2. Learning Objectives
Some pregnancy complications are
related to women’s nutritional status
Nutritional interventions for pregnancy
complications can benefit maternal
and infant health
Should be based on scientific evidence
for safety, effectiveness, & affordability
4. Hypertensive Disorders of Pregnancy
Hypertension (HTN): defined as systolic
blood pressure ≥140 mm Hg or diastolic
blood pressure ≥90 mm Hg
Affects 6-8% of pregnancies
Contributes to stillbirths, fetal & newborn
deaths, & other complications
Previously known as “Pregnancy-
induced hypertension”
5. Hypertensive Disorders of Pregnancy,
Oxidative Stress, & Nutrition
HTN in pregnancy is related to:
Inflammation
Oxidative stress
Damage to the endothelium (cells lining the
inside of blood vessels)
Consequences of endothelial
dysfunction:
Impaired blood flow
Increased tendency to clot
Plaque formation
6.
7. Ways to Reduce Oxidative Stress
Exclude trans fats from diet
Adequate intake of vitamins C & E, the
carotenoids, & antioxidants from plants
Ample physical activity
Weight loss if overweight (not recommended
during pregnancy)
Consume low-glycemic index foods
8. Chronic Hypertension
HTN present before pregnancy or
diagnosed <20 weeks
Estimated incidence is 1-5%
More common in:
African American, obese, >35 years of age, or
history of HTN with previous pregnancy
Blood pressure ≥ 160/110 mm Hg
associated with increased risk of:
fetal death, preterm delivery, & fetal growth
retardation
9. Nutritional Interventions for Women with
Chronic Hypertension in Pregnancy
Intervention should aim to achieve adequate &
balanced diets for pregnancy
Weight gain is same as for other pregnant
women
If salt-sensitive, Na restriction required for
blood pressure control yet without too little
that could impair fetal growth
10. Gestational Hypertension
Hypertension diagnosed for first time
after 20 weeks of pregnancy
If blood pressure returns to normal by
12 weeks postpartum, it’s called
transient hypertension of pregnancy
11. Preeclampsia-Eclampsia
A pregnancy-specific syndrome
occurring >20 weeks gestation
accompanied by proteinuria
Proteinuria: urinary excretion of ≥0.3 gram
protein in 24-hour urine sample (or >30
mg/dL protein or ≥2 on dipstick reading)
Eclampsia: occurrence of seizures not
attributed to other causes
12. Characteristics of Preeclampsia-Eclampsia
Oxidative stress, inflammation, & endothelial
dysfunction
Blood vessel spasms & constriction
Increased blood pressure
Adverse maternal immune system responses to the
placenta
Platelet aggregation & blood coagulation due to
deficits in prostacyclin relative to thromboxane
Alterations of hormonal & other systems related to
blood volume & pressure control
Alteration in calcium regulatory hormone
Reduced calcium excretion
16. Diabetes in Pregnancy
Diabetes: 2nd leading complication in
pregnancy
Forms of diabetes include:
Type 1 diabetes: results from destruction of
insulin-producing cells of pancreas
Type 2 diabetes: due to body’s inability to
use insulin normally, or produce enough
insulin
Gestational: CHO intolerance with 1st onset
during pregnancy
17. Gestational Diabetes
Seen in ~3-7% of pregnant women
Women who develop gestational
diabetes appear to be predisposed to
insulin resistance & type 2 diabetes
Associated with increased levels of
blood glucose, triglycerides, fatty acids
& blood pressure
18. Potential Consequences of
Gestational Diabetes
Elevated glucose from mother reaches
fetus resulting in increased insulin
production
Increased insulin leads to increased glucose
uptake & triglyceride formation in fetus
Fetal changes may increase likelihood of
complications later in life such as:
Insulin resistance
Type 2 diabetes
High blood pressure
19.
20.
21. Diagnosis of Gestational Diabetes
Glucose screening recommended for
women at high risk
Risk factors are listed below:
Marked obesity
Diabetes in a parent or sibling
History of glucose intolerance
Previous macrosomic infant
Current glucosuria
22. Treatment of Gestational Diabetes
First approach is to normalize blood
glucose levels with diet & exercise
If postprandial glucose remains high 2
weeks after adhering to diet &
exercise, insulin injections are added
Medical nutrition therapy decreases
risk of adverse perinatal outcomes
23. Exercise Benefits & Recommendations
Regular aerobic exercise decreases
insulin resistance & blood glucose in
gestational diabetes
Exercise should approximate 50-60% of
VO2 max
24. Nutritional Management of Women
with Gestational Diabetes
1. Assess dietary & exercise habits
2. Develop individualized diet & exercise
plan
3. Monitor weight gain
4. Interpret blood glucose & urinary
ketone results
5. Ensure follow-up during & after
pregnancy
25. Type 1 Diabetes during Pregnancy
Potentially, a more hazardous condition than
most cases of gestational diabetes
Mother with type 1 is at risk of:
Kidney disease
Hypertension
Other complications
Newborn born to her is at risk of:
Mortality
Being SGA or LGA
Hypoglycemia within 12 hours after birth
26. Nutritional Management of Type 1
Diabetes during Pregnancy
Control of blood glucose levels
Nutritional adequacy of diet
Achieve recommended weight gain
Careful home monitoring of glucose
levels & dietary intake, exercise, insulin
dose, & urinary ketone levels
27. Multifetal Pregnancies
U.S. rates of multifetal pregnancies
have increased
Linked to assisted reproductive
technologies
Only 1 in 5 triplets are spontaneously
conceived
Incidence highest in women 45 to 54
y/o (1 in 5 are multifetal)
28. Background Information
About Multifetal Pregnancies
Dizygotic Monozygotic
2 eggs are fertilized 1 egg is fertilized
AKA Fraternal AKA Identical
~70% of twins (or almost identical)
Different genetic Always same sex
“fingerprints” ~30% of twins
Incidence increased Rates appear not to be
by perinatal nutrient influenced by heredity
supplements
29. Differences in Placentas & Amniotic Sacs
Twins with 2 amniotic Twins with 1 Twins with 2
sacs, 2 chorions, & 2 amniotic sac, 1 amniotic sacs, 1
placentas chorion, & 1 chorion, & fused
placenta placentas
30. Nutrition & the Outcome of
Multifetal Pregnancy
Weight gain in multifetal pregnancy
35-45 pounds
Rate of weight gain in twin pregnancy
0.5 pounds per week in 1st trimester
1.5 pounds per week in 2nd & 3rd trimesters
Weight gain in triplet pregnancy
Gain of ~50 pounds or 1.5 pounds per week
31. Nutrition & the Outcome of
Multifetal Pregnancy
Dietary intake in twin pregnancy
Benefits from increases in essential fatty
acids, iron & calcium
Vitamin and mineral supplements
Needs unknown
Nutritional recommendations
Based on logical assumptions & theories
32. HIV/AIDS during Pregnancy
Treatment of HIV/AIDS
Needed before, during, & after pregnancy
Consequences of HIV/AIDS during
pregnancy
Infectiondoes not appear to be related to
adverse pregnancy outcome
Nutritional factors and HIV/AIDS during
pregnancy
Nutritional
needs increase the most in
advanced stages of HIV/AIDS
33. Nutritional Management for Women
With HIV/AIDS during Pregnancy
Goalsfor nutritional management
include:
Maintenance of positive nitrogen balance &
preservation of lean muscle & bone mass
Adequate intake of energy & nutrients to
support maternal physiological changes &
fetal growth & development
Correction of elements of poor nutritional
status identified by nutritional assessment
Avoid foodborne infection
34. Eating Disorders in Pregnancy
Rare in pregnancy since most females
with disorders are subfertile or infertile
Bulimics more likely to become
pregnant than those with anorexia
nervosa
Eating disorder symptoms subside in
2nd & 3rd trimester but return
postpartum
35. Eating Disorders in Pregnancy
Consequences of eating disorders in
pregnancy
Treatment of women with eating
disorders during pregnancy
Nutritional interventions for women
with eating disorders
36. Fetal Alcohol Spectrum
“Fetalalcohol spectrum” describes
range of effects that fetal alcohol
exposure has on mental
development & physical growth
Effectsinclude
Behavioral problems
Mental retardation
Aggressiveness
Nervousness & short attention span
Stunting growth & birth defects
37. Fetal Alcohol Spectrum
Fetal exposure to alcohol is a
leading preventable cause of
birth defects
~1 in 12 American pregnant
women drink alcohol
1 in 30 consume ≥5 drinks on 1
occasion at least monthly
1 in 1000 newborns are affected
by fetal alcohol syndrome
38. Effects of Alcohol on Pregnancy Outcome
Alcohol easily crosses placenta to fetus
Alcohol remains in fetal circulation
because fetus lacks enzymes to break
down alcohol
Alcohol exposure during critical periods
of growth & development can
permanently impair organ & tissue
formation
39. Effects of Alcohol on Pregnancy Outcome
Heavy drinking (4-5 drinks/day) increases
risk of miscarriage, stillbirth, & infant death
~40% of fetuses born to women who drink
heavily will have fetal alcohol syndrome
A “safe” dose of alcohol consumption
during pregnancy has not been identified
Recommendation: women should not drink
alcohol while pregnant
40. Nutrition & Adolescent Pregnancy
Growth during adolescent pregnancy
Teen growth in height & weight at
expense of fetus
Infants born to teens average 155g less
than those born to older adults
42. Obesity, Excess Weight Gain, &
Adolescent Pregnancy
Overweight & obese adolescents
are at increased risk for:
Cesarean delivery
Hypertensive disorders of pregnancy
Gestational diabetes
Delivery of excessively large infants
43. Dietary Recommendations for
Pregnant Adolescents
Adolescents may need more calories to
support their own growth as well as
that of fetus
Caloric need should be from a
nutrient-dense diet
Calcium DRI for pregnant teens is
1300 mg
44. Nutritional Management of
Adolescent Pregnancy
Multidisciplinary counseling
services should include:
Individualized nutrition
assessment
Intervention education
Guidance on weight gain
Follow-up birthweight outcomes
46. Evidence-Based Practice
“Enormous amounts of new knowledge are
barreling down the information highway, but
they are not arriving at the doorsteps of our
patients.”
Claude Lenfant, National Institutes of Health
