This document discusses various nutrition-related conditions and interventions during pregnancy. It covers topics like hypertensive disorders, gestational diabetes, obesity, multifetal pregnancies, HIV/AIDS, eating disorders, and fetal alcohol spectrum. For each condition, it describes characteristics, potential consequences, diagnosis and treatment approaches. Nutritional recommendations are provided to support maternal and fetal health for different pregnancy complications. The goal is to provide evidence-based nutritional interventions that are safe, effective and affordable.

1. Nutrition
Conditions &
Interventions
during
Pregnancy

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

7. 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

8. 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

9. 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 yet without too little
that could impair fetal growth

10. 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

11. 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

12. 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

13. Outcomes related to the existence of
preeclampsia during pregnancy

15. Nutrient
Intake &
Preeclampsia

16. 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

17. 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

18. 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

21. 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

22. 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

23. Exercise Benefits & Recommendations
 Regular aerobic exercise decreases
insulin resistance & blood glucose in
gestational diabetes
 Exercise should approximate 50-60% of
VO2 max

24. 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

25. 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

26. Nutritional Management of Type 1
Diabetes 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

27. 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)

28. 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 be
by perinatal nutrient influenced by heredity
supplements

29. Differences in Placentas & 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

30. Nutrition & 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

31. Nutrition & the Outcome of
Multifetal 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

32. 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

33. Nutritional Management for Women
With 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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

41. Risks Associated with
Adolescent Pregnancy

42. 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

43. Dietary Recommendations for
Pregnant 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

44. Nutritional Management of
Adolescent Pregnancy
 Multidisciplinary counseling
services should include:
 Individualized nutrition
assessment
 Intervention education
 Guidance on weight gain
 Follow-up birthweight outcomes

45. Nutritional Management of
Adolescent Pregnancy
 Services should focus on:
 Psychosocial needs
 Support/discussion groups
 Home visits

46. 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