Chapter 5.docx

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10 Apr 2012
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Chapter 5 -
Obesity and Pregnancy
->excess body fat alters many metabolic processes and influences the development of two of theof the clinical conditions presented in this
chapter
-> obesity prior to pregnancy is associated with higher rates of gestational diabetes and hypertensive disorders of pregnancy
->unfavourable metabolic changes initiated by excessive body fat:
-increased blood glucose levels
-high C-reactive protein levels (a key marker of inflamation)
-increased blood concentration of insulin
-insulin resistance
-increased blood pressure
-high blood levels of total cholesterol, LDL cholesterol, and triglycerides
- low levels of HDL-cholesterol
70% of obese persons and 23% of normal weight persons have 2 or more of these which increase disease risk
->visceral fat lies beneath skin and muscles of the abdomen, much more strongly related to disease risk
->subcutaneous fat lies beneath the skin
->metabolic processes initiated by visceral fat produce chronic inflammation, free-radical generation, and oxidative stress these promote
insulin resistance, elevated blood glucose, insulin and tryglyceride concentrations and increased blood pressure these increase the risk of
gestational diabetes hypertensive disorders and other clinical conditions during pregnancy
-> increased prevalence of gestational diabetes, and hypertension during pregnancy due to higher rates of obesity, 28.4% of woman 20-34
in the US are obese compared to 10% in 1980
moms obesity and infant outcomes
->stillbirths, large for gestational newborns, and c section delivery higher in obese women
->these kids have high risk of becoming overweight during childhood, and developing type 2 diabetes later in life, related to increased to
fetal exposure to high levels of insulin and a propensity towards developing insulin resistance
Nutritional recommendations and interventions for obesity during pregnancy
->women loose weight rapidly after bariatric surgery due to limited food intake, fat malabsorption, and presence of dumping syndrome: a
condition characterized by weakness, dizziness, flushing, nausea, and palpitation immediately following eating and produced by
abnormally rapid emptying of the stomach , especially in individuals who have had part of the stomach removed. this may persist into
pregnancy
->rapid weight loss and limited food and nutrient intake lead to depletion of tissue stores of many nutrients such as thiamin , vitamin D,
B12, iron calcium and folate are common.
->pregnancy should be postponed for a year or 2 after bariatric surgery
-> gestational diabetes, and preeclampsia are lower in obese women who had weight loss surgery compared to those who did not
Nutritional care for pregnant women post-bariatric surgery
->should have assessment of dietary intake, supplement use, nutrient biomarker status, weight gain, physical activity, and gastrointestinal
symptoms
->roux-en-y bypass and biliopancreatic diversion surgery severly restrict food intake, and are associated with greater weight loss and
nutrient deficits than "lap band" ( vertical banded gastroplasty) involves placement of band around top of stomach limits size of stomach
and restricts amount of food that can be consumed. sometimes adjusted during pregnancy
->at risk for gestational diabetes and many will experience dumping syndrome if given standard 100-gram glucose load for blood glucose
testing use fasting glucose levels or home values instead
Hypertensive disorders of Pregnancy
->second leading cause of maternal mortality in the US, affect 6-10% of pregnancies and contribute significantly to stillbirths, fetal and
newborn deaths, and other adverse outcomes of pregnancy
->causes unknown and cures elusive
->all forms of hypertension in pregnancy are related to chronic inflammation , oxidative stress, and damage to the endothelium of blood
vessels throughout the body, leads to endothelial dysfunction consequences of this are impaired blood flow, increased tendency of blood
to clot, and plaque formation
->hypertensive disorders may benefit from lifestyle and dietary changes
types of hypertensive disorders and characteristics (summary of table 5.2)
->Chronic hypertension
presents before pregnancy
defined as blood pressure >140mm Hg systolic or >90mm Hg diastolic blood pressure
if diagnosed during pregnancy but doesn't resolve after is considered hypertensive also
->Gestational hypertension
elevated blood pressure levels are detected for the first time after mid-pregnancy
not accompanied by proteinuria
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