Lifecycle Nutrition Chapter 5

Nutrition during pregnancy; conditions and interventions

What conditions are associated with obesity during pregnancy?

Gestational diabetes, preeclampsia, postpartum hemorrhage, and preterm delivery

Visceral fat

Visceral fat lies beneath skin and muscles of the abdomen, and around internal organs, more metabolically active than subcutaneous fat and more strongly related to disease risk

How does visceral fat contribute to disease risk?

Metabolic processes initiated by visceral fat produce chronic inflammation, free-radical generation, and oxidative stress, promoting the development of insulin resistance, elevated blood glucose, insulin, triglyceride concentrations, and increased blood pressure

What is the risk of having excess visceral fat during pregnancy?

Increases risk of gestational diabetes, hypertensive disorders, and other clinical conditions

What risks are present for the child of a mother with excess visceral fat during pregnancy?

Higher risk of becoming obese, developing type 2 diabetes, heart disease, stroke, and asthma

What embryonic and fetal exposure is influencing the development of obesity?

Excess blood concentrations of inflammatory markers, oxidative stress, and elevated blood glucose levels

What are the weight gain trends during pregnancy for women who enter pregnancy obese?

More likely to gain too much weight and to retain more of the weight gained after pregnancy

What are weight management recommendations for obese pregnant women?

Interventions aimed at maintaining appropriate rates of weight gain, should not try to lose weight while pregnant, consume variety of nutritious foods, exercise regularly

What are the risks of pregnancy for women who have had bariatric surgery?

Women lose weight rapidly after surgery due to limited intake, malabsorption of macronutrients (especially protein), which depletes nutrient stores

What is the recommendation for women trying to get pregnant after having bariatric surgery?

Recommended that pregnancy be postponed, possibly several years, until weight has stabilized and nutrient stores have replenished.

Dumping syndrome

Condition characterized by weakness, dizziness, flushing, nausea, and palpitation immediately or shortly after eating and produced by abnormally rapid emptying of the stomach, especially in individuals who have had part of the stomach removed.

Gestational diabetes

Carbohydrate intolerance with onset of, or first recognition in, pregnancy

Preeclampsia

Condition typically diagnosed after the 20th week of pregnancy. Characterized by blood pressure higher than 140/90 mm/Hg at two different readings at least 4 hours apart

What are some risk factors for hypertension during pregnancy?

Chronic inflammation, hypertension, chronic kidney disease, polycystic ovary syndrome, obesity, and high maternal age

Oxidative stress

Condition that occurs when cells are exposed to more oxidizing molecules (i.e. free radicals) than to antioxidant molecules that neutralize them and help repair cell damage

Endothelial dysfunction in pregnancy

Caused by oxidative stress, which can lead to restriction of placental blood flow, increased tendency of blood clots, and plaque formation

Endothelium

Layer of cells lining the inside of blood vessels

Placenta abruption

Separation of the placenta from uterus wall before delivery, complications for mother and baby range from mild to severe depending on blood loss, extent of fetal distress, gestational age, etc.

Gestational hypertension

Condition when elevated blood pressure levels are detected for the first time after mid-pregnancy, not indicated by proteinuria

Eclampsia

Term used when a woman with preeclampsia experiences seizures late in pregnancy that cannot be attributed to another cause

What are the nutritional recommendations for chronic hypertension in pregnancy?

Healthy diet pattern, exercise, follow normal weight-gain recommendations, don’t restrict sodium intake

Deficits in what compounds are responsible for platelet aggregation and coagulation during preeclampsia?

Prostacyclin and thromboxane

What are some symptoms of preeclampsia?

Hypertension, decreased plasma volume expansion (Hb >13 g/dL), low urine output, persistent and severe headaches, sensitivity to bright lights, blurred vision, abdominal pain, nausea

What are some outcomes related to preeclampsia for the mother?

Early delivery via C-section, acute renal dysfunction, increased risk of gestational diabetes, hypertension, and type 2 diabetes later in life, and placenta abruption

What are the outcomes associated with preeclampsia for newborns?

Preterm delivery, growth restriction, respiratory distress syndrome, fetal death, maternal death

Prostacyclin

Potent inhibitor of platelet aggregation and a powerful vasodilator and blood pressure reducer derived from n-3 fatty acids

Thromboxane

Parent of a group of thromboxanes derived from the n-6 fatty acid arachidonic acid, increases platelet aggregation and constricts blood vessels, causing blood pressure to increase

What are some risk factors for preeclampsia?

Obesity, underweight, African American or American Indian, diabetes, over 35, multifetal pregnancy, insulin resistance, chronic hypertension

What are some dietary recommendations to prevent the development of preeclampsia?

Ideally beginning before pregnancy; regularly consuming variety of colorful fruits and vegetables, consuming fiber, water, low-fat dairy, use of vegetable oils, limit processed meats, moderate physical activity

What is the cure for preeclampsia and eclampsia?

Delivery of the placenta

What are some adverse outcomes of gestational diabetes for the mother?

C-section, shoulder dystocia, increased risk of preeclampsia, type 2 diabetes, hypertension, obesity, hypoglycemia, maternal death

What are some adverse outcomes of gestational diabetes for the fetus?

Stillbirth, spontaneous abortion, congenital anomalies, macrosomia (>10lb/4500g), neonatal death, neonatal hypoglycemia, hypocalcemia, hyperbilirubinemia, increased risk of insulin resistance, type 2 diabetes, high blood pressure, and obesity

What happens when maternal blood glucose levels are high?

Causes the fetus to increase insulin production to lower glucose, increasing glucose uptake and the conversion of glucose to triglycerides

What are acceptable blood glucose concentrations?

Fasting glucose: <95 mg/dL (<5.3 mmol/L)

1-hour postprandial: <140 mg/dL (7.8 mmol/L)

2-hour postprandial: <120 mg/dL (<6.7 mmol/L)

Can hemoglobin A1c be used to monitor blood glucose?

No, doesn’t reflect current blood glucose levels

Hemoglobin A1c

Form of hemoglobin used to identify blood glucose levels over the lifetime of red blood cell. The amount of glucose molecules attached to hemoglobin is proportional to glucose levels in blood. Normal range is 4-5.9%

Why should oral diabetes medications not be used for pregnant women?

Can be transferred to the fetus via the placenta

Type 2 diabetes in pregnancy

When is hypertension diagnosed during pregnancy?

When > 130/80 mmHg

Chronic hypertension

Diagnosed before 20th week of pregnancy, increases risk of fetal death, preterm delivery, retarded fetal growth

Gestational hypertension

Diagnosed after 20th week of pregnancy, usually resolves within one week postpartum

Preeclampsia

Occurs after 20 weeks of pregnancy, up to 6 weeks postpartum, only cured through delivery, if left untreated can progress into eclampsia

Signs of preeclampsia

Hypertension, proteinuria, excessive edema, low urine output, headache, blurred vision, abdominal pain, convulsion

Biochemical changes during preeclampsia

Blood clots, vasoconstriction, high insulin/homocysteineW

What organs are affected by preeclampsia?

Placenta, mother’s kidneys, liver, and brain

Risk factors for preeclampsia + eclampsia

First pregnancy, obesity, underweight, mother’s smallness at birth, multifetal pregnancy, >35 years old, history of preeclampsia, insulin resistance, high homocysteine levels, chronic hypertension, renal disease, inadequate diet

Nutrition recommendations for preeclampsia

Regular intake of colorful fruits and vegetables, good sources of fiber, water to replace sugar-sweetened beverages, low-fat dairy, vegetable oils, limit processed and red meats, moderate-intensity physical activity for 30 mins a day, appropriate weight gain

What are risk factors for gestational diabetes?

Obesity, weight gain between pregnancy, underweight, >35 years, ethnicity, family history, history of GDM, chronic HTN, mother SGA at birth

Treatment of gestational diabetes

Goal is to normalize blood glucose levels through lifestyle changes, insulin injection if not (oral meds can pass through placenta)

What are the dangers of type 1 diabetes for mother?

Increased risk of kidney disease, hypertension, preeclampsia, and other complications of pregnancy

What are the dangers of type 1 diabetes for newborns?

Increased risk of mortality, of being SGA or LGA, experiencing hypoglycemia and other problems within 12 hours after birth

Management of type 1 diabetes in pregnancy

Monitoring of glucose levels & urinary ketone, nutritional care, exercise, insulin

Risk factors for multifetal pregnancies

>35 years old, obesity

Risks of complications in multifetal pregnancies decrease when

Twins: 3000 - 3500g, born at 37-39 wks Triplet: >2000g, born at 34-35 wks

Risks to mother associated with multifetal pregnancy

Preeclampsia, iron-deficiency anemia, gestational diabetes, hyperemesis gravidarum, placenta previa, kidney disease, fetal loss, preterm delivery, C-section

Risks to fetus associated with multifetal pregnancy

Neonatal death, congenital abnormalities, respiratory distress syndrome, intraventricular hemorrhage, cerebral palsy

Rate of weight gain in twin pregnancy

0.5 lbs/wk in 1st trimester, 1.5 lbs/wk in the 2nd and 3rd trimester

Nutritional recommendations for multifetal pregnancies

+450 kcals pre-pregnancy intake

Nutritional factors associated with HIV/AIDS during pregnancy

Nutrient losses & malabsorption due to diarrhea, body’s ability against infection compromised by poor nutritional status, new drugs associated with increased insulin resistance and central body fat, further decrease in immune response during pregnancy make women susceptible to foodborne infection

Nutritional management of HIV/AIDS during pregnancy

Maintenance of a positive nitrogen balance and preservation of lean muscle mass, adequate intake of energy and nutrients to support maternal physiological change and fetal growth and development, correction of elements of poor nutrition, avoidance of foodbourne illness

Consequences of eating disorders

Spontaneous abortion, hypertension, difficult deliveries, low weight gain, small infants, and neonatal complications

Growth during adolescent pregnancy

Teens gain ht and wt during pregnancy at expense of fetal growth, teens gain more fat tissues and retain more postpartum weight

Risks associated with adolescent pregnancy

Low birthweight, perinatal death, C-section, cephalopelvic disproportion, preeclampsia, iron deficiency, delayed/reduced educational achievement, poverty, poor diet quality

RDA for calcium in pregnant teens

1300 mg per day, 300 mg higher than adult pregnant women