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GI problems in pregnancy       Dr Rania Abd El Hamid Hussein                  MBBSch     Master’s degree in Internal Medic...
Nausea and vomiting:morning sickness• Occur early in pregnancy: 6  weeks after the start of last  menstrual period and las...
Treatment1. Keep stomach filled but not overfilled2. Eat small frequent meals3. Separate consumption of fluids and   solid...
Heart burnIt is caused by:• Relaxation of muscles →↓ gastric     emptying → esophageal     regurgitation.• In late pregnan...
ConstipationIt is caused by:2. ↓ physical activity3. ↓ intestinal motility4. ↓water intake5. ↓ fiber intake in diet6. The ...
Treatment of constipation1. Adequate fluid intake2. Increasing dietary fiber3. Use of bulking agents as bran→ flatulence  ...
Craving and aversion• Craving and aversion are powerful urges to  consume or not consume particular foods or  beverages, i...
• 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...
Exercise during pregnancy         Dr Rania Hussein
Benefits• A positive self image• Maintenance of fitness• Shorter labor, and fewer surgical  interventions                 ...
Recommendations1. Avoidance of activities with excessive twists   and turns, or those that may cause   abdominal trauma.2....
High Risk Pregnancy       Dr Rania Hussein
Maternal and family conditions•   Age: adolescent – older gravida•   Low SE socioeconomic status•   History of poor pregna...
Maternal health problems andPrenatal complicated pregnancy•   Obesity, underweight, or poor gestational weight    gain•   ...
Maternal behavior1.   Cigarette smoking2.   Alcohol consumption3.   Caffeine intake4.   Vegeterianism                    D...
Maternal age1. Adolescent2. Older gravida              Dr Rania Hussein
Pregnancy in Adolescence         Dr Rania Hussein
1.   ↓ nutrient stores     and ↑ nutritional needs :•  Adolescents are still in growth phase →   Competition for nutrients...
2. Is likely to be poor2. → ↓ intake of nutrients → ↓ prepregnancy   weight and ↓ gestational weight3. Late entry to prena...
Consequences of pregnancy inadolescence1.   Preterm delivery2.   Low birth weight infant3.   Difficult labor and delivery4...
Recommended energy and nutrientintake for the pregnant adolescentEnergy levels greater than the additional  300Kcal/day ar...
Recommended gestational weightgain for adolescents  Prepregnant BMI weight gain in Kg              <19.8   18           19...
Taking care of the pregnantadolescent          1. Family should be supportive             and more sympathetic          2....
Older gravida (35 years and older )Risks:2. Multiple fetuses3. Medical conditions : DM, cardiovascular diseases,    obesit...
Socioeconomic statusThey include:2. Social status3. Income4. Education5. Employment6. Marital status7. Availability of hea...
Consequences of low        socioeconomic status↓ maternal weight gain →• Preterm infants• Low birth weight infants        ...
Maternal obesity and underweight            Dr Rania Hussein
Underweight mothers are at      higher risk of having1. Low-birth-weight infants2. Preterm delivery                   Dr R...
Obese women are at a greater           risk of having•    Hypertension.•    Diabetes.•    Complications during labor: Feta...
Multiple birthsConsequences:2. Preterm infants3. Low birth weight infantsEnergy and nutrient requirements are increasedWei...
Hyperemesis gravidarum• It is a nutritionally debilitating condition  characterized by intractable vomiting that  develops...
Complications include;2. Weight loss, dehydration, electrolyte   imbalance3. Fetal growth restriction4. Utilization of bod...
Treatment1. Hospitalization2. Intravenous fluids to correct dehydration and   electrolyte imbalance3. Correction of ketone...
If the woman fails to respond to oral feeding,   food is introduced either through a commercial   formula via tube into th...
Diabetes mellitus in pregnancy            Dr Rania Hussein
• It is a chronic disorder in which blood levels  of glucose are elevated.• The cause is either insulin deficiency or  res...
Types of DM are:• Type 1 Insulin dependant diabetes• Type 2 Non insulin dependant diabetes• Gestational diabetes          ...
In all types of Diabetes in Pregnancy↑maternal blood glucose → blood glucose passes to the fetus → fetal pancreatic insuli...
Consequences of Diabetes•   Preeclampsia•   Frank diabetes later in life.•   Fetal macrosomia and birth injuries•   Operat...
In pregestational diabetes,• Insulin requirements ↓in the first half of  pregnancy, as the fetus uses some of mother’s  gl...
Gestational Diabetes: GD•   Intolerance to carbohydrates, first    recognized in pregnancy.•   Late in the 2nd trimester.•...
Nutrition goals in the management ofgestational diabetes1. Provide necessary nutrients to the fetus and   mother2. Maintai...
Screening for diabetes• Initial screening is done between 24 and 28 weeks of  gestation.• Rescreening at 32 weeks gestatio...
Treatment of Gestational diabetes1. Dietary changes,2. Moderate exercise3. Blood glucose monitored daily                  ...
Hypertension during pregnancy       Blood pressure >140/90                300                                             ...
Preeclampisa1. Pregnancy-specific syndrome observed after 20 th   week2. Blood pressure >140/903. Proteinurea•   Eclampsia...
Role of diet in preeclampsia:• Calcium supplementation ↓ BP• Mg supplements and antioxidants (Vit A and  E) can prevent pr...
Substance use and abuse in        pregnancy          Dr Rania Hussein
Cigarette smoking• CO+ Hb= carboxyhemoglobin→↓ available  sites for oxygen binding → fetal hypoxia, and  fetal growth rest...
Alcohol consumption•   Alcohol is directly toxic to the embryo and    fetus ( it crosses the placenta, while fetal    orga...
Consequences of alcohol           consumptionFetal alcohol syndrome:• Mental retardation• Growth retardation• Facial abnor...
Caffeine intake1. ↑ urinary excretion of Ca and thiamin2. ↓absorption of Zn and Fe.3. ↑ heart rate and blood pressure4. ga...
Recommendations• Limitation of substance use• Multivitamin and mineral supplementation                   Dr Rania Hussein
References• Brown JE, Isaacs J, Wooldridge N, Krinke B,  Murtaugh M. Nutrition through the lifecycle,  2007 . 3rd ed. Wads...
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pregnancy tips

pregnancy tips

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pregnancy tips

  1. 1. GI problems in pregnancy Dr Rania Abd El Hamid Hussein MBBSch Master’s degree in Internal Medicine Doctor in Nutrition and Public Health Assistant Professor of Nutrition Faculty of Applied Medical Sciences KAU Dr Rania Hussein
  2. 2. Nausea and vomiting:morning 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 Dr Rania Hussein
  3. 3. Treatment1. Keep stomach filled but not overfilled2. Eat small frequent meals3. Separate consumption of fluids and solid foods.4. Consume easily digested foods5. Avoid strong-flavored foods6. When nauseated , do not drink fluids, but eat toast or crackers. Dr Rania Hussein
  4. 4. Heart burnIt is caused by:• Relaxation of muscles →↓ gastric emptying → esophageal regurgitation.• In late pregnancy, the pregnant uterus compresses the diaphragm .Treatment:5. Eating small frequent meals6. Avoiding lying down soon after meals7. Antacids can be used Dr Rania Hussein
  5. 5. ConstipationIt is caused by:2. ↓ physical activity3. ↓ intestinal motility4. ↓water intake5. ↓ fiber intake in diet6. The enlarging uterus exerts pressure on the bowel Dr Rania Hussein
  6. 6. Treatment of constipation1. Adequate fluid intake2. Increasing dietary fiber3. Use of bulking agents as bran→ flatulence and bloating Dr Rania Hussein
  7. 7. Craving 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. Dr Rania Hussein
  8. 8. • 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. Dr Rania Hussein
  9. 9. Exercise during pregnancy Dr Rania Hussein
  10. 10. Benefits• A positive self image• Maintenance of fitness• Shorter labor, and fewer surgical interventions Dr Rania Hussein
  11. 11. Recommendations1. 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. Dr Rania Hussein
  12. 12. High Risk Pregnancy Dr Rania Hussein
  13. 13. Maternal and family conditions• Age: adolescent – older gravida• Low SE socioeconomic status• History of poor pregnancy outcome• Short inter pregnancy interval• High parity Dr Rania Hussein
  14. 14. Maternal health problems andPrenatal complicated pregnancy• Obesity, underweight, or poor gestational weight gain• Hyperemesis gravidarum• Multiple fetuses• Anemia• Hypertensive disorders of pregnancy• DM• Viral infections (HIV, Rubella) Dr Rania Hussein
  15. 15. Maternal behavior1. Cigarette smoking2. Alcohol consumption3. Caffeine intake4. Vegeterianism Dr Rania Hussein
  16. 16. Maternal age1. Adolescent2. Older gravida Dr Rania Hussein
  17. 17. Pregnancy in Adolescence Dr Rania Hussein
  18. 18. 1. ↓ nutrient stores and ↑ nutritional needs :• 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 Dr Rania Hussein
  19. 19. 2. Is likely to be poor2. → ↓ intake of nutrients → ↓ prepregnancy weight and ↓ gestational weight3. Late entry to prenatal care Dr Rania Hussein
  20. 20. Consequences of pregnancy inadolescence1. Preterm delivery2. Low birth weight infant3. Difficult labor and delivery4. Pregnancy- induced hypertension Dr Rania Hussein
  21. 21. Recommended energy and nutrientintake for the pregnant adolescentEnergy levels greater than the additional 300Kcal/day are recommended.RDA for protein is increased by 15 g/dayIron, Folate, and calcium supplementation should be recommended routinely Dr Rania Hussein
  22. 22. Recommended gestational weightgain for adolescents Prepregnant BMI weight gain in Kg <19.8 18 19.8-26 16 26-29 11.5 Dr Rania Hussein
  23. 23. Taking care of the pregnantadolescent 1. Family should be supportive and more sympathetic 2. Ensure prenatal and postnatal care Dr Rania Hussein
  24. 24. Older gravida (35 years and older )Risks:2. Multiple fetuses3. Medical conditions : DM, cardiovascular diseases, obesity, tumors4. Down syndrome5. Preterm infants6. Low birth weight infants7. Maternal and perinatal mortality Dr Rania Hussein
  25. 25. Socioeconomic statusThey include:2. Social status3. Income4. Education5. Employment6. Marital status7. Availability of health care systems Dr Rania Hussein
  26. 26. Consequences of low socioeconomic status↓ maternal weight gain →• Preterm infants• Low birth weight infants Dr Rania Hussein
  27. 27. Maternal obesity and underweight Dr Rania Hussein
  28. 28. Underweight mothers are at higher risk of having1. Low-birth-weight infants2. Preterm delivery Dr Rania Hussein
  29. 29. Obese women are at a greater risk of having• Hypertension.• Diabetes.• Complications during labor: Fetal macrosomia and shoulder dystocia• Thromboembolism• Obesity may double the risk of NTD Dr Rania Hussein
  30. 30. Multiple birthsConsequences:2. Preterm infants3. Low birth weight infantsEnergy and nutrient requirements are increasedWeight gain should exceed that of single pregnancies (about 22 Kg weight gain in twin pregnancy) Dr Rania Hussein
  31. 31. Hyperemesis 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. Dr Rania Hussein
  32. 32. Complications include;2. Weight loss, dehydration, electrolyte imbalance3. Fetal growth restriction4. Utilization of body fats and proteins, ketonemia→ this impairs neurologic development of the fetus Dr Rania Hussein
  33. 33. Treatment1. Hospitalization2. Intravenous fluids to correct dehydration and electrolyte imbalance3. Correction of ketonemia4. Oral intake is slowly introduced (small frequent meals low in fat, high in carbohydrates, with liquids consumed at different times) Dr Rania Hussein
  34. 34. 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) Dr Rania Hussein
  35. 35. Diabetes mellitus in pregnancy Dr Rania Hussein
  36. 36. • 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. Dr Rania Hussein
  37. 37. Types of DM are:• Type 1 Insulin dependant diabetes• Type 2 Non insulin dependant diabetes• Gestational diabetes Dr Rania Hussein
  38. 38. In 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 Dr Rania Hussein
  39. 39. Consequences of Diabetes• Preeclampsia• Frank diabetes later in life.• Fetal macrosomia and birth injuries• Operative delivery• Neonatal hypoglycemia• Congenital anomalies Dr Rania Hussein
  40. 40. 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. Dr Rania Hussein
  41. 41. Gestational Diabetes: GD• Intolerance to carbohydrates, first recognized in pregnancy.• Late in the 2nd trimester.• Carbohydrate tolerance is normal before pregnancy and after delivery. Dr Rania Hussein
  42. 42. Nutrition goals in the management ofgestational diabetes1. Provide necessary nutrients to the fetus and mother2. Maintain normal blood glucose (euglycemia), and prevent ketosis3. Achieve appropriate weight gain Dr Rania Hussein
  43. 43. Screening 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. Dr Rania Hussein
  44. 44. Treatment of Gestational diabetes1. Dietary changes,2. Moderate exercise3. Blood glucose monitored daily Dr Rania Hussein
  45. 45. Hypertension during pregnancy Blood pressure >140/90 300 280 260 240 290 270 250 230 220 210• ↑ risk of preeclampsia, preterm 200 190 180 170 160 150 140 130 120 delivery, fetal growth restriction 110 100 90 80 70 60 50 40 30 20• 10 2 types:• Gestational hypertension: detected for the first time after mid pregnancy• Chronic hypertension: detected before pregnancy Dr Rania Hussein
  46. 46. Preeclampisa1. Pregnancy-specific syndrome observed after 20 th week2. Blood pressure >140/903. Proteinurea• Eclampsia= preeclampsia + seizures• Risk factors for preeclampsia: maternal obesity, diabetes, chronic hypertension Dr Rania Hussein
  47. 47. 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. Dr Rania Hussein
  48. 48. Substance use and abuse in pregnancy Dr Rania Hussein
  49. 49. Cigarette 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 Dr Rania Hussein
  50. 50. Alcohol consumption• Alcohol is directly toxic to the embryo and fetus ( it crosses the placenta, while fetal organs are still immature)• The mother is usually undernourished• It ↓ absorption and utilization of some nutrients Dr Rania Hussein
  51. 51. Consequences of alcohol consumptionFetal alcohol syndrome:• Mental retardation• Growth retardation• Facial abnormalities• Nervous, cardiac, and genitourinary system impairment Dr Rania Hussein
  52. 52. Caffeine intake1. ↑ urinary excretion of Ca and thiamin2. ↓absorption of Zn and Fe.3. ↑ heart rate and blood pressure4. gastric reflux Dr Rania Hussein
  53. 53. Recommendations• Limitation of substance use• Multivitamin and mineral supplementation Dr Rania Hussein
  54. 54. References• 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 Hussein

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