�Vast majority of pregnancies proceed normally
-Result in delivery of a healthy newborn
�For others, a number of health conditions may occur
-Nutrition plays a role in their etiology and management
�Obesity before and during pregnancy
-Often produces unfavorable genetic, hormonal, and metabolic conditions
�Affect maternal health, fetal growth and development, and subsequent health of the mother and child
-Several unfavorable metabolic changes
Increased blood glucose levels, blood conce
�Nutritional recommendations and interventions for obesity in pregnancy
-Meet nutrient needs
-Consume a variety of basic foods
-Participate in physical activity
-Maintain appropriate rates of weight gain
�Weight loss is not recommended
�Pregnancy after bariatric surgery
-Use of bariatric surgery for weight loss has increased
-Weight rapidly lost after the surgery due to limited food intake, fat malabsorption, decreased appetite, and dumping syndrome
-Deficiencies of many nutrient stores
�Thiamine, vitamins D, B12, folate
�Nutrition care for pregnant women post-bariatric surgery includes:
-Assessment of dietary intake
-Supplement use
-Nutrient biomarker status
-Weight gain and physical activity
-Gastrointestinal symptoms
�Nutrient deficiencies vary depending on type of bariatric surgery performed
Hypertensive Disorders of Pregnancy
�Affects five to ten percent of pregnancies
-Contributes to stillbirths, fetal and newborn deaths, and other adverse conditions
�Causes of most cases remain unknown
-Cures remain elusive
�Hypertensive disorders of pregnancy, oxidative stress, and nutrition
-Hypertension in pregnancy is related to:
�Chronic inflammation, oxidative stress, and damage to endothelium of blood vessels
-Consequences of endothelial dysfunction:
�Impaired blood flow, increased tendency to clot, and plaque formation
�Chronic hypertension
-Present prior to pregnancy or diagnosed before 20 weeks
-Estimated incidence is three percent
-More common in those who are non-Hispanic Black Americans, obese, over 35 years of age, or who have had prior pregnancy high blood pressure
�Nutritional interventions for women with chronic hypertension in pregnancy
-Diets should be monitored
�Gestational hypertension
-Hypertension that first occurs during pregnancy
-Increased risk for developing preeclampsia later in pregnancy or during the first week postpartum, and chronic hypertension later in life
�Preeclampsia-eclampsia
-Pregnancy-specific syndrome
-Signs and symptoms range from mild to severe as do the health consequences
-Cause is unknown
�Characteristics of preeclampsia
-Oxidative stress, inflammation, and endothelial dysfunction
-Platelet aggregation and blood coagulation
-Blood vessel spasms and constriction
-Increased blood pressure
-Insulin resistance
-Adverse maternal immune system responses to the placenta
-Elevate
�Nutritional recommendations and interventions for preeclampsia
-Adequate calcium and vitamin D status
-Use of multi-vitamin/minerals if needed
-Five or more servings of colorful vegetables and fruits daily
-Adequate fiber intake
-Consumption of basic food recommendations
-Moderate-intensity exercise
Recommended weigh
�Diabetes is a leading complication in pregnancy and has three main forms
-Type 1
-Type 2
-Gestational
�Women developing gestational diabetes appear to be predisposed to insulin resistance, and have impaired insulin production
-Prevalence: two to twelve percent
-Accounts for 88 percent of all cases of diabetes in pregnancy
�Risks related to gestational diabetes
-Increased risk of spontaneous abortion, stillbirth, congenital anomalies, and neonatal death
�Risk factors for gestational diabetes
-Linked to multiple genetic factors and their environmental triggers
�Excess body fat
�Unhealthful diets
�Low physical activity levels
�Diagnosis of gestational diabetes
-All pregnant women should be screened at first prenatal visit
�Confirm positive result for:
-Hemoglobin A1c (A1c) > 6.5%
-Fasting plasma glucose > 126 mg/dL
-Two-hour glucose > 200 mg/dL after 75-gram oral glucose load
-Classic symptoms of hyperglycemia
�Diagnosis of gestational diabetes contd
-All pregnant women without diabetes should be tested by a 75-gm oral glucose tolerance test at 24-28 weeks
�Diagnosis cutpoints:
-Fasting plasma glucose > 92 mg/dL
-1-hr plasma glucose > 180 mg/dL
-2-hr plasma glucose > 153 mg/dL
�Management of gestational diabetes
-Mainstay: medical nutrition therapy to normalize blood glucose levels with diet and exercise
�Blood glucose levels can be brought down with low calorie intake; avoid elevated ketones
�Oral medication metformin (glyburide) is used to decrease insulin resi
Exercise benefits and recommendations (gestational diabetes)
-Regular aerobic exercise
�Nutritional management of women with gestational diabetes
-Assess dietary and exercise habits
-Develop a diet and exercise plan
-Monitor weight gain
-Interpret blood glucose and urinary ketone results
-Ensure follow-up during and after pregnancy
�The dietary pattern plan(gestational diabtetes)
-Whole-grain breads and cereals, vegetables, fruits, and high-fiber foods
-Minimally processed, nutrient-dense foods
-Limited intake sugars
-Low-glycemic index foods
-Unsaturated fats
-Three regular meals and snacks daily
�Prevention of gestational diabetes
-Reduce excessive weight and obesity
-Increase physical activity
-Decrease insulin resistance prior to pregnancy
�Care should be individualized and follow protocol(type 2 diabetes)
-Primary goal: maintain normal blood glucose
�Management of type 2 diabetes in pregnancy
-Hyperglycemia and hypoglycemia pose threats
-Routine testing for urinary ketones not recommended
Potentially, a more hazardous condition than gestational or type 2 diabetes(type 10
-Mother is at risk for kidney disease, hypertension, and preclampsia, etc.
-Newborn is at risk for mortality, being SGA or LGA, and hypoglycemia within 12 hours after birth
�Nutritional management of type 1 diabetes during pregnancy
-Control of blood glucose levels
-Caloric and nutritional adequacy of diet
-Achieve recommended weight gain
-Careful home monitoring of glucose levels and dietary intake, exercise, and insulin dose
�U.S. rates of multifetal pregnancies have increased
-Linked to assisted reproductive technologies, progressively older ages, and weight status
Dizygotic (multifetal pregnancies)
-two eggs are fertilized
�Incidence increased by perinatal nutrient supplements
Monozygotic(multiefetal pregnancies)
-one egg is fertilized
�Always the same sex
�Rates appear not to be influenced by heredity
�In utero growth of twins and triplets
-Weight gain rate variations
�The vanishing twin phenomenon
disappearance of embryos within 13 weeks of conception
�Interventions and services for risk reduction
-Special multidisciplinary programs
-Weight gain in multifetal pregnancy based on prepregnancy weight
�Normal gain: 37-54 pounds
�Five to seven pounds in the first trimester
�One to two pounds per week in second and third trimesters
-Weight gain in triplet pregnancy
�Gain of about 50 pounds
�Dietary intake in twin pregnancy
-Higher caloric need
-Benefits from increases in essential fatty acids, iron, and calcium
�Vitamin and mineral supplements(multifetal pregnancies)
-Needs unknown
�Treatment of HIV/AIDS
-Needed before, during, and after pregnancy
�Consequences of HIV/AIDS during pregnancy
-Infection does not appear to be related to adverse pregnancy outcome
�Nutritional factors and HIV/AIDS during pregnancy
-Needs increase most in advanced stages
�Eating disorders are rare in pregnancy
-Most females with such disorders are subfertile or infertile
�Eating disorder symptoms often subside in second and third trimester but return after delivery
�Consequences of eating disorders in pregnancy
-Spontaneous abortion
-Hypertension
-Preterm labor
-Anemia
-Genitourinary tract infection
-Difficult deliveries
�Treatment of women with eating disorders during pregnancy
-Refer to eating disorders clinic or specialist
�Nutritional interventions for women with eating disorders during pregnancy
-Behavioral changes
-Improve nutritional status
-Appropriate weight gain
�Range of effects fetal alcohol exposure has on mental development and physical growth
-Fetal alcohol syndrome (FAS)
-Alcohol-related neurodevelopmental disorder (ARND)
-Alcohol-related birth defects (ARBD)
�Recommendations concerning alcohol intake during pregnancy
-It is recommended that women do not drink alcohol while pregnant
�Rates of teen birth
-Declined by 63 percent over past 20 years
�Growth during adolescent pregnancy
-Teens grow in height and weight at the expense of the fetus
-Infants born to teens average 155 grams less thank those born to adults
�Obesity, excess weight gain, and adolescent pregnancy
-Increased risk for Cesarean delivery, hypertensive disorders, gestational diabetes, and delivery of excessively large infants
�Nutritional recommendations for pregnant adolescents
-More calories to support their own growth and the fetus
�Evidence-based practice(Nutrition and Adolescent Pregnancy)
�Evidence-based practice
-Practices not supported by scientific evidence should always be questioned and confirmed to represent "best practice" insofar as that can be determined