Click icon to add picture

DIETARY PROBLEMS IN
PREGNANCY
BY
ANANE .A. ISAAC
(MEDICAL WARD, CCTH)
.

1
 PRESENTATION OUTLINE

Food
aversions
Iron Heart
Pregnancy Gestationa and
overview deficiency Pica burns in
sickness l diabetes cravings
anemia pregnancy
in
pregnancy

2
 INTRODUCTION
• women have distinct nutritional requirements • ,.
throughout their life – especially before and during
pregnancy and while breastfeeding, when nutritional
vulnerability is greatest.
• Before pregnancy, women need nutritious and safe
diets to establish sufficient reserves for pregnancy.
• During pregnancy, poor diets lacking in key nutrients
like iodine, iron, folate, calcium and zinc  can cause
anemia, pre-eclampsia, hemorrhage and death in
mothers. They can also lead to stillbirth, low
birthweight, wasting and developmental delays for
children.
3
 INTRODUCTION 2/2
 WHO promotes healthy eating, micronutrient supplementation (iron and folic acid or
multiple micronutrients, and calcium), deworming prophylaxis, weight gain
monitoring, physical activity, and rest to improve the nutrition of pregnant women.
 Worldwide, women’s diets are influenced by various factors;
• food access and affordability
• Gender inequality  
• social and cultural norms that may constrain women’s ability to make decisions about
their nutrition and care. (ref: UNICEF)

Https://www.WHO.Int/news/item/07-11-2016-new-guidelines-on-antenatal-care-for-a-positive-pre
gnancy-experience 4
 GESTATIONAL DIABETES (GDM)
• GDM is a type of diabetes that is first seen in a pregnant
woman who did not have diabetes before pregnancy.
• usually shows up in the middle of pregnancy; Doctors most
often test for it between 24 and 28 weeks of pregnancy.
• For most women with gestational diabetes, the diabetes goes
away soon after delivery.
• Every year, 2% to 10% of pregnancies in the United States
are affected by GDM. (ref. CDC)

5
 RISK FACTORS OF GDM

Had gestational Have given birth to a

diabetes during a baby who weighed
previous pregnancy. over 9 pounds (4.08kg)

overweight before Are more than 40

conception. years old.

Have a hormone disorder

Have a family history called 
of type 2 diabetes. polycystic ovary syndro 6
me
 (pcos)
 EFFECTS OF GDM
If you have gestational diabetes, your baby is at higher risk of:
 Excessive birth weight.
 Early (preterm) birth. 

 Low blood sugar (hypoglycemia). Sometimes babies have low blood sugar (hypoglycemia)
shortly after birth.
 Obesity and type 2 diabetes later in life. 
 Stillbirth :Untreated gestational diabetes can result in a baby's death either before or shortly
after birth.

7
 EFFECTS OF GDM 2/2
Gestational diabetes may also increase your risk of:
 High blood pressure : Gestational diabetes raises your risk of high blood pressure.

 Having a surgical delivery (c-section): You're more likely to have a c-section if you have
gestational diabetes.
 Future diabetes: If you have gestational diabetes, you're more likely to get it again during a
future pregnancy

8
 TIPS FOR WOMEN WITH GDM
 Eat healthy foods: eat healthy foods from a meal plan made for a person with diabetes. 

 Increase dietary fiber(25-40g/d). Most guidelines recommend carbs intake of 33-45% of

the total energy (madras diabetes research foundation, 2021).
 Exercise regularly: exercise is another way to keep blood sugar under control. It helps to
balance food intake.
 Monitor blood sugar often: Because pregnancy causes the body’s need for energy to
change, blood sugar levels can change very quickly

Https://www.Cdc.Gov/diabetes/managing/eat-well/meal-plan-method.Html

9
 TIPS FOR WOMEN WITH GDM 2/2

 Take insulin, if needed: sometimes a woman with gestational diabetes must take insulin. If
insulin is ordered by your doctor, take it as directed in order to help keep blood sugar under
control.
 Other medications
 Get tested for diabetes after pregnancy: get tested for diabetes 6 to 12 weeks after your
baby is born, and then every 1 to 3 years

10
 ROUTINE SCREENING FOR
GESTATIONAL DIABETES

Screening tests may vary slightly depending on your health care provider, but generally include:
• Initial glucose challenge test. You'll drink a syrupy glucose solution. One hour later, you'll
have a blood test to measure your blood sugar level.
• A blood sugar level of below 140mg/dl (7.8mmol/L) is considered standard
• A blood sugar level of 140mg/dl (7.8 mmol/L) to less than 190mg/dl (10.6mmol/L) indicates
the need for OGTT.
• A blood sugar level of 190mg/dl (10.6mmol/L) or higher indicates GDM. Further testing
might not be needed.

11
 IRON DEFICIENCY ANEMIA IN
PREGNANCY (IDA)
 Pregnancy increases the risk of iron deficiency anemia.
 During pregnancy, the volume of blood in the body increases, and so
does the amount of iron you need
 Iron deficiency anemia is a condition where a lack of iron in the body leads to
a reduction in the number of red blood cells.
 Biochemical indicators of Iron deficiency
 Low RBC
 low Hemoglobin
 low hematocrit (Hct)
 Low ferritin

Https://www.Healthline.Com/nutrition/iron-deficiency-signs-symptoms
12
 IDA 2/2

The most important factor in the diagnosis of iron deficiency anemia is laboratory testing.
  A serum ferritin concentration <30 μg/L together with an Hb concentration <11 g/dl
during the 1st trimester, <10.5 g/dl during the 2 nd trimester, and <11 g/dl during the
3rd trimester are diagnostic for anemia during pregnancy. 
 If serum ferritin is low (<30 μg/L), but the Hb is normal (≥11 g/dl) during the 1 st trimester,
≥10.5 g/dl during the 2nd trimester, and ≥11 g/dl during the 3rd trimester) the diagnosis is
iron deficiency; however, if serum ferritin is low (<30 μg/L) and Hb is also low (<11 g/dl
during the 1st trimester, <10.5 g/dl during the 2nd trimester, and <11 g/dl during the
3rd trimester), the diagnosis is iron deficiency anemia. 

13
 RISK FACTORS OF IDA
IN PREGNANCY

Have two closely spaced pregnancies

Are pregnant with more than one baby

vomiting frequently due to morning sickness

Don't consume enough iron-rich foods

Have a heavy pre-pregnancy menstrual flow

Have a history of anemia before your pregnancy

14
SIGNS AND SYMPTOMS OF IDA IN PREGNANCY

Anemia signs and symptoms include:  Headache

 Fatigue  Pale or yellowish skin

Weakness  Shortness of breath

 Craving or chewing ice (pica)
 Dizziness

15
 COMPLICATIONS OF IDA IN PREGNANCY

 Increased risk of infections: Research has shown iron deficiency anemia can affect your immune
system  which increases your vulnerability to infection.
 Pregnancy complications: Research suggests babies born to mothers who have untreated anemia
are more likely to:
• Be born prematurely – before the 37th weeks of pregnancy
• Have a low birth weight
• Have problems with iron levels themselves
• Do less well in mental ability tests
 Restless legs syndrome: A common condition that affects the nervous system, and causes an
overwhelming, irresistible urge to move the legs. It also causes an unpleasant feeling in the feet, calves
and thighs.
16
 TREATING IDA IN PREGNANCY

 Dietary advice
• Iron-rich foods include: Dark-green leafy vegetables, Iron-fortified cereals or bread, Brown
rice, Pulses and beans ,Nuts and seeds, White and red meat ,Fish ,Eggs etc.
 Iron supplements
 Folic acid supplements
 Vitamin C
 Treating the underlying cause
• For example, if non-steroidal anti-inflammatory drugs (NSAID) are causing bleeding in your
stomach.
17
 TREATING IDA IN PREGNANCY 2/2

 Intravenous (iv) iron: iv iron may be necessary to treat iron deficiency in patients who do
not absorb iron well in the GIT, patients with severe iron deficiency.
 Iron dextran
 Iron sucrose
 Ferric gluconate

 Blood transfusion

18
 FOOD AVERSIONS AND CRAVINGS IN
PREGNANCY
 A food aversion is an intense dislike of a specific food,
together with unpleasant physical symptoms when you see
or smell a particular food.
 Food aversions are common, and around 6 in 10 people
experience a food aversion while pregnant.
 You can experience food aversions resulting from generalized
nausea (also known as ‘morning sickness’) at any time of day,
and it tends to peak between week 6 and week 14 of
pregnancy

Https://www.Pregnancybirthbaby.Org.Au/u/dealing-with-morning-si
ckness 19
 CAUSES OF FOOD AVERSIONS IN PREGNANCY

 While the cause of food aversions during pregnancy isn't clear,

 hormonal changes could affect the food you enjoy, particularly early in your pregnancy. For
example, human gonadotropin (also known as hcg) is a hormone produced during
pregnancy. It can cause feelings of nausea, appetite changes and food aversion
  Pregnancy can also cause a greater sensitivity to smell and taste, which can influence the
foods you prefer to eat
 Common food aversions include:

Alcohol, coffee, tea, meat, fatty food, spicy food, eggs etc.

Https://www.Pregnancybirthbaby.Org.Au/hcg-levels
20
 FOOD CRAVINGS IN PREGNANCY

 Food cravings are sudden urges to eat a certain type of food or non-food (pica)
 Sometimes you might want to eat unusual food combinations or a foods that you normally
don’t like.
 Common food cravings include ice cream, chocolate, other sweet foods, fish, dairy products,
and fruit.

21
 SOME TIPS FOR MANAGING CRAVINGS

The following suggestions will help manage  Get plenty of sleep (research has shown
food cravings: that people who are sleep deprived tend to
Eat healthy meals at regular times to help crave junk food more often than healthy
prevent sudden feelings of hunger foods)

Keep your pantry stocked with healthy snacks  Remain physically active

Don’t do the grocery shopping when you are
 Drink plenty of water
hungry

Choose healthy, low glycemic index (GI) foods  Clean your teeth regularly
that keep you full for longer (such as
unsweetened rolled oats (porridge),
wholegrain breads, and fresh fruit)
22
 PICA
 Pica is an eating disorder and It may be diagnosed if you constantly eat nonfood items for
at least 1 month
 Some research has found that pica may be connected to anemia, including iron deficiency
anemia. It can occur at any stage of pregnancy but often appears in the first trimester.
 Some of the things that people with pica may eat include:
 ice (pagophagia), paper, clay or dirt (geophagia), soap, chalk etc.
 A deficiency in important minerals like iron and zinc may trigger pica.

Https://www.Healthline.Com/nutrition/common-eating-disorders
23
 PICA 2/2

 One study in 286 pregnant women in Ghana noted that

pregnant women most at risk of pica may include those who
have:
 Poor nutrition or nutrient deficiencies
 A history of or cultural exposure to eating nonfood items, such
as eating clay as medicine in some cultures
 The study also found that 47.5% of the women had some form
of pica during pregnancy. The most common items consumed
were white clay and ice.
 The researchers noted that some participants believed
that the white clay and ice had nutritional value.
24
 HEART BURNS IN PREGNANCY
  It can be caused by hormonal changes and the growing baby pressing
against your stomach. 
 Making changes to your diet and lifestyle can help ease heart burns and
there are medicines that are safe to take in pregnancy
 Symptoms of heart burns and indigestion
 A burning sensation or pain in the chest, Feeling full, heavy or
bloated, Burping or belching, Feeling of being sick, Bringing up food
 You can get symptoms at any point during your pregnancy, but they are
more common from 27 weeks onwards.

25
 TIPS TO HELP WITH HEART BURNS AND
INDIGESTION
 Changes to your diet and lifestyle may be enough to control your symptoms, particularly if
they are mild.
• Healthy eating practice: If you're pregnant, it may be tempting to eat more than you would
normally, but this may not be good for you or your baby.
• Change your eating and drinking habits: Cutting down on drinks containing caffeine, and
foods that are spicy or fatty, can also ease symptoms
• Keep upright: sit up straight when you eat. This will take the pressure off your stomach
• Avoid alcohol
• Medicines for indigestion and heartburn

26
 CASE SUMMARY: 3RD – 15TH FEBRUARY, 2023.

 Patient GO is a 32 y/o female who has had 3 pregnancies (current pregnancy inclusive) with
all two children alive.
 Hx of having microsomic baby in previous pregnancy (4.2kg)
 Current medical Diagnosis:

• Preterm PROM and GDM

 She is a trader and lives with her husband and two children in Mempeasem.
 eGA: 30 weeks + 1day (initial visit)

27
 NUTRITION ASSESSMENTS

 Anthropometry
 Ht:162cm
 Reported wt. Before pregnancy: 57kg
 BMI before pregnancy: 21.72kg/m2
 Current weight: 69kg
 Medications
 Tab Amoxicillin 500mg 8hrly
 Oral Erythromycin 500mg 8hrly
 IM Dexamethasone 6mg 12hrly 2 days
(completed)

 MUAC: 24.1cm

28
 NUTRITION ASSESSMENT

Biochemical Data/ Medical Tests and

• Albumin: 37.37 g/L (LL:34.00)
Procedures(01/02/23)
• Total protein: 68.2 g/L (LL:62.0)
• Hb: 11.6g/dl (LL:11.5) (N)
• Creatinine: 72.21 µmol/L (UL: 123.80)
• Rbc: 3.44 (ll:4.0) (L)
• Bun/cre: 29.67 (ul:36)
• Hct: 32.2 (LL:37.7) (L)
• Na: 134.4 mmol/L (UL:145.0)
• Mcv: 93.6 (ll:80)
• OGTT: 0mins=5.1, 60mins=8.4,
• Wbc: 11.08 (ul:10) (H)
120mins=7.6, 180mins=4.8

29
 NUTRITION ASSESSMENTS
NFPE
• No Fat wasting (triceps, ribs)
• No Muscle wasting (clavicle, quadriceps, gastrocnemius)
• BP: 102/68 mmHg
• C/o vomiting after eating ( since onset of pregnancy)
• C/o loss of appetite
• No C/o dysphagia
• No edema
• C/o heart burns
• c/o frontal headache
30
 NUTRITION ASSESSMENT

Food and nutrition related hx  Adequate fluid intake(2l/d)

 Pt feeds 3 times daily  Pt sometimes skips lunch (3/7)

 Pt depends on both home meals and food  estimated daily caloric intake of 1600kcal
vendors/ hospital kitchen ( low)
 Low fruit intake (1/7)
 Excessive Intake of carbs (260g/d)
 Low fiber intake(15g/day)
 Inconsistent meal timing
 High intake of carbonated drinks (14/7) 31
 NUTRITION DIAGNOSIS

 Excessive intake of carbohydrates(240g) R/T patient’s food preferences as evidenced by diet

history and reported symptoms of uncontrolled blood glucose (OGTT: 0mins=5.1, 60mins=
8.4mmol/L).
 Inadequate intake of fiber (15g) r/t excessive intake of refined carbohydrates as evidenced by
Pt diet hx and intake of 15g of fiber as against daily recommendation of 25-40g of fiber daily.
 Inadequate energy intake(1600kcal) R/T Pt skipping meals and loss of appetite as evidenced
by diet hx.

32
 NUTRITION INTERVENTION

 Pt was counselled on MNT for condition  Pt was educated on the condition

based on 2000kcal/day for the start.
 Pt was counselled to avoid skipping meal
 Carbohydrates-45% (225g=15servings)
 A detailed diet plan was given to patient
 Proteins -30% (120g=16servings)
 Fat – 25% (52g=9servings)

 fiber – 28g

33
 M/E

 Monitor pt. adherence to diet plan

 Monitor FBS and RBS

 Monitor pt. weight

 Monitor pt. tolerance to foods included in diet plan.

34
35