Idea Transcript
Maternal Nutrition Before, During, and After Pregnancy: Update on What to Eat During the Childbearing Years Elizabeth M. Ward, M.S., R.D.
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Preconception Care: Get Ready to Get Pregnant
Recommendations to Improve Preconception Health and Health Care, 2005
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Details the goals of preconception care for women in their childbearing years (15 to 44 yrs.)
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Recommends: – Screening for health risks, such as iron deficiency, diabetes, and overweight – Health promotion and education – Implementing interventions that address the identified risks to mom and to pregnancy outcome
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm
Act Like You’re Pregnant •
Nearly 50% of pregnancies in US are unexpected or mistimed
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The embryo is highly susceptible to birth defects and other problems during the first 10 weeks of development
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Women with unintended pregnancies are less likely to seek early prenatal care
http://www.cdc.gov/reproductivehealth/unintendedpregnancy/ http://www.nlm.nih.gov/medlineplus/ency/article/002398.htm
Pre-pregnancy Planning • Address existing chronic conditions, such as diabetes, overweight or obesity, HTN, anemia, etc. • If there’s a history of LBW baby, pre-term delivery, birth defect, or infant death: seek medical advice prior to conceiving
Women of Childbearing Age: Overweight and Undernourished
Body Weight and Women of Childbearing Age • ∼60% of women of CB age are overweight • Obesity is more prevalent among women of lower socioeconomic status and of color who often times lack health insurance. http://www.iom.edu/Reports/2009/weight-Gain-during-pregnancy-Reexamining-the-Guidelines.aspx
Prevalence of Obesity in U.S. Women Obesity = BMI of 30 and above • 20-39 years: 32% • 40-59 years: 36% Future Shot: • 12-19 years: 17% http://www.cdc.gov/obesity/data/adult.html
Pregravid Body Weight and Pregnancy Outcome • Maternal pregravid BMI has a stronger relationship with fetal adiposity than GWG and GDM • Maternal obesity before pregnancy and excessive weight gain during pregnancy are deleterious for mother and fetus and a “cause for public health concern.” -2010 Dietary Guidelines for Americans http://www.cnpp.usda.gov/dietaryguidelines.htm; http://www.iom.edu/Reports/2009/weight-Gain-during-pregnancy-Reexamining-the Guidelines.aspx
Consequences of Excess Pregravid Body Weight • May reduce fertility and chances of conception, even with ART • Increases risk for cesarean delivery, gestational DM, HTN, and preeclampsia • Obesity increases the risk of structural defects, heart defects, and hypospadias; linked to lower breastfeeding initiation and duration • Increases the risk of post-partum weight retention in mom • Obese moms have children with a greater risk for obesity, diabetes, HTN vs. the children of non-obese moms Siega-Riz, et al. JADA. 2009;109:918-27; Hillier et al. Diabetes Care. 2007;30:2287-92.
Hyperglycemia and Pregnancy Outcomes • Elevated BG in first trimester increases the risk of birth defects and miscarriage.
• An estimated 80 million Americans have pre-diabetes: -A1C of 5.7% – 6.4% - Fasting blood glucose of 100 – 125 mg/dl - OGTT 2 hour blood glucose of 140 mg/dl – 199 mg/dl • Pre-diabetes often predicts GDM and post-pregnancy type 2 DM; screen women before pregnancy, and if GDM, after, too http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm; http://www.diabetes.org/diabetesbasics/diabetes-statistics/; http://www.cdc.gov/features/diabetespregnancy/
Weight Gain During Pregnancy: Reexamining the Guidelines Institute of Medicine, 2009
Criteria for Classifications of Pre-pregnancy Weight Status Body Mass Index (kg/m2) Underweight