GI problems in pregnancy -...

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Dr Rania Hussein Dr Rania Hussein 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

Transcript of GI problems in pregnancy -...

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Dr Rania HusseinDr Rania Hussein

GI problems in pregnancy

Dr Rania Abd El Hamid HusseinMBBSch

Master’s degree in Internal Medicine

Doctor in Nutrition and Public Health

Assistant Professor of Nutrition

Faculty of Applied Medical Sciences

KAU

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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

D4

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Slide 2

D4 D.RANIA, 10/25/2009

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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.

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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 meals

2. Avoiding lying down soon after meals

3. Antacids can be used

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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

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Treatment of constipationTreatment of constipation

1. Adequate fluid intake

2. Increasing dietary fiber

3. Use of bulking agents as bran→ flatulence

and bloating

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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.

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• 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.

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Exercise during pregnancy

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BenefitsBenefits

• A positive self image

• Maintenance of fitness

• Shorter labor, and fewer surgical

interventions

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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.

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High Risk Pregnancy

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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

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Maternal health problems and Maternal health problems and

Prenatal complicated pregnancyPrenatal complicated pregnancy

1. Obesity, underweight, or poor gestational weight gain

2. Hyperemesis gravidarum

3. Multiple fetuses

4. Anemia

5. Hypertensive disorders of pregnancy

6. DM

7. Viral infections (HIV, Rubella)

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Maternal behaviorMaternal behavior

1. Cigarette smoking

2. Alcohol consumption

3. Caffeine intake

4. Vegeterianism

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Maternal ageMaternal age

1. Adolescent

2. Older gravida

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Pregnancy in

Adolescence

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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

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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

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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

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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

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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

D3

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Slide 22

D3 Dr Rania HusseinD.RANIA, 10/25/2009

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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

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Older Older gravidagravida (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

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Socioeconomic statusSocioeconomic status

They include:

1. Social status

2. Income

3. Education

4. Employment

5. Marital status

6. Availability of health care systems

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Consequences of low Consequences of low

socioeconomic statussocioeconomic status

↓ maternal weight gain →

• Preterm infants

• Low birth weight infants

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Maternal obesity and underweight

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Underweight mothers are at Underweight mothers are at

higher risk of havinghigher risk of having

1. Low-birth-weight infants

2. Preterm delivery

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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

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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)

D5

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Slide 30

D5 Dr Rania HusseinD.RANIA, 10/25/2009

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Dr Rania HusseinDr 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.

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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

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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)

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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)

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Diabetes mellitus in pregnancy

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• 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.

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Types of DM are:

• Type 1 Insulin dependant diabetes

• Type 2 Non insulin dependant diabetes

• Gestational diabetes

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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

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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

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Dr Rania HusseinDr Rania Hussein

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.

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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.

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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

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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.

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Treatment of Gestational diabetes Treatment of Gestational diabetes

1. Dietary changes,

2. Moderate exercise

3. Blood glucose monitored daily

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Hypertension during pregnancyHypertension during pregnancy

Blood 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

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PreeclampisaPreeclampisa

1. Pregnancy-specific syndrome observed after 20 th week

2. Blood pressure >140/90

3. Proteinurea

• Eclampsia= preeclampsia + seizures

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

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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.

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Substance use and abuse in

pregnancy

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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

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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

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Consequences of alcohol Consequences of alcohol

consumptionconsumption

Fetal alcohol syndrome:

• Mental retardation

• Growth retardation

• Facial abnormalities

• Nervous, cardiac, and genitourinary system

impairment

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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

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RecommendationsRecommendations

• Limitation of substance use

• Multivitamin and mineral supplementation

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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