This document discusses gastrointestinal issues and nutrition in pregnancy. It covers common problems like nausea and vomiting, heartburn, constipation, as well as cravings and aversions. It provides treatment recommendations. It also discusses the benefits of and recommendations for exercise during pregnancy. Additionally, it covers high risk factors in pregnancy such as maternal age, obesity, diabetes, hypertension, and substance use. Throughout it emphasizes the importance of adequate nutrition and hydration for both maternal and fetal health.

1. GI problems in pregnancy
Dr Rania Abd El Hamid Hussein
MBBSch
Master’s degree in Internal Medicine
Doctor in Nutrition and Public Health
Assistant Professor of Nutrition
Faculty of Applied Medical Sciences
KAU
Dr Rania Hussein

2. Nausea and vomiting:
morning sickness
• Occur early in pregnancy: 6
weeks after the start of last
menstrual period and last for 6
weeks
• The cause may be hormonal
changes during early pregnancy
Dr Rania Hussein

3. Treatment
1. Keep stomach filled but not overfilled
2. Eat small frequent meals
3. Separate consumption of fluids and
solid foods.
4. Consume easily digested foods
5. Avoid strong-flavored foods
6. When nauseated , do not drink fluids,
but eat toast or crackers.
Dr Rania Hussein

4. Heart burn
It is caused by:
• Relaxation of muscles →↓ gastric
emptying → esophageal
regurgitation.
• In late pregnancy, the pregnant
uterus compresses the diaphragm .
Treatment:
5. Eating small frequent meals
6. Avoiding lying down soon after
meals
7. Antacids can be used
Dr Rania Hussein

5. Constipation
It is caused by:
2. ↓ physical activity
3. ↓ intestinal motility
4. ↓water intake
5. ↓ fiber intake in diet
6. The enlarging uterus exerts
pressure on the bowel
Dr Rania Hussein

6. Treatment of constipation
1. Adequate fluid intake
2. Increasing dietary fiber
3. Use of bulking agents as bran→ flatulence
and bloating
Dr Rania Hussein

7. Craving and aversion
• Craving and aversion are powerful urges to
consume or not consume particular foods or
beverages, including foods that were neither
craved nor considered avulsive before.
• Food craving may range from pickles to ice
cream.
• Food aversion are usually to coffee and meat.
Dr Rania Hussein

8. • Pica is the ingestion of non food substances as
clay.
• May be due to the body’s search for a source
of nutrients it is lacking.
Dr Rania Hussein

9. Exercise during pregnancy
Dr Rania Hussein

10. Benefits
• A positive self image
• Maintenance of fitness
• Shorter labor, and fewer surgical
interventions
Dr Rania Hussein

11. Recommendations
1. Avoidance of activities with excessive twists
and turns, or those that may cause
abdominal trauma.
2. A carbohydrate snack before exercise to
sustain blood glucose.
Dr Rania Hussein

12. High Risk Pregnancy
Dr Rania Hussein

13. Maternal and family conditions
• Age: adolescent – older gravida
• Low SE socioeconomic status
• History of poor pregnancy outcome
• Short inter pregnancy interval
• High parity
Dr Rania Hussein

14. Maternal health problems and
Prenatal complicated pregnancy
• Obesity, underweight, or poor gestational weight
gain
• Hyperemesis gravidarum
• Multiple fetuses
• Anemia
• Hypertensive disorders of pregnancy
• DM
• Viral infections (HIV, Rubella)
Dr Rania Hussein

15. Maternal behavior
1. Cigarette smoking
2. Alcohol consumption
3. Caffeine intake
4. Vegeterianism
Dr Rania Hussein

16. Maternal age
1. Adolescent
2. Older gravida
Dr Rania Hussein

17. Pregnancy in
Adolescence
Dr Rania Hussein

18. 1. ↓ nutrient stores
and ↑ nutritional needs :
• Adolescents are still in growth phase →
Competition for nutrients between
mother and fetus →↓ placental blood
flow → premature or low birth weight
babies.
2. Smaller pelvis of the young adolescent
mother → cephalopelvic disproportion
→ difficulties in delivery
Dr Rania Hussein

19. 2. Is likely to be poor
2. → ↓ intake of nutrients → ↓ prepregnancy
weight and ↓ gestational weight
3. Late entry to prenatal care
Dr Rania Hussein

20. Consequences of pregnancy in
adolescence
1. Preterm delivery
2. Low birth weight infant
3. Difficult labor and delivery
4. Pregnancy- induced hypertension
Dr Rania Hussein

21. Recommended energy and nutrient
intake for the pregnant adolescent
Energy levels greater than the additional
300Kcal/day are recommended.
RDA for protein is increased by 15 g/day
Iron, Folate, and calcium supplementation
should be recommended routinely
Dr Rania Hussein

22. Recommended gestational weight
gain for adolescents
Prepregnant BMI weight gain in Kg
<19.8 18
19.8-26 16
26-29 11.5
Dr Rania Hussein

23. Taking care of the pregnant
adolescent
1. Family should be supportive
and more sympathetic
2. Ensure prenatal and postnatal
care
Dr Rania Hussein

24. Older gravida (35 years and older )
Risks:
2. Multiple fetuses
3. Medical conditions : DM, cardiovascular diseases,
obesity, tumors
4. Down syndrome
5. Preterm infants
6. Low birth weight infants
7. Maternal and perinatal mortality
Dr Rania Hussein

25. Socioeconomic status
They include:
2. Social status
3. Income
4. Education
5. Employment
6. Marital status
7. Availability of health care systems
Dr Rania Hussein

26. Consequences of low
socioeconomic status
↓ maternal weight gain →
• Preterm infants
• Low birth weight infants
Dr Rania Hussein

27. Maternal obesity and underweight
Dr Rania Hussein

28. Underweight mothers are at
higher risk of having
1. Low-birth-weight infants
2. Preterm delivery
Dr Rania Hussein

29. Obese women are at a greater
risk of having
• Hypertension.
• Diabetes.
• Complications during labor: Fetal
macrosomia and shoulder dystocia
• Thromboembolism
• Obesity may double the risk of NTD
Dr Rania Hussein

30. Multiple births
Consequences:
2. Preterm infants
3. Low birth weight infants
Energy and nutrient requirements are increased
Weight gain should exceed that of single
pregnancies (about 22 Kg weight gain in
twin pregnancy)
Dr Rania Hussein

31. Hyperemesis gravidarum
• It is a nutritionally debilitating condition
characterized by intractable vomiting that
develops during the first 22 weeks of
gestation.
• Cause is unknown , but may be due to
hormonal changes during pregnancy.
Dr Rania Hussein

32. Complications include;
2. Weight loss, dehydration, electrolyte
imbalance
3. Fetal growth restriction
4. Utilization of body fats and proteins,
ketonemia→ this impairs neurologic
development of the fetus
Dr Rania Hussein

33. Treatment
1. Hospitalization
2. Intravenous fluids to correct dehydration and
electrolyte imbalance
3. Correction of ketonemia
4. Oral intake is slowly introduced (small
frequent meals low in fat, high in
carbohydrates, with liquids consumed at
different times)
Dr Rania Hussein

34. If the woman fails to respond to oral feeding,
food is introduced either through a commercial
formula via tube into the stomach (enteral
feeding), or nutrient needs are given by
intravenous infusion (parenteral nutrition)
Dr Rania Hussein

35. Diabetes mellitus in pregnancy
Dr Rania Hussein

36. • It is a chronic disorder in which blood levels
of glucose are elevated.
• The cause is either insulin deficiency or
resistance,
• Net result is hyperglycemia.
Dr Rania Hussein

37. Types of DM are:
• Type 1 Insulin dependant diabetes
• Type 2 Non insulin dependant diabetes
• Gestational diabetes
Dr Rania Hussein

38. In all types of Diabetes in Pregnancy
↑maternal blood glucose → blood glucose passes
to the fetus → fetal pancreatic insulin
secretion → ↑ protein and fat synthesis in
fetus→ macrosomia
Dr Rania Hussein

39. Consequences of Diabetes
• Preeclampsia
• Frank diabetes later in life.
• Fetal macrosomia and birth injuries
• Operative delivery
• Neonatal hypoglycemia
• Congenital anomalies
Dr Rania Hussein

40. In pregestational diabetes,
• Insulin requirements ↓in the first half of
pregnancy, as the fetus uses some of mother’s
glucose.
• Insulin requirements↑ In the second half of
pregnancy, due to hormonal changes.
Dr Rania Hussein

41. Gestational Diabetes: GD
• Intolerance to carbohydrates, first
recognized in pregnancy.
• Late in the 2nd trimester.
• Carbohydrate tolerance is normal
before pregnancy and after
delivery.
Dr Rania Hussein

42. Nutrition goals in the management of
gestational diabetes
1. Provide necessary nutrients to the fetus and
mother
2. Maintain normal blood glucose
(euglycemia), and prevent ketosis
3. Achieve appropriate weight gain
Dr Rania Hussein

43. Screening for diabetes
• Initial screening is done between 24 and 28 weeks of
gestation.
• Rescreening at 32 weeks gestation is recommended
• Screening is done to the following groups:
-25 years of age or older
- <25 years + obese
- Family history of diabetes in first degree
relatives
- If a mother shows any symptoms or signs of
diabetes at any stage of pregnancy.
Dr Rania Hussein

44. Treatment of Gestational diabetes
1. Dietary changes,
2. Moderate exercise
3. Blood glucose monitored daily
Dr Rania Hussein

45. Hypertension during pregnancy
Blood pressure >140/90 300
280
260
240
290
270
250
230
220
210
• ↑ risk of preeclampsia, preterm
200
190
180
170
160
150
140
130
120
delivery, fetal growth restriction
110
100
90
80
70
60
50
40
30
20
•
10
2 types:
• Gestational hypertension: detected for
the first time after mid pregnancy
• Chronic hypertension: detected before
pregnancy
Dr Rania Hussein

46. Preeclampisa
1. Pregnancy-specific syndrome observed after 20 th
week
2. Blood pressure >140/90
3. Proteinurea
• Eclampsia= preeclampsia + seizures
• Risk factors for preeclampsia: maternal obesity,
diabetes, chronic hypertension
Dr Rania Hussein

47. Role of diet in preeclampsia:
• Calcium supplementation ↓ BP
• Mg supplements and antioxidants (Vit A and
E) can prevent preeclampsia
• Adequate dietary protein intake to replace the
losses in urine.
Dr Rania Hussein

48. Substance use and abuse in
pregnancy
Dr Rania Hussein

49. Cigarette smoking
• CO+ Hb= carboxyhemoglobin→↓ available
sites for oxygen binding → fetal hypoxia, and
fetal growth restriction
• ↓ absorption and availability of some nutrients:
vit C, Iron, Zinc, folic acid
Dr Rania Hussein

50. Alcohol consumption
• Alcohol is directly toxic to the embryo and
fetus ( it crosses the placenta, while fetal
organs are still immature)
• The mother is usually undernourished
• It ↓ absorption and utilization of some
nutrients
Dr Rania Hussein

51. Consequences of alcohol
consumption
Fetal alcohol syndrome:
• Mental retardation
• Growth retardation
• Facial abnormalities
• Nervous, cardiac, and genitourinary system
impairment
Dr Rania Hussein

52. Caffeine intake
1. ↑ urinary excretion of Ca and thiamin
2. ↓absorption of Zn and Fe.
3. ↑ heart rate and blood pressure
4. gastric reflux
Dr Rania Hussein

53. Recommendations
• Limitation of substance use
• Multivitamin and mineral supplementation
Dr Rania Hussein

54. References
• Brown JE, Isaacs J, Wooldridge N, Krinke B,
Murtaugh M. Nutrition through the lifecycle,
2007 . 3rd ed. Wadsworth publishing.
• Mahan LK, Escott- Stamp S. krause’s food,
and nutrition therapy 2008. 12th ed. Saunders
Elsevier. Canada.
dr Rania Hussein