GI problems in pregnancy -...
Transcript of GI problems in pregnancy -...
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
Dr Rania HusseinDr Rania Hussein
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
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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
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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)
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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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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
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