Pregnancy Changes, Complications, LBW Flashcards
Effect of malnutrition on placental growth
Malnutrition → low blood volume expansion → low cardiac output → low placental blood → decreased placenta size/nutrient transfer → fetal growth retardation (IUGR)
- placental infarction (smoking), severe hypotension and renal disease
EFA deficiencies → defects in placental integrity → IUGR and LBW
- eicosanoids play roles in vasodilation, placental blood flow and nutrient delivery
- highest distribution of DHA is in fetal brain (and arachidonic acid)
Side effects of pregnancy
1) Changes in smell and taste → food cravings and aversions due to hormones
2) Heartburn and GERD: caused by relaxation of lower esophageal sphincter from estrogen/progesterone increase OR pressure from uterus/fetus
3) Nausea and vomitings - morning sickness from week 6-12, unknown cause
- positive pregnancy predictor
4) Constipation: ↓ motility, hormonal changes, relaxation of musculature of GI, ↓ activity, Fe supplements
- treatments: ↑ fluids, ↑ fiber to 30g, probiotics, avoid laxatives
Appropriate weight gain during pregnancy based on BMI
Goal: 22% body weight as fat
Underweight or adolescent <18.5 BMI 28-40lbs
Normal 18.5-24.9 BMI 25-35lbs
Overweight 25-29.9 BMI 15-25lbs
- associated with macrosomia, poor blood glucose control, lung problems in kid
Obese > 30 BMI 11-20 lbs
- weight loss during pregnancy not advised
Twins: 35-45lbs weight gain regardless of BMI
Obligatory weight gains during pregnancy
Consequences of low weight gain
2/3 of gains: fetus, placenta, uterine growth, breast tissue, blood volume
<20lb weight gain during pregnancy → increased risk of premature birth or small for gestational age
- bone/muscle loss, nutrient deficiencies, IUGR and LBW
- decreased placental development and ability to breakdown corticosteroids, thyroxine, and insulin → increased risk of HTN later in life
Risks of overweight pregnancy
gestational diabetes, hypertension/preeclampsia, dyslipidemia, CVD, C section, ↓ breastfeeding
fetal death, congenital malformations, increased perinatal complications
Pattern of ideal weight gain
Pattern of gain: 3-4lbs first 10 weeks (more increases risk of preeclampsia, edema, low blood flow to placenta)
1lb per week after 10 weeks
Exercise recommendations during pregnancy
Contraindications for exercise
moderate-vigorous exercise - 30 min 5x/week or 150 min/week
- to maintain appropriate gestational weight gain, reduce hypertensive disorders and gestational diabetes
- strength and aerobic + adequate rest, fluids and nutrition
Contraindications: low-lying placenta, severe anemia, 2nd/3rd trimester persistent bleeding, preeclampsia, multiple babies, previous miscarriage history
Proportionate vs disproportionate IUGR
Proportionate IUGR: fetal weight and length are affected from the start of the pregnancy
Due to –> extreme fetal malnutrition OR decreased growth potential due to congenital infection, genetic disorder or environmental toxins
- Often more severe and with many effects –> neurological, effects to milestones after birth, developmental outcomes
Disproportionate IUGR:
- Due to uteroplacental insufficiency or maternal malnutrition
- issues which occur more towards 2-3rd trimester which affect growth
- not as severe health risks compared to proportionate
IUGR Definition
IUGR associated with
Definition: < 2 SD or < 10th percentile in weight for gestational age, < 2.5kg + gestational age ≤ 37 weeks
Associated with congenital abnormalities, low energy intake, low BMI, short stature, HTN, smoking, alcohol, malaria
Preterm definition
Causes of preterm birth
Mild vs. Severe Preterm
Preterm = ≤ 37 weeks gestational age
genitourinary infection, multiple pregnancies, hypertension, low BMI, smoking, strenuous physical activity
Mild preterm = 32-36 weeks
⇡ risk of respiratory distress syndrome, infection and mortality
Severe preterm = <32 weeks
⇡ risk of morbidity, retinopathy, chronic lung disease, neurocognitive impairment
LBW risks
decreased lung capacity, 2x risk CVD, 6x risk diabetes/poor glucose metabolism, increased blood pressure, high TG, low HDL
Health conditions during pregnancy
When they arise, risks associated and how to treat
1) Gestational diabetes = glucose intolerance diagnosed during 2nd-3rd trimester for first time
- usually resolves after birth but ↑ risk of developing T2D and recurring GDM with future pregnancies
- ↑ risk of C-section, macrosomia, neonatal hypoglycemia
2) Hypertension = > 140 mm Hg systolic and/or > 90 mm Hg diastolic pressure
- Chronic, gestational or preeclampsia
- restricts blood flow to fetus → LBW
3) Preeclampsia = high blood pressure + proteinuria after 20 weeks
- treatment: delivery of baby, adherence to DASH diet
4) Anxiety and depression: Linked with deficiencies in Fe, folate and B12
- Child: ↑ emotional issues for child, ADHD, impaired cognitive development
- Mother: ↑ risk of preeclampsia, birth difficulties, ↓ breastfeeding
5) Eating disorders: Anorexia nervosa, bulimia nervosa, binge eating disorder - can impede weight gain during pregnancy
6) Pica = cravings for non-nutritive substances → Fe deficiency anemia, lead poisoning and other toxicities
- associated with low hemoglobin, hematocrit, plasma zinc
Categories for Nutritional Risk During Pregnancy
Poverty – poorer nutritional intake/status, ↑ smoking → 2x LBW (↓ by 200-300 g)
Adolescence – high nutritional demands/food fads/ poor financial status, obstetric and nutritional support, increased use of drugs and smoking
Short inter-conception interval –high physiological/nutritional demands on body stores of nutrients
Chronic systemic illness – diabetes, chronic infection, cancer, alcoholism, malabsorption
Unusual dietary patterns – food faddism, pica
History of anemia or obesity – long term imbalanced or inappropriate diet
Poor reproductive history – prior LBW/premature labor/spontaneous abortions
Nutrients that do not change during either:
Fibre, Vit D, Vit K, Na, Cl, Ca, Fl
Nutrients that only change during pregnancy (but not lactation):
Mg
