3. Pregnancy Effects + Nutrtion

expected reproductive changes during pregnancy

• uterus capacity increases

• cervix softens

• vaginal vascularity increases

• ovulation stops

• breasts enlarge in preparation for lactation

how much does the uterus grow in pregnancy?

from 10mL capacity to 5000mL capacity

because of estrogen, the vagina’s _____ increases during pregnancy

vascularity

• also causes stuffy big noses

GI pregnancy symptoms

• swollen, hyperemic. friable gums

• ptylaism

• gingivitis

• decreased peristalsis and smooth muscle relaxation

• constipation

• hemorrhoids (risk increased)

• slowed gastric emptying (heartburn)

• prolonged gallbladder emptying

• nausea & vomiting

why do gums bleed more easily during pregnancy?

increased vascularity makes the gums hyperemic, swollen, and friable

• bleeding ≠ gingivitis

what is ptyalism?

excessive salivation

what causes constipation during pregnancy?

smooth-muscle relaxation slows peristalsis, allowing more water absorption from stool

what causes constipation during pregnancy?

smooth-muscle relaxation slows peristalsis, allowing more water absorption from stool

what causes heartburn during pregnancy?

slower gastric emptying and relaxation of the lower esophageal sphincter allow reflux

how does pregnancy affect the gallbladder?

gallbladder emptying slows, increasing gallstone risk

expected cardiovascular changes during pregnancy

• blood volume increases about 50%

• cardiac output, venous return, and HR increase

• BP declines slightly until midpregnancy, then returns toward baseline

what causes physiologic anemia of pregnancy?

plasma volume increases more than RBC volume, causing hemodilution

• iron requirements also increase

pregnancy creates a _____ state *

hypercoagulable

• increased fibrinogen + clotting factors help limit blood loss during birth, but clot risk also increases

what teaching helps reduce clot risk during pregnancy? *

encourage regular movement and ambulation to reduce venous stasis

• bed rest is not encouraged in pregnancy

what helps relieve leg varicosities during pregnancy?

• ice (NO heat)

• compression stockings

• leg elevation

• walking

• avoiding prolonged standing or sitting

what causes supine hypotension during pregnancy?

the enlarged uterus compresses the vena cava, reducing venous return and cardiac output

• fetal perfusion can decrease

• reposition the patient onto her side, preferably the left

in supine hypotension, the blood flow to the fetus can _____

decrease

how to treat supine hypotension

reposition the patient onto her left side

expected respiratory changes during pregnancy

• shortness of breath

• more diaphragmatic breathing

• congestion because of increased vascularity

• increased O2 consumption

what does relaxin do during pregnancy? *

it loosens pelvic ligaments and joints to help the pelvis accommodate birth

how does pregnancy affect posture and gait?

• the center of gravity shifts forward, increasing lordosis and upper-spine compensation

• joint loosening contributes to a waddling gait

what is melasma?

hyperpigmentation: dark facial patches

what is linea nigra?

darkened line down belly

what is striae gravidarum?

stretch marks

vascular skin changes during pregnancy

• varicosities: enlarged veins

• vascular spiders: small visible branching blood vessels

• palmar erythema: reddened palms

how do hair and nails change during pregnancy?

• hair shedding decreases (increases again after birth)

• nail growth increases

during pregnancy, basal metabolic rate _____ *

increases

• mom needs more calories

how does increased basal metabolic rate affect nutritional needs during pregnancy? *

caloric intake needs to increase

which nutritional needs increase during pregnancy?

• protein

• iron

• folate

• calories

• take a daily prenatal vitamin/mineral supplement

how much low-mercury fish/seafood is recommended during pregnancy? *

up to 12 oz weekly

• provides omega-3 fatty acids

what kind of fish should women avoid during pregnancy?

high mercury fish

high-mercury fish to avoid during pregnancy

big fish

• shark, swordfish

• king mackerel

• orange roughy

• ahi tuna, tilefish

lower-mercury seafood choices

• salmon and canned light tuna

• sole, tilapia, cod, and haddock

• ollock and catfish

• shrimp and lobster

what does folic acid help prevent? *

neural tube defects

• adequate intake matters before conception and early in pregnancy

how much folic acid does a woman of child-bearing age need daily to prevent neural tube defects? *

400–800 mcg daily

• a previous pregnancy affected by a neural tube defect may require a higher prescribed dose

why is listeriosis dangerous during pregnancy? *

it can cross the placenta and cause miscarriage, stillbirth, or severe newborn infection

foods to avoid to reduce foodborne infection risk during pregnancy *

• raw or unpasteurized dairy

• soft cheeses such (Brie and feta)

• raw fish and undercooked meat (no sushi)

• rare meats or lamb

• refrigerated pâté and uncooked refrigerated smoked seafood

recommended total pregnancy weight gain for BMI under 18.5 *

28–40 lb

recommended total pregnancy weight gain for BMI 18.5–24.9 *

25–35 lb

recommended total pregnancy weight gain for BMI 25–29.9 *

15–25 lb

recommended total pregnancy weight gain for BMI 30 or higher *

11–20 lb