Pregnancy Nutrition - Conditions and Interventions Flashcards
What conditions are associated with obesity prior to pregnancy?
higher rates of gestational diabetes and hypertensive disorders
What unfavorable metabolic changes are associated with gestational diabetes and hypertensive conditions?
increased blood glucose levels
high c-reactive protein levels (inflammation market)
increased blood concentration of insulin
insulin resistance
increased blood pressure
high blood levels of total cholesterol, LDL and triglycerides; low levels of HDL
What are the infant outcomes associated with obesity?
higher rates of LGA newborns, stillbirths, c-section
may be at higher risk of becoming overweight during childhood and developing type 2 diabetes due to exposure to high levels of insulin
What are the hypertensive disorders of pregnancy?
chronic hypertension
gestational hypertension
preeclampsia-eclampsia
pre-e superimposed on chronic hypertension
What is chronic hypertension?
present before pregnancy or diagnosed before 20 weeks of pregnancy or diagnosed during pregnancy and doesn’t resolve afterward
blood pressure >=140 systolic; >=90 diastolic
What is gestational hypertension?
elevated blood pressure detected for the first time during mid-pregnancy and there is no protein in the urine
*often obese or overweight with central body fat
What is pre-eclampsia and eclampsia?
pregnancy-specific syndrome
usually occurs after 20 weeks
blood pressure >=140 systolic; >=90 diastolic and accompanied by proteinuria
eclampsia includes seizures with no other cause
*cause unknown
What is pre-e superimposed on chronic hypertension?
the development of proteinuria in women with chronic hypertension
What are all forms of hypertension related to?
chronic inflammation, oxidative stress, damage to the endothelium of blood vessels
oxidative stress within the endothelium leads to endothelial dysfunction who’s consequences are impaired blood flow, tendency to clot, and plaque formation
What dietary factors are associated with chronic inflammation and oxidative stress?
decrease - physical activity; sufficient vitamin D, EPA and DHA; regular intake of colorful F&V, dried beans and whole-grains
increase - frequent intake of processed and high-fat meats and soft drinks and SSBs; regular intake of baked products and trans fats; physical inactivity; high levels of (visceral) body fat; smoking
Who is most likely to have chronic hypertension?
african americans
obese
35+
experienced high blood pressure in previous pregnancy
What characteristics represent pre-e and eclampsia?
oxidative stress, inadequate antioxidant defenses, 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 placenta
elevated blood levels of tris, free fatty acids, and chol
What maternal organs are affected by pre-e?
all can be
most common: placenta, kidney, liver, and brain
What is the cure for pre-e?
delivery
What does pre-e increase the risk for later in life (in the mother)?
heart disease, stroke, hypertension, type 2 diabetes
likelihood of having it in subsequent pregnancies
What are the outcomes related to pre-e?
outcomes range from mild to severe
mother - early delivery by c-section; acute renal disfunction, increased risk of other diseases; placenta rupture
newborn - growth restriction, respiratory distress syndrome
What are some risk factors for pre-e?
first pregnancy, obesity, underweight, mother was SGA, African American or Native American, history of pre-e, type 2 diabetes, 35+, multifetal, insulin resistance, high blood tris, chronic hypertension, renal disease, poor vitamin D or calcium status, diet that promotes inflammation and oxidative stress
What are nutritional recommendations and interventions for pre-e?
ideally begin preconception or asap
calcium supplement, adequate vitamin D, multivitamin, 5+ servings of F&V, follow MyPlate, moderate exercise, follow weight gain recommendations
*iron supplements can aggravate the problem
What are the potential consequences of gestational diabetes for the fetus?
A1c 8+% - spontaneous abortion, stillbirth, neonatal death, congenital anomalies
exposure to high insulin levels in utero - increased fetal formation of fat and muscle, may program metabolic adaptations and increase likelihood of disease in later life
the higher the mother’s glucose and tris the higher the chances of developing these disorders
What is A1c?
form of hemoglobin used to id blood close levels, long-term marker
What are the adverse outcomes associated with gestational diabetes for the mother?
c-section (big babies)
increased risk for pre-e
increased risk for type 2, hypertension and obesity later
gestational diabetes in a subsequent pregnancy
What are risk factors for gestational diabetes?
excess body fat, physical inactivity, low fiber, high glycemic load, weight gain b/t pregnancies, underweight, 35+, certain ethnicities, family history, chronic hypertension, mother was SGA
Who is considered at low risk?
under 25, low-risk ethnic group, no diabetes in first degree relatives, normal weight and gain, no history of glucose intolerance, no prior poor outcomes
How is gestational diabetes screened?
glucose screening - initial 50g 1 hour test
if high (130+ mg/dL) than follow with oral glucose tolerance test
OGTT - 100g 3-hour test
How is gestational diabetes treated?
initially through diet and exercise, insulin if necessary
shouldn’t be controlled through low-calorie intake or restricting weight gain
What hazards does type 1 diabetes present during pregnancy?
potentially more hazardous than gestational diabetes
kidney disease, hypertension, other complications
baby - increased risk of mortality, SGA, LGA, hypoglycemia within 12 hours after birth, congenital malformations of the pelvis, central nervous system and heart
What are the goals of nutritional management of type 1 diabetes during pregnancy?
continual control of blood glucose
nutritional adequacy of dietary intake
achieve recommended weight gains
healthy mother and newborn
Why are multifetal pregnancies increasing?
assisted reproductive technology
progressively older age of mothers (35+ more likely to have multiples)
multiples more likely with increasing weight status
What are the risks associated with multifetal pregnancy?
mother - pre-c, iron-deficiency anemia, gestational diabetes, hyperemesis gravidarum, placenta prevue, kidney disease, fetal loss, preterm and c-section delivery
newborns - neonatal death, congenital abnormalities, respiratory distress syndrome, intraventricular hemorrhage, cerebral palsy
What are the nutritional management goals during pregnancy for women with HIV/AIDS?
maintain positive nitrogen balance and preserve lean muscle and bone mass
adequate intake of energy and nutrients
correct elements of poor nutritional status
adopt safe food-handling practices (high risk)
deliver a healthy newborn
What are the consequences of eating disorders in pregnancy?
higher risk for spontaneous abortion, hypertension, difficult delivery
newborns tend to be smaller and experience higher rates of complications
What is the difference between fetal alcohol spectrum and fetal alcohol syndrome?
spectrum describes a range of effect
syndrome is when they exhibit a specific set of characteristics
What risks does heavy drinking pose?
increased risk of miscarriage, stillbirth, infant death within first month
What effects can alcohol exposure during critical periods have on the infant?
permanently impair organ and tissue formation, growth, health and mental development
What are the characteristics of fetal alcohol syndrome?
pSGA, mental retardation, set of common malformations - short noses, flat nasal bridges, thin upper lip, small chin, abnormal ear shape, small eye openings, smooth philtrum, upturned nose, flat mid face, epicentral folds
must also have a documented neurological disorder and reduced growth
What is included in the fetal alcohol spectrum?
behavioral problems, short attention span, mental retardation, aggressiveness, nervousness, growth-stunting, birth defects
doesn’t usually have the malformation of FAS
What complications are pregnant adolescents at higher risk for?
low birth weight, perinatal death, c-section, head too large for birth canal, pre-e, iron-deficiency anemia, low income, delayed or reduced educational achievement
What is the concern with growing adolescents compared to non-growing adolescents?
they compete for the calories and nutrients at the expense of the fetus
have higher rates of spontaneous abortion, preterm birth, low birth weight, retain more postpartum weight, surge of blood leptin in last trimester increasing utilization of glucose instead of fat stores
How are dietary recommendations for adolescents different than older women?
basically the same
may need more calories to support their own growth
higher calcium requirement - 1300 mg per day
How does PKU impact babies with it and how can it be identified?
neonatal screening
one of few preventable causes of mental retardation
need a special formula and can’t be breastfeed
What do mothers with PKU need to do?
ideally start back on the special PKU diet 6 months before conception and stick to it strictly through pregnancy
What is PKU?
the inability to synthesize phenylalanine into tyrosine so the phe builds up in the body and causes health problems
What foods are high in phenylalanine?
protein foods - meat, fish, dairy diet sodas wheat beans and legumes nuts
What can fetal exposure to high phe levels cause?
mental retardation, microcephaly, IUGR, congenital heart defects
Why is alcohol consumption a problem for the fetus (compared to other exposures)?
alcohol easily crosses the placenta
fetus lacks the enzymes to break it down
What are the 3 types of diabetes?
Type 1 - body can’t produce insulin
Type 2 - body doesn’t use insulin normally or can’t produce enough
Gestational - carb intolerance
How common is gestational diabetes?
approx. 5% of pregnant women
What is the nutritional management plan for women with gestational diabetes?
assess diet and exercise habits individualized diet and exercise plan monitor weight gain interpret blood glucose & urinary ketone results follow up during and after pregnancy 15% remain glucose intolerant 10-15% develop Type 2 within 2-5 years
What’s a normal blood pressure?
120/80
What is the difference between systolic and diastolic blood pressure?
systolic - pressure when the heart is contracting
diastolic - pressure when the heart is relaxing
What percent of pregnancies are affected by HTN?
6-10%
chronic: 1-5%
What are potential consequences of HTN during pregnancy?
contributes to stillbirths, fetal and newborn deaths and other adverse conditions, retardation
*especially above 160/110
What are ways to reduce oxidative stress?
physical activity prevent overweight (before pregnancy) adequate intake of vitamin D and essential fatty acids regular intake of colorful F&V, whole grains, dried beans
What are nutrition interventions for chronic HTN?
aim to achieve adequate and balanced diets
weight gain recs are the same
for salt sensitive type - restrict but too much to harm fetus
How do you test for proteinuria?
24 hr urine sample: >= 0.3g protein (30 mg/dL)
dipstick: reading >=2
What are signs and symptoms of pre-e?
HTN, increased urinary protein, decreased blood volume expansion, low urine output, persistent and severe headaches, blurred vision, sensitivity to light, nausea, abdominal pain
