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Nutrition & Pregnancy _SHARED (Maternal Nutrition & Nutrient…
Nutrition & Pregnancy
_SHARED
Maternal Weight Gain
~20% of ideal BW; more for adolescent mothers
Increase Caloric Need in Pregnancy
100 kcal/day on average;
:arrow_down_small: in early pregnancy,
:arrow_up_small: in later preg
Risks Associated w/ Maternal Obesity
Mother
Gestational Diabetes
#
7%; :arrow_heading_up:risk DM in mom
Hypertension
Preeclampsia
*2x incidence with :arrow_upper_right:5-7 BMI
C-section delivery
Infant
Macrosomia / Large-for-Gestational Age (LGA) infants
*hyperglycemia in mom; baby=fat; risk of injury; C-section likely
Stillbirth
Preterm birth
Infant hypoglycemia
Neural Tube Defects (NTD)
NOT FROM FOLATE DEFICIENCY
*2x :arrow_double_up: risk; poor glycemic control;
Maternal Nutrition & Nutrient Transfer to Fetus
Risks of Maternal Malnutrion
Developmental Origins of "Health & Disease Hypothesis"
EX1: Dutch Hunger Winter of WWII
Children of malnourished mothers were heavier and had :arrow_up:risk CV disease
EX2: Pre- VS. Post-Bariatric Surgery
Children conceived post-surgery were healthier ( :arrow_down:obesity)
EX3: Low Birth Weight = Fewer Cells
:arrow_down:kidney function :arrow_upper_right:risk HTN
Fetal Malnutrition
Spontaneous preterm delivery
Increased infant mortality
Epigenetic changes
DNA Methylation of infant's genes affecting metabolism
Poor Prenatal Nutrition >> Infant programmed for Famine :diamond_shape_with_a_dot_inside: increase risk of
Metabolic Syndrome
Central Obesity
Insulin Resistance
Type 2 DM
CV disease
Mercury from Fish
Motor, Attention, Verbal deficits
No IQ deficits
Folate
All women of childbearing age need supplements
If deficient:
:arrow_down:nucleotide levels
:arrow_up:homocysteine (& possible ox stress)
Omega-3 FA
(DHA & EPA)
DHA
Most abundant in cerebral grey matter
Must be habitual pre-preg nutrition
Possible :arrow_down:pre-term birthrate
Calcium
(active transport)
Estrogen
Protects skeleton of mom
:arrow_up:Vit D3 (:arrow_up: absorp)
Iron
(3rd trimester most imp)
Needed for 4 things:
Placental Development
Fetal Hb
Fetal iron stores
Maternal Hb
:arrow_down:Hepcidin
( :arrow_up:absorp, :arrow_up:release)
Vitamin C
Premature Rupture of Chorioamniotic Membrane (PROM)
10-20%; main cause of pre-term delivery
Collagen synthesis
Vitamin A
#
Teratogenic in 1st month
Facilitated Diffusion
Glucose
Ketone Bodies
Placental LPL
Essential FA
Secondary Active Transport
AA
Vitamin C
Common Issues in Pregnancy Affecting Maternal Diet
Food Cravings
Can affect maternal diet; may req vitamins
Food / Smell Aversions
:arrow_up:sensitivity to smells; can cause nausea
Morning Sickness (Nausea & Vomiting of Pregnancy; NVP)
70-80% suffer; NOT usually restricted to morning; peaks early preg; may req Vit B6, ginger, or mint
Maternal & Fetal nutrition OK; NVP normal
Hyperemesis Gravidarum
(less common but serious:!:)
=extreme nausea & vomiting
:warning:Adverse outcomes for mom and fetus
36,000 hospitalizations/year
dehydration, electrolytes, acid/base imbalance
Tx: nutritional support to avoid deficiencies and weight loss
Role of the PLACENTA
Role as an Endocrine Gland
hCG
(released 1st)
Progesterone
Estrogen
#
hPL
(human placental lactogen)
:arrow_heading_up:mom's insulin to produce
maternal insulin resistance
(normal response)
:arrow_up:Post-prandial hyperglycemia
:arrow_up:lypolysis
:arrow_up:ketogenesis
:arrow_down::!:AA utilization
Facilitates Transfer of Maternal Antibodies
Mom's IgG antibodies
Active Transport via placenta
Protects infant for 3-6 mos
Insulin Resistance in Pregnancy
Smoking
= LOW BIRTH WEIGHT
DOSE DEP. :arrow_down:fetal nutrition (& prematurity) with smoking via
vasoCONSTRICT
Nicotine
10% :arrow_up:epinephrine
10% reduced O2 carrying capacity (mom)
Alcohol
Fetal Alcohol Syndrome
Face & Head Microcephaly
CNS Intellectual Disability
Skeleton Growth Retardation
Alcohol-Related Neurodevelopmental Abnormalities (ARND)
FEWER FACIAL features;
:arrow_down:growth, learning problems
Binge drinking worst
Et-OH may compete with Vit A enzyme that makes Retinoic Acid
Prevention of Nutrition Problems in Pregnancy
Estrogen & hPL promote lactation
50% :arrow_up: maternal blood
30-50% :arrow_up: cardiac output