Chapter 5
Nutrition During Pregnancy:
Conditions and
Interventions
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Introduction
• Vast majority of pregnancies proceed normally
– Result in delivery of a healthy newborn
• For others, a number of health conditions may
occur
– Nutrition plays a role in their etiology and management
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Obesity and Pregnancy
• Obesity before and during pregnancy
– Often produces unfavorable genetic, hormonal, and
metabolic conditions
• Affect maternal health, fetal growth and
development, and subsequent health of the mother
and child
– Several unfavorable metabolic changes
• Increased blood glucose levels, blood
concentration of insulin, insulin resistance, blood
pressure, high C-reactive protein levels, etc.
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Obesity and Pregnancy (cont’d.)
• Nutritional recommendations and interventions
for obesity in pregnancy
– Meet nutrient needs
– Consume a variety of basic foods
– Participate in physical activity
– Maintain appropriate rates of weight gain
• Weight loss is not recommended
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Obesity and Pregnancy (cont’d.)
• Pregnancy after bariatric surgery
– Use of bariatric surgery for weight loss has increased
– Weight rapidly lost after the surgery due to limited food
intake, fat malabsorption, decreased appetite, and
dumping syndrome
– Deficiencies of many nutrient stores
• Thiamine, vitamins D, B12, folate, iron, and calcium
dumping syndrome
A condition characterized by weakness, dizziness,
flushing,
nausea, and palpitation immediately or shortly after
eating
and produced by abnormally rapid emptying of the
stomach,
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Obesity and Pregnancy (cont’d.)
• Nutrition care for pregnant women post-bariatric
surgery includes:
– Assessment of dietary intake
– Supplement use
– Nutrient biomarker status
– Weight gain and physical activity
– Gastrointestinal symptoms
• Nutrient deficiencies vary depending on type of
bariatric surgery performed
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Hypertensive Disorders of Pregnancy
• Affects five to ten percent of pregnancies
– Contributes to stillbirths, fetal and newborn deaths,
and other adverse conditions
• Causes of most cases remain unknown
– Cures remain elusive
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Hypertensive Disorders of Pregnancy
(cont’d.)
• Hypertensive disorders of pregnancy, oxidative
stress, and nutrition
– Hypertension in pregnancy is related to:
• Chronic inflammation, oxidative stress, and
damage to endothelium of blood vessels
– Consequences of endothelial dysfunction:
• Impaired blood flow, increased tendency to clot,
and plaque formation
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Hypertensive Disorders of Pregnancy
(cont’d.)
• Chronic hypertension
– Present prior to pregnancy or diagnosed before 20
weeks
– Estimated incidence is three percent
• Nutritional interventions for women with chronic
hypertension in pregnancy
– Diets should be monitored
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Hypertensive Disorders of Pregnancy
(cont’d.)
• Gestational hypertension
– Hypertension that first occurs during pregnancy
– Increased risk for developing preeclampsia later in
pregnancy or during the first week postpartum, and
chronic hypertension later in life
• Preeclampsia-eclampsia
– Pregnancy-specific syndrome
– Signs and symptoms range from mild to severe as do
the health consequences
– Cause is unknown
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Hypertensive Disorders of Pregnancy
(cont’d.)
• Characteristics of preeclampsia
– Oxidative stress, 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 the
placenta
– Elevated blood levels of triglycerides, free fatty acids,
and cholesterol
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Hypertensive Disorders of Pregnancy
(cont’d.)
• Nutritional recommendations and interventions
for preeclampsia
– Adequate calcium and vitamin D status
– Use of multi-vitamin/minerals if needed
– Five or more servings of colorful vegetables and fruits
daily
– Adequate fiber intake
– Consumption of basic food recommendations
– Moderate-intensity exercise
– Recommended weight gain
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Diabetes in Pregnancy
• Diabetes is a leading complication in pregnancy
and has three main forms
– Type 1
– Type 2
– Gestational
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Gestational Diabetes
• Women developing gestational diabetes appear
to be predisposed to insulin resistance, and have
impaired insulin production
– Prevalence: two to twelve percent
– Accounts for 88 percent of all cases of diabetes in
pregnancy
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Gestational Diabetes (cont’d.)
• Risks related to gestational diabetes
– Increased risk of spontaneous abortion, stillbirth,
congenital anomalies, and neonatal death
• Risk factors for gestational diabetes
– Linked to multiple genetic factors and their
environmental triggers
• Excess body fat
• Unhealthful diets
• Low physical activity levels
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Gestational Diabetes (cont’d.)
• Management of gestational diabetes
– Mainstay: medical nutrition therapy to normalize blood
glucose levels with diet and exercise
• Blood glucose levels can be brought down with low
calorie intake; avoid elevated ketones
• Oral medication metformin (glyburide) is used to
decrease insulin resistance
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Gestational Diabetes (cont’d.)
• Exercise benefits and recommendations
– Regular aerobic exercise
• Nutritional management of women with
gestational diabetes
– Assess dietary and exercise habits
– Develop a diet and exercise plan
– Monitor weight gain
– Interpret blood glucose and urinary ketone results
– Ensure follow-up during and after pregnancy
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Gestational Diabetes (cont’d.)
• Prevention of gestational diabetes
– Reduce excessive weight and obesity
– Increase physical activity
– Decrease insulin resistance prior to pregnancy
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Type 2 Diabetes in Pregnancy
• Care should be individualized and follow protocol
– Primary goal: maintain normal blood glucose
• Management of type 2 diabetes in pregnancy
Hypoglycemia and hyperglycemia pose threats to
maternal and fetal health and should be avoided.
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Type 1 Diabetes During Pregnancy
• Potentially, a more hazardous condition than
gestational or type 2 diabetes
– Mother is at risk for kidney disease, hypertension, and
preclampsia, etc.
– Newborn is at risk for mortality, being SGA or LGA,
and hypoglycemia within 12 hours after birth
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Type 1 Diabetes During Pregnancy
(cont’d.)
• Nutritional management of type 1 diabetes
during pregnancy
– Control of blood glucose levels
– Caloric and nutritional adequacy of diet
– Achieve recommended weight gain
– Careful home monitoring of glucose levels and dietary
intake, exercise, and insulin dose
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Multifetal Pregnancies
• U.S. rates of multifetal pregnancies have
increased
– Linked to assisted reproductive technologies,
progressively older ages, and weight status
assisted reproductive
technology (ART) An umbrella term for
fertility treatments such as in vitro
fertilization (IVF, a technique in which egg
cells are fertilized by sperm outside the
woman’s body), artificial insemination,
and hormone treatments.
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Multifetal Pregnancies (cont’d.)
• Background information about multifetal
pregnancies
– Dizygotic: two eggs are fertilized
• Incidence increased by perinatal nutrient
supplements
– Monozygotic: one egg is fertilized
• Always the same sex
• Rates appear not to be influenced by heredity
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Multifetal Pregnancies (cont’d.)
• Dietary intake in twin pregnancy
– Higher caloric need
– Benefits from increases in essential fatty acids, iron,
and calcium
• Vitamin and mineral supplements
– Needs unknown
• Nutritional recommendations
– Food-intake recommendations for women with
multifetal pregnancy are primarily estimated based on
assumptions related to caloric and nutrient needs
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Eating Disorders in Pregnancy
• Eating disorders are rare in pregnancy
– Most females with such disorders are subfertile or
infertile
• Eating disorder symptoms often subside in second
and third trimester but return after delivery
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Eating Disorders in Pregnancy (cont’d.)
• Consequences of eating disorders in pregnancy
– Spontaneous abortion
– Hypertension
– Preterm labor
– Anemia
– Genitourinary tract infection
– Difficult deliveries
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Eating Disorders in Pregnancy (cont’d.)
• Treatment of women with eating disorders during
pregnancy
– Refer to eating disorders clinic or specialist
• Nutritional interventions for women with eating
disorders during pregnancy
– Behavioral changes
– Improve nutritional status
– Appropriate weight gain
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