This PPT will discuss the problems facing pregnant women during pregnancy

1. Dr. Louay Labban

2. • Some complications of pregnancy are related
to women’s nutritional status
• Nutritional interventions for a number of
complications of pregnancy can benefit
maternal and infant health outcomes.
• Nutritional intervention during pregnancy
should be based on scientific evidence that
supports their safety, effectiveness and
affordability

3.  Chronic hypertension: that is present before
pregnancy or diagnosed before 20 weeks of
pregnancy. Hypertension is defined as blood
pressure ≥ 140 mm Hg systolic or ≥ 90 mm Hg
diastolic blood pressure.

4.  This condition is more likely to occur in
African-Americanand obese women, women
over 35 years old and women who had
previous Bp in the last pregnancy

5.  High BP is associated with and increased risk
of fetal death, preterm delivery and fetal
growth retardation.
 Nutritional intervention for women with
chronic hypertension during pregnancy is
through monitoring Na intake prior and
during pregnancy and exercise.

6.  Gestational hypertension:This condition
exists when elevated blood levels are
detected for the first time after mid-
pregnancy.
 It is not accompanied with proteinuria
 If BP returns to normal by 12 weeks
postpartum, it is called transit hypertension
 If it remains elevated, it is called chronic

7.  Preeclampsia-Eclampsia: occurs after 20
week of gestation (or earlier)This represents a
syndrome characterized by:
1- Blood vessel spasm and constriction
2- Increased BP
3- Adverse maternal immune system responses
to placenta

8. 5-Alterations of hormonal and other system
related to blood volume and pressure control
6-Oxidative tissue damage and inflammation
7- Alteration in calcium regulatory hormones

9. • Hypertension
• Increased urinary protein ( albumin )
• Decreased plasma volume expansion
( hemoglobin levels > 13 g/dL)
• Low urine output
• Persistent and severe headache
• Sensitivity of the eyes to bright light
• Blurred vision

10.  Nausea
 Increased platelet aggregation,
vasoconstriction

11. Mother
1- Early delivery
2- Acute renal dysfunction
3- Increased risk of gestational diabetes,
hypertension and diabetes type 2 later
4- Rupture of plancenta

12. New born
1- Growth restriction
2- Respiratory distress syndrome

13.  First pregnancy
 Obesity, central obesity
 Underweight
 Mother’s smallness at birth
 EthnicityAfricanAmerican,American Indians
 History of preeclampsia
 Age over 35

14.  Multifetal pregnancy
 Insulin resistance
 Chronic hypertension
 Renal disease
 High blood levels of homocystein
 Nutrient deficiency such vitaminC, E calcium,
Zinc andOmega 3- fatty acids

15.  1000 mg per day of dietary calcium
 400 mcg of folate
 ≥ 5 servings of fruit and vegetables per day
 Moderate exercise for 30 minutes for 5
days/week at least

16.  Weight gain based on prepregnancy weight
status
 Three regular meals and snacks a day
 Consumption of low glycemic indexCHO
foods

17.  Is considered 2nd leading complication in
pregnancy and has several forms:
 Gestational diabetes
 Type 2
 Type 1
 Other specific types

18.  Over than 3% of pregnant women develop
gestational diabetes
 It is considered a type of NIDDM or type 2
 Gestational diabetes in underweight and
normal weight women appears to be related
to insulin resistance in pregnancy combined
with reduction in insulin production

19. • Obesity ( central obesity )
• Weight gain between pregnancies
• Underweight
• Age > 35
• Ethnicity
• Family history
• History of delivery of macrosomic newborn
( > 4500 g)

21.  Chronic hypertension
 Mother was SGA at birth
 History of gestational diabetes in previous
pregnancies
 Diabetes in pregnant women’s mother during
pregnancy with them and LGA at birth

22. Mother
1. C-section to prevent shoulder dystocia
2. Increased risk for preeclampsia
3. Increased risk for diabetes type 2,
hypertension and obesity
4. Increased risk for gestational diabetes in
subsequent pregnancies

23. Offspring:
1. Stillbirth
2. Spontaneous abortion
3. Macrosomia ( > 10 lbs or 4500 g)
4. Neonatal hypoglycemia
5. Increased risk of insulin resistance, type 2
diabetes, high BP and obesity

24.  Is diagnosed by OralGlucoseToleranceTest
OGTT
 100 g glucose and 3 hours test is used
 The practice of loading women up with high
CHO diet for 3 days prior to test is no longer
used.
 The beverage provided should be consumed
in 5 minutes

27.  A diagnosis for gestational diabetes is made
when two or more values for venous serum or
plasma glucose concentrations exceed these
levels:
 Overnight fast 95 mg/dL
 1 hour after glucose load 190 mg/dL
 2 hours after glucose load 155 mg/dL
 3 hours after glucose load 140 mg/dl

28.  The main goal is to control blood glucose
levels and to get healthy newborn
 Other goals are to minimize the risk for other
diseases such as diabetes, heart disease,
hypertension and obesity,
 The nutritional management is done through:

29. 1. Assessing dietary and exercise habits
2. Developing an individualizeddiet and
exercise plan
3. Monitoring weight gain
4. Interpreting blood glucose and urinary
ketone results
5. Ensuring follow-up during pregnancy and
postpartum

30.  Whole-grain breads and cereals, vegetables,
fruits and high fiber foods
 Limited intake of simple sugars
 Low GI foods or CHO that less than 50
 Monounsaturated fats

34.  Three regular meals and snacks daily
 Clorie distribution among meals and snacks
 Lunch is largest meal
 Breakfast and snacks are limited to 10-15% of
total calories

35.  40-50 % from CHO
 30-40 from fat
 20% from protein

36.  Twins increased from 1:56 births in 1988 to
1:34births in 2001
 Triplets or higher in creased from 1:2941 to 1:
551 in the same period
 Only 1:5 triplets pregnancies are
spontaneously conceived

38. Pregnant women
1. Preeclampsia
2. Iron-deficiency anemia
3.Gestational diabetes
4. Kidney disease

39. 7. Fetal loss
8. Preterm delivery
9.C-section

40. Newborns
1. Neonatal death
2. Congenital abnormalities
3. Respiratory distress syndrome
4. Intraventricular hemorrhage
5. Cerebral palsy

41.  Weight gain
Twin pregnancies 15.9-20.5 kg
Triplets 22.7 kg or 0.7 kg/day

42.  Daily food intake
 > 6 servings of cereal group
 > 3 servings vegetables
 > 2 servings fruits
 > 3 servings of meat, poultry, fish, beans,
eggs
 > 3 servings of milk, cheese, yogurt
 Fats and sugar very rarely

43.  For triplet pregnancies :
Food intake from food guide pyramid groups
should be consumed at a level that promotes
targeted weight gain.

44. Caloric intake:
 Twin pregnancies : 450 kcal above
prepregnancy intake.
 Triplet pregnancies: intake should be
consistent with targeted weight gain

45. Nutrient intake:
 Twin and triplet pregnancy:
- DRI level or somewhat more than these levels
- Intake should be lower than ULs

46.  Twin pregnancy:
Minerals vitamins
Iron : 30 mg Vitamin B6: 2 mg
Zinc : 15 mg Folate : 300 mcg
Copper : 2 mg Vitamin C : 50 mg
Calcium : 250 mg Vitamin D: 200 IU

47.  Triplet pregnancy:
 Provide a supplement containing at least the
above levels for twin pregnancy while
avoiding excessive amounts.

48.  Anorexia nervosa
 Bulimia
 Bing eating

50.  Spontaneous abortion
 Difficult deliveries
 Weight gain low
 Smaller newborns
 Higher rates of neonatal complications

51.  Behavioral changes
 Improvements in nutritional status
 Weight gain increase

52.  USA has the highest rates of adolescent
pregnancies of all developed countries
 In 2002 teen pregnancies were 43 births per
1000 female aged 15-19
 Between 1991-2001 it was 26% less

53.  Low birthweight
 Perinatal death
 C-section
 Cephalopelvic ( head too large for birth canal)

54.  Preeclampsia
 Iron-deficiency anemia
 Delayed-reduced educational acheivemnt
 Low income

55.  Are basically the same as for older pregnant
women
 DRI for calcium is 1300 mg/day