Ntr450 chapter5 1

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  • 1. NutritionConditions &InterventionsduringPregnancy
  • 2. Learning Objectives Some pregnancy complications are related to women’s nutritional status Nutritional interventions for pregnancy complications can benefit maternal and infant health  Should be based on scientific evidence for safety, effectiveness, & affordability
  • 3. Introduction  Health conditions impacting pregnancy include:  Hypertensive disorders of pregnancy  Preexisting & gestational diabetes  Obesity  Multifetal pregnancies  HIV/AIDS  Eating disorders  Fetal alcohol spectrum  Adolescent pregnancy
  • 4. Hypertensive Disorders of Pregnancy Hypertension (HTN): defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg  Affects 6-8% of pregnancies  Contributes to stillbirths, fetal & newborn deaths, & other complications Previously known as “Pregnancy- induced hypertension”
  • 5. Hypertensive Disorders of Pregnancy,Oxidative Stress, & 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
  • 6. 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
  • 7. Chronic Hypertension HTN present before pregnancy or diagnosed <20 weeks Estimated incidence is 1-5% More common in:  African American, obese, >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
  • 8. Nutritional Interventions for Women withChronic 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 yet without too little that could impair fetal growth
  • 9. 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 hypertension of pregnancy
  • 10. 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
  • 11. Characteristics of Preeclampsia-Eclampsia Oxidative stress, inflammation, & endothelial dysfunction Blood vessel spasms & constriction Increased blood pressure Adverse maternal immune system responses to the placenta Platelet aggregation & blood coagulation due to deficits in prostacyclin relative to thromboxane Alterations of hormonal & other systems related to blood volume & pressure control Alteration in calcium regulatory hormone Reduced calcium excretion
  • 12. Outcomes related to the existence ofpreeclampsia during pregnancy
  • 13. NutrientIntake &Preeclampsia
  • 14. Diabetes in Pregnancy Diabetes: 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
  • 15. 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, triglycerides, fatty acids & blood pressure
  • 16. Potential Consequences ofGestational 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
  • 17. Diagnosis of Gestational Diabetes Glucose screening recommended for women at high risk Risk factors are listed below:  Marked obesity  Diabetes in a parent or sibling  History of glucose intolerance  Previous macrosomic infant  Current glucosuria
  • 18. 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
  • 19. Exercise Benefits & Recommendations  Regular aerobic exercise decreases insulin resistance & blood glucose in gestational diabetes  Exercise should approximate 50-60% of VO2 max
  • 20. Nutritional Management of Womenwith Gestational Diabetes1. Assess dietary & exercise habits2. Develop individualized diet & exercise plan3. Monitor weight gain4. Interpret blood glucose & urinary ketone results5. Ensure follow-up during & after pregnancy
  • 21. Type 1 Diabetes during Pregnancy Potentially, a more hazardous condition than most cases of gestational diabetes Mother with type 1 is at risk of:  Kidney disease  Hypertension  Other complications Newborn born to her is at risk of:  Mortality  Being SGA or LGA  Hypoglycemia within 12 hours after birth
  • 22. Nutritional Management of Type 1Diabetes during Pregnancy Control of blood glucose levels Nutritional adequacy of diet Achieve recommended weight gain Careful home monitoring of glucose levels & dietary intake, exercise, insulin dose, & urinary ketone levels
  • 23. 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)
  • 24. Background InformationAbout 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 be by perinatal nutrient influenced by heredity supplements
  • 25. Differences in Placentas & Amniotic SacsTwins with 2 amniotic Twins with 1 Twins with 2sacs, 2 chorions, & 2 amniotic sac, 1 amniotic sacs, 1 placentas chorion, & 1 chorion, & fused placenta placentas
  • 26. Nutrition & the Outcome ofMultifetal 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
  • 27. Nutrition & the Outcome ofMultifetal Pregnancy Dietary intake in twin pregnancy  Benefits from increases in essential fatty acids, iron & calcium Vitamin and mineral supplements  Needs unknown Nutritional recommendations  Based on logical assumptions & theories
  • 28. HIV/AIDS during Pregnancy Treatment of HIV/AIDS  Needed before, during, & after pregnancy Consequences of HIV/AIDS during pregnancy  Infectiondoes not appear to be related to adverse pregnancy outcome Nutritional factors and HIV/AIDS during pregnancy  Nutritional needs increase the most in advanced stages of HIV/AIDS
  • 29. Nutritional Management for WomenWith HIV/AIDS during Pregnancy Goalsfor nutritional management include:  Maintenance of positive nitrogen balance & preservation of lean muscle & bone mass  Adequate intake of energy & nutrients to support maternal physiological changes & fetal growth & development  Correction of elements of poor nutritional status identified by nutritional assessment  Avoid foodborne infection
  • 30. Eating Disorders in Pregnancy Rare in pregnancy since most females with disorders are subfertile or infertile Bulimics more likely to become pregnant than those with anorexia nervosa Eating disorder symptoms subside in 2nd & 3rd trimester but return postpartum
  • 31. Eating Disorders in Pregnancy Consequences of eating disorders in pregnancy Treatment of women with eating disorders during pregnancy Nutritional interventions for women with eating disorders
  • 32. Fetal Alcohol Spectrum “Fetalalcohol spectrum” describes range of effects that fetal alcohol exposure has on mental development & physical growthEffectsinclude Behavioral problems Mental retardation Aggressiveness Nervousness & short attention span Stunting growth & birth defects
  • 33. 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
  • 34. 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
  • 35. 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 A “safe” dose of alcohol consumption during pregnancy has not been identified  Recommendation: women should not drink alcohol while pregnant
  • 36. Nutrition & 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
  • 37. Risks Associated withAdolescent Pregnancy
  • 38. Obesity, Excess Weight Gain, &Adolescent Pregnancy Overweight & obese adolescents are at increased risk for:  Cesarean delivery  Hypertensive disorders of pregnancy  Gestational diabetes  Delivery of excessively large infants
  • 39. Dietary Recommendations forPregnant Adolescents Adolescents may need more calories to support their own growth as well as that of fetus Caloric need should be from a nutrient-dense diet Calcium DRI for pregnant teens is 1300 mg
  • 40. Nutritional Management ofAdolescent Pregnancy Multidisciplinary counseling services should include:  Individualized nutrition assessment  Intervention education  Guidance on weight gain  Follow-up birthweight outcomes
  • 41. Nutritional Management ofAdolescent Pregnancy Services should focus on:  Psychosocial needs  Support/discussion groups  Home visits
  • 42. Evidence-Based Practice “Enormous amounts of new knowledge are barreling down the information highway, but they are not arriving at the doorsteps of our patients.” Claude Lenfant, National Institutes of Health