Foul smelling and cloudy urine.
When bacteria spreads to kidney she may experience back pain, chills,
fever, nausea and vomiting.

10. Kidney infection may cause:
Early labor.
Low birth weight baby.
Incresed risk for newborn mortality.
Treatment:
• 3-7 days course of antibiotics.
Prevention:
• Stay hydrated.
• Drink cranberry juice.
• Practice good hygiene conditions.
• Urinate frequently.
• Don’t ignore urge to urinate.

11. CONSTIPATION AND HEMORRHOIDS
 The pressure of the enlarging uterus on the lower portion of
the intestine, in addition to the hormonal muscle relaxant
effect of placental hormones on GI tract may result in
constipation.It usually occur in third trimester.
 The weight of the fetus and downword pressure on the veins
also may lead to the development of hemorrhoids.

12.  Causes:
 Reduced gut motility
 Physical inactivity
 Pressure exerted on the bowel by the
enlarged uterus
Treatment:
• Increased fluid intake and use of natural
laxative foods.
• Regular habit of exercise and sleep

13. HYPEREMESIS GRAVIDARUM
HG is the presence of
severe and persistent
nausea and vomiting,
causing dehydration and
weight loss associated with
an increase in maternal free
thyroid hormone.
HG is more extreme than
morning sickness.

14. Signs and symptoms:
 Nausea
 Vomiting several times every day,
 Weight loss
 Dehydration
 Reduced appetite
Treatment:
 Have smaller, more frequent meals
 Drink smaller drinks but more often
 Nutritional supplements
 Get enough sleep and try to manage your stress
 Thiamine and a high protein diet

15. OBESITY AND WEIGHT GAIN
Obesity during pregnancy is associated with:
 Increased use of healthcare and physician services.
 Longer hospital stay for delivery.
 Less physical activity.
Complications:
Gestational diabetes
Preeclampsia
Labor problems
C-section

16. MENTAL HEALTH CONDITIONS
Depression and anxiety are most common
mental health problems in pregnancy.
Reasons:
 The type of mental illness she have
experienced.
 Recent stressful event in her family.
 She may or may not be happy about
being pregnant.
 Fear that there will be problem with
pregnancy or the baby.
 Fear of child birth.

17. Symptoms:
 Sad mood
 Loss of interest in fun activities
 Change in appetite, sleep and
energy
 Helplessness and irritability
 Thoughts of harming herself
and baby
Treatment: women who are
pregnant might be helped
withone or a combination of
treatment option including:
 Psychological Therapy
 Medicine

18. COMPLICATIONS DURING
PREGNANCY
Miscarriage
Premature labor and birth
Preeclampsia
Low amniotic fluid (oligohydramnios)
Gestational diabetes
Ectopic Pregnancy
Placenta previa

19. MISCARRIAGE
Miscarriage means expulsion of Product of Conception (POC) before
22nd week of Period of Gestation (POG), which mean before period of
foetal viability.

20. CAUSES
Maternal age > 35 years
Infections
Endocrine disorders
Immunological disorders
Abnormalities in uterus
Psychological disorder
Chromosomal abnormalities
Exposure to chemical agents

21. TYPES OF
MISCARRIAGE• THREATENED ABORTION – bleeding, cervix closed;
risk 50%
• INEVITABLE ABORTION – bleeding, cervix dilated,
cramping, no POC expelled yet
• INCOMPLETE ABORTION – incomplete evacuation
of products
• MISSED ABORTION - retained non-viable
pregnancy upto 4 weeks
• SEPTIC ABORTION – incomplete, with secondary
infection
• RECURRENT SPONTANEOUS ABORTION – three or
more consecutive pregnancy losses
• BLIGHTED OVUM – gestational sac + placenta with
no yolk sac; failure of embryo development

22. RISK FACTORS
• Advanced maternal age
• Cigarette smoking, alcohol abuse, drug abuse
• Occupational chemical exposure
• Excessive caffeine – 200mg/day
• Uterine anomalies
• Incompetent cervix
• Diabetes mellitus
• Progesterone deficiency
• Thyroid disease

24. PREMATURE LABOR
AND BIRTH• Preterm labor is defined as regular contractions of the uterus resulting
in changes in the cervix that start before 37 weeks of pregnancy.
Changes in the cervix include effacement (the cervix thins out) and
dilation (the cervix opens so that the foetus can enter the birth canal)

25. RISK FACTORS
 Smoking
 Being very overweight or underweight before pregnancy
 Not getting good prenatal care
 Drinking alcohol or using street drugs during pregnancy
 Having health conditions, such as high blood
pressure, preeclampsia,diabetes, blood clotting disorders, or
infections
 Being pregnant with a baby that has certain birth defects
 Being pregnant with a baby from in vitro fertilization
 Being pregnant with twins or other multiples
 A family or personal history of premature labor
 Getting pregnant too soon after having a baby

26. SIGNS AND SYMPTOMS
 Change in type of vaginal discharge (watery, mucus, or bloody)
 Increase in amount of discharge
 Pelvic or lower abdominal pressure
 Constant low, dull backache
 Mild abdominal cramps, with or without diarrhoea
 Regular or frequent contractions or uterine tightening, often painless
 Ruptured membranes

27. REDUCING THE RISK
 Get early prenatal care
 Know the risks. Certain pregnant women are more likely to deliver early. Risk factors
include a prior early delivery; smoking or illegal drug use; high blood pressure or
diabetes; carrying multiple foetuses, such as twins; a uterine infection during
pregnancy; an age of 35 or older; pregnancy complications such as preeclampsia;
being over- or underweight;
 Get tested. Uterine infections that can begin in the lower genital tract may be
responsible for up to half of all preterm births, particularly those that occur before 30
weeks' gestation
 Watch the weight. The average woman should put on 25 to 35 pounds during
pregnancy. Gain too much and there are odds of complications like gestational
diabetes and preeclampsia, which increase preterm labor risk.
 Eat right and exercise. Eating a nutritious diet during pregnancy can be vital to
healthy foetal development.

28. PREGNANCY
INDUCED
HYPERTENSION
(PIH)
PREECLAMPSIA

29.  Hypertension (BP≥ 140/90 mm Hg) during pregnancy can be classified
as chronic or gestational.
 Chronic Hypertension is BP that is high before pregnancy or before 20
week gestation.
 Gestational Hypertension develops after 20 week gestation, and
remits by 6 week gestation.
 Preeclampsia is defined by high blood pressure and excess protein
in the urine after 20 weeks of pregnancy.
 It may also be called as toxaemia.
 The only cure for preeclampsia is delivery of the baby. After the baby is
born, blood pressure usually returns to normal within a few days.

30. SIGNS AND SYMPTOMS
>Elevated blood pressure
(hypertension)
>Presence of excess protein
in urine after 20 weeks of
pregnancy
>Severe headaches
>Blurred vision or light
sensitivity
>Upper abdominal pain
>Unexplained anxiety
>Nausea
>Dizziness
>Decreased urine output
>Edema

31. POSSIBLE CAUSES OF
PREECLAMPISA
Insufficient blood flow to the uterus
Injury to the blood vessels
Damage to the lining of the blood vessels
Disruption in hormones that maintain the blood
vessels
Poor diet
Lack of magnesium or calcium

32. COMPLICATIONS DUE TO
PREECLAMPSIA
>HELLP Syndrome –
Hemolysis; Elevated Liver Enzymes;
Low Platelet count
>Eclampsia – Pain in the upper
right side of the abdomen;
Severe headache;
Vision problems, including seeing
flash lights;
Change in mental status, such as
decreased alertness
FOR THE BABY
>It affects the arteries carrying blood
to the placenta;
>It can also cause slow growth or a
low birth weight;
>Preeclampsia is a leading cause of
preterm baby.
IN ADDITION,
>increased risk of placental
abruption;
>May affect the growth of the fetus.

33. PREVALENCE
More than half of the respondents (n=22,061, 55.6%) reported pre-eclampsia. Rural–
urban and marked geographic variation were found with rates for pre-eclampsia ranging
from as low as 33% (Haryana) to 87.5% (Tripura). With various risk factors and
background factors statistically controlled, the prevalence odds ratios of pre-eclampsia
was higher among women with twin pregnancy, terminated pregnancy, women with
severe to mild anemia, tobacco smoking, diabetes, asthma, consuming fruits
weekly/occasionally, eggs daily, fish weekly, and residing in eastern northeastern and
central part of India with reference to their counterparts.
SOURCE: South Asia Network for Chronic Disease, Public Health Foundation of India,
New Delhi, India (2014)

34. LOW AMNIOTIC FLUID
The amniotic sac fills with fluid that protects and supports
your developing baby. When there's too little fluid, it's called
oligohydramnios. About 4 percent of pregnant women have
low levels of amniotic fluid at some point, usually in their third
trimester.
If this happens the caregiver should follow the pregnancy
closely to be sure the baby continues to grow normally. If
mother is near the end of the pregnancy, labor will
be induced.

35. P L A C E N TA P R A E V I A
Placenta previa is an
obstetric complication
In which placenta is
inserted wholly or
partially
In the lower segment

36. In the last trimester of pregnancy the isthmus of the uterus
unfolds and forms the lower segment. In placenta praevia
the placenta overlie the lower segment then it may shear
off and the small section may bleed.

37. SIGNS AND SYMPTOMS
 Painless bright red vaginal bleeding.
 Failure of enlargement of fetal head.

38. CAUSE
It is hypothesized to be related to abnormal
vascularization of endometrium caused by scarring from
previous trauma , surgery or infection.

39. CLASSIFICATION
TYPE DESCRIPTION
MINOR
MAJOR
Placenta is in lower uterine
segment , but the lower
edge doesn’t cover the
internal os.
Placenta is in lower uterine
segment , and lower edge
covers the internal os.

40. RISK FACTORS
 Use of alcohol.
 Closely spaced pregnancies.
 Smoking during pregnancy.
 Age <20 years.
 Women with large placentae
from twins.

41. MANAGEMENT
Women are treated in hospital from the first bleeding episode until birth .
Immediate delivery should be done if fetus is mature or mother and
fetus are distressed.
Corticosteroids are given but there is a increased risk of premature birth.

42. GESTATIONAL DIABETES MELLITUS
It is a condition in which
women without previously
diagnosed diabetes exhibit
high blood glucose levels
during pregnancy(esp. during
3rd trimester).Body doesn’t
utilize insulin because of
human placental lactogen ,
estrogen , free cortisol results
in degradation of insulin.

43. PREVALENCE
• The prevalence of GDM was 35% using WHO 2013 criteria vs 9% using WHO
1999 criteria. FPG measurements identified 94% of WHO 2013 GDM cases as
opposed to 11% of WHO 1999 GDM cases. Using logistic regression with
backward elimination, urban habitat, illiteracy, non-vegetarianism, increased
BMI, Hindu religion and low adult height were all independent risk factors of
GDM using the 1999 criteria, whereas only urban habitat, low adult height and
increased age were independent risk factors of GDM using the 2013 criteria.
REFERENCE
• http://www.ncbi.nlm.nih.gov/pubmed/26012589

44. 2013 CRITERIA
• Gestational diabetes mellitus should be diagnosed at any time in pregnancy if
more of the following criteria are met:
• - fasting plasma glucose 5.1-6.9 mmol/l (92 -125 mg/dl)
• - 1-hour plasma glucose 10.0 mmol/l (180 mg/dl) following a 75g oral glucose
• - 2-hour plasma glucose 8.5-11.0 mmol/l (153 -199 mg/dl) following a 75g oral
glucose load

45. CAUSES
• Quick weight gain during pregnancy.
• Family history of type 2 diabetes.
• Age over 25.
• Prediabetes.
• Baby weighing more than 4.5 kg.
• Polycystic ovarian syndrome.

47. EFFECTS
• Babies may grow too large.
• Increased risk of c-section
delivery.
• Infant may suffer from jaundice
or breathing problems.
• Sudden drop in child’s blood
glucose level.

48. MANAGEMENT
• Eating regular meals.
• Getting regular exercise.
• Checking blood sugar levels.
• Monitoring fetal growth and
well being.
• Getting regular medical check
ups.
• Taking diabetes medicines and
insulin shots.

49. DIETARY MANAGEMENT
• Plenty of whole fruits and vegetables
• Moderate amounts of lean proteins and healthy fats
• Moderate amounts of whole grains, such as bread, cereal, pasta, and rice, plus starchy
vegetables, such as corn and peas
• Fewer foods that have a lot of sugar, such as soft drinks, fruit juices, and pastries.
• High-fiber, whole-grain carbohydrates are healthy choices.
• Vegetables are good for your health and your blood sugar

50. ECTOPIC PREGNANCY
Also known as tubal pregnancy . In this embryo
attaches outside the uterus . When the cilia is less in
fallopian tube which moves egg down the uterus ,
then egg implants in the tube and ectopic
pregnancy occurs.

52. SIGNS AND SYMPTOMS
Up to 10% of tubal pregnancies
have no symptoms and 1/3rd have
no medical signs. Other symptoms
are:-
 Vaginal bleeding.
 Sudden lower abdominal pain.
 Nausea , vomiting, diarrhoea .
These are the more rare symptoms.

53. Rupture of ectopic pregnancy may
lead to:-
 Abdominal distension
 Tenderness.
 Peritonism (Inflammation of
peritoneum)
 Hypovolemic shock (Low blood
profusion to tissues resulting in
cellular injury)

54. TREATMENT
Surgical treatments are done in
order to treat ectopic pregnancy.
Sometimes methotrexate is given
to absorb the pregnancy tissue by
body and may save the fallopian
tube. In emergency laparoscopy is
done.

55. THANK YOU!