"Nutrition and Lifestyle during Pregnancy"

This module addresses appropriate maternal nutrition and lifestyle before and during pregnancy and its significance for favorable pregnancy outcomes. Current international recommendations for adequate nutrient intakes through diet and supplements are addressed. Physiological explanations for nutrient transfer are given to better understand why appropriate maternal weight gain is so important for infant and maternal health. Similarly, physical activity and lifestyle recommendations are specified along with recommendations for the avoidance of food-borne illnesses. This module focuses particularly on the nutrition needs of the mother and fetus during normal pregnancies while also addressing special nutrition and metabolic challenges such as obesity, gestational diabetes and eating disorders.

This module has received accreditation by the German Medical Association with 18 CME credits.

This module has received accreditation by the European Accreditation Council for Continuing Medical Education (EACCME) with 13 CME credits.

Module overview
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During pregnancy, a woman's body undergoes dramatic physiological changes in order to support optimal fetal growth and development. Over the course of a normal pregnancy, each organ system adapts to this demanding situation differently and at its own pace. Similarly, maternal metabolism undergoes many physiological changes in order to assist the increasing needs of the fetus and to ensure an adequate supply of critical nutrients during key phases of fetal development.

Beyond the changes in maternal metabolism, various other factors impact fetal development and later health, pregnancy outcomes, and maternal well-being. These include pre-pregnancy Body Mass Index (BMI), gestational weight gain (GWG) and placental function.

The smooth interplay of all of these factors reduces the risk for complications during pregnancy and allows for optimal fetal growth and development.

The placenta, for example, functions as an endocrine organ, and a transporter of nutrients and other molecules between the mother and fetus. Alterations in maternal metabolism can change placental structure and function and thus impact fetal growth and development. Also, placental function can influence maternal metabolism and thereby influence fetal outcome.

Understanding the unique physiologic and metabolic alterations during pregnancy and their relationship is crucial to understanding the mechanisms underlying optimal fetal development, pathological fetal development and pregnancy outcomes.

This unit presents an overview of physiologic changes of maternal physiology, endocrine function, embryonic and fetal development and placental function during the prenatal period.

Healthy nutrition is fundamental to good health. Healthy nutrition during pregnancy is particularly important since it not only affects the woman's health but also that of her offspring. Improving women's nutrition and establishing healthy dietary patterns even before pregnancy, and continuing during pregnancy and lactation, will promote optimal fetal growth and development.

There is increasing evidence that maternal good health and nutrition may have positive effects on the health of the offspring, with reduced risks of stunting, obesity, chronic noncommunicable diseases, such as diabetes and cardiovascular diseases, skeletal diseases, etc.

Nutrition is defined as the intake of food necessary for optimal growth, function and health. A well-balanced diet that provides all essential nutrients in optimal amounts and proportion is considered good nutrition. Attention to nutrition during pregnancy is vital to meet the greater nutritional need to supply the developing fetus and maternal physiological changes.
Although, the myth of "eating for two” is still common place in some cultures, evidence has shown that : "Think for two, but don't eat for two” is the best motto during pregnancy.

In this unit, the learner will be able to engage in the various aspects of nutrition leading to a healthy pregnancy with favorable outcomes for mother and child. In Lesson 1 and 2, preconception care with nutritional advice will be discussed with a focus on healthy eating patterns and specific counseling such as starting a pregnancy with a healthy BMI and preconception folic acid supplementation.

Lesson 3 overviews healthy nutrition during pregnancy and how to counsel and increase awareness of the importance of proper nutrition during gestation. Lesson 4 discusses specific micronutrients that are important during pregnancy for fetal growth and proper development. Lesson 5 is about avoidance of foodborne diseases in pregnancy, and Lesson 6 tackles dietary counseling for women with special diets.

This unit points out the important role of a healthy lifestyle during pregnancy. Lifestyle optimization in the form of adequate physical activity, a healthy, balanced diet and weight control - ideally implemented before conception, offers huge benefits for mothers and children. Current, scientifically-based recommendations for pregnant women are presented, addressing the quality and extensiveness of physical activity, the influences of biological stress and the crucial balance of work and personal life.

The user will also learn about the dangers of alcohol consumption, smoking and caffeine during pregnancy. The role of environmental substances, stress and relaxation on pregnancy outcomes is also highlighted and current information on maternal working patterns are given.

Pregnant women are susceptible to any medical disorder that may affect women of child-bearing age. Therefore, medical and obstetrical complicated pregnancies often occur and are actually quite prevalent. Some of these conditions can precede pregnancy, as for example chronic disorders such as obesity, previous diabetes (type 1 or type 2), hypertension, mental disorders, and so on. However, they may also appear acutely during the pregnancy, possibly complicating an otherwise normal pregnancy. Many of these complications, for example some infectious diseases, that would not have much impact in a normal adult population, may cause significant maternal and neonatal morbidity during pregnancy.

Many medical or obstetric complications during pregnancy are manageable by obstetricians and midwives or general practitioners. However, some of them will warrant specialized consultations and may even require a multidisciplinary team (e.g. maternal-fetal specialists, nutritionists, surgeons, and anesthesiologists) in order to offer the best clinical practice. Therefore, health care providers should have knowledge of signs and symptoms of the wide range of medical complications that can affect women of child bearing age and women that are pregnant to be able to promptly recognize and manage such disorders.

In managing a pregnancy with complications, the health care provider may find it helpful to address a number of questions:

  • What management plan would be recommended if the woman were not pregnant?
  • If the proposed management is different because the woman is pregnant, can this be justified?
  • What are the risks versus benefits to the mother and her fetus, and are they counter to each other?
  • Can an individualized management plan be devised that balances the benefits versus risks of any alterations?

Answering these questions would be helpful in avoiding penalizing a woman just because she is pregnant and would bring the best clinical practice in the management of such disorders. In this UNIT, the best evidence-based clinical practice was sought after and only evidence-based national (or global) guidelines were used for recommendations.

Due to the worldwide obesity endemic, obesity complicated pregnancy is highly prevalent and it is the most common complication that health care providers have to be prepared to manage during the prenatal period. Lesson 1 in this Unit will go through the pathophysiological mechanisms in women who are obese during their pregnancy, adverse outcomes and management of the obese pregnant woman. Lesson 2 will highlight the role of interventional approaches through diet and physical activity specifically for women who are overweight or obese. Lesson 3 is about diabetes during pregnancy and discusses diabetes definition and screening during pregnancy and its management.

As already seen in Unit 4, pregnant women are susceptible to any medical disorder that may affect women in child-bearing age. Some of these conditions can precede pregnancy, as for example chronic disorders such as obesity, previous diabetes (type 1 or type 2), hypertension, mental disorders, and so on. However, they may also appear acutely during the pregnancy, possibly complicating an otherwise normal pregnancy.

Nausea and vomiting of pregnancy is the most common pregnancy- related complaint.  However, effective management and advice in how to deal with this common complication is currently most lacking.  Mental health is especially relevant for women during pregnancy, as depression is one of the most common medical complications during pregnancy and postpartum. Hypertensive disorders of pregnancy (HDP) are an important public global health problem, causing maternal and perinatal morbidity and mortality worldwide. HDP accounts for nearly 18% of maternal deaths globally, making it an important issue that has to be assessed in every pregnancy.

The very common complication of nausea and vomiting of pregnancy will be overviewed in Lesson 1. Lesson 2 is about maternal mental health during pregnancy, including clinical depression and eating disorders and their impact in maternal and neonatal outcomes. Finally, Lesson 3 will give an overview of hypertensive disorders of pregnancy, including screening, diagnosis and management of gestational hypertension and preeclampsia.

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