Weight Gain In Pregnancy

WEIGHT GAIN IN PREGNANCY Introduction During pregnancy physiological, endocrine and metabolic changes occur in the mother to provide for the growth and development of the fetus. These changes lead to increase in the weight of the mother and the fetus

NORMAL WEIGHT GAIN

• Weight gain is not uniform throughout in pregnancy • Weight falls in the 1st three months due to nausea, vomiting and loss of appetite. • Weight gain starts from 12 – 20 weeks when nausea/vomiting stops and she eats freely • Greatest weight gain in pregnancy occurs between 20 30 weeks. Also excess weight gain in this period is associated with pre eclampsia. • >30weeks diminishes • 38 – 39weeks marked fall in the weight gain. • Post partum - rapid weight loss between 4 – 10 days then falls gradually at 250gm/week.

NORMAL WEIGHT GAIN Mean weight gain in pregnancy is 12.5kg (10 – 16kg) - 17 – 20% of pre pregnancy weight Any weight again > 500mg /week is abnormal

Distribution of weight gain in pregnancy • • • • • • •

Uterus Blood Breast Fliud,fat, Fetus Amniotic fluids Placenta

1kg 1.5kg 1kg 5kg 3 – 4kg 1kg 0.5kg

• • • • • • • • • •

< 45 kg is under weight > 90 kg is obese Poor weight gain < 9 kg Normal weight gain 9 – 16 kg Excess weight gain >16 kg Body/mass index:< 20kg/m2 thin 20 -24kg/m2 normal 25 – 29kg/m2 over weight > 30kg/m2 obese

CAUSES OF POOR WEIGHT GAIN Inadequate food and fluid in take Hyperemesis gravidarium Poor sleep ,HIV, cancer Athlete Poverty, crowded accommodation and shared food New food intolerance

EFFECTS OF POOR WEIGHT GAIN IN PREGNANCY • • • • •

Anaemia IUGR Preterm labour Infections Increased Perinatal mortality

CAUSES OF EXCESS WEIGHT • • • •

Obesity PET DM Multiple pregnancy

EFFECTS OF EXCESS WEIGHT GAIN IN PREGNANCY Difficult abdominal palpations Thrombophlebitis FETAL MACROSOMIA DYSTOSIA UTI PPH

DIET DURING PREGNANCY • Well balanced and adequate diet is important • Fetus is a parasite – takes all what is required from the mother even at the detriment of her general health • The diet should contain adequate :• Protein, carbohydrate ,fat, fresh fruits and fluids. • vitamins

MEGADOSES OF VITAMINS &MINERALS • Large doses of fat soluble vitamins –A,D. cause birth defects • Excess selenium & zinc • Fluoride - mottled teeth • Zinc competes with iron

- suppress immunity

VEGETARIANS • Ovolactovegetarians

milk,egg,fish,puoltry

• Lactovegetarians - milk and vegetables. They need Ca,Fe, B co supplements. - Vegans - Eat plants only. They also need Ca,Fe, B co supplements - Zen macrobiotics – Eat fruits only. They should not get pregnant

PRESENTATION • HISTORY – nutritional, psychological sports and food intolerance. • Measure height ,weight, BP ,blood sugar, ultrasound

MANAGEMENT • Preconception care :• for the underweight and obese • Joint treatment by dietician, physician, psychiatrist and the obstetrician to correct weight before pregnancy

ANTENATAL CARE • Monitor fetus with :• fetal kick count, EFM, BIOPHYSICAL profile and Doppler scans • Joint management by physician, dietician and OBGYN

LABOUR CARE • Team work by OB GYN, NEONATOLOGIST,ANAESTHETIST • Watch out for preterm labour , premature baby and asphyxia in under nourished mothers • Also expect high BP, PET, DYSTOSIA and increase rate of operative deliveries in obese patients. •

Post partum • PPH • INFECTION • ENCOURAGE BREAST FEEDING

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