pregnancy tips

Dr Rania HusseinDr Rania Hussein

GI problems in pregnancyDr Rania Abd El Hamid Hussein

MBBSch Master’s degree in Internal MedicineDoctor in Nutrition and Public Health

Assistant Professor of NutritionFaculty of Applied Medical Sciences

KAU


Nausea and vomiting:Nausea and vomiting: morning sicknessmorning sickness

• Occur early in pregnancy: 6 weeks after the start of last menstrual period and last for 6 weeks

• The cause may be hormonal changes during early pregnancy

D.RANIA


TreatmentTreatment

1. Keep stomach filled but not overfilled

2. Eat small frequent meals

3. Separate consumption of fluids and solid foods.

4. Consume easily digested foods

5. Avoid strong-flavored foods

6. When nauseated , do not drink fluids, but eat toast or crackers.


Heart burnHeart burn

It is caused by:• Relaxation of muscles →↓ gastric

emptying → esophageal regurgitation.

• In late pregnancy, the pregnant uterus compresses the diaphragm .

Treatment:1. Eating small frequent meals2. Avoiding lying down soon after

meals3. Antacids can be used


ConstipationConstipation

It is caused by:

1. ↓ physical activity

2. ↓ intestinal motility

3. ↓water intake

4. ↓ fiber intake in diet

5. The enlarging uterus exerts pressure on the bowel


Treatment of constipationTreatment of constipation

1. Adequate fluid intake

2. Increasing dietary fiber

3. Use of bulking agents as bran→ flatulence and bloating


Craving and aversionCraving and aversion

• Craving and aversion are powerful urges to consume or not consume particular foods or beverages, including foods that were neither craved nor considered avulsive before.

• Food craving may range from pickles to ice cream.

• Food aversion are usually to coffee and meat.


• Pica is the ingestion of non food substances as clay.

• May be due to the body’s search for a source of nutrients it is lacking.


Exercise during pregnancy


BenefitsBenefits

• A positive self image

• Maintenance of fitness

• Shorter labor, and fewer surgical interventions


RecommendationsRecommendations

1. Avoidance of activities with excessive twists and turns, or those that may cause abdominal trauma.

2. A carbohydrate snack before exercise to sustain blood glucose.


High Risk Pregnancy


Maternal and family conditionsMaternal and family conditions

1. Age: adolescent – older gravida

2. Low SE socioeconomic status

3. History of poor pregnancy outcome

4. Short inter pregnancy interval

5. High parity


Maternal health problems and Maternal health problems and Prenatal complicated pregnancyPrenatal complicated pregnancy 1. Obesity, underweight, or poor gestational weight

gain2. Hyperemesis gravidarum3. Multiple fetuses4. Anemia5. Hypertensive disorders of pregnancy6. DM7. Viral infections (HIV, Rubella)


Maternal behaviorMaternal behavior

1. Cigarette smoking

2. Alcohol consumption

3. Caffeine intake

4. Vegeterianism


Maternal ageMaternal age

1. Adolescent

2. Older gravida


Pregnancy in Adolescence


1.1. ↓ ↓ nutrient stores nutrient stores and ↑ nutritional needs :and ↑ nutritional needs :

1. Adolescents are still in growth phase → Competition for nutrients between mother and fetus →↓ placental blood flow → premature or low birth weight babies.

2. Smaller pelvis of the young adolescent mother → cephalopelvic disproportion → difficulties in delivery


2. Is likely to be poor2. Is likely to be poor

1. → ↓ intake of nutrients → ↓ prepregnancy weight and ↓ gestational weight

2. Late entry to prenatal care


Consequences of pregnancy in Consequences of pregnancy in adolescenceadolescence

1. Preterm delivery

2. Low birth weight infant

3. Difficult labor and delivery

4. Pregnancy- induced hypertension


Recommended energy and nutrient Recommended energy and nutrient intake for the pregnant adolescentintake for the pregnant adolescent

Energy levels greater than the additional 300Kcal/day are recommended.

RDA for protein is increased by 15 g/day

Iron, Folate, and calcium supplementation should be recommended routinely


Recommended gestational weight Recommended gestational weight gain for adolescentsgain for adolescents

Prepregnant BMI weight gain in Kg <19.8 18

19.8-26 16

26-29 11.5

D.RANIA

Dr Rania Hussein


Taking care of the pregnant Taking care of the pregnant adolescentadolescent

1. Family should be supportive and more sympathetic

2. Ensure prenatal and postnatal care


Older gravida Older gravida (35 years and older )(35 years and older )

Risks:

1. Multiple fetuses

2. Medical conditions : DM, cardiovascular diseases, obesity, tumors

3. Down syndrome

4. Preterm infants

5. Low birth weight infants

6. Maternal and perinatal mortality


Socioeconomic statusSocioeconomic status

They include:

1. Social status

2. Income

3. Education

4. Employment

5. Marital status

6. Availability of health care systems


Consequences of low Consequences of low socioeconomic statussocioeconomic status

↓ maternal weight gain →

• Preterm infants

• Low birth weight infants


Maternal obesity and underweight


Underweight mothers are at Underweight mothers are at higher risk of havinghigher risk of having

1. Low-birth-weight infants

2. Preterm delivery


Obese women are at a greater Obese women are at a greater risk of havingrisk of having

1. Hypertension.

2. Diabetes.

3. Complications during labor: Fetal macrosomia and shoulder dystocia

4. Thromboembolism

5. Obesity may double the risk of NTD


Multiple birthsMultiple births

Consequences:

1. Preterm infants

2. Low birth weight infants

Energy and nutrient requirements are increased

Weight gain should exceed that of single pregnancies (about 22 Kg weight gain in twin pregnancy)

D.RANIA

Dr Rania Hussein


Hyperemesis gravidarumHyperemesis gravidarum

• It is a nutritionally debilitating condition characterized by intractable vomiting that develops during the first 22 weeks of gestation.

• Cause is unknown , but may be due to hormonal changes during pregnancy.


Complications include;

1. Weight loss, dehydration, electrolyte imbalance

2. Fetal growth restriction

3. Utilization of body fats and proteins, ketonemia→ this impairs neurologic development of the fetus


TreatmentTreatment

1. Hospitalization

2. Intravenous fluids to correct dehydration and electrolyte imbalance

3. Correction of ketonemia

4. Oral intake is slowly introduced (small frequent meals low in fat, high in carbohydrates, with liquids consumed at different times)


If the woman fails to respond to oral feeding, food is introduced either through a commercial formula via tube into the stomach (enteral feeding), or nutrient needs are given by intravenous infusion (parenteral nutrition)


Diabetes mellitus in pregnancy


• It is a chronic disorder in which blood levels of glucose are elevated.

• The cause is either insulin deficiency or resistance,

• Net result is hyperglycemia.


Types of DM are:

• Type 1 Insulin dependant diabetes

• Type 2 Non insulin dependant diabetes

• Gestational diabetes


In all types of Diabetes in PregnancyIn all types of Diabetes in Pregnancy

↑maternal blood glucose → blood glucose passes to the fetus → fetal pancreatic insulin secretion → ↑ protein and fat synthesis in fetus→ macrosomia


Consequences of DiabetesConsequences of Diabetes

1. Preeclampsia

2. Frank diabetes later in life.

3. Fetal macrosomia and birth injuries

4. Operative delivery

5. Neonatal hypoglycemia

6. Congenital anomalies


In pregestational diabetes,In pregestational diabetes,

• Insulin requirements ↓in the first half of pregnancy, as the fetus uses some of mother’s glucose.

• Insulin requirements↑ In the second half of pregnancy, due to hormonal changes.


Gestational Diabetes: GDGestational Diabetes: GD

1. Intolerance to carbohydrates, first recognized in pregnancy.

2. Late in the 2nd trimester.

3. Carbohydrate tolerance is normal before pregnancy and after delivery.


Nutrition goals in the management of Nutrition goals in the management of gestational diabetesgestational diabetes

1. Provide necessary nutrients to the fetus and mother

2. Maintain normal blood glucose (euglycemia), and prevent ketosis

3. Achieve appropriate weight gain


Screening for diabetesScreening for diabetes

• Initial screening is done between 24 and 28 weeks of gestation.

• Rescreening at 32 weeks gestation is recommended• Screening is done to the following groups: -25 years of age or older - <25 years + obese - Family history of diabetes in first degree relatives - If a mother shows any symptoms or signs of diabetes at any stage of pregnancy.


Treatment of Gestational diabetes Treatment of Gestational diabetes

1. Dietary changes,

2. Moderate exercise

3. Blood glucose monitored daily


Hypertension during pregnancyHypertension during pregnancyBlood pressure >140/90Blood pressure >140/90

• ↑ risk of preeclampsia, preterm delivery, fetal growth restriction

• 2 types:

1. Gestational hypertension: detected for the first time after mid pregnancy

2. Chronic hypertension: detected before pregnancy

300

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260

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220

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180

160

140

120

100

80

60

40

20

290

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230

210

190

170

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130

110

90

70

50

30

10


PreeclampisaPreeclampisa

1. Pregnancy-specific syndrome observed after 20 th week

2. Blood pressure >140/903. Proteinurea

• Eclampsia= preeclampsia + seizures

• Risk factors for preeclampsia: maternal obesity, diabetes, chronic hypertension


Role of diet in preeclampsia:

• Calcium supplementation ↓ BP

• Mg supplements and antioxidants (Vit A and E) can prevent preeclampsia

• Adequate dietary protein intake to replace the losses in urine.


Substance use and abuse in pregnancy


Cigarette smokingCigarette smoking

• CO+ Hb= carboxyhemoglobin→↓ available sites for oxygen binding → fetal hypoxia, and fetal growth restriction

• ↓ absorption and availability of some nutrients: vit C, Iron, Zinc, folic acid


Alcohol consumptionAlcohol consumption

1. Alcohol is directly toxic to the embryo and fetus ( it crosses the placenta, while fetal organs are still immature)

2. The mother is usually undernourished

3. It ↓ absorption and utilization of some nutrients


Consequences of alcohol Consequences of alcohol consumptionconsumption

Fetal alcohol syndrome:

• Mental retardation

• Growth retardation

• Facial abnormalities

• Nervous, cardiac, and genitourinary system impairment


Caffeine intakeCaffeine intake

1. ↑ urinary excretion of Ca and thiamin

2. ↓absorption of Zn and Fe.

3. ↑ heart rate and blood pressure

4. gastric reflux


RecommendationsRecommendations

• Limitation of substance use

• Multivitamin and mineral supplementation

ReferencesReferences

• Brown JE, Isaacs J, Wooldridge N, Krinke B, Murtaugh M. Nutrition through the lifecycle, 2007 . 3rd ed. Wadsworth publishing.

• Mahan LK, Escott- Stamp S. krause’s food, and nutrition therapy 2008. 12th ed. Saunders Elsevier. Canada.

dr Rania Husseindr Rania Hussein