CHAPTER 4-5 FSHN 322

Preterm pregnancy

Defined as delivery before 37 weeks of gestation.

Term pregnancy

Defined as pregnancy lasting between 38 to 42 weeks.

Post-term pregnancy

Defined as pregnancy lasting beyond 42 weeks.

Low birthweight

Infants who weigh less than 2500 grams at birth, often associated with preterm deliveries.

Preterm delivery

Delivery that occurs before 37 completed weeks of pregnancy.

nutritional Increasing risk

o   Underweight and gain less than recommended

o   Pre-pregnancy obesity

o   Increased cholesterol, TG, FFA, markers of inflammation and oxidative stress

·       Decreasing risk

o   Use of multivitamin supplements and adequate folate intake

o   1-3 fish meals per week

o   exercise

Infant mortality

The death of an infant before their first birthday.

Nutritional genomics

Study of how nutrition and genetics interact and how this affects disease risk.

Epigenetic modification

Changes in gene expression caused by mechanisms other than changes in the DNA sequence.

Fetal origins of adult disease hypothesis

Theory suggesting that environmental factors during fetal development may affect health later in life.

Dutch famine studies

Research analyzing health effects on individuals exposed to famine during gestation. • Decreased glucose tolerance

 Famine exposure during early gestation

• Atherogenic lipid profile

• Increased BMI and CHD risk

Anabolic phase of pregnancy

The first 20 weeks where nutrient stores are built and fat is accumulated.

 Blood volume expansion

 increased cardiac output

 buildup of fat, nutritent, and liver glycogen stores

 growth of some maternal organs

 increased appetite & food intake

 decreased exercise tolerance

 increased levels of anabolic hormones

Catabolic phase of pregnancy

The phase after 20 weeks when fat and nutrient stores are mobilized for fetal growth.

 Mobilization of fat and nutrient stores

 Increased production and blood levels of glucose, triglycerides, and fatty acids

 Decreased liver glycogen stores

 Accelerated fasting metabolism

 Increased appetite and food intake declines near term

 Increased levels of catabolic hormones

Placenta

o   Hormone and enzyme synthesis

o   Nutrient and gas exchange

o   Removal of waste products from fetus

o   Prevents passage of maternal red blood cells, bacteria, and large proteins

Human Chorionic Gonadotropin (hCG)

   Maintains early pregnancy by stimulation estrogen and progesterone production by 2^nd month

Progesterone

• Maintains implant

• Induces changes in uterine and gastrointestinal structure

• Stimulates Brest duct development

• Promotes Brest and uterine development

Estrogen

• Increases fat synthesis and deposition

• Protein synthesis

• Promotes breast and uterine development

Human Chorionic Somatotropin (hCS)

• Increases maternal insulin resistance

• Promotes protein synthesis

• Breakdown of maternal energy source

Leptin

• Regulates appetite and fat metabolism

• Weight gain

• Utilization of fat as maternal energy source

Glucose metabolism in pregnancy

Insulin insensitivity in the third trimester increases glucose availability for the fetus.

Protein metabolism in pregnancy

Accumulation of proteins occurs, with minimal nitrogen excretion.

Fat metabolism in pregnancy

 First half: fat storage

 Second half: fat breakdown

Calcium requirements in pregnancy

Pregnant women need additional calcium to support fetal skeletal development.

o   Increased water volume and tissue synthesis requires increased sodium and other electrolytes

Sodium requirements in pregnancy

Increased sodium intake is necessary due to increased blood volume.

Pica

Craving for non-food items, often linked to mineral deficiencies.

Fetal growth classifications

AGA, LGA, IUGR, SGA - classifications based on growth parameters.

AGA

Appropriate for gestational age - 10th to 90th percentile.

LGA

Large for gestational age - above the 90th percentile.

IUGR

Intrauterine growth restriction - term for infants who are smaller than expected.

SGA

Small for gestational age - below the 10th percentile.

Postpartum weight retention

Women retaining more weight after delivery due to insufficient weight loss.

Caloric recommendations during pregnancy

Additional caloric intake of 340-452 kcal/day based on trimester.

+0 kcal/day for first trimester

+340 kcal/day for second trimester

 +452 kcal/day for 3^rd trimester

Carbohydrate needs in pregnancy

45-65% of daily calories should come from carbohydrates, with a minimum of 175g.

 At least 175g

 From:

• Whole grain products

• Fruits and vegetables

• Other foods that contain no added sugars

Protein needs in pregnancy

Recommended protein intake is 71g/day for tissue synthesis.

 Needs to increase

 71 g/day

 Used for tissue synthesis (for baby)

Omega-3 fatty acids in pregnancy

300mg/day of EPA and DHA is recommended for fetal neural development.

• 1.4g/day

• Eicosapentaenoic acid (EPA) & Docosahexaenoic acid (DHA) are crucial for fetal neural development, and can be made from dietary ALA, but in low amounts (only 9% conversion of ALA to EPA/DHA)

o Must be obtained from diet

o From:

 Cod liver oil

 Fish oil (salmon, sardines, herring)

Folic acid requirements in pregnancy

600 mcg daily; 400 mcg from fortified foods.

·       Orange

·       Pineapple juice

·       Papaya juice

·       Dried beans

·       Cereal

·       Bread

·       Pasta

·       Rice

MTHFR C677T variant

Gene variant affecting folate metabolism, higher risk for neural tube defects.

Food safety considerations in pregnancy

o Pregnant women are more susceptible to foodborne infections

 Listeria monocytogenes (spontaneous abortions and stillbirth)

o Avoid:

 Raw fish

 Oysters

 Uncooked meat

 Unpasteurized milk

 Correctly store lunch meats and hotdogs

 Raw meats

• Can be passed on from cats

 Large, long lived fish

• Sharks

• Swordfish

• Tilefish

• Albacore tuna

• Bass

o Risks

 Toxoplasma gondii (mental retardation, blindness, death)

 Mercury (fetal neurotoxin)

Exercise recommendations during pregnancy

At least 150 minutes of moderate exercise per week.

Hyperemesis gravidarum

Severe nausea and vomiting during pregnancy.

Heartburn management during pregnancy

Eat small meals, avoid lying down after eating, limit acidic foods.

Constipation management during pregnancy

Increase dietary fiber and hydration; laxatives are not recommended.

Gestational diabetes (GDM)

Diabetes that develops during pregnancy, often managed through diet and exercise.

Risks associated with GDM

Increased risks of stillbirth, macrosomia, and early C-section.

Mean gestational age for twins

Twins average a gestational age of 37 weeks.

Mean gestational age for triplets

Triplets average a gestational age of 33-34 weeks.

Weight gain guidelines for multifetal pregnancies

Recommended gain of 37-54 lbs for twin pregnancies.

Eating Disorders during pregnancy

Associated with risks such as low fertility and poor weight gain.

Nutrition recommendations for pregnant teens

Increased caloric, calcium, and vitamin D needs, similar protein as adults.

weight gain guidelines

o dSGA

disproportionally SGA

 <10th percentile for gestational age

 with normal length and head circumference

 Skinny, wasted appearance, small abdomens, little body fat

 Due to low maternal weight gain or poor nutrition in 3rd trimester

o pSGA

proportionally SGA

 <10th percentile for weight, length,and head circumference

 Small but normally proportioned

 Likely due to long-term malnutrition in utero

postpartum weight retention

o Prevent by:

 Pregnancy weight gain management programs

 Weight loss of 1 to 2 pounds per month

 Breastfeeding may facilitate weight loss but should not be promoted as an effective weight loss method

Linoleic acid (omega-6)

• 13g/day

• From plany oils

four types of hypertensive disorders during pregnancy

o   Chronic hypertension

o   Gestational hypertension

o   Preeclampsia & eclampsia

o   Preeclampsia & eclampsia

 Oxidative stress

 Platelet aggression, increased coagulation

 Restricted blood flow

 Hypertension

 Insulin resistance

 Increased FA TG cholesterol

 Proteinuria

 Pre-pregnancy and pregnancy diets high in plant foods and fiber tend do decrease while diets high in processed meats, drinks and salty snacks tend to increase the risk

 Additional antioxidants

• No individual supplement has shown to be effective

 Salt

• No restriction has shown to make change

Gestational hypertension

 First occurs during pregnancy

 Increased risk of later hypertension and stroke

 Associated with maternal obesity and central adiposity

 Recommendations

• Similar dietary recommendations to chronic hypertension

o Chronic hypertension

 Diagnosed before pregnancy

 Increased risk of preeclampsia, preterm, growth, retardation

 Recommendations

• Follow hypertension related diet prescribed before pregnancy

• Salt restriction is NOT recommended but can be decreased if previously treated

the three main types of diabetes during pregnancy

o   Gestational diabetes

o   Type 2

o   Type 1

Type 1

 Blood glucose should be monitored closely

 Management

• Dietary intake

• Exercise

• Insulin dose

• Ketones should be monitored

Type 2

 Occurs in women who enter pregnancy with T2DM will need medical nutrition therapy and close monitoring

 Management

• Good glucose control before pregnancy

• Time meals with glucose levels and insulin

• Minimize hyper OR hypo glycamia

• Monitor and adjust weight gain

• Manage carbs and include appropriate fiber, fruits, veg, unsat fats

o Gestational diabetes

 In 2-12% of pregnancy, increases with maternal obesity

 Outcomes in mother

• Early C section

• Shoulder dystocia

• Maternal death

• Increased risk of preeclampsia

• Increased risk of gestational diabetes, hypertensino, T2DM

 Outcomes in newborn

• Stillbirth, spontaneous abortion, macrosomia (>10lbs)

• Congenital anomalies

• Increased risk of obesity, hypertension, T2DM, Hypoglycemia, Hypocalcemia

 Treated through diet and exercise

• Assess diet and exercise habits

• Develop individualized diet and exercise plan

• Monitor weight gain and dietary intake

• Interpret blood glucose and urinary ketone results

• Follow up during pregnancy and postpartum

• Diet plan

o Whole grains

o Fruits

o Vegetables

o Unsat fat

o Decrease foods and beverages with simple sugars

o Monitor carb intake

o 3 meals and snacks with distributed calories

GM in mother

• Early C section

• Shoulder dystocia

• Maternal death

• Increased risk of preeclampsia

• Increased risk of gestational diabetes, hypertensino, T2DM

GM in newborn

• Stillbirth, spontaneous abortion, macrosomia (>10lbs)

• Congenital anomalies

• Increased risk of obesity, hypertension, T2DM, Hypoglycemia, Hypocalcemia

twin risks in mom

 Hypertension and preelampsia

 Anemia

 GDM

 Placenta previa

 Kidney disease

 Preterm delivery

 C section

 Fetal loss

twin risks in baby

 Death

 Congenital abnormalities

 Respiratory distress

 Cardiac dysfunction

 Cerebral palsy

 LBW

twin birth age & brithweights

 37 weeks

 5.4 lbs

triplet birth age & brithweights

 33-34 weeks

 4.0 lbs

nutritional recommendations for twins+

 Balanced diet

 Increase caloric needs (+450 cal a day)

 Vitamin and minerals similar to when having one

risk with ED pregnancy

o Risks

 Low fertility

 Preterm labor

 Spontaneous abortion

 IUGR

 Hypertension

 Anemia

 UTI

 Poor weight gain

o Behavioral changes

o Ketosticks to help understand when they are not consuming enough food for healthy pregnancy

guidelines for pregnant teens

o   Similar weight gain and protein as adults

o   Increased caloric needs

o   Increased calcium (+300 mg) and vitamin D needs

o   Referral to food and nutrition programs