Dr. Louay Labban

• Some complications of pregnancy are related to women’s nutritional status

• Nutritional interventions for a number of complications of pregnancy can benefit maternal and infant health outcomes.

• Nutritional intervention during pregnancy should be based on scientific evidence that supports their safety, effectiveness and affordability

Chronic hypertension: that is present before pregnancy or diagnosed before 20 weeks of pregnancy. Hypertension is defined as blood pressure ≥ 140 mm Hg systolic or ≥ 90 mm Hg diastolic blood pressure.

This condition is more likely to occur in

African-American and obese women, women over 35 years old and women who had previous Bp in the last pregnancy

High BP is associated with and increased risk of fetal death, preterm delivery and fetal growth retardation.

Nutritional intervention for women with chronic hypertension during pregnancy is through monitoring Na intake prior and during pregnancy and exercise.

Gestational hypertension: This condition exists when elevated blood levels are detected for the first time after mid-pregnancy.

It is not accompanied with proteinuria If BP returns to normal by 12 weeks

postpartum, it is called transit hypertension If it remains elevated, it is called chronic

Preeclampsia-Eclampsia: occurs after 20 week of gestation (or earlier)This represents a syndrome characterized by:

1- Blood vessel spasm and constriction 2- Increased BP 3- Adverse maternal immune system responses

to placenta

5- Alterations of hormonal and other system related to blood volume and pressure control

6- Oxidative tissue damage and inflammation 7- Alteration in calcium regulatory hormones

• Hypertension • Increased urinary protein ( albumin ) • Decreased plasma volume expansion

( hemoglobin levels > 13 g/dL) • Low urine output • Persistent and severe headache • Sensitivity of the eyes to bright light • Blurred vision

Nausea Increased platelet aggregation,

vasoconstriction

Mother 1- Early delivery 2- Acute renal dysfunction 3- Increased risk of gestational diabetes,

hypertension and diabetes type 2 later 4- Rupture of plancenta

New born 1- Growth restriction 2- Respiratory distress syndrome

First pregnancy Obesity, central obesity Underweight Mother’s smallness at birth Ethnicity African American, American Indians History of preeclampsia Age over 35

Multifetal pregnancy Insulin resistance Chronic hypertension Renal disease High blood levels of homocystein Nutrient deficiency such vitamin C, E calcium,

Zinc and Omega 3- fatty acids

1000 mg per day of dietary calcium 400 mcg of folate ≥ 5 servings of fruit and vegetables per day Moderate exercise for 30 minutes for 5

days/week at least

Weight gain based on prepregnancy weight

status Three regular meals and snacks a day Consumption of low glycemic index CHO

foods

Is considered 2nd leading complication in pregnancy and has several forms:

Gestational diabetes Type 2 Type 1 Other specific types

Over than 3% of pregnant women develop gestational diabetes

It is considered a type of NIDDM or type 2 Gestational diabetes in underweight and

normal weight women appears to be related to insulin resistance in pregnancy combined with reduction in insulin production

• Obesity ( central obesity ) • Weight gain between pregnancies • Underweight • Age > 35 • Ethnicity • Family history • History of delivery of macrosomic newborn

( > 4500 g)

Chronic hypertension Mother was SGA at birth History of gestational diabetes in previous

pregnancies Diabetes in pregnant women’s mother during

pregnancy with them and LGA at birth

Mother 1. C-section to prevent shoulder dystocia 2. Increased risk for preeclampsia 3. Increased risk for diabetes type 2,

hypertension and obesity 4. Increased risk for gestational diabetes in

subsequent pregnancies

Offspring: 1. Stillbirth 2. Spontaneous abortion 3. Macrosomia ( > 10 lbs or 4500 g) 4. Neonatal hypoglycemia 5. Increased risk of insulin resistance, type 2

diabetes, high BP and obesity

Is diagnosed by Oral Glucose Tolerance Test OGTT

100 g glucose and 3 hours test is used The practice of loading women up with high

CHO diet for 3 days prior to test is no longer used.

The beverage provided should be consumed in 5 minutes

A diagnosis for gestational diabetes is made when two or more values for venous serum or plasma glucose concentrations exceed these levels:

Overnight fast 95 mg/dL 1 hour after glucose load 190 mg/dL 2 hours after glucose load 155 mg/dL 3 hours after glucose load 140 mg/dl

The main goal is to control blood glucose levels and to get healthy newborn

Other goals are to minimize the risk for other diseases such as diabetes, heart disease, hypertension and obesity,

The nutritional management is done through:

1. Assessing dietary and exercise habits 2. Developing an individualized diet and

exercise plan 3. Monitoring weight gain 4. Interpreting blood glucose and urinary

ketone results 5. Ensuring follow-up during pregnancy and

postpartum

Whole-grain breads and cereals, vegetables,

fruits and high fiber foods Limited intake of simple sugars Low GI foods or CHO that less than 50 Monounsaturated fats

Three regular meals and snacks daily Clorie distribution among meals and snacks Lunch is largest meal Breakfast and snacks are limited to 10-15% of

total calories

40-50 % from CHO 30-40 from fat 20% from protein

Twins increased from 1:56 births in 1988 to 1:34births in 2001

Triplets or higher in creased from 1:2941 to 1: 551 in the same period

Only 1:5 triplets pregnancies are spontaneously conceived

Pregnant women 1. Preeclampsia 2. Iron-deficiency anemia 3. Gestational diabetes 4. Kidney disease

7. Fetal loss 8. Preterm delivery 9. C-section

Newborns 1. Neonatal death 2. Congenital abnormalities 3. Respiratory distress syndrome 4. Intraventricular hemorrhage 5. Cerebral palsy

Weight gain Twin pregnancies 15.9-20.5 kg Triplets 22.7 kg or 0.7 kg/day

Daily food intake > 6 servings of cereal group > 3 servings vegetables > 2 servings fruits > 3 servings of meat, poultry, fish, beans,

eggs > 3 servings of milk, cheese, yogurt Fats and sugar very rarely

For triplet pregnancies : Food intake from food guide pyramid groups

should be consumed at a level that promotes targeted weight gain.

Caloric intake: Twin pregnancies : 450 kcal above

prepregnancy intake. Triplet pregnancies: intake should be

consistent with targeted weight gain

Nutrient intake: Twin and triplet pregnancy: - DRI level or somewhat more than these levels - Intake should be lower than ULs

Twin pregnancy: Minerals vitamins

Iron : 30 mg Vitamin B6: 2 mg

Zinc : 15 mg Folate : 300 mcg

Copper : 2 mg Vitamin C : 50 mg

Calcium : 250 mg Vitamin D: 200 IU

Triplet pregnancy: Provide a supplement containing at least the

above levels for twin pregnancy while avoiding excessive amounts.

Anorexia nervosa Bulimia Bing eating

Spontaneous abortion Difficult deliveries Weight gain low Smaller newborns Higher rates of neonatal complications

Behavioral changes Improvements in nutritional status Weight gain increase

USA has the highest rates of adolescent pregnancies of all developed countries

In 2002 teen pregnancies were 43 births per 1000 female aged 15-19

Between 1991-2001 it was 26% less

Low birthweight Perinatal death C-section Cephalopelvic ( head too large for birth canal)

Preeclampsia Iron-deficiency anemia Delayed-reduced educational acheivemnt Low income

Are basically the same as for older pregnant women

DRI for calcium is 1300 mg/day