Ntr450 chapter5 1

  • 296 views
Uploaded on

 

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
296
On Slideshare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
11
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 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