Proper nutrition during pregnancy is of paramount importance, as it directly influences the health and development of both the expectant mother and the growing fetus. A well-rounded diet during this time ensures not only a successful pregnancy but also sets the foundation for the long-term well-being of the child. Adequate caloric intake, including an extra 300-500 calories per day in the later stages of pregnancy, supports the increased energy demands. Essential nutrients like protein aid in the development of the baby's organs and tissues, while folic acid helps prevent neural tube defects. Iron is crucial for preventing anemia and supporting the expanded blood volume, while calcium is necessary for the baby's bone growth and heart function. Omega-3 fatty acids contribute to the baby's brain and eye development. Vitamins such as D, C, and A play diverse roles, from enhancing calcium absorption to bolstering the immune system. Hydration, avoiding harmful substances, and managing gestational diabetes are additional factors to consider. Prenatal vitamins can provide a nutritional safety net, but consulting a healthcare provider is key to tailoring dietary choices to individual needs. In essence, a balanced and well-managed diet during pregnancy is a fundamental investment in the health and future of both mother and child

1. NUTRITION DURING
PREGNANCY
Conditions and Intervention

2. Obesity and
pregnancy:
Obesity before and during pregnancy can have
negative effects on both the mother and child. It
can lead to genetic, hormonal, and metabolic
changes that impact the health of the mother
and the development of the fetus. Obesity
increases the risk of preterm delivery, gestational
diabetes, and hypertensive disorders during
pregnancy. It is also associated with giving birth
to larger-than-average babies. Children born to
obese mothers are more likely to become obese
themselves during childhood, and both the
mother and child have a higher risk of
developing type 2 diabetes later in life.
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3. The increased risk of these disorders is
associated with unfavorable metabolic changes
related to
excessive body fat, such as:
• Increased blood glucose levels
• High C-reactive protein levels (a key marker
of
• inflammation)
• 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
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4. 20XX presentation title 4
Weight
status
Underweig
ht
Normal Overweight Obese Very
obese
Extremely
obes
BMI, kg/m2 18.5 18.5–
24.9
25–29.9 30–34.9 35–39.9 .40
Preterm 11.6% 8.1% 8.4% 10.6% 8.9% 12.4%
Gestational
diabetes
3.5% 3.8% 4.7% 7.0% 9.6% 11.0%
Preexisting
diabetes
0% 0.8% 1.7% 2.4% 6.9% 9.7%
Hypertensive
disorde
5.8% 9.1% 13.3% 20.7% 23.3% 31.7%

5. • 70% of obese individuals and 23% of
normal-weight individuals have multiple
metabolic abnormalities
• High levels of visceral fat primarily cause
these metabolic effects
• Visceral fat is located around internal
organs and is more metabolically active
than subcutaneous fat
• Visceral fat leads to chronic inflammation,
free-radical generation, and oxidative stress
• The metabolic effects of visceral fat include
insulin resistance, elevated blood glucose
and insulin levels, increased triglyceride
concentrations, and higher blood pressure.
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6. • Obesity is a disease, not a choice, and has
various factors contributing to its development.
• Obese women may struggle with reducing food
intake due to genetic factors affecting appetite
and satiety.
• nutrition recommendations for pregnant women
apply to obese women, including a balanced
diet and appropriate physical activity.
• Weight loss during pregnancy in obese women
may decrease the risk of large-for-gestational-
age infants but increase the risk of small-for-
gestational-age infants and premature birth.
• Weight loss during pregnancy is not
recommended.
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Nutritional
Recommendations
and
Interventions for
Obesity During
Pregnancy

7. Bariatric Surgery:
Gastric bypass and other weight-loss
surgeries — known collectively as
bariatric surgery —involve making
changes to your digestive system to
help you lose weight. Bariatric surgery
is done when diet and exercise haven't
worked or when you have serious
health problems because of your
weight
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Pregnancy After
Bariatric
Surgery

8. TYPES:
1. Roux-en-Y bypass:
Gastric bypass, also called Roux-en-Y (roo-en-
wy) gastric bypass, is a type of weight-loss
surgery that involves creating a small pouch from
the stomach and connecting the newly created
pouch directly to the small intestine.
2. Biliopancreatic Diversion:
It involves removal of part of the stomach to
restrict how much food the stomach can hold,
along with diverting the GI tract beyond some of
the small intestine so fewer calories are
absorbed.
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9. Lap band surgery:
Lap band surgery involves placement
of a band around the top of the
stomach. The band limits the size of
the stomach and restricts the amount
of food that can be consumed. The lap
band is sometimes adjusted during
pregnancy to help regulate food intake
and weight gain
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10. Deficiency:
• Thiamin deficiency can develop within
20 days after the surgery,22
• Deficiencies of vitamins D
• B12
• Iron
• Calcium
• Folate
Complications in case of
pregnancy:
• Gestational diabetes
• Preeclampsia
• Large for gestational-age newborns
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DEFICIENCY &
COMPLICATION

11. Women lose weight rapidly after bariatric surgery
due to limited food intake, fat malabsorption,
decreased appetite, and the presence of
dumping syndrome, a common side effect of
the surgery.
DUMPING SYNDROME:
A condition characterized by weakness,
dizziness, flushing, nausea, and palpitation
immediately or shortly after eating and produced
by abnormally rapid emptying of the stomach,
especially in individuals who have
had part of the stomach removed.
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REASONS OF
WEIGHT LOSS

12. It is recommended that pregnancy be
postponed
for a year or two after bariatric surgery, when
body weight is stable and nutrient stores have
been established.
Nutrition care services are recommended for
pregnant women with a history of bariatric
surgery.
These services include:
• Assessment of dietary intake
• Supplement uses
• Nutrient biomarker status
• Weight gain
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RECOMMENDATIO
N

13. Hypertensive
Disorders
of Pregnancy

14. In pregnancy, various types of high blood pressure
(hypertension) and other conditions like diabetes
are linked to ongoing inflammation, oxidative
stress, and harm to the inner lining of blood
vessels. These factors gradually lead to
dysfunction in the inner lining (endothelium) of
blood vessels. This dysfunction has several
consequences, such as reduced blood flow to the
placenta, an increased tendency for blood clotting,
and the formation of plaque. Pregnant women who
experience hypertensive disorders are affected by
these outcomes
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Hypertensive
Disorders of
Pregnancy,
Oxidative Stress, and
Nutrition

15. 1.Decrease:
• Regular intake of colorful fruits and vegetables,
dried beans, and whole-grain products
• Vitamin D sufficiency
• Physical activity
2.Increase:
• Frequent intake of processed and high-fat meats
• Frequent consumption of soft drinks, other high-
sugar beverages
• Physical inactivity
• High levels of body fat, especially visceral fat
• Smoking
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Dietary and other
environmental
exposures that
increase or decrease
chronic inflammation
and oxidative stress

16. Hypertension that is present before
pregnancy or diagnosed before 20
weeks of pregnancy. Hypertension is
defined as blood pressure ≥140 mm
Hg systolic or ≥90 mm Hg diastolic
blood pressure. Hypertension first
diagnosed during pregnancy that does
not resolve after pregnancy is also
classified as chronic hypertension.
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Chronic
Hypertensi
on

17. Rates of preterm delivery, fetal growth
retardation, placenta abruption, and
Cesarean delivery are higher in
women with chronic hypertension than
other women.
Placental abruption:
The separation of the placenta from its
attachment to the uterus wall before
the baby is delivered. Also called
abruptio placenta. Consequences of
this condition range from mild to
severe for the mother and fetus
depending on blood loss, extent of
fetal distress, gestational age of the
fetus, and other factors.
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EFFECTS

18. This condition exists when elevated blood
pressure levels are detected for the first
time after mid-pregnancy. It is
accompanied by proteinuria or the onset
of new symptoms. If blood pressure
returns to normal within 10 days
postpartum, the condition is considered to
be transient hypertension of pregnancy. If
it remains elevated, then the woman is
considered to have chronic hypertension.
Women with gestational hypertension are
at lower risk for poor pregnancy outcomes
than are women with preeclampsia.
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GESTATIONAL
HYPERTENSION

19. A pregnancy-specific syndrome that usually
occurs after 20 weeks gestation (but that
may occur earlier) in previously
normotensive women. It is determined by
increased blood pressure during pregnancy
to ≥140 mm Hg systolic or ≥90 mm Hg
diastolic and is accompanied by proteinuria.
• Proteinuria is defined as the urinary
excretion of ≥ 0.3 grams of protein in a
24-hour urine specimen.
• Eclampsia is defined as the occurrence of
seizures that cannot be attributed to other
causes in women with preeclampsia.
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PREECLAMP
SIA-
ECLAMPSIA

20. It represents a syndrome characterized
by:
• Oxidative stress, inadequate antioxidant
defenses, inflammation, and endothelial
dysfunction
• Platelet aggregation and blood
coagulation due to deficits in
prostacyclin relative to thromboxane
• Blood vessel spasms and constriction,
restricted blood flow
• Increased blood pressure
• Insulin resistance
• Adverse maternal immune system
responses to the placenta
• Elevated blood levels of triglycerides,
free fatty acids, and cholesterol
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CHARACTERISTIC
S

21. • Hypertension
• Increased urinary protein
• Decreased plasma volume
expansion (hemoglobin levels 13
g/dL)
• Low urine output
• Persistent and severe headaches
• Sensitivity of the eyes to bright light
• Blurred vision
• Abdominal pain
• Nausea
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SIGN AND
SYMPTOMPS OF
PREECLAMPSIA

22. Mother
• Early delivery by Caesarean
section
• Acute renal (kidney) dysfunction
• Increased risk of gestational
diabetes, hypertension, and
• type 2 diabetes later in life
• Placenta abruption
Newborn
• Preterm delivery
• Growth restriction
• Respiratory distress syndrome
• Fetal death
• Maternal death
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Outcomes related
to the existence of
preeclampsia
during pregnancy

23. • The cause of preeclampsia is unknown but
appears to originate from abnormal
implantation and vascularization of the
placenta, and poor blood flow through the
placenta. Abnormal blood flow through the
placenta is an important characteristic of
preeclampsia because it decreases the
delivery of nutrients and gases to the fetus.
• Eclampsia can be a life-threatening condition
and one that can be difficult to predict.
Eclamptic seizures appear to be related to
hypertension, the tendency of blood to clot,
and spasms of and damage to blood vessels
in the brain. The only cure for preeclampsia
and eclampsia is delivery of the placenta.
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24. • First pregnancy (nulliparous)
• Obesity, especially high levels of central body
fat
• Underweight
• Mother’s smallness at birth
• African American, American Indian ancestry
• Preexisting diabetes mellitus
• Multifetal pregnancy
• Insulin resistance
• Abnormally high blood triglyceride levels
• Chronic hypertension
• Renal disease
• Poor vitamin D status
• Poor calcium status
• Consumption of a pro-inflammatory, pro-
oxidative stress diet
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RISK FACTORS
FOR
PREECLAMPSI
A

25. • Nutritional and physical activity
recommendations that may benefit
women at risk of preeclampsia include:
• Adequate calcium and vitamin D
status; use of supplemental calcium
and vitamin D if needed
• Consumption of five or more servings
of colorful vegetables and fruits daily
• Adequate fiber intake (28 grams daily)
• Consumption of the assortment of
other basic foods recommended in
ChooseMyPlate
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Nutritional
Recommendation
s and
Interventions for
Preeclampsia

26. • Moderate-intensity physical activity
(e.g., brisk walking, swimming,
tennis, aerobic dancing) for 30
minutes daily unless medically
contraindicated
• Weight gain that follows
recommendations based on pre-
pregnancy weight status.
• Iron supplements, especially if taken
in high doses, may aggravate
inflammation by increasing the
body’s free radical load.
• Women with preeclampsia should
not be given high-dose iron
supplements.
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27. 20XX presentation title 27
Vitamin and
Mineral
Supplementation
and the Risk of
Preeclampsia
• Oxidative stress and lack of antioxidant defense contribute to
preeclampsia.
• Early studies suggested that vitamin C and E supplementation
could reduce oxidative stress and preeclampsia risk.
• However, vitamin C and E supplements should not be used for
preeclampsia prevention.
• Fish oils, folic acid supplements, magnesium supplements, and
garlic are also ineffective in preventing preeclampsia.
• Supplemental vitamin D and calcium can lower preeclampsia
risk in women with poor vitamin D status or calcium intake.
• Multivitamin and mineral supplements before and early in
pregnancy reduce preeclampsia risk in normal-weight women.

28. 20XX presentation title 28
Dietary
Intake and
the Risk of
Preeclampsi
a
•Certain dietary patterns during the first 22 weeks of
pregnancy are associated with preeclampsia risk.
•Diets high in plant foods that decrease inflammation
and oxidative stress.
•Diets including processed meat, sweet drinks, and
salty snacks are associated with higher
preeclampsia risk.
•High-fiber diets may lower preeclampsia risk by
reducing elevated blood levels of triglycerides and
cholesterol, which contribute to oxidative stress
development.

29. • High sodium intake was once believed to
be linked to preeclampsia development,
and low salt intake was thought to prevent
it.
• However, clinical studies have shown that
these assumptions are inaccurate.
• Restricting salt during pregnancy does not
prevent preeclampsia, hypertension, or
other pregnancy-related complications.
Instead, it is advised to make salt
consumption during pregnancy a personal
preference rather than a routine restriction
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Sodium (Salt)
Intake and the
Risk of
Preeclampsia

30. 20XX presentation title 30
Dietary Approach to
Stop Hypertension
Potassium, calcium,
magnesium, fiber, and
protein are important.
Fatty meat, full-fat dairy,
sweets beverages, sugar,
and sodium are limited.

31. Diabetes in
Pregnancy

32. Diabetes is a leading complication in
pregnancy. It has three main forms:
• Gestational diabetes
• Type 2 diabetes
• Type 1 diabetes
Due to placental hormones, growth factors,
and other physiological changes,
pregnancy exerts a diabetogenic effect on
maternal carbohydrate utilization. Insulin
resistance and requirement increase as
pregnancy progresses.
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DIABETE
S

33. Diabetes during pregnancy is called
gestational diabetes.
The prevalence of gestational diabetes
varies from 2 to 12 percent.
Gestational diabetes accounts for 88
percent of all cases of diabetes in pregnancy
and is similar in many ways to type 2
diabetes.
It is characterized by high blood sugar
levels and can pose risks to both the mother
and the baby.
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Gestation
al
Diabetes

34. Mother
• Cesarean delivery
• Shoulder dystocia
• Increased risk for preeclampsia
• Increased risk of type2diabetes,
hypertension, and obesity later in life
• Increased risk for gestational diabetes in a
subsequent pregnancy
• Hypoglycemia
• Maternal death
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Risks Related
to Gestational
Diabetes

35. Offspring
• Stillbirth
• Spontaneous abortion
• Congenital anomalies
• Macrosomia (. 10 lb or . 4500 g)
• Stillbirth
• Neonatal hypoglycemia, hypocalcemia,
hyperbilirubinemia
• Increased risk of insulin resistance, type 2
diabetes, high
• blood pressure, and obesity later in life
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congenital
anomalies
Structural, functional,
or
metabolic abnormalities
present at birth. Also
called congenital
anomalies

36. • Obesity, especially high levels of central body
fat
• Native American, Hispanic, and Asian ancestry
• Genetic traits (GIP variant)
• History of delivery of a macrosomic newborn
• (. 4500 g or . 10 lb.)
• Chronic hypertension
• Mother was SGA at birth
• History of gestational diabetes in a previous
pregnancy
• Physical inactivity
• Polycystic ovary syndrome
• Multifetal pregnancy
• Consumption of a Western-type diet (low fiber
intake, low vegetable, and fruit intake, regular
intake of sugars and high-glycemic-index foods,
red and processed meats)
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Risk Factors for
Gestational
Diabetes

37. Diabetes Association and other groups
recommend a two-step approach for
testing for gestational diabetes:
1. Pregnant women should be screened at
the first prenatal visit for preexisting
diabetes by the standard criteria used for
individuals who are not pregnant. One
positive, confirmed result for any of the
following criteria would form the basis of a
diagnosis of diabetes:
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Diagnosis
of
Gestational
Diabetes

38. • Hemoglobin A1c (A1c) ≥ 6.5%
• Fasting plasma glucose ≥ 126 mg/dL (7.0
mmol/L)
• 2-hour glucose ≥200 mg/dL (11.1 mmol/L)
after a 75-gram oral glucose load
• Classic symptoms of hyperglycemia
present
• A random plasma glucose level ≥ 200
mg/dL (11.1 mmol/L
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39. 2. All pregnant women without diabetes should
be
tested for gestational diabetes by a 75-gram, 2-
hour
oral glucose tolerance test (OGTT) performed
between 24 and 28 weeks of gestation. Women
with one elevated plasma glucose level based
on the following cut-off points, receive a
diagnosis of gestational diabetes:
• Fasting plasma glucose level ≥ 92 mg/dL
(5.1 mmol/L)
• 1-hour plasma glucose level ≥ 180 mg/dL
(10.0 mmol/L)
• 2-hour plasma glucose levels ≥153 mg/dL
(8.5 mmol/L)
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40. A form of hemoglobin used to identify
blood glucose levels over the lifetime of a red
blood cell (120 days). Glucose molecules in
blood will attach to hemoglobin (and stay
attached). The amount of glucose that
attaches to hemoglobin is proportional to the
levels of glucose in the blood. The normal
range of hemoglobin A1c is 4–5.9 percent.
Also called glycosylated hemoglobin and
glycated hemoglobin.
• The use of hemoglobin A1c for monitoring
blood glucose levels is not recommended
for diabetes management because the
values don’t reflect current blood glucose
levels.
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Hemoglobi
n A1c

41. Blood glucose levels can be brought down
by low-calorie intake But:
• It can lead to an elevation of blood
ketone level
• Ketones accumulate in blood if
insufficient glucose is available for
energy formation and fat is primarily
used to meet energy needs.
• High blood concentrations of beta-
hydroxybutyrate (the most common
type of ketone body) during pregnancy
has been related to decreased mental
development in 2-year-olds
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Management
of
Gestational
Diabetes

42. • Metformin (Glucophage)suppresses
glucose production by the liver,
increases tissue uptake of glucose,
and improves insulin sensitivity. Insulin
will be used if needed.
• The oral medication metformin is
generally used for the management of
blood glucose levels during gestational
diabetes in the second half of
pregnancy when diet and exercise
aren’t adequately controlling blood
glucose levels.
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ORAL
MEDICATION

43. • Jogging
• Swimming
• Cycling
• Hiking
• Brisk walking, 30 minutes a day of brisk
walking, decreases the risk of poor
pregnancy outcomes in women with
gestational diabetes compared to
women with gestational diabetes who
are physically inactive.
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Exercise
Benefits and
Recommendatio
ns

44. The following are components of the
nutritional management of women
with gestational diabetes:
• Assessing dietary habits and exercise
habits
• Developing an individualized, culturally
appropriate, and acceptable dietary
pattern and exercise plan for blood
glucose control
• Monitoring weight gain, dietary intake
• Interpreting blood glucose and urinary
ketone results
• Ensuring follow-up during pregnancy
and postpartum
20XX presentation title 44
Nutritional
Management of
Women with
Gestational
Diabetes

45. • Whole-grain breads and cereals,
vegetables, fruits, and high-fiber
foods
• Minimally processed, nutrient-
dense foods consumed in
appropriate portion sizes
• Limited intake of sugars and foods
and beverages that contain them
• Low-glycemic index and high-fiber
foods
• Unsaturated fats
• Three regular meals and snacks
daily
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The
Dietary
Pattern
Plan

46. Women’s allotment of calories is generally
spread across three meals and several
snacks, including a low-carbohydrate
bedtime snack to help prevent nighttime
hypoglycemia. Proportions of daily calorie
intake generally assigned to meals and
snacks are:
• 10–20 percent for breakfast
• 20–30 percent for lunch
• 30–40 percent for dinner
• 30 percent for snacks
Diets of pregnant women should
provide at least 175 grams of carbohydrate
daily as recommended by the Institute of
Medicine.
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47. • About 15 percent of women with
gestational diabetes will remain glucose
intolerant postpartum, and 10–15
percent will develop type 2 diabetes
within 2-5 years.
• Women requiring insulin for glucose
management should be tested for
fasting and 2-hour postprandial blood
glucose values before hospital
discharge.
• A 75-gram oral glucose tolerance test is
recommended 6–12 weeks postpartum
in women who were diagnosed with
gestational
diabetes during pregnancy.
20XX presentation title 47
POSTPARTUM
FOLLOW UP

48. • Reducing overweight and obesity
• Increase physical activity
• Decrease insulin resistance prior to
pregnancy
• Healthy eating
• Aerobic and resistance exercise
• Maintenance of normal weight
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PREVENTIO
N OF
GESTATION
AL
DIABETES

49. • Due to obesity
• Insulin independent
• The primary goal of management is the
maintenance of blood glucose levels
within the normal range.
• Medical nutrition therapy is a major part
of the management of type 2 diabetes
during pregnancy
20XX presentation title 49
TYPE 2
DIABETES
IN
PREGNAN
CY

50. 20XX presentation title 50

51. • Insulin dependent
• Type 1 diabetes is more hazardous to
mother and fetus than gestational and
type 2 diabetes
MOTHER:
• Kidney disease
• Hypertension
• Preeclampsia
• Other complications of pregnancy
FETUS:
• Macrosomic infants
• Congenital malformations of the pelvis,
central nervous system, and heart in
offspring
• Mortality , SGA and , LGA
20XX presentation title 51
TYPE 1
DIABETES
DURING
PREGNANC
Y

52. Primary goals for the nutritional
management of type 1 diabetes in
pregnancy:
• Continual control of blood glucose levels
• Calorie and nutrient adequacy of dietary
intake
• Achievement of recommended amounts
of weight gain
• Ensuring a healthy mother and newborn
Careful home monitoring of glucose levels
and adjustments in:
• Dietary intake
• Exercise
20XX presentation title 52
NUTRITIONAL
MANAGEMENT
OF TYPE 1
DIABETES IN
PREGNANCY

53. • Availability of new types of insulin, insulin
pump for subcutaneous insulin infusion, and
self-monitoring technology is revolutionizing
the care of type 1 diabetes during pregnancy.
• An artificial pancreas utilizing a closed-loop
insulin delivery system with continuous
glucose monitoring and insulin pump has
been developed and may become available
for use in the future.
• The artificial pancreas device appears to
effectively assist in the control of blood
glucose levels in individuals with type 1
diabetes.
20XX presentation title 53