LB2882MaternalNutriti+ - Mead Johnson Nutrition

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TAbLE 12. SELECTED FOODbORNE PATHOGENS AND RISkS TO MATERNAL AND FETAL HEALTH Organism May result in To reduce risk, avoid Listeria monocytogenes Miscarriage, preterm delivery, infant death Hot dogs, luncheon meats, foods made with unpasteurized milk and cheese, refrigerated pate, meat spreads, and smoked seafood Escherichia coli Abdominal cramps, bloody diarrhea, vomiting Undercooked beef, contaminated bean sprouts, fresh leafy greens, unpasteurized milk and juice Salmonella Diarrhea, fever, cramps Undercooked animal foods, unpasteurized milk, raw eggs Toxoplasma gondii Vision loss, mental disability in offspring Undercooked meat, dust, contaminated kitty litter boxes, and outdoor areas where cat feces found Source: CDC.gov. Accessed 09/12 PREGNANCY–ASSOCIATED CONDITIONS AND POSSIbLE DIET AND LIFESTYLE INTERVENTIONS Nausea, Vomiting, and Hyperemesis Gravidarum Rapidly rising blood levels of human chorionic gonadotropin (HCG) may be culpable for so-called “morning sickness” that includes nausea or vomiting in the fi rst trimester that may signifi cantly reduce a woman’s appetite. 137,138 Management of nausea and vomiting typically involves avoiding offending foods and eating small, frequent meals and snacks. 3 Hyperemesis gravidarum is persistent, extreme nausea and vomiting that may result in dehydration and poor weight gain. 138 It is distinguished from morning sickness by weight loss (> 5% of weight) and development of dehydration and ketoacidosis. 138 Hyperemesis gravidarum requires medical supervision to monitor maternal and fetal well-being. 137 Hypertensive Disease About 10% of pregnant women worldwide develop hypertensive disorders of pregnancy. These disorders include preeclampsia and eclampsia, gestational hypertension and chronic hypertension. Pre-eclampsia, which is characterized by hypertension and proteinuria, is a primary cause of maternal and perinatal morbidity and mortality worldwide. 39 In addition to gestational hypertension, risk factors for pre-eclampsia include being pregnant with more than one child, maternal obesity, a history of pre-eclampsia, and pre-existing diabetes. 139,140 An increase in pre-pregnancy BMI between pregnancies poses a risk for pre-eclampsia in the second pregnancy for women with no previous history of the condition. 140 Managing hypertensive disease during pregnancy is critical for reducing infant mortality and maternal morbidity and mortality. 39 In 2011, The World Health Organization published 23 recommendations for prevention and treatment of pre-eclampsia and eclampsia. The target audience was health care providers, particularly those in under-resourced settings. 39 While the guidelines are not intended as a comprehensive guide on treatment of pre-eclampsia and eclampsia, they do review the evidence of important topics related to the management of these disorders. Four of MATERNAL NUTRITION 26
the recommendations, summarized below, are related to micronutrient intakes and/or supplementation. In general, the group that developed the guidelines agreed that “healthy dietary practices should be promoted in the general population, including among pregnant women.” 39 The WHO guidelines recommend calcium supplementation for pregnant women residing in areas where dietary calcium intake is low. The recommendation states, “ In areas where dietary calcium intake is low, calcium supplementation during pregnancy (at doses of 1.5-2.0 g elemental calcium/day) is recommended for the prevention of pre-eclampsia in all women, but especially in those at high risk of developing pre-eclampsia.” Additional calcium supplementation, however, does not improve outcomes related to pre-eclampsia and pregnancy- related hypertensive disorders for populations with adequate calcium intake. 39 The expert group agreed that avoiding excessive dietary salt intake is a healthy dietary practice. However, restricting dietary salt intake during pregnancy to prevent pre-eclampsia was not recommended. The group did not define “excessive salt intake.” (Sodium intake recommendations during pregnancy are provided in Table 9). In addition, supplementation with vitamin D and supplementation with the antioxidant vitamins C and E, individually or in combination, are not recommended to prevent pre-eclampsia and its complications since research data available at the time did not support a beneficial effect. 39 Gestational Diabetes Gestational diabetes mellitus (GDM) affects about 4% of all pregnancies worldwide. 141 Risk factors for GDM include having an immediate family member with diabetes, being overweight, having pre-diabetes, or having a history of GDM in a past pregnancy. Women with GDM have an increased risk of developing hypertension during pregnancy and are more likely to have a cesarean delivery, as infants born to mothers with poorly controlled GDM may be larger at birth, and macrosomic neonates are more prone to birth injury. 142 Children born to mothers with poorly controlled GDM are at greater risk for breathing problems and other serious illnesses in the newborn period, and they are more likely to become overweight in childhood or as adults. All pregnant women should be screened for GDM risk at their first prenatal visit. 40 Women with GDM should receive nutritional counseling about a balanced diet that meets pregnancy nutrition needs, promotes appropriate weight gain, and fosters blood glucose control. 40 Appropriate weight gain may lessen risk of undesirable pregnancy outcomes. For example, women with singleton pregnancies diagnosed with GDM who gained more than the suggested amounts during pregnancy had higher risk of preterm delivery, delivering macrosomic neonates, and cesarean delivery. 143 In obese women with GDM, moderate caloric restriction may improve glycemic control without inducing ketonuria. 123 Women should also be made aware of the glucose-lowering benefits of physical activity. Programs of moderate physical exercise have been shown to lower maternal glucose concentrations in women with GDM and those without medical or obstetrical contraindications should be encouraged to start or continue a program of moderate exercise as a part of treatment for GDM. 144 Women with GDM should be aware that they have a much higher risk (about 7 times higher) for developing type 2 diabetes after delivery than women without GDM. 145 Therefore, in the US, the National Diabetes Education Program recommends that women with GDM be screened for type 2 diabetes 6 to 12 weeks after delivery. If initial blood glucose concentrations are normal, these women should be screened for type 2 diabetes every 3 years. 145 Women who had GDM can help lower their risk for developing type 2 diabetes by losing weight, increasing physical activity and making healthy food choices. Children born to women with GDM are also more likely to become obese and develop type 2 diabetes. Children’s risk is also lower if they stay at a healthy weight, consume a healthy diet and incorporate daily physical activity. 145 27
Page 1 and 2: MATERNAL NUTRITION bY Elizabeth M.
Page 3 and 4: TAbLE OF CONTENTS EXECUTIVE SUMMARY
Page 5 and 6: EXECUTIVE SUMMARY A mother’s nutr
Page 7 and 8: INTRODUCTION A mother’s nutrition
Page 9 and 10: Preconception Care In 2005, the WHO
Page 11 and 12: Nutrient Needs during Pregnancy and
Page 13 and 14: During lactation, the U.S. Dietary
Page 15 and 16: The United States has not establish
Page 17 and 18: Folate and Folic Acid Folate is a g
Page 19 and 20: Vitamin D Vitamin D’s principal r
Page 21 and 22: Iron Iron is vital to the productio
Page 23 and 24: Table 10. WHO Recommended Nutrient
Page 25 and 26: Guidelines for Physical Activity du
Page 27: FOOD SAFETY ISSUES Fish and Seafood
Page 31 and 32: Women are encouraged to enter pregn
Page 33 and 34: 53. Viswanathan M, Siega-Riz AM, Mo
Page 36: XXXXXX NEW 12/12 ©2012 Mead Johnso

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