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breastmilk\tproduction.\nIron.\nThe\tRDA\tfor\tiron\tsignificantly\tincreases\tin\tpregnancy.\tAn\testimated\t42%\tof\tpregnant\twomen\nworldwide\thave\tiron\tdeficiency\tanemia\twith\twide\tregional\tvariability.\tAlthough\tprevalence\n\tis\thighest\nin\tdeveloping\tcountries,\tan\testimated\t33%\tof\tlow-income\tpregnant\twomen\tin\tthe\tUnited\tStates\tare\nanemic\tin\tthe\tthird\ttrimester\t(
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anemic\tin\tthe\tthird\ttrimester\t(\nMurray-Kolb,\t2011\n).\nInadequate\tiron\tconsumption\tmay\tlead\tto\tpoor\themoglobin\tproduction,\tfollowed\tby\tcompromised\ndelivery\tof\toxygen,\tas\twell\tas\tiron,\tto\tthe\tuterus,\tplacenta,\tand\tdeveloping\tfetus.\tThe\tplacenta\ncontains\tmultiple\tiron\ttransporter\tproteins\tfor\n\tboth\theme\tand\tnonheme\tiron\tbut\tthey\tare\tnot\tyet
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both\theme\tand\tnonheme\tiron\tbut\tthey\tare\tnot\tyet\nfully\tdescribed,\tespecially\tfor\theme\tiron\t(\nFisher\tand\tNemeth,\t2017\n).\tThere\tis\tsome\tevidence\tthat\nferritin\tcan\talso\tbe\ttransported,\tas\twell\tas\tpreliminary\tevidence\tthat\tdietary\theme\tiron\tis\npreferentially\ttransported\tto\tthe\tfetus\t(\nO’Brien\tand\tRu,\t2017\n).\tIron\ttransport\tis\tregulated,\tbalancing
|
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O’Brien\tand\tRu,\t2017\n).\tIron\ttransport\tis\tregulated,\tbalancing\nmaternal\tand\tfetal\tneeds\t(\nCao\tand\tFleming,\t2016\n).\tThe\tfetus\n\tappears\tto\tdrive\tplacental\tiron\ntransport,\talthough\tit\tis\tunclear\thow\tthe\tplacenta\tsenses\tthe\tfetal\tdemand.\tFetal\thepcidin,\tas\twe
|
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] |
currently\tunderstand\tit,\tusually\tremains\tlow,\tallowing\thigh\ttransfer\trates\tof\tiron\tfrom\tthe\tplacenta\tto\nthe\tfetus.\tHowever,\tthere\tis\tspeculation\tthat\televated\tfetal\thepcidin\tlevels,\tas\tmight\tbe\tfound\tin\tfetal\ninflammation,\t(i.e.,\tchorioamnionitis),\tmay\tinhibit\tthe\ttransfer\n\tof\tiron\tfrom\tthe\tplacenta\tto\tthe\tfetus\n(\nFisher\tand\tNemeth,\t2017
|
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] |
of\tiron\tfrom\tthe\tplacenta\tto\tthe\tfetus\n(\nFisher\tand\tNemeth,\t2017\n).\tSupplementation\tmay\timprove\tmaternal\tstatus\tbut\tdoesn’t\tnecessarily\nimprove\tcord\tlevels\tbecause\tfetal\ttransfer\tcan\tbe\tsustained\tuntil\tmaternal\tanemia\tbecomes\ttoo\nsevere\t(hemoglobin\t<\t9\tg/dL\tor\tserum\tferritin\t<\t13.6\tmcg/L)\t(\nGeorgieff,\t2017\n).
|
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] |
Georgieff,\t2017\n).\nIron\tdeficiency\tanemia\t(IDA)\tis\tassociated\twith\tIUGR\t(threefold\tincrease\tin\tLBW),\tpreterm\n\tdelivery\n(twofold\tincreased\tincidence),\tincreased\tfetal\tand\tneonatal\tmortality,\tand\tif\tsevere\t(hemoglobin\t<\t9\ng/dL),\twith\tcomplications\tduring\tdelivery\t(\nAuerbach,\t2018\n).\tIDA\talso\tis\tassociated\twith\tincreased
|
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] |
Auerbach,\t2018\n).\tIDA\talso\tis\tassociated\twith\tincreased\nfetal\tcortisol\tproduction\tand\toxidative\tdamage\tto\tfetal\terythrocytes\t(\nHovdenak\tand\tHaram,\t2012\n).\nEarly\tiron\tdeficiency\taffects\tfetal\tbrain\tdevelopment\tand\tthe\tregulation\tof\tbrain\tfunction\n\tin\tmultiple\nways\t(see\t\nTable\t14.7
|
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0.004375804681330919,
0.06634518504142761,
0.11315056681632996,
0.0923302173614502,
-0.019783630967140198
] |
in\tmultiple\nways\t(see\t\nTable\t14.7\n).\tBecause\terythropoiesis\tgets\tpriority\tover\tthe\tbrain\tand\tother\torgans,\tfetal\nbrain\tiron\tdeficiency\tcan\toccur\tbefore\tmaternal\tIDA\tis\tidentified\tand\tbetter\tfunctional\tmeasures\tare\nneeded\t(\nGeorgieff,\t2017\n).\tNeonatal\tiron\tdeficiency\tcan\tresult\tif\tthe\tmother\tis\textremely\tiron
|
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] |
deficient,\tbut\tmaternal\thypertension\tand\ttherefore\trestricted\tblood\tflow,\tas\twell\tas\tmaternal\nsmoking\tand\tprematurity,\talso\tincrease\tthe\trisk.\tInfants\tof\tmothers\twith\tdiabetes\tare\talso\tmore\nlikely\tto\tdevelop\tiron\tdeficiency\tbecause\tof\tincreased\tfetal\tdemands\twith\tmacrosomia\tand\tfetal
|
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] |
hyperglycemia/hyperinsulinemia\tincreasing\tfetal\toxygen\tconsumption,\tbut\talso\twith\nhyperglycosylation\tof\tthe\tplacental\ttransferrin\treceptors\trestricting\tiron\ttransport\tto\tthe\tfetus\t(\nRao\nand\tGeorgieff,\t2012\n),\tall\tresulting\tin\ta\t40%\treduction\tin\tbrain\tiron\tconcentration.\tThese\tchanges
|
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] |
result\tin\tlong-term\tneurobehavioral\timpairments\taffecting\ttemperament,\tinteractions\twith\tothers,\nlearning,\tand\tmemory\tand\talso\tmay\tresult\tin\tgenomic\tchanges.\nMaternal\teffects\tof\tIDA\tinclude\tfatigue,\tdyspnea,\tlight-headedness,\tand\tpoor\texercise\ttolerance.\nPrenatal\tweight\tgain\tis\tlikely\tto\tbe\tlow.\tThe\tmother\tis\tat\trisk
|
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Prenatal\tweight\tgain\tis\tlikely\tto\tbe\tlow.\tThe\tmother\tis\tat\trisk\n\tof\tincreased\tblood\tloss\twith\tuterine\natony\tduring\tdelivery,\tthus\tincreasing\ther\trisk\tof\tneeding\ta\tblood\ttransfusion.\tWound\thealing\tand\nimmune\tfunction\tare\timpaired.\tShe\tis\tmore\tlikely\tto\tsuffer\tfrom\tpostpartum\tdepression,\tpoor
|
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] |
maternal/infant\tinteraction,\tand\timpaired\tlactation.\tThere\tis\tsome\tevidence\tthat\tnegative\talterations\nin\tcognition,\temotions,\tquality\tof\tlife,\tand\tbehavior\tmay\toccur\tbefore\n\tovert\tIDA\tis\treached,\tbut\tthe\ndegree\tof\tiron\tdeficiency\tassociated\twith\tnegative\tconsequences\tremains\tunknown.\tTreatment
|
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during\tpregnancy\timproves\tmaternal\tiron\tstatus\tpostpartum\tand\talso\tis\tassociated\twith\timproved\ninfant\tdevelopment\t(\nMurray-Kolb,\t2011\n).\nPlasma\tvolume\tincreases\t50%\tfrom\tbaseline,\tand\tnormal\terythrocyte\tvolume\tincreases\tby\t20%\tto\n30%\tin\tpregnancy.\tThis\tmarked\tincrease\tin\tthe\n\tmaternal\tblood\tsupply\tduring\tpregnancy,\tas\twell\tas
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] |
maternal\tblood\tsupply\tduring\tpregnancy,\tas\twell\tas\nfetal\tneeds,\tgreatly\tincreases\tthe\tdemand\tfor\tiron.\tThe\testimated\ttotal\trequirement\tfor\tpregnancy\tis\n1190\tmg,\tbut\twith\tthe\tcessation\tof\tmenses,\tthe\taverage\tnet\tdeficit\tis\t580\tmg.\tAdded\tto\ther\tnormal\nrequirements,\ta\tpregnant\twoman\toften\tneeds\tto\tabsorb\t17\tmg/day\tby\tthe\tthird\ttrimester.\tNormal
|
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0.03451995551586151,
0.08006738871335983,
-0.006201320793479681,
0.000530243618413806,
0.04102036729454994,
0.07771573960781097,
0.07708308845758438,
0.07742185145616531,
-0.01854310743510723
] |
absorption\tis\toften\t1\tto\t2\tmg/day\tfrom\ta\tnormal\tdiet,\tand\n\t3\tto\t5\tmg/day\tif\tthe\tdiet\tcontains\thigh-iron\nfoods\t(\nLee\tand\tOkam,\t2011\n).\tAbsorption\tof\tboth\theme\tand\tnonheme\tiron\tincreases\tduring\npregnancy.\tHepcidin\tlevels\tdecrease\tin\tthe\tsecond\tand\tthird\ttrimesters,\tthus\tincreasing\tthe\tavailable\niron\tto\tthe\tplacenta\tand\ttherefore,\tthe\tfetus\t(
|
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] |
iron\tto\tthe\tplacenta\tand\ttherefore,\tthe\tfetus\t(\nFisher\tand\tNemeth,\t2017\n).\tHowever,\tthe\tmechanism\nthat\tcauses\tthis\tdecrease\tin\tmaternal\thepcidin\tis\tnot\tyet\tknown\tand\n\tit\tis\talso\tunknown\thow\tiron\nsupplementation\taffects\thepcidin\tlevels\tduring\tpregnancy.\tWhile\thepcidin\tcertainly\taffects\tthe
|
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] |
availability\tof\tnonheme\tiron,\tthere\tis\talso\tsome\tevidence\tthat\tit\timpacts\theme\tiron\tavailability\tas\nwell.\tElevated\tmaternal\thepcidin\tlevels,\tcausing\tlower\tthan\toptimal\ttransfer\tof\tiron\tto\tthe\tplacenta,\nwould\tbe\timportant\tin\tthe\tcase\tof\tinflammation.\tHowever,\tthe\tnormal\tinflammation\n\tof\thealthy
|
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] |
of\thealthy\npregnancies\tdoes\tnot\tseem\tto\tincrease\thepcidin.\tPregnancies\twith\tmore\tintense\tinflammation\tmay,\nhowever,\tcause\thepcidin\tlevels\tto\tincrease\tand\ttherefore,\tiron\tavailability\tto\tdrop.\tHow\timportant\nthis\tis\tin\tthe\tcase\tof\tthe\tinflammation\tassociated\twith\tmaternal\tobesity\tor\texcessive\tweight\tgain\tis
|
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currently\tunclear.\tThe\teffect\tof\tsupplementation\ton\tintestinal\tabsorption\tis\talso\tunclear,\n\tas\tis\tthe\npossible\tincreased\trisk\tof\thigher\texposure\twith\tincreased\tintake\t(\nBrannon\tet\tal,\t2017\n),\tas\twell\tas\tthe\nrole\tof\tunabsorbed\tiron\ton\tthe\tmicrobiome.\tMost\taccretion\toccurs\tafter\tthe\ttwentieth\tweek\tof
|
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gestation,\twhen\tmaternal\tand\tfetal\tdemands\tare\tgreatest.\tThose\tat\thighest\trisk\tof\tIDA\tare\twomen\nwith\tinadequate\tiron\tstores,\tincluding\tthose\twith\tshort\tinterconceptual\tperiods,\tthose\twith\tpoor\nhabitual\tintakes,\tthose\twith\timpaired\tabsorption\tincluding\ta\thistory\tof\tbariatric\tsurgery\tor\tchronic
|
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] |
use\tof\tantacids,\tand\tthose\twho\thave\texperienced\tred\tcell\tdestruction\tfrom\tmalaria\tor\texcessive\nblood\tloss\tfrom\theavy\tmenstrual\tflow\tor\tprior\thookworm\tinfections.\nA\tfirst\ttrimester\tserum\tferritin\tlevel\tmay\tbe\tassessed\tand\tif\tless\tthan\t20\tmcg/L,\tsupplementation\nmay\tbe\tnecessary\t(\nLee\tand\tOkam,\t2011
|
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] |
may\tbe\tnecessary\t(\nLee\tand\tOkam,\t2011\n).\tHowever,\tchecking\tred\tblood\tcell\tindices\ton\tthe\tcomplete\nblood\tcount\t(CBC)\t(see\t\nChapter\t5\n)\tis\toften\tadequate.\tHemoglobin\tand\thematocrit\tvalues\tnormally\ndecrease\tin\tthe\tsecond\ttrimester\t(see\t\nTable\t14.5\n).\tNot\tdecreasing\tmay\tbe\ta\tsign\tof\tpoor\tblood
|
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0.0744289979338646,
-0.04604523256421089,
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0.09610792249441147,
0.003087983699515462,
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0.06538834422826767,
0.05511593818664551,
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0.03124201111495495,
0.031801141798496246,
0.04721498861908913,
0.050708066672086716,
-0.04249758645892143
] |
Table\t14.5\n).\tNot\tdecreasing\tmay\tbe\ta\tsign\tof\tpoor\tblood\nvolume\texpansion,\twhich\tis\tassociated\twith\tincreasing\trisk\tof\ta\tgrowth-restricted\tinfant,\tpreterm\ndelivery,\tand\tstillbirth\t(\nLuke,\t2015\n).\tSerum\tvalues\n\tshould\tincrease\tagain\tin\tthe\tthird\ttrimester\tfor
|
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0.05737384781241417,
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0.05046805739402771,
0.027918700128793716,
0.010757479816675186,
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0.07560538500547409,
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0.04550248011946678,
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0.09626311808824539,
0.08059349656105042,
0.0799766555428505,
0.03562631458044052
] |
).\tSerum\tvalues\n\tshould\tincrease\tagain\tin\tthe\tthird\ttrimester\tfor\nbest\toutcomes,\tbut\toften\tthis\trise\tis\tnot\tseen\tand\tintervention\tis\tmerited.\tIf\tanemia\tdoes\tnot\timprove\nwith\tiron\ttherapy\t(i.e.,\tan\tincrease\tof\t1\tg\themoglobin\tor\t3%\tin\thematocrit\tby\t4\tweeks\t[\nCDC,\t1998\n]),\nit\tis\tadvised\tto\tcheck\tvitamins\tB\n6\n,\tB\n12
|
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] |
CDC,\t1998\n]),\nit\tis\tadvised\tto\tcheck\tvitamins\tB\n6\n,\tB\n12\n,\tand\tfolate\tstatus,\talthough\tmany\tother\tnutrients,\tincluding\nprotein,\tcobalt,\tmagnesium,\tselenium,\tzinc,\n\tcopper,\tvitamins\tA\tand\tC,\tlipids,\tand\tcarbohydrate,\talso\nmay\tplay\ta\trole\t(\nLee\tand\tOkam,\t2011\n;\t\nMechanick\tet\tal,\t2013\n;\t\nWu\tet\tal,\t2012a\n).
|
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] |
Lee\tand\tOkam,\t2011\n;\t\nMechanick\tet\tal,\t2013\n;\t\nWu\tet\tal,\t2012a\n).\nHigh\tiron\tstatus\tis\talso\tassociated\twith\tpoor\tfetal\tgrowth,\tpreterm\tdelivery,\tpreeclampsia,\ngestational\tdiabetes,\tand\tstillbirth.\tHowever,\tthe\tmechanism(s)\tare\tunclear\tbut\tmay\tinclude\tthe\nactual\tiron\tstatus\t(increased\tviscosity\tand\ttherefore\tcompromised\tblood
|
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flow\tand/or\tpoor\tplacental\nperfusion),\trelative\tzinc\tand\tcopper\tdeficiencies,\toxidative\tstress\twith\tsupplementation,\taltered\tgut\nmicrobiome,\tand/or\tpoor\tplasma\tvolume\texpansion\titself\t(\nBrannon\tand\tTaylor,\t2017\n;\t\nFisher\tand\nNemeth,\t2017\n).\tSerum\tferritin\tmay\talso\tjust\tbe\ta\tproxy\tmeasure\tfor\tinflammation,\tespecially\tin\tthe
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context\tof\tmaternal\tobesity\t(\nVricella,\t2017\n).\tThere\tare\tno\tgood\tfunctional\n\tmeasures\tof\treplete\tvs.\nexcess\tiron\tstatus\t(\nBrannon\tand\tTaylor,\t2017\n),\tnor\tis\tthere\ta\tgood\tway\tto\tadjust\tserum\tferritin\tor
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hepcidin\tfor\tinflammation\tbut\tthere\tis\tevidence\tthat\tthe\tobesity-associated\tinflammation\tdoes\tnot\noverride\tthe\tinfluence\tof\tlow\tiron\tstatus\ton\thepcidin\tsignaling\t(\nO’Brien\tand\tRu,\t2017\n).\nBecause\tmany\twomen\tdo\tnot\tenter\tpregnancy\twith\tsufficient\tiron\tstores\tto\tcover\tthe\tphysiologic
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needs\tof\tpregnancy,\tiron\tsupplementation\t(usually\tas\ta\tferrous\tsalt)\toften\tis\tprescribed,\tbut\tthe\namount\tof\telemental\tiron\tcontained\tvaries\tby\tthe\tpreparation\t(\nOffice\tof\tDietary\tSupplements\t[ODS],\n2018\n).\tThe\tiron\tin\tthe\tsupplement\talready\tis\treduced\t(i.e.,\tferrous\trather\tthan\tferric),\tso\ttaking\tthe
|
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] |
supplement\twith\twater\tis\teffective\tand\tconsuming\tit\twith\tjuice\tis\tnot\tnecessary.\tAs\twith\tall\tnonheme\nsources,\tsupplements\tshould\tnot\tbe\ttaken\twith\tcoffee,\ttea,\tor\tmilk\tto\toptimize\tabsorption.\tIron\nsupplements\tshould\tbe\ttaken\tseparately\tfrom\tthe\tprenatal\tvitamins\tto\tminimize\tthe\tcompetition\twith
|
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other\tminerals.\tAbsorption\tis\tbest\tif\ttaken\ton\tan\tempty\tstomach,\tbut\ttolerance\tis\toften\tworse.\nMultiple\tsupplements\tshould\tbe\ttaken\tseparately\tfrom\teach\tother\tto\tmaximize\tabsorption,\tbut\ndiminishing\tabsorption\n\tis\tseen\twith\tincreasing\tdosage,\tso\ttolerance\tof\tside\teffects\tshould\tbe
|
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] |
balanced\tagainst\tneed.\tEnteric-coated\tand\tdelayed-release\tpreparations\tproduce\tfewer\tside\teffects,\nbut\tbecause\tthey\tare\tnot\twell\tabsorbed\tthey\tare\tnot\trecommended.\tIntravenous\tiron\tcan\tbe\tused\nduring\tpregnancy,\teven\tas\ta\tfirst\tline\ttreatment,\tin\tthe\tsecond\tand\tthird\ttrimesters\t(\nAuerbach,\n2018\n).\nIron\tsupplementation\tis\tcontroversial.
|
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] |
Auerbach,\n2018\n).\nIron\tsupplementation\tis\tcontroversial.\n\tCDC\tand\tWHO\trecommend\troutine\tearly\tiron\nsupplementation\tto\tlower\tthe\trisk\tof\tmaternal\tanemia,\tLBW,\tand\tpreterm\tdelivery\t(\nWHO,\t2016b\n).\nThe\tUSPSTF\tstates\tthat\twhile\tsupplementation\tmay\timprove\tmaternal\tiron\tstatus,\tthe\tevidence
|
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supporting\troutine\tsupplementation\tto\timprove\teither\tmaternal\tor\tinfant\tclinical\toutcomes\tis\ninconclusive\t(\nCantor\tet\tal,\t2015\n).\tACOG\trecommends\tscreening\teveryone\tand\tsupplementing\n\tthose\nwith\tdocumented\tIDA.\tHowever,\tfor\tthose\tat\trisk\tof\tchronic\tiron\toverload,\tincluding\tthose\twith
|
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] |
hemochromatosis\tand\tbeta-thalassemia,\tiron\tsupplementation\tmay\tnot\tbe\trecommended.\tIron\nsupplements\tmay\tcause\toxidative\tdamage\tand\tmay\texacerbate\tinflammation.\tConsequently,\novertreatment\tof\tIDA\tis\tnow\tthought\tto\tbe\tassociated\twith\tpreterm\tdelivery,\tIUGR,\tand\tGDM\n(\nHovdenak\tand\tHaram,\t2012\n;\tsee\t\nChapter\t7
|
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] |
(\nHovdenak\tand\tHaram,\t2012\n;\tsee\t\nChapter\t7\n\tfor\tother\texamples\tof\toxidative\tdamage).\tIntermittent\nsupplementation\t(one\tto\ttwo\ttimes\tper\tweek)\tmay\tbe\teffective\t(\nKaiser\tand\tCampbell,\t2014\n),\tpossibly\nby\tminimizing\tthe\tincrease\tin\thepcidin\tlevels\t(\nAuerbach,\t2018\n).\tNonphysiologic\tintakes\tof\tiron,\tas
|
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] |
Auerbach,\t2018\n).\tNonphysiologic\tintakes\tof\tiron,\tas\nwould\tbe\tachieved\twith\tsupplementation,\tmay\tincrease\tthe\trisk\tof\tinfections,\tespecially\timportant\nfor\tpeople\tliving\tin\tunsanitary\tsettings\t(\nPrentice\tet\tal,\t2017\n).\tIn\tareas\twhere\tbacterial\tand\tprotozoal
|
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] |
Prentice\tet\tal,\t2017\n).\tIn\tareas\twhere\tbacterial\tand\tprotozoal\ninfections,\tespecially\tmalaria,\tare\tof\tconcern,\tfood\tfortification\tproviding\tsmaller\tdoses\tat\ta\ttime\tmay\nbe\tsafer\tthan\tsupplementation.\tIn\taddition,\tiron\tsupplements\tare\textremely\tdangerous\tfor\tsmall\nchildren.\tDoses\tas\tlittle\tas\t36\tmg\telemental\tiron/kg\tbody\tweight\thave\tbeen\tlethal\t(
|
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] |
ODS,\t2018\n),\tso\nmothers\tmust\tbe\treminded\tto\tkeep\tsupplements\tout\tof\tthe\treach\n\tof\tchildren.\nBecause\tof\tthe\tconcerns\twith\tiron\tsupplementation,\tincluding\tcompliance,\tsafety,\tand\neffectiveness,\temphasizing\tdietary\tsources\tof\tiron\tis\tnecessary.\tThe\tbest\tsources\tof\tiron\tare\tred\nmeats,\tincluding\twild\tmeats,\t(see\t\nAppendix\t43
|
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] |
meats,\tincluding\twild\tmeats,\t(see\t\nAppendix\t43\n)\tbecause\tof\ttheir\theme\tcontent,\tand\tmany\torgan\nmeats\tmay\tcontain\teven\thigher\tlevels\tof\tiron.\tIt\tis\timportant\tto\tlimit\tthe\tamount\tof\tliver\tand\tliver\nproducts\n\t(pté,\tliverwurst,\tbraunschweiger)\tin\tthe\tfirst\ttrimester\tbecause\tof\ttheir\thigh\tvitamin\tA\ncontents.
|
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] |
contents.\nVegetable\tsources,\tcontaining\tonly\tnonheme\tiron,\tare\tless\twell\tabsorbed,\tand\tvolume\tmay\tbecome\nthe\tlimiting\tfactor,\tespecially\tlate\tin\tpregnancy.\tAbsorption\tcan\tbe\tenhanced\tby\teating\tthem\twith\nascorbic\tacid\tor\ta\tlittle\tmeat.\nWomen\twho\tfollow\tvegetarian\tdiets\tshould\tpay\tparticular\tattention\tto\tiron\n\tand\ttry\tto\tprevent
|
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and\ttry\tto\tprevent\nhaving\ttheir\thematocrit\tdrop\tso\tfar\tthat\tit\tcannot\trecover\tsufficiently.\tFollowers\tof\tJehovah’s\tWitness\nalso\tmust\tpay\tclose\tattention\tto\ttheir\tiron\tlevels.\tBecause\tthey\tchoose\tnot\tto\treceive\tblood\ntransfusions,\tthese\twomen\tshould\treceive\tnutrition\tcounseling\ton\thigh-iron\tfoods\tearly\tin\tpregnancy,
|
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] |
with\treinforcement\tas\tthe\tpregnancy\tcontinues.\nMagnesium.\nMagnesium\tfunctions\n\tas\tan\tenzyme\tcofactor\tand\tactivator.\tThe\tfull-term\tfetus\taccumulates\t1\tg\tof\nmagnesium\tduring\tgestation,\tand\tmaternal\tdeficiency\tmay\tinterfere\twith\tfetal\tgrowth\tand\ndevelopment,\tincluding\tpossible\tteratogenesis\t(\nHovdenak\tand\tHaram,\t2012\n).\tRecommendations\tfor
|
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] |
Hovdenak\tand\tHaram,\t2012\n).\tRecommendations\tfor\nmagnesium\tincrease\tslightly\tduring\tpregnancy,\tbut\tits\trole\tin\tpreterm\tlabor,\tpreeclampsia,\ngestational\tdiabetes,\tand\tpoor\tfetal\tgrowth\tis\n\tnot\twell\tunderstood\t(\nDalton\tet\tal,\t2016\n).\tMagnesium\nsulfate\tis\tsometimes\tused\tto\ttreat\twomen\twith\tpreeclampsia,\tbut\twhether\tsupplementation\tof
|
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magnesium\tfor\tany\tof\tthese\tconditions\tis\thelpful\twhen\ta\twoman\tis\tnot\tdeficient\tin\tmagnesium\tis\nunknown.\tMaternal\tmagnesium\tdeficiency\thas\tbeen\tspeculated\tto\tplay\ta\tpart\tin\tincreased\trisk\tfor\nsudden\tinfant\tdeath\tsyndrome\t(SIDS),\tbut\tprospective\tsupplementation\n\ttrials\thave\tnot\tbeen\tdone.
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0.05199353024363518,
0.05147285386919975,
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] |
trials\thave\tnot\tbeen\tdone.\nModerate\tmagnesium\tdeficiency\tis\tassociated\twith\tsubtle\trenal\tdeficits\tin\toffspring\t(\nRichard\tet\tal,\n2017\n).\tOptimal\tmagnesium\tlevels\tmay\tbe\tbeneficial\tin\thelping\tprevent\tleg\tcramps\t(see\t\nEdema\tand\nLeg\tCramps\n).\tHowever,\ttoo\tfew\tdata\tare\tavailable\tto\tgive\tsupplementation\trecommendations\n(\nHovdenak\tand\tHaram,\t2012
|
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] |
(\nHovdenak\tand\tHaram,\t2012\n).\tSee\t\nAppendix\t43\n\tfor\tgood\tdietary\tsources.\tProlonged,\thigh\n\tdoses\tof\nmagnesium\tsupplements\tshould\tbe\tavoided\t(see\t\nHeartburn\n).\nPhosphorus.\nPhosphorus\tis\tfound\tin\ta\tvariety\tof\tfoods,\tand\tdeficiency\tis\trare\tif\tone\tis\table\tto\teat\tnormally.
|
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] |
Requirements\tdo\tnot\trise\twith\tpregnancy.\tHowever,\tlow\tphosphorus\tlevels,\tindicative\tof\t“refeeding\nsyndrome,”\thave\tbeen\tfound\tin\twomen\texperiencing\tsevere\tvomiting\tor\tother\tsituations\tresulting\tin\nstarvation.\tHypophosphatemia\n\tcan\tbe\tlife\tthreatening\tbecause\tphosphorus\tis\timportant\tin\tenergy
|
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] |
can\tbe\tlife\tthreatening\tbecause\tphosphorus\tis\timportant\tin\tenergy\nmetabolism\tas\ta\tcomponent\tof\tadenosine\ttriphosphate\t(ATP)\tand\tmust\tbe\treplenished\tpromptly\t(see\nChapter\t12\n).\nSelenium.\nSelenium\tfunctions\tas\tan\tantioxidant\tand\tis\timportant\tfor\treproduction.\tLow\tselenium\tstatus\tis
|
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associated\twith\trecurrent\tmiscarriages,\tpreeclampsia,\tand\tIUGR.\tThe\tDRI\tincreases\tslightly\tduring
|
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] |
pregnancy,\tbut\n\tthere\tare\tno\tevidence-based\trecommendations\tfor\tsupplementation\t(\nHovdenak\tand\nHaram,\t2012\n).\tExcess\tselenium\tintake\tis\talso\tof\tconcern,\tespecially\tif\twomen\teat\tlocally\tfrom\tareas\nwhere\tsoil\tselenium\tcontents\tare\thigh.\tThere\tare\tno\tknown\tareas\tin\tthe\tUnited\tStates\tor\tCanada\nwith\trecognized\tcases\tof\tselenosis.\tSee\t\nAppendix\t45\n.
|
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] |
with\trecognized\tcases\tof\tselenosis.\tSee\t\nAppendix\t45\n.\nSodium.\nThe\thormonal\tmilieu\tof\tpregnancy\taffects\tsodium\tmetabolism.\n\tIncreased\tmaternal\tblood\tvolume\nleads\tto\tincreased\tglomerular\tfiltration\tof\tsodium.\tCompensatory\tmechanisms\tmaintain\tfluid\tand\nelectrolyte\tbalance.
|
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women\twith\tedema,\tthe\tuse\tof\ndiuretics\tis\tnot\trecommended\tbut\tcorrecting\thigh\tsodium\tintakes\tfrom\tthe\tdiet\tis\twarranted.\tNormal\nintakes\tare\toften\tmuch\thigher\tthan\tthe\tDRI,\twhich\tdoes\tnot\tincrease\tduring\tpregnancy.\tACOG\thas\npreviously\trecommended\tthat\tsodium\tintake\tshould\tnot\tbe\trestricted\tbelow\t2300\tmg/day,\twhich\tis\nhigher\tthan\tthe\tcurrent\tDRI.\t(
|
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] |
higher\tthan\tthe\tcurrent\tDRI.\t(\nACOG,\t2013c\n).\tUse\tof\tiodized\tsalt\tshould\tbe\tencouraged,\n\tbut\nprocessed\tfood\tconsumption,\tthe\tsource\tof\tmore\tthan\t75%\tof\tdietary\tsodium\tin\tthe\tUnited\tStates,\nshould\tbe\tlimited\tbecause\tof\tthe\tnoniodized\tsalt\tcontent.\nZinc.\nZinc\tis\tcritical\tfor\tgrowth\tand\tdevelopment,\tand\trequirements\trise\tduring\tpregnancy.\tA\tzinc-
|
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] |
deficient\tdiet\tdoes\tnot\tresult\tin\teffective\tmobilization\tof\tzinc\tstored\tin\tthe\tmaternal\tskeletal\tmuscle\nand\tbone.\tTherefore\ta\tcompromised\n\tzinc\tstatus\tdevelops\trapidly.\tZinc\tis\tpart\tof\t100\tenzymes\trelated\nto\tthe\tmetabolism\tof\tmacronutrients\t(\nHovdenak\tand\tHaram,\t2012\n).\tIt\tprovides\ta\tstructural\tfunction
|
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] |
Hovdenak\tand\tHaram,\t2012\n).\tIt\tprovides\ta\tstructural\tfunction\nin\tmany\ttissues,\tincluding\tsome\tproteins\tinvolved\tin\tgene\texpression.\tDeficiency\tis\thighly\nteratogenic,\tleading\tto\tcongenital\tmalformations,\tincluding\tanencephaly\tand\tpossibly\toral\tclefts.\nEven\ta\tmild\tzinc\tdeficiency\tmay\tlead\tto\timpaired\n\tfetal\tgrowth\tand\tbrain\tdevelopment,\tas\twell\tas
|
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fetal\tgrowth\tand\tbrain\tdevelopment,\tas\twell\tas\nimpaired\timmune\tfunction.\tWomen\twith\tuntreated\tlow\tzinc\tlevels\tassociated\twith\tacrodermatitis\nenteropathica\thave\tincreased\trisk\tof\tmiscarriage,\tfetal\tgrowth\trestriction,\thypertension,\npreeclampsia,\tpreterm\tdelivery,\tand\tintrapartum\themorrhage.
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] |
preeclampsia,\tpreterm\tdelivery,\tand\tintrapartum\themorrhage.\nZinc\tis\twidely\tavailable\tand\tgood\tsources\tinclude\tred\tmeat,\tseafood,\twhole\tgrains,\tand\tsome\nfortified\tbreakfast\n\tcereals\t(see\t\nAppendix\t47\n).\tSupplementation\texceeding\tthat\tfound\tin\tprenatal\nvitamins\tusually\tis\tnot\trequired\tbut\tmay\tbe\tnecessary\tfor\twomen\twith\tGI\tdisorders\tthat\taffect
|
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] |
absorption.\tOvert\tdeficiency\tis\trare\tin\tthe\tUnited\tStates,\tbut\trates\tare\thigher\twhere\tthe\tmain\tstaple\nfoods\tare\thigh\tin\tphytates\t(i.e.,\tthe\tunrefined\tcereals),\tand\twomen\tfollowing\ta\tvegetarian\tdiet\tmay\nexperience\tlow\tzinc\tbioavailability.\n\tHigh\tlevels\tof\tiron\tsupplementation\tmay\tinhibit\tzinc\tabsorption\tif\nboth\tare\ttaken\twithout\tfood\t(
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both\tare\ttaken\twithout\tfood\t(\nKaiser\tand\tCampbell,\t2014\n).\nPregnancy\tweight\tgain\trecommendations\nGeneral\tweight\tgain\trecommendations\nWith\ta\tsingleton\tgestation,\tless\tthan\thalf\tof\tthe\ttotal\tweight\tgain\tof\ta\tnormal-weight\tpregnant\nwoman\tresides\tin\tthe\tfetus,\tplacenta,\tand\tamniotic\tfluid.\tThe\tremainder\tis\tin\tmaternal\treproductive
|
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0.005374194122850895,
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0.06221814826130867,
0.0871041938662529,
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0.010144148021936417,
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0.12940052151679993,
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0.004697679076343775,
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0.08889231830835342,
0.12747813761234283,
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0.005344561766833067,
0.05614308640360832,
0.04321670159697533,
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0.007983272895216942,
0.09766127914190292,
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0.008639100939035416,
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0.07332261651754379,
0.051457762718200684,
0.026988018304109573,
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0.03406139463186264,
0.10473113507032394,
0.06426797062158585,
0.08087191730737686,
-0.028643835335969925
] |
tissues\t(breast\ttissues\tand\tuterus),\tinterstitial\tfluid,\tblood\tvolume,\tand\tmaternal\tadipose\ttissue.\nIncreased\tsubcutaneous\tfat\tin\tthe\tabdomen,\tback,\tand\tupper\tthigh\tserves\tas\tan\tenergy\treserve\tfor\npregnancy\tand\tlactation.\tThe\tnormal\tdistribution\tof\tweight\tis\tillustrated\tin\t\nFig.\t14.6\n.\nFIG.\t14.6\nDistribution\tof\tweight\tgain\tduring\tpregnancy.
|
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0.03893588110804558
] |
Fig.\t14.6\n.\nFIG.\t14.6\nDistribution\tof\tweight\tgain\tduring\tpregnancy.\nRecommended\tweight\tgains\tto\tsupport\ta\thealthy\tpregnancy\tvary\tby\tprepregnant\tBMI\tand\tare\nsummarized\tin\t\nTable\t14.11\n.\tDesigned\tfor\twomen\tliving\tin\thealthy\tenvironments,\tthe\tIOM\tweight\ngain\tguidelines\tbalance\tthe\trisk\tof\tadverse\tbirth\toutcomes\twith\tthe\tmother’s\trisk\tof\tpostpartum
|
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] |
weight\tretention.\tInsufficient\tgain,\tespecially\tif\talso\tassociated\n\twith\tprepregnant\tunderweight,\tis\nassociated\twith\tincreased\trisk\tof\tSGA\tbabies\tand\tspontaneous\tpreterm\tdeliveries.\tExcessive\tgain\noften\tresults\tin\tLGA\tbabies,\twith\tincreased\trisk\tduring\tdelivery.\tExcessive\tgain\tis\talso\tthe\tstrongest
|
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] |
predictor\tof\tlater\tmaternal\tobesity.\tOutcomes\tare\tbest\twhen\twomen\tgain\twithin\tthe\trecommended\nranges.\tHowever,\tless\tthan\tone\tthird\tof\tpregnant\twomen\tdo\tso,\tand\n\tmost\t(especially\tthose\twho\tare\noverweight\tor\tobese)\tgain\ttoo\tmuch,\talthough\ta\tsignificant\tproportion\tof\tunderweight\twomen\tgain\ntoo\tlittle\t(\nSiega-Riz\tand\tGray,\t2013
|
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too\tlittle\t(\nSiega-Riz\tand\tGray,\t2013\n).\tWomen\twant\tadvice\ton\thow\tmuch\tweight\tthey\tshould\tgain\tbut\ta\nrecent\tstudy\tfound\tthat\t26%\treceived\tno\tguidance\tfrom\ttheir\thealth\tcare\tprovider\t(\nDeputy\tet\tal,\n2018\n).\tThose\tthat\treceived\tadvice\ttried\tto\tfollow\tit,\teven\tif\tit\twas\tinappropriate,\n\tresulting\tin\tboth
|
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0.042324405163526535,
-0.06232403963804245
] |
resulting\tin\tboth\ninadequate\tand\texcessive\tgains\tamong\tthose\tstudied.\nTABLE\t14.11\nU.S.\tInstitute\tof\tMedicine\t(IOM)\tPrenatal\tWeight\tGain\tGoals\nPrepregnant\nWeight\nCategory\nTotal\nSingleton\nWeight\nGain\nRates\tof\tGain\tin\t2\nnd\n\tand\t3\nrd\nTrimesters\tfor\tSingletons\n*\nMean/week\t(Range)\nTotal\tTwins\tWeight\tGain\n(Provisional\nguidelines)\nUnderweight\nBMI\t<\t18.5
|
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0.03550499305129051
] |
(Provisional\nguidelines)\nUnderweight\nBMI\t<\t18.5\n28-40\tlb\n[12.5-18\nkg]\n1\tlb\t(1-1.3)\n[0.51\tkg\t(0.44-0.58)]\nInsufficient\tinformation\navailable\tfor\nguideline\nNormal\nweight\nBMI\t18.5-24.9\n25-35\tlb\n[11.5-16\nkg]\n1\tlb\t(0.8-1)\n[0.42\tkg\t(0.35-0.50)]\n37-54\tlb\n[17-25\tkg]\nOverweight\nBMI\t25.0-29.9\n15-25\tlb\n[7-11.5\tkg]\n0.6\tlb\t(0.5-0.7)\n[0.28\tkg\t(0.23-0.33)]
|
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15-25\tlb\n[7-11.5\tkg]\n0.6\tlb\t(0.5-0.7)\n[0.28\tkg\t(0.23-0.33)]\n31-50\tlb\n[14-23\tkg]\nObese\nBMI\t≥\t30.0\n11-20\tlb\n[5-9\tkg]\n0.5\tlb\t(0.4-0.6)\n[0.22\tkg\t(0.17-0.27)]\n25-42\tlb\n[11-19\tkg]\n*\nCalculations\tassume\ta\tfirst\ttrimester\tgain\tfor\tsingleton\tpregnancy\tof\t1\tto\t3\tkg\t(2.2\tto\t6.6\tlb)\tfor\twomen\twho\tare\tunderweight,\n\tnormal\tweight,\tor
|
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] |
normal\tweight,\tor\noverweight\tand\t0.5\tto\t2\tkg\t(1.1\tto\t4.4\tlb)\tfor\tthose\twho\tare\tin\tthe\tobese\tcategory.\nAdapted\tfrom\tRasmussen\tKM\tet\tal:\tRecommendations\tfor\tweight\tgain\tduring\tpregnancy\tin\tthe\tcontext\tof\tthe\tobesity\tepidemic,\t\nObstet\tGynecol\n116:1191,\t2010;\tRasmussen\tKM,\tYaktine\tAL:\t\nWeight\tgain\tduring\tpregnancy:\treexamining\tthe\tguidelines
|
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] |
Weight\tgain\tduring\tpregnancy:\treexamining\tthe\tguidelines\n,\tWashington,\tDC,\t2009,\tIOM,\tNRC.\nHeight\tand,\tideally,\n\tprepregnant\tweight\tshould\tbe\tmeasured,\tnot\tasked,\tto\tdetermine\tprepregnant\nBMI.\tSelf-reported\tprepregnancy\tweight\tcan\tbe\tused\tif\tnecessary\tbut\tit\tis\tsubject\tto\terror\tand\tis\nusually\tunderreported\t(\nHeaden\tet\tal,\t2017
|
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] |
usually\tunderreported\t(\nHeaden\tet\tal,\t2017\n).\tIf\tprepregnant\tweight\tis\tunknown\tor\tunreliable,\tuse\tthe\nweight\tat\tthe\tfirst\tvisit,\tassuming\tshe\tis\tearly\tin\tpregnancy,\tas\ta\tgood\testimate\tof\tprepregnant\nweight.\tIf\tshe\tstarts\tprenatal\n\tcare\tlate\tand\thas\tno\tidea\tof\ther\tprepregnant\tweight,\testimate\tthat\tshe
|
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] |
has\thad\tappropriate\tgain\tto\tthat\tpoint.\tLater\tin\tpregnancy\tBMI\tis\tnot\ta\trobust\testimate\tof\tbody\tfat\nbecause\tof\tthe\tincrease\tin\ttotal\tbody\twater\t(\nCatalano\tand\tShankar,\t2017\n).\nWomen\tneed\tguidance\ton\ttarget\tweight\tgains.\tOne\tthird\tof\twomen\ttry\tto\tkeep\tthe\tsame\tweight\tor\neven\tlose\tweight\tduring\tpregnancy\t(\nRasmussen\tand\tYaktine,\t2009
|
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even\tlose\tweight\tduring\tpregnancy\t(\nRasmussen\tand\tYaktine,\t2009\n).\tWeight\tgain\tshould\tbe\nmonitored\tas\ta\tway\tto\tevaluate\tprogress\tand\tto\tintervene\twhen\tnecessary.\tThe\tpattern\tof\tweight\ngain\tis\talso\timportant.\tIn\tan\tobservational\tcohort,\texcessive\tfirst\ttrimester\tweight\tgain\twas\ta
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] |
stronger\tpredictor\tof\tmaternal\tweight\tretention,\thigher\twaist\tcircumference,\tand\thigher\tblood\npressure\tthan\twas\tweight\tgain\tlater\tin\tpregnancy\t(\nWalter\tet\tal,\t2015\n).\tIt\tis\talso\tassociated\n\twith\ntoddler\tobesity,\tin\tspite\tof\thaving\tno\teffect\ton\tbirthweight\t(\nKarachaliou\tet\tal,\t2015\n).\tHigher\trates\tof
|
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] |
Karachaliou\tet\tal,\t2015\n).\tHigher\trates\tof\nweight\tgain\tin\tthe\tsecond\ttrimester\tare\tassociated\twith\thigher\tbirth\tweight,\tespecially\tamong\nwomen\twhose\tprepregnant\tBMI\tis\tless\tthan\t26\t(\nRasmussen\tand\tYaktine,\t2009\n).\tMaternal\tweight\ngain\tplotted\ton\tthe\tappropriate\tgrid\tis\tan\teffective\tteaching\ttool.\tSee\t\nAppendix\t3\n\tfor\tall\tpregnancy\nweight
|
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] |
Appendix\t3\n\tfor\tall\tpregnancy\nweight\n\tgain\tgrids,\tas\twell\tas\ttables\t(using\tpounds/inches\tand\tkilograms/centimeters)\tto\tquickly\nchoose\tthe\tcorrect\tgrid\twithout\tneeding\tto\tcalculate\tthe\tprepregnant\tBMI.\nWeight\tloss\tduring\tpregnancy\tshould\tbe\tdiscouraged.\tThere\tare\tno\tintervention\tstudies\ndocumenting\tbenefit\t(\nFurber\tet\tal,\t2013
|
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] |
documenting\tbenefit\t(\nFurber\tet\tal,\t2013\n).\tAs\tadipose\ttissue\tis\tmobilized,\tsemivolatile\torganic\ncompounds\tmay\tbe\treleased\t(see\t\nClinical\tInsight:\n\tWhat’s\n\tin\tThat\tFat\tWhen\tYou\tLose\tIt\tin\t\nChapter\n20\n).\tBecause\tof\tthe\taccelerated\tstarvation\tcharacteristic\tof\tpregnancy,\twomen\tare\tmore\tlikely\tto
|
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] |
develop\tketonemia\tand\tketonuria\tafter\ta\t12-\tto\t18-hour\tfast,\twith\tketone\tlevels\thigher\tthan\tin\nnonpregnant\twomen.\tAlthough\tthe\tfetus\thas\ta\tlimited\tability\tto\tmetabolize\tketones,\tthese\ncompounds\tmay\tadversely\taffect\tfetal\tbrain\tdevelopment\t(\nRasmussen\tand\tYaktine,\t2009\n).\tIn
|
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Rasmussen\tand\tYaktine,\t2009\n).\tIn\naddition,\tmobilized\tprotein\tstores,\tincreased\tfree\tfatty\tacids,\turinary\tnitrogen\texcretion,\tand\tlower\nplasma\tglucose,\tinsulin,\tand\tgluconeogenic\tamino\tacids\thave\tbeen\tseen,\tresulting\tin\tincreased\trisk\nof\tIUGR\tand\tpreterm\tbirth\t(\nFurber\tet\tal,\t2013\n.\nPrenatal\tweight\tgain\tguidelines\tvary\tsomewhat\tworldwide\t(
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] |
.\nPrenatal\tweight\tgain\tguidelines\tvary\tsomewhat\tworldwide\t(\nScott\tet\tal,\t2014\n).\tWHO\thas\tdiscussed,\nbut\tnot\timplemented,\tdifferent\tweight\tgain\tguidelines\n\tbased\ton\tethnic\tdifferences\tin\tbody\ncomposition\tand,\ttherefore,\tdifferent\trisks\t(\nMa\tet\tal,\t2016\n).\tThe\tIOM\tguidelines\tare\tbased\ton
|
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] |
Ma\tet\tal,\t2016\n).\tThe\tIOM\tguidelines\tare\tbased\ton\nobservational,\tnot\tinterventional,\tdata.\tThus\tsome\tcountries\tdo\tnot\tadvocate\teither\ta\tparticular\nweight\tgain\tor\teven\troutine\tweighing\tafter\tdetermining\tthe\tprepregnant\tBMI\tstatus.\tAlthough\tthere\nare\tmany\tsmall\tintervention\tstudies,\tlarge\ttrials\tare\tnot\tyet\tavailable.
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] |
It\talso\tmust\tbe\tnoted\tthat\tit\tis\nunclear\twhether\tmaternal\tweight\tgain\titself\tis\ta\tcritical\tvariable\tor\twhether\tit\tis\ta\tmarker\tfor\nnutritional\tstatus.\tEven\tso,\ttracking\tweight\tgain\tis\tuseful\tand\twhen\tvariation\tfrom\tnormal\tpatterns\tis\nnoted,\tmore\tquestions\tshould\tbe\tasked.\tWhile\tseeing\tthe\tgrid\tor\thearing\tthe\tactual\tweight\tmay\tbe
|
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] |
stressful\tfor\tsome,\tmany\twomen\tfind\tthe\tvisual\ttracking\tof\ttheir\tweight\n\tgain\tagainst\tthe\tappropriate\ngrid\tboth\teffective\tand\talso\treassuring.\tJust\ttracking\tweight\tgain\twithout\tguidance\tor\tsupport\tis\tnot\nbeneficial.\nObesity\tweight\tgain\trecommendations
|
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] |
Pregravid\tobesity\tis\tdescribed\tas\tclass\tI\t(BMI\t30\tto\t34.9),\tclass\tII\t(BMI\t35\tto\t39.9),\tand\tclass\tIII\n(BMI\tat\tleast\t40).\tThe\tIOM’s\tweight\tgain\trecommendation\tof\t11\tto\t20\tpounds\tdoes\tnot\tdistinguish\nbetween\tthese\tclasses\n\t(\nRasmussen\tand\tYaktine,\t2009\n).\tOptimal\tgestational\tweight\tgains\tfor\tthese
|
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] |
).\tOptimal\tgestational\tweight\tgains\tfor\tthese\ngroups\tare\tnot\tyet\tknown\tand\tresearch\tcontinues,\twith\tsome\tevidence\tthat\tlower\tgains,\tor\teven\tloss,\ncan\tbe\tmanaged\tsuccessfully\tas\tindividuals\tmay\tbalance\tintakes\twell\tenough\tto\tavoid\tketonemia.\nOverweight,\tand\ttherefore\tovernutrition,\tis\tnot\tthe\tsame\tas\tgood\tquality\tnutrition\tand,\tin\tfact,
|
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] |
obesity\tis\tassociated\twith\tlower\n\tserum\tlevels\tof\tcarotenoids;\tvitamins\tC,\tD,\tB\n6\n,\tK;\tfolate;\tiron;\tand\nselenium\t(\nSaltzman\tand\tKarl,\t2013\n;\tsee\talso\t\nChapter\t20\n).\tIndividual\tguidance\tand\tclinical\tjudgment,\nincluding\toptimizing\tnutrient\tintakes\tand\tencouraging\texercise,\tis\tnecessary,\tand\tfetal\tgrowth\tmust
|
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] |
be\tmonitored.\tAlthough\tweight\tgain\ttargets\tmay\tbe\ttoo\thigh\tfor\tsome\twomen,\tevidence\tsuggests\nthat\tthe\trisk\tof\tpreterm\tdelivery,\n\tIUGR,\tand\tperinatal\tmortality\tall\tincrease\tif\tthe\tweight\tgain\tis\ttoo\nrestrictive.\tEpigenetic\teffects\talso\tmust\tbe\tconsidered.\tInadequate\tweight\tgain\tand\tweight\tloss\nshould\tnot\tbe\tencouraged\t(\nACOG,\t2015d
|
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] |
should\tnot\tbe\tencouraged\t(\nACOG,\t2015d\n).\tThe\tUnited\tStates,\tCanada,\tAustralia,\tNew\tZealand,\tand\nGreat\tBritain\thave\tsimilar,\tbut\tnot\tidentical,\tguidelines\tregarding\tthe\tmanagement\tof\tobesity\tin\npregnancy\tbut\tall\trecommend\tthat\ta\tnutrition\n\tconsultation\tshould\tbe\toffered\tto\tall\twomen\twho\tare\noverweight\tor\tobese\tbefore\tpregnancy\t(\nVitner\tet\tal,\t2019
|
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] |
overweight\tor\tobese\tbefore\tpregnancy\t(\nVitner\tet\tal,\t2019\n).\tNo\tstudy\thas\tyet\texamined\tthe\tpregnancy\noutcomes\tof\tlow\tweight\tgain/weight\tloss\tresulting\tfrom\tinsufficient\tfood\tintake\tvs.\tthat\tresulting\nfrom\treplacing\tfoods\tcontaining\texcessive\tfats\tand\tsweets\twith\tthose\tof\thigher\tnutrient,\tbut\tlower\ncaloric\tcontents.\nPostbariatric\tsurgery.\nThe
|
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] |
caloric\tcontents.\nPostbariatric\tsurgery.\nThe\n\thigh\tprevalence\tof\tobesity\thas\tresulted\tin\tan\tincrease\tin\tbariatric\tsurgeries.\tAlthough\nprepregnancy\tweight\tloss\tmay\timprove\tfertility,\tit\thas\tthe\tpotential\tto\tprovide\ta\tsuboptimal\tuterine\nenvironment\tfor\tthe\tdeveloping\tfetus,\tand\tadequate\tnutrient\tsupplementation\tis\tessential.\tWhich
|
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] |
nutrients\tare\tmost\tlikely\tto\tbe\tdeficient\twill\tbe\tdetermined\tby\tthe\ttype\tof\tsurgery\tand\tthe\tnutritional\nstatus\tsince\n\tthat\tsurgery\t(see\t\nChapter\t20\n),\tbut\tcommonly\tinclude\tprotein,\tas\twell\tas\tvitamins\tD,\nfolate,\tB\n12\n,\tB\n1\n,\tand\tA;\tiron;\tcalcium;\tmagnesium;\tcopper;\tand\tzinc.\tOther\tdeficiencies,\talthough\npotentially\tsevere,\tare\tmore\tsporadic\t(
|
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] |
potentially\tsevere,\tare\tmore\tsporadic\t(\nSaltzman\tand\tKarl,\t2013\n)\tbut\tmay\tinclude\tvitamins\tC,\tB\n6\n,\tB\n2\n,\nniacin,\tE,\tand\tK;\tselenium;\tand\tessential\tfatty\tacids\t(with\tbiliopancreatic\tdiversion).\tIf\tanemia\tdoes\nnot\trespond\n\tto\ttreatment,\tvitamin\tB\n12\n,\tfolate,\tprotein,\tcopper,\tselenium,\tand\tzinc\tshould\tbe\tassessed\n(\nMechanick\tet\tal,\t2013
|
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] |
(\nMechanick\tet\tal,\t2013\n).\tACOG\trecommends\twomen\tbe\tevaluated\tfor\tnutrient\tdeficiencies\tand\nsupplemented\tas\tneeded\t(\nACOG,\t2015d\n).\nThe\toptimal\ttiming\tof\tpregnancy\tfollowing\tbariatric\tsurgery\tis\tstill\tunclear.\tAlthough\t1\tyear\thas\nbeen\tcommonly\tcited,\tACOG\tnow\trecommends\tdelaying\tpregnancy\tfor\t18\tmonths\tto\tavoid\n\tthe\tperiod
|
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] |
the\tperiod\nof\trapid\tweight\tloss.\tHowever,\ta\trecent\tstudy\tis\tmore\tconservative\t(\nParent\tet\tal,\t2017\n).\tThey\tfound\nthat\tif\tpregnancy\toccurred\twithin\t2\tyears\tof\tsurgery,\tthe\trisk\tof\tprematurity\tincreased\t(14%\tvs.\n8.6%),\tas\tdid\tthe\trates\tof\tneonatal\tintensive\tcare\tunit\t(NICU)\tadmission\t(15.2%\tvs.\t11.3%),\tSGA
|
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] |
prevalence\t(13%\tvs.\t8.9%),\tand\tlow\tAPGAR\tscores\t(17.5%\tvs.\t14.8%),\tcompared\twith\ta\tmatched\ncohort.\n\tThey\tsuggest\tthat\twomen\tshould\twait\tat\tleast\t3\tyears\tto\tconceive.\tAn\tindividualized\napproach\thas\talso\tbeen\tsuggested,\tdelaying\tpregnancy\tuntil\tthe\tweight\thas\tbeen\tstable\tfor\t2\tyears
|
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] |
and\twith\tall\tnutrient\tdeficiencies\ttreated\tprior\tto\tconception.\tHowever,\tmany\twomen\tdon’t\tfollow\nthis\tadvice\tand\tare\tlikely\tto\tbe\tentering\tpregnancy\twith\tless\tthan\tideal\tnutrient\tstatus.\nAn\toptimum\tnutrient\tprescription\n\tand\tcaloric\trequirement\tfor\tpregnant\twomen\tafter\tbariatric
|
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] |
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