Preeclampsia- pregnancy induced hypertension
alcohol syndrome (FAS) or fetal alcohol spectrum
Weight Gain in Pregnancy
(1) maternal body composition changes,
including increased blood and
extracellular fluid volume;
(2) the maternal support tissues, such
as the increased size of the uterus and
breasts; and
(3) the products of conception,
including the fetus and the placenta
Pregnancy BMI
Normal weight= Normal weight (18.5-24.9 kg/m2)
Poor weight gain may then lead to
intrauterine growth retardation in the
infant
between 37-54 lbs (16.8-24.5kg) women
Caffeine
-may alter deoxyribonucleic acid (DNA) and,
in some individuals, may alter circulating
levels of neurotransmitters and increase
blood pressure.
Drugs
The growing fetus, particularly during the
period of organogenesis in the first
trimester, is highly susceptible to insult
-isotretinoin (Accutane) contains high levels
of retinoic acid in the form of a vitamin A
analog. This medi-cation causes fetal
malformations such as craniofacial
abnormalities and microcephaly (abnormal
smallness of head with brain
underdevelopment)
Excessive vitamin A causes=
malformations such as anencephaly
(defective brain devel-opment), cleft palate,
spina bifida, webbed fingers or toes, and
facial malformations
Alcohol
may produce fetal
disorder
(FASD) in the infant.
-central nervous systems defects and
specific anatomic defects such as a low
nasal bridge, short nose, flat midface, and
short palpebral fissures.
Tobacco
-prematurity, low birth weight, SGA, still-
birth, placenta previa (location in lower
uterine area), abruptio placentae
(separation from uterine wall), and, post-
natally, sudden infant death syndrome
(SIDS)
Foodborne Illness
Pathogens
such as Listeria monocytogenes, Salmonella
species, and Toxo-
plasma gondii are high risk for a pregnant
woman and her fetus.
Exercise
-strenuous exercise was thought to divert
blood to the exercis-ing muscles and thus
reduce the blood supply to the fetus.
-if beginning a new exercise program, a
woman should keep a pulse rate below 140
beats per minute and work toward 1 hour
of physical activity 3 days a week.
Maternal Age
-women older than 35 years of age are at
higher risk for poor pregnancy outcome.
Dietary factors to assess are the poor
dietary habits typical of many teens, fre-
quency with which meals are eaten away
from home each day, and the possible
preoccupation with weight gain during
pregnancy.
Preeclampsia
also known as pregnancy-induced
hypertension.
- experiences a sudden and severe rise in
arterial blood pressure, rapid weight gain,
and marked edema, often neces-sitating
immediate delivery of the fetus to save the
life of both mother and infant.
Preeclampsia may progress to eclampsia.
Eclampsia may result in seizures that can
be fatal to the mother and the infant.
Diabetes Mellitus
Pregnancy significantly affects insulin
requirements.
mplications include
macrosomia (larger body size),
hypoglycemia,
ery-thremia (abnormal increase of red
blood cells),
hyperbilirubinemia.- neonatal condition of
excessively high levels of bilirubin (red bile
pigment) leading to jaundice, in which bile
is deposited in tissues throughout the body.
-Insulin dosages will require adjustment
because many of the hor-mones of
pregnancy, such as estrogen, progesterone,
human chorionic, somatotropin, and
maternal cortisol, act in an antagonistic
fashion with insulin.
Gestational diabetes mellitus (GDM) is a
form of diabetes occurring during
pregnancy, most commonly after the twen-
tieth week of gestation
Maternal Phenylketonuria
-Phenylketonuria (PKU) is an inborn error of
metabolism characterized by extremely low
levels of the enzyme phenyl-alanine
hydroxylase, which catalyzes the conversion
of phe-nylalanine to tyrosine. Absence of
this crucial enzyme causes a failure in the
metabolism of the amino acid
phenylalanine and low levels of tyrosine.
-completely eliminate, the risk of an
adverse pregnancy outcome.
Human Immunodeficiency Virus Infection
-hormones and proteins of pregnancy
(including estrogen, progesterone, human
chorionic gonadotropin (HGC), alpha
fetoprotein, corticosteroids, prolactin, and
alpha globulin) have immunosuppressive
effects.
Woman with hiv has increased needs for
kcal, protein, vitamins, and minerals.
Relief from Common Discomforts during
Pregnancy
Nausea and Vomiting
it may be caused by hormonal factors such
as a rise in estrogen or the placental
hormone HCG.
eat small, frequent meals; drink liquids
between rather than with meals;
-reduce coffee intake and to prepare meals
near an open window to avoid cooking
odors
-If nausea on getting out of bed in the
morning is a problem, dry toast or crackers
eaten before getting out of bed
Hyperemesis gravidarum is severe and
unrelenting vomiting and usually requires
intravenous replacement of nutrients and
fluids.
Heartburn
-when the fetus rapidly grows in size, the
uterus pushes up against the stomach,
which may cause a feeling of fullness in the
mother.
Progesterone causes relaxation of the
gastroesophageal sphincter may occur,
resulting in some reflux of gastric contents
into the lower esophagus
dietary reme-dies include
eating small,
frequent meals;
avoiding foods high in fat;
drinking fluids between rather than with
meals;
limit-ing spicy foods; and
avoiding lying down for 1 to 2 hours after
eating.
Constipation
Constipation is common during the first
and third trimesters of pregnancy
-growing fetus crowds the other internal
organs, again pos-sibly slowing GI motility
Dietary treatment
fiber,
such as whole grain cereals,
fresh fruit, and raw vegetables, as well as
inclusion of plenty of fluids should alleviate
constipa-tion.
Moderate exercise
Pregnancy
progesterone, - lobules or alveoli
increase in size and number
estrogen -stimulates proliferation of the
ductal system.
oxytocin. - uterine contrac-tions of labor
that bring about birth.
Oxytocin and prolactin-
Prolactin is primarily responsible for
milk synthesis;
oxytocin is involved with milk ejection
from the breast.
This is called the let-down reflex, or the
milk-ejection reflex. -caused by the flood of
oxytocin resulting to the ejection of milk from
the mothers breast to the infants mouth
Deterrents to the let-down reflex may
include
fatigue,
stress,
alcohol,
smoking, and some
prescription medications.
colostrum which is the fluid secreted
from the breast during late pregnancy
and the first few days postpartum.
-average woman produces 750 to 1000
mL of milk per day.
- pro-vides immunologic active
substances (maternal antibodies) and
essential nutrients.
Energy and Nutrient Needs during Lactation
The energy cost of milk production is
approximately 500 to 800 kcal per day,
depending on the volume of milk
production.
-Protein (71 g per day) and for most of
the vitamins and minerals over the
normal adult levels.
Coffee or cola drinks should be avoided
or used on a minimal basis.
-diuretics in the mother’s body, and
caffeine, a stimulant, passes into breast
milk in small amounts.
Alcohol
-may inhibit oxytocin, consequently
reducing the let-down reflex.
-An energy intake of at least 1800 kcal
per day should be maintained for
adequate lactation regard-less of
maternal fat stores.
Contraindications to Breastfeeding
contraindications to breastfeeding:
• Active tuberculosis
• Human immunodeficiency
virus/acquired immunode-ficiency
syndrome (HIV/AIDS)
• Herpes simplex lesions on the
maternal breast • Maternal alcoholism
• Maternal drug addiction
• Malaria
• Maternal chicken pox (first 3 weeks
postpartum only)
• Maternal breast cancer requiring
treatment

NUTRITION BEFORE PREGNANCY

BMI-
Underweight (18.5 kg/m2)
Overweight (25.0-29.9 kg/m2)
Normal weight (18.5-24.9 kg/m2)
Obese (30.0 kg/m2)