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and\tcaloric\trequirement\tfor\tpregnant\twomen\tafter\tbariatric\nsurgery\thas\tnot\tbeen\tdetermined\tand\tmust\tbe\tindividualized.\tProtein\tintake\trecommendations\nfollowing\tsurgery\tare\thigher\tthan\tnormal\t(1.0\tto\t2.1\tg/kg\tideal\tbody\tweight)\tbut\tit\tis\tunknown\twhat\nfurther\tincrease\tis\tneeded\tfor\tpregnancy.\tSpecific\tvitamin\tand\tmineral\trecommendations\tare\talso
|
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unknown.\tThese\twomen\tmay\thave\tmore\tdifficulty\teating\n\tenough\tif\tthey\thave\thad\ta\trestrictive\nprocedure\tand\tthe\tgastric\tband\tmay\tneed\tto\tbe\tadjusted.\tThose\twith\tbypass\tprocedures\tmay\thave\nmalabsorptive\tproblems\tand\tmany\twomen\tmay\tdevelop\tfood\tintolerances.\tIn\taddition,\twomen\twith\ta
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] |
history\tof\tbariatric\tsurgery\tmay\tbe\tless\twilling\tto\tgain\tenough\tweight\tafter\thaving\tinvested\tso\tmuch\nin\tlosing\tit,\tso\tguidance\twith\treassurance\tand\tsupport\tmay\tbe\tnecessary\n\t(see\t\nChapter\t20\n).\tAlthough\nthe\tweight\tgain\tguidelines\tare\tbased\ton\tprepregnant\tBMI\tand\tare\tthe\tsame\tas\tfor\tthose\twithout
|
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] |
surgery,\tthey\tare\tdifficult\tto\tachieve\tfor\tthese\twomen.\tFocus\ton\thigh\tnutrient,\tlow\tvolume\tfoods\tand\nminimize\tthe\tintake\tof\tfoods\tthat\tdon’t\thelp\tfetal\tgrowth\tor\tdevelopment.\nThese\twomen\tneed\tto\tbe\tmonitored\tcarefully\tduring\tpregnancy\tand\ttheir\tprenatal\tcare\tmay\tneed\nto\tbe
|
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] |
to\tbe\n\tmodified.\tPractitioners\tshould\thave\ta\thigh\tdegree\tof\tsuspicion\twhen\thearing\tabout\ndiscomforts.\tThe\tgastric\tband\tcan\tslip,\tcausing\tan\tobstruction\tthat\tcan\tmimic\thyperemesis\tbut\tcan\nresult\tin\tfetal\tdeath\t(\nJacquemyn\tand\tMeesters,\t2014\n).\tThis\tband\tmigration\tcan\thappen\tyears\tafter
|
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).\tThis\tband\tmigration\tcan\thappen\tyears\tafter\nsurgery,\tafter\tuneventful\tpregnancies,\tand\talso\tafter\tdelivery.\tRoux-en-Y\tsurgery\thas\tbeen\tshown\tto\nincrease\tthe\trisk\tof\n\tbowel\tobstruction.\tGI\themorrhage,\tanastomotic\tleaks,\tinternal\tor\tventral\nhernias,\tgastric\trupture,\tpeptic\tulcers,\tcholelithiasis,\tand\tband\terosion\thave\tall\tbeen\tseen.\tThose
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experiencing\tdumping\tsyndrome\t(primarily\tafter\tRoux-en-Y)\tmay\trequire\tglucose\tmonitoring\trather\nthan\ttrying\tto\tuse\tthe\tglucola\tto\tdiagnose\tgestational\tdiabetes.\tGlucose\tmonitoring\tmay\talso\tneed\tto\nbe\tmodified.\tBecause\tthese\twomen\n\texperience\thigher,\tshorter\tglucose\tpeaks\tand\tlower\tlows,
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experience\thigher,\tshorter\tglucose\tpeaks\tand\tlower\tlows,\nidentification\tof\ta\tproblem\tmay\tbe\tmissed\tif\tthe\tcommon\t2-hour\twindow\tis\tused\t(\nBonis\tet\tal,\t2016\n;\nFeichtinger\tet\tal,\t2017\n).\nEarlier\tresearch\tfound\tlittle\tor\tno\tdifference\tin\tpregnancy\toutcomes\tafter\tbariatric\tsurgery\tbut
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0.10997917503118515,
0.024802306666970253,
0.0470186248421669,
0.0015856263926252723
] |
studies\twere\tsmall,\tshort\tterm,\tand\thad\tinconsistent\tresults.\tNewer\tstudies\tare\tlarger\tand\thave\nmatched\tcontrols,\tenabling\n\tresearchers\tto\tbetter\tcharacterize\tthe\tadditional\trisk\tfor\tpregnancy\tafter\nbariatric\tsurgery,\ttaking\tinto\taccount\tthe\televated\trisk\tof\tcontinued\tobesity.\tWomen\twho\thave\thad
|
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bariatric\tsurgery\toften\thave\tsuccessful\tpregnancy\toutcomes,\twith\tlower\trates\tof\tgestational\ndiabetes,\thypertension,\tpreeclampsia,\tmacrosomia,\tand\tchildhood\tobesity\tthan\tseen\tamong\twomen\nwith\tobesity\twho\thave\tnot\tundergone\n\tbariatric\tsurgery\t(\nKassir\tet\tal,\t2016\n).\tHowever,\tthey\talso\thave\nhigher\trisk\tof\tfetal\tgrowth\trestriction\tand\tpreterm\tbirths\t(
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higher\trisk\tof\tfetal\tgrowth\trestriction\tand\tpreterm\tbirths\t(\nKwong\tet\tal,\t2018\n),\tincluding\thigher\nmiscarriage\tand\tneonatal\tmortality\trates\tafter\tsurgery\t(\nKassir\tet\tal,\t2016\n).\tIf\twomen\thave\thad\tRoux-
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en-Y\tor\tbiliopancreatic\tdiversion\tsurgery,\twith\tor\twithout\tthe\tduodenal\tswitch,\tthey\tmay\talso\thave\nhigher\trisk\tof\tfetal\tmalformations\t(\nPelizzo\tet\tal,\t2014\n),\tbut\tthere\tappears\tto\tbe\tno\tconsistent\nincrease\tin\tthe\trisk\tof\tmalformations.\tSome\thave\tfound\tan\tincreased\trisk\tof\tNTDs\tand\tcase\treports
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] |
describe\tthe\tconsequences\tof\tspecific\tnutrient\tdeficiencies,\tincluding\tvitamins\tK,\tB\n12\n,\tand\tA.\nThe\testimation\tof\tnutritional\trisk\tfrom\tbariatric\tsurgery\thas\trisen\tover\ttime,\tas\tevidenced\tby\tthe\nincreased\tnumber\tof\tnutrients\tbeing\tmonitored,\tthe\ttesting\tfrequency,\n\tand\tthe\tlevel\tof\troutine\nsupplementation\trecommended.\tCurrent\tguidelines\t(
|
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] |
supplementation\trecommended.\tCurrent\tguidelines\t(\nParrott\tet\tal,\t2017\n)\tare\tnot\tspecific\tto\npregnancy\t(see\t\nChapter\t20\n).\tStudies\tregarding\tpregnancy\tfollowing\tbariatric\tsurgery\tare\tongoing\n(\nJans\tet\tal,\t2016\n),\tincluding\texamining\tthe\teffect\tof\tbariatric\tsurgery\ton\tbreastmilk\tcomposition,\tand
|
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] |
better\tguidance\tis\texpected\tin\tthe\tfuture.\tAs\twith\tother\tdietary\tsupplements,\tbariatric\n\tmultivitamin-\nmultimineral\tsupplements\tare\tnot\tstandardized\tand\tsome\tfit\tthe\tprofile\tof\tprenatal\tnutrient\nrecommendations\tbetter\tthan\tothers\tdo.\nMultiple\tbirths
|
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] |
recommendations\tbetter\tthan\tothers\tdo.\nMultiple\tbirths\nThe\tincidence\tof\tmultiple\tbirths\tin\tthe\tUnited\tStates\tis\trising\tbecause\tof\tthe\tincreased\tuse\tof\tfertility\ndrugs\tand\tART,\tage\tat\tconception,\tand\tobesity\trates\tamong\tpregnant\twomen\t(\nACOG,\t2016b\n).\nMultifetal\tgestations\tcause\tsignificant
|
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0.09037544578313828,
0.08296238631010056,
0.06971427798271179,
0.03315049409866333
] |
ACOG,\t2016b\n).\nMultifetal\tgestations\tcause\tsignificant\n\tmaternal\tphysiologic\tadaptations\tbeyond\tthe\tusual\tpregnancy\nchanges,\tincluding\tincreased\tplasma\tvolume,\tmetabolic\trate,\tand\tincreased\tinsulin\tresistance\n(\nGoodnight\tand\tNewman,\t2009\n).\nThese\tinfants\thave\ta\tgreater\trisk\tof\tpreterm\tdelivery\twith\taccompanying\tIUGR\tor\tLBW\tthan\tdo
|
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] |
singletons.\tAdequate\tmaternal\tweight\tgain,\tespecially\tearly\tin\tpregnancy\t(before\t20\tweeks),\thas\nbeen\tshown\tto\tbe\tparticularly\n\timportant\tfor\toptimal\tgrowth\tand\ttime\tin-utero\t(\nGreenan\tet\tal,\t2017\n).\nA\tcommon\trule\tof\tthumb\tis\tto\ttarget\ta\t24-pound\tgain\tby\t24\tweeks\tof\tgestation\tfor\ttwins\t(\nGoodnight\nand\tNewman,\t2009
|
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] |
Goodnight\nand\tNewman,\t2009\n)\tbut\tintervention\tshould\tbegin\tin\tthe\tfirst\ttrimester.\tThe\tIOM\tweight\tgain\nguidelines\tfor\ttwins\tare\tprovisional\t(see\t\nTable\t14.11\n\tand\t\nAppendix\t3\n)\tbut\tare\tsupported\tby\tmore\nrecent\tresearch\t(\nHutcheon\tet\tal,\t2018\n).\n\tThe\teffect\tof\tchorionicity\ton\toptimal\tweight\tgain\tis\tunknown.
|
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] |
).\n\tThe\teffect\tof\tchorionicity\ton\toptimal\tweight\tgain\tis\tunknown.\nFor\tthose\tpregnant\twith\ttriplets\tor\tother\thigher-order\tmultiples,\tthere\tis\tlimited\tinformation\navailable,\tbut\tbest\tpractice\tadvice\tdoes\texist.\tTarget\ta\tgain\tof\tat\tleast\t36\tpounds\tby\t24\tweeks\tof\ngestation\tfor\ttriplets\t(\nStone\tand\tKohari,\t2015
|
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] |
gestation\tfor\ttriplets\t(\nStone\tand\tKohari,\t2015\n).\tMean\tgestational\tweight\tgain\tfor\ttriplets\tis\t45\tto\t51\npounds\t(20.5\tto\t23\tkg)\tat\t32\tto\t34\tweeks.\n\tFor\tquadruplets,\tit\tis\t46\tto\t68\tpounds\t(20.8\tto\t31\tkg)\tat\t31\nto\t32\tweeks\t(\nRasmussen\tand\tYaktine,\t2009\n)\tbut\tbetter\toutcomes\thave\tbeen\tseen\twith\thigher\tgains\n(\nLuke\tet\tal,\t2017\n;\t\nLuke,\t2015\n).
|
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] |
(\nLuke\tet\tal,\t2017\n;\t\nLuke,\t2015\n).\nThe\toptimal\tnutrient\trequirements\tfor\ttwins\tand\thigher-order\tmultiples\tare\tnot\tyet\tknown\tbut\tare\ncertainly\thigher\tthan\tfor\tsingleton\tpregnancies.\tThere\tare\tmore\tfetuses\tand\tmore\tplacentas\tneeding\nnourishment.\n\tIn\taddition,\tthe\tincreased\tmaternal\tweight\tmay\tincrease\tinflammation\tand\ttherefore
|
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] |
negatively\taffect\tthe\tnutrient\ttransport\t(\nCao\tand\tO’Brien,\t2013\n).\tIt\tis\tassumed\tthat\tat\tleast\tthe\tmilk\nand\tmeat\tfood\tgroups\tneed\tto\tbe\tdoubled\tfor\ttwins,\tincreasing\tas\tneeded\tfor\toptimal\tfetal\tgrowth,\nwith\teven\thigher\tservings\tfor\tthe\thigher\torder\tmultiples\t(\nLuke\tet\tal,\t2017\n).\nA\tsummary\tof\tcurrent\tnutritional\tplans\n\tfor\ttwins\tis\tsummarized\tin
|
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A\tsummary\tof\tcurrent\tnutritional\tplans\n\tfor\ttwins\tis\tsummarized\tin\t\nTable\t14.12\n\tbut\tmay\thave\tto\ninclude\tiodine\tand\tcholine\tas\twell;\tnewer\tevidence\tcautions\tagainst\thigh\tdoses\tof\tvitamins\tC\tand\tE\n(see\tHypertension\tand\tnutrient\tsections)\t(\nACOG,\t2013c\n).\tBecause\tof\ta\tgreater\tneed\tfor\tnutritional
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ACOG,\t2013c\n).\tBecause\tof\ta\tgreater\tneed\tfor\tnutritional\ndensity\tin\tthe\tdiet,\tit\tis\trecommended\tthat\tonly\t40%\tof\tcalories\tcome\tfrom\tcarbohydrate,\twith\t20%\nfrom\tprotein,\tand\t40%\tfrom\tfat\t(\nGoodnight\tand\tNewman,\t2009\n).\tA\twoman\tpregnant\twith\tmultiples\nhas\tincreased\tnutrient\tneeds\tbut\tdecreased\tspace.\tCounseling\tshould\tfocus\ton\tthe\tconsumption\tof
|
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very\thigh\tnutrient\tfoods.\tShe\tmust\teat\tvery\tfrequently,\tpossibly\tevery\thour,\tand\tmust\tfocus\ton\tfoods\nthat\taid\tfetal\tgrowth\teach\ttime\tshe\teats.\tUsing\tfruits\tand\tvegetables\tas\tdesserts\trather\tthan\tsnacks\noften\thelps,\tas\tdoes\tsuggesting\tthat\tshe\teat\tbefore\tdrinking\n\tliquids.\tConsumption\tof\tany\tfoods\tthat
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] |
liquids.\tConsumption\tof\tany\tfoods\tthat\ndon’t\thelp\tfetal\tgrowth\tand\tdevelopment\tshould\tbe\tdiscouraged.
|
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] |
TABLE\t14.12\nNutrient\tRecommendations\tfor\tWomen\tPregnant\twith\tTwins\nNutrient\nTwins\nComments\nCalories\nUnderweight:\t4000\tkcal\nNormal:\t3000-3500\tkcal\nOverweight:\t3250\tkcal\nObese:\t2700-3000\tkcal\nEstimated\tneeds\tare\t40-45\tkcal/kg.\tMonitor\tweight\tgain\tand\nmodify\tcalories\tto\tmeet\ttarget\n\tweight\tgoals.\nProtein\nUnderweight:\t200\tg\nNormal:\t175\tg
|
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weight\tgoals.\nProtein\nUnderweight:\t200\tg\nNormal:\t175\tg\nOverweight:\t163\tg\nObese:\t150\tg\nTarget\t20%\tof\tcalories\tfrom\tprotein.\tChoose\tconcentrated\nsources\tas\tspace\tbecomes\tlimiting.\nCarbohydrate\nUnderweight:\t400\tg\nNormal:\t350\tg\nOverweight:\t325\tg\nObese:\t300\tg\nEncourage\tlow\tglycemic\tchoices.\nFat\nUnderweight:\t178\tg\nNormal:\t156\tg\nOverweight:\t144\tg
|
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] |
Fat\nUnderweight:\t178\tg\nNormal:\t156\tg\nOverweight:\t144\tg\nObese:\t133\tg\nEncourage\thealthy\tfats.\nVitamin\tD\n1000\tIU/day\tor\tmore\tas\nneeded\t(1000\tIU/day\nraises\tblood\t5\nmg/dL)\nAssessment\tof\tmaternal\tlevels\tshould\tbe\tconsidered\tin\tfirst\nand\tearly\tthird\ttrimesters\tto\tallow\talterations\tin\tthe\nsupplemental\tdose,\tespecially\timportant\tif\tthe\tmother\tis\ton
|
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] |
supplemental\tdose,\tespecially\timportant\tif\tthe\tmother\tis\ton\nbed\trest.\nVitamin\tC\n500-1000\tmg/day\nThis\tis\thalf\tof\tthe\tUL\tof\t1800-2000\tmg/day.\tSee\tmore\trecent\ncautions.\nVitamin\tE\n400\tmg/day\nThis\tis\thalf\n\tof\tthe\tUL\tof\t800-1000\tmg/day.\tSee\tmore\trecent\ncautions.\nZinc\n15\tmg/day\t(T1);\t30-45\nmg/day\t(T2-3)
|
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] |
cautions.\nZinc\n15\tmg/day\t(T1);\t30-45\nmg/day\t(T2-3)\nDiet\talone\tmay\tnot\tbe\tenough.\tSupplementation\tmay\tbe\nrequired.\nIron\n30\tmg/day\tas\tpart\tof\t1\nmultivitamin/day\n(T1),\t2\nmultivitamins/day\n(T2\tand\tT3)\nTwin\tgestation\trequirement\tis\tlikely\tdouble\tthat\tof\tsingletons.\nHigher\tintakes\tmay\tbe\tneeded\tfor\ttreatment\tof\tanemia.\nFolic\tacid\n800-1000\tmcg/day,\n\t4
|
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] |
Folic\tacid\n800-1000\tmcg/day,\n\t4\nmg\tif\twith\ta\thistory\nof\tNTD\nCalcium\n1500\tmg/day\t(T1);\n2500-3000.\tmg\t(T2-\n3)\nUL:\t2500\tmg/day,\tconsider\tlimiting\tif\tthere\tis\ta\thistory\tof\nkidney\tstones.\nMagnesium\n400\tmg/day\t(T1);\t800-\n1200.\tmg/day\t(T2-3)\nDHA\t+\tEPA\n300-1000\tmg/day
|
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] |
400\tmg/day\t(T1);\t800-\n1200.\tmg/day\t(T2-3)\nDHA\t+\tEPA\n300-1000\tmg/day\nAdapted\tfrom\tGoodnight\tW,\tNewman\tR:\tOptimal\tnutrition\tfor\timproved\ttwin\tpregnancy\toutcome,\t\nObstet\tGynecol\n\t114:1121,\t2009;\tLuke\tB:\tNutrition\nfor\tmultiples,\n\t\nClin\tObstet\tGynecol\n\t58:585,\t2015;\tLuke\tB,\tEberlein\tT,\tNewman\tR:\t\nWhen\tyou’re\texpecting\ttwins,\ttriplets,\tor\tquads
|
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] |
When\tyou’re\texpecting\ttwins,\ttriplets,\tor\tquads\n,\ted\t4,\tNew\tYork,\n2017,\tHarper.\t\nDHA\n,\tDocosahexaenoic\tacid;\t\nEPA\n,\teicosapentaenoic\tacid;\t\nNTD\n,\tneural\ttube\tdefect;\t\nT\n,\ttrimester;\t\nUL\n,\ttolerable\tupper\tlimit.\nAdolescent\tpregnancy\nPublic\thealth\tinitiatives\thave\thelped\treduce\tthe\tincidence\tof\tteen\tpregnancies\toverall,\tbut\tit\ncontinues
|
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0.004278527572751045
] |
continues\n\tas\ta\tmajor\tproblem\tin\tthe\tUnited\tStates\tamong\tsome\tminority\tgroups\t(\nCDC,\t2018c\n).\tRisk\nfactors\tfor\tpoor\toutcome\tin\tpregnant\tadolescents\tare\tlisted\tin\t\nBox\t14.3\n.\nBOX\t14.3\nRisk\tFactors\tfor\tPoor\tPregnancy\tOutcome\tin\tTeenagers\n•\t\nYoung\tmaternal\tage\n•\t\nPregnancy\tless\tthan\t2\tyears\tafter\tonset\tof\tmenarche\n•
|
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•\t\nPregnancy\tless\tthan\t2\tyears\tafter\tonset\tof\tmenarche\n•\t\nPoor\tnutrition\tand\tlow\tprepregnancy\tweight\n•\t\nPreexisting\tanemia\n•\t\nInappropriate\tweight\n\tgain\t(too\tlow\tand\ttoo\thigh)\n•\t\nObesity\n•\t\nSexually\ttransmitted\tdisease\tor\tinfection\n•\t\nSubstance\tabuse:\tsmoking,\tdrinking,\tand\tdrugs\n•\t\nPoverty\n•\t\nLack\tof\tsocial\tsupport\n•\t\nLow\teducational\tlevel
|
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] |
•\t\nRapid\trepeat\tpregnancies\n•\t\nLack\tof\taccess\tto\tage-appropriate\tprenatal\tcare\n•\t\nLate\tentry\tinto\tthe\thealth\tsystem\n•\t\nUnmarried\tstatus\n•\t\nUnstable\thousing,\tshelter\tliving,\thomelessness
|
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] |
Increased\trates\tof\tLBW\tand\tpreterm\tdelivery\tare\tespecially\tcommon\tamong\tthose\twho\tare\tvery\nyoung\tand\tunderweight,\tfor\twhom\tthere\tmay\tbe\tcompetition\tfor\tnutrients\tbetween\tthe\tmother\tand\nthe\tfetus\t(see\t\nChapter\t17\n).\tPoor\toutcomes\tare\talso\tcommon\tin\tobese\tteens\tthat\tbecome\tpregnant.
|
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] |
).\tPoor\toutcomes\tare\talso\tcommon\tin\tobese\tteens\tthat\tbecome\tpregnant.\nMany\tteens\tenter\tpregnancy\twith\tsuboptimal\tnutritional\tstatus,\tespecially\tfor\tiron,\tcalcium,\tand\tfolic\nacid.\tIn\tone\n\tstudy,\twomen\tin\tthe\tUnited\tStates\twho\tgave\tbirth\tas\tteens\twere\tmore\tlikely\tto\tbe\noverweight\tor\tobese\tas\tadults\t(\nChang\tet\tal,\t2013\n).
|
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] |
overweight\tor\tobese\tas\tadults\t(\nChang\tet\tal,\t2013\n).\nImproved\tdietary\tpractices\tcan\tbe\tone\tof\tthe\tmost\timportant\tfactors\tfor\tthe\tpregnant\tteen.\tIn\ncounseling\tyoung\tmothers,\tthe\tnutrition\tprofessional\tmust\tbe\taware\tof\tthe\tteen’s\tpsychosocial\tand\nliteracy\tlevels,\ther\teconomic\tstatus\tand\tlevel\tof\tindependence,\tas\twell\n\tas\ther\tcultural\tenvironment,
|
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] |
as\ther\tcultural\tenvironment,\nall\tof\twhich\tmay\tinfluence\ther\tfood\tchoices.\nComplications\tand\tnutritional\timplications\nMany\tof\tthe\tfollowing\tcomplications\tfollow\tfrom\tthe\tnormal\thormonal\tchanges\tduring\tpregnancy.\nThese\tchanges\tcause\tthe\tGI\ttransit\tto\tslow\tso\tthat\tmore\tnutrients\tare\tavailable\tto\tthe\tfetus.
|
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] |
However,\tthat\tcauses\tmore\tnausea\tand\tvomiting,\tconstipation,\tand\theartburn.\tAlthough\tnormal,\nthese\tcomplications\tcan\tbe\tuncomfortable\tand\tpotentially\tdangerous\tbut\tcan\tbe\tmanaged.\nConstipation,\themorrhoids,\tand\tdiarrhea\nWith\tthe\thormonal\tchanges\tof\tpregnancy,\twomen\tbecome\tconstipated\tif\tthey\tfail\tto\tconsume
|
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] |
adequate\twater\tand\tfiber.\tWomen\twho\treceive\tiron\tsupplements\toften\tcomplain\tof\tconstipation.\nThose\twho\tare\ttreated\twith\tondansetron\tfor\tnausea\tand\tvomiting\toften\texperience\tsevere\nconstipation.\tCompression\tof\tthe\tpelvic\tfloor\tby\tthe\tfetus,\tas\twell\tas\tstraining\tduring\tstooling
|
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] |
(Valsalva),\tincreases\tthe\trisk\tfor\themorrhoids.\tIncreased\tconsumption\tof\tfluids\tand\tfiber-rich\tfoods\n(see\t\nAppendix\t27\n),\tincluding\tdried\tfruits\t(especially\tprunes),\tusually\tcontrols\tthese\tproblems.\tSome\nwomen\talso\tmay\trequire\ta\tbulking\ttype\tof\tstool\tsoftener\tbut\tlaxatives\tcontaining\tstimulants\tare\tnot
|
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] |
recommended.\tAdding\tunprocessed\twheat\tbran\tto\tfoods\tis\tsafe\tand\teffective.\nDiarrhea\tmay\talso\tbe\tcaused\tby\ta\tchange\tin\thormones\tearly\tin\tpregnancy.\tIt\tmay\talso\toccur\twhen\na\tmother\tis\tstarting\tlabor.\tInfectious\tand\tother\tmedical\tcauses\tshould\tbe\truled\tout.\tSee\t\nChapter\t27\nfor\ttreatment\toptions.\tPrevention\tof\tdehydration\tis\timportant.
|
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] |
for\ttreatment\toptions.\tPrevention\tof\tdehydration\tis\timportant.\nCravings,\taversions,\tand\tpica\nMost\twomen\tchange\ttheir\tdiets\n\tduring\ttheir\tpregnancies\tas\ta\tresult\tof\tmedical\tadvice,\tcultural\nbeliefs,\tor\tchanges\tin\tfood\tpreference\tand\tappetite.\tFood\tintake\tin\tpregnancy\tmay\tbe\taffected,\tboth
|
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positively\tand\tnegatively,\tby\tchanges\tin\thormone\tlevels.\tThere\tis\tlimited\tresearch\ton\tpregnancy’s\neffect\ton\tthe\tvarious\thormones\trelated\tto\tappetite\tcontrol.\tTaste\tpreferences\toften\tchange\tduring\npregnancy,\tlikely\tdue\tto\tthe\tpregnancy\n\thormones\taffecting\tboth\tthe\ttaste\tbuds\tand\tthe\tcentral\nnervous\tsystem\t(\nFaas\tet\tal,\t2010
|
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] |
nervous\tsystem\t(\nFaas\tet\tal,\t2010\n).\tFood\tavoidances\tmay\tnot\treflect\ta\tmother’s\tconscious\tchoice\tbut\nmay\tinclude\tan\tadverse\tresponse\tto\tsmell\tcaused\tby\tan\tenhanced\tperception\tof\taromas,\ta\nheightened\tgag\tresponse,\tgetting\till\twhile\teating\tor\tsmelling\ta\tparticular\tfood,\tor\taltered\tgastric\ncomfort.\nCravings\tand\taversions.\nCravings\tand\taversions
|
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] |
comfort.\nCravings\tand\taversions.\nCravings\tand\taversions\n\tare\tpowerful\turges\ttoward\tor\taway\tfrom\tfoods,\tincluding\tfoods\tabout\twhich\nwomen\texperience\tno\tunusual\tattitudes\twhen\tnot\tpregnant.\tIn\tthe\tUnited\tStates\tthe\tmost\tcommonly\ncraved\tfoods\tare\tsweets,\tfruits,\tand\tdairy\tproducts,\tor\tfoods\tthat\tcan\tbe\teaten\tquickly.\tThe\tmost
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-0.04097144678235054,
-0.00784361083060503,
-0.032454997301101685,
-0.0435425266623497,
0.0019235591171309352,
-0.009475735947489738,
0.018965018913149834,
0.05368947610259056,
0.00003932261097361334,
-0.04995881766080856,
0.03764691203832626,
0.09514811635017395,
0.09721002727746964,
-0.008639619685709476,
0.03966214507818222,
0.035519231110811234,
0.03950934112071991,
-0.049754563719034195,
-0.024866726249456406,
-0.034531235694885254,
-0.003998495638370514,
0.062282927334308624,
-0.01015238743275404,
-0.035595208406448364,
-0.014614700339734554,
0.0627809464931488,
0.01975414715707302,
-0.05464848503470421,
0.06596867740154266,
-0.05995295196771622,
0.06871333718299866,
0.05436120182275772,
-0.10874754190444946,
0.034912582486867905,
-0.024634137749671936,
-0.1548248678445816,
-0.059225935488939285,
0.028724035248160362,
0.032070744782686234,
-0.030071798712015152,
0.019604496657848358,
0.04733024910092354,
0.04061657935380936,
0.07427644729614258,
0.026964306831359863,
0.04996287822723389,
-0.10839223861694336,
0.014946355484426022,
-0.08811534941196442,
-0.030103452503681183,
-0.00034332493669353426,
-0.0047274003736674786,
-0.01959642395377159,
-0.04773114249110222,
-0.0204335805028677,
-0.0021998092997819185,
-0.04075906053185463,
0.05060191825032234,
0.011158538050949574,
-0.0510064996778965,
0.03140439838171005,
0.04442126676440239,
-0.11810968071222305,
-0.11640265583992004,
-3.11574585716437e-33,
-0.035312168300151825,
-0.008735795505344868,
-0.02231898531317711,
0.05736660584807396,
0.0008116611279547215,
-0.06458745896816254,
-0.009636799804866314,
0.015566708520054817,
0.028417984023690224,
0.0015981360338628292,
0.07756637036800385,
0.028602631762623787,
-0.00036191780236549675,
-0.07333428412675858,
0.003224201500415802,
0.09916265308856964,
0.013660149648785591,
0.06930837780237198,
-0.028103360906243324,
-0.020309288054704666,
-0.08187678456306458,
0.02711355872452259,
-0.12551352381706238,
0.08237244933843613,
-0.004069933667778969,
0.029711520299315453,
0.06852824985980988,
-0.013881753198802471,
0.048073697835206985,
-0.03330836445093155,
0.06023438274860382,
-0.11794313043355942,
-0.01941070891916752,
0.09732792526483536,
-0.003246511798352003,
0.03722621500492096,
-0.002351180650293827,
-0.032665662467479706,
-0.07978661358356476,
0.04673628881573677,
0.01665741391479969,
-0.0014063901035115123,
0.057553332298994064,
0.002376097021624446,
0.014600047841668129,
-0.031148206442594528,
-0.07790340483188629,
-0.10178832709789276,
-0.061618998646736145,
0.03132496774196625,
0.0976615697145462,
0.035807475447654724,
-0.03414864465594292,
0.023988332599401474,
0.03514823317527771,
0.001927797682583332,
-0.04258366674184799,
-0.05552214756608009,
-0.06299550831317902,
-0.07809508591890335,
0.0001341052702628076,
0.016513995826244354,
0.09353549778461456,
-0.011156351305544376,
0.06560545414686203,
-0.08954726159572601,
-0.07340432703495026,
-0.043490439653396606,
-0.03573014214634895,
-0.05463039129972458,
-0.027952194213867188,
-0.017007192596793175,
-0.056862398982048035,
-0.15453101694583893,
0.04110521823167801,
-0.024278433993458748,
0.06127128750085831,
-0.025571035221219063,
-0.02922198548913002,
-0.00877244584262371,
-0.0452493317425251,
-0.04834140092134476,
0.019951390102505684,
-0.016176097095012665,
-0.03218618780374527,
-0.006930691655725241,
0.040825944393873215,
0.03603598102927208,
0.08298461139202118,
0.06236092746257782,
-0.06507935374975204,
0.034705232828855515,
-0.012608988210558891,
0.0708804801106453,
0.06780418008565903,
-4.116971297207783e-8,
-0.00938565842807293,
-0.0473189577460289,
0.006560633424669504,
0.05141371861100197,
0.042086631059646606,
-0.02025773748755455,
0.09021467715501785,
0.020718848332762718,
-0.03565017506480217,
0.0022694366052746773,
0.013730162754654884,
0.12095029652118683,
-0.0594107024371624,
-0.013998277485370636,
0.06122800335288048,
0.028416434302926064,
0.026021024212241173,
0.09964218735694885,
-0.010812432505190372,
-0.04768132045865059,
0.032053157687187195,
0.09280374646186829,
-0.025953641161322594,
0.029908137395977974,
-0.0007761148735880852,
0.005581600591540337,
-0.0344930998980999,
-0.014947677031159401,
0.07706974446773529,
0.08516702055931091,
0.07637687027454376,
-0.04522576183080673,
-0.03806887939572334,
-0.040088213980197906,
-0.042394086718559265,
0.02893850952386856,
-0.08647126704454422,
-0.005429019685834646,
0.033138521015644073,
0.11118636280298233,
-0.03287719190120697,
-0.027720332145690918,
-0.03263300284743309,
0.08250244706869125,
0.006682646926492453,
-0.07104343175888062,
-0.05844275280833244,
0.08927050232887268,
-0.02145414426922798,
-0.02469697967171669,
-0.0023773727007210255,
0.07361595332622528,
0.030111566185951233,
-0.002598599763587117,
-0.016949092969298363,
-0.015208532102406025,
0.06074615940451622,
-0.007013735361397266,
0.011282905004918575,
0.021475207060575485,
0.03683488443493843,
0.034953199326992035,
0.025260282680392265,
-0.018148133531212807
] |
common\taversions\treported\tare\tto\talcohol,\tcoffee,\tmeats,\tand\tthe\tsmell\tof\tfrying.\tHowever,\tcravings\nand\taversions\tare\tnot\tlimited\n\tto\tany\tparticular\tfood\tor\tfood\tgroups,\tthey\toften\toverlap,\tand\tcultural\ndifferences\texist.\tFor\texamples,\tsee\t\nTable\t14.13\n.
|
[
0.0180965568870306,
-0.0585901215672493,
0.01737412065267563,
-0.05728613957762718,
-0.01715271733701229,
0.000173704102053307,
0.08649379014968872,
0.003663766197860241,
-0.028443751856684685,
-0.008773493580520153,
0.09707849472761154,
0.0002900430408772081,
-0.0003893418179359287,
0.019541045650839806,
-0.018973881378769875,
-0.007811786141246557,
-0.0402531623840332,
0.04577958583831787,
-0.01652447320520878,
-0.04185279831290245,
-0.0047725895419716835,
0.06408872455358505,
0.023068124428391457,
0.025204893201589584,
0.0108136972412467,
0.0431729331612587,
-0.0646112933754921,
-0.039223141968250275,
0.06493346393108368,
-0.0656014233827591,
-0.1272546350955963,
0.08045808970928192,
0.01191855687648058,
0.011606987565755844,
0.07492364943027496,
0.034044794738292694,
0.010324518196284771,
-0.01226172223687172,
0.016703560948371887,
0.010148817673325539,
-0.016062846407294273,
-0.050966810435056686,
-0.054931242018938065,
0.04178013280034065,
0.0030621164478361607,
-0.044192563742399216,
-0.02748417668044567,
0.0025414281990379095,
-0.05623060092329979,
-0.027653194963932037,
-0.06745848059654236,
-0.022768519818782806,
-0.10330984741449356,
0.05927775055170059,
0.051419783383607864,
-0.023169701918959618,
-0.03089427947998047,
-0.018272485584020615,
-0.016122236847877502,
0.01390262134373188,
-0.03825928270816803,
-0.021694453433156013,
-0.08497528731822968,
0.045586634427309036,
0.002434649271890521,
0.05586831644177437,
-0.021921681240200996,
0.015336190350353718,
-0.002640547463670373,
0.014287418685853481,
-0.11947037279605865,
-0.009771503508090973,
-0.0588085763156414,
0.15075382590293884,
-0.04732198640704155,
0.07074105739593506,
0.06844918429851532,
0.007831725291907787,
-0.031762439757585526,
-0.06555866450071335,
-0.1032334715127945,
0.04923505708575249,
0.034541863948106766,
0.03578289598226547,
0.0014000697992742062,
0.0026402920484542847,
-0.03567963466048241,
0.0459379218518734,
0.036428458988666534,
0.01649291068315506,
-0.04996175318956375,
-0.022280344739556313,
0.039072830229997635,
-0.025006482377648354,
-0.0587589293718338,
0.018912194296717644,
0.06852027773857117,
-0.007329093758016825,
0.005892093293368816,
0.03400975465774536,
0.012673902325332165,
0.003199489088729024,
0.060622747987508774,
0.0007596401846967638,
-0.06117662042379379,
-0.030780911445617676,
0.009488271549344063,
-0.09876896440982819,
0.057202231138944626,
-0.051219385117292404,
-0.06949958205223083,
-0.02339867688715458,
-0.02266620472073555,
-0.11985503137111664,
-0.061870358884334564,
-0.0929684266448021,
-0.08844160288572311,
-0.006434459704905748,
0.1363409161567688,
0.04963293671607971,
-0.015810303390026093,
-0.049527112394571304,
0.04625173658132553,
0.0770379900932312,
-0.05661499872803688,
-0.04421892389655113,
0.011010425165295601,
1.820706302257348e-33,
0.013286812230944633,
0.06020651012659073,
-0.004707003477960825,
0.06776473671197891,
0.03960960730910301,
0.0005406133714132011,
-0.03648965805768967,
-0.0020033661276102066,
-0.08261150121688843,
0.048767853528261185,
-0.05312487110495567,
0.021016672253608704,
-0.07628297805786133,
0.09679888188838959,
0.07836870849132538,
-0.06506761908531189,
0.009390009567141533,
0.04065990075469017,
0.010050239972770214,
-0.09248994290828705,
-0.025373347103595734,
0.17282995581626892,
0.0005203831242397428,
0.010390229523181915,
-0.054011162370443344,
-0.03503862023353577,
0.006974313873797655,
-0.0570213608443737,
-0.010678363032639027,
0.03761087730526924,
0.04020705074071884,
-0.06247184798121452,
0.04627969115972519,
0.00908877607434988,
-0.02710697241127491,
0.030918924137949944,
-0.03777753561735153,
0.003133184276521206,
0.03228446841239929,
0.00006081436004023999,
-0.056121475994586945,
0.02502758987247944,
0.03447003662586212,
0.02698506973683834,
0.04205458611249924,
-0.017229463905096054,
-0.04646941274404526,
0.004079628270119429,
-0.03066236525774002,
-0.025951780378818512,
-0.005087240133434534,
0.029074668884277344,
0.05738640949130058,
0.021341240033507347,
-0.02677285484969616,
-0.04300481081008911,
0.014104796573519707,
0.020040756091475487,
-0.007175195496529341,
0.071943499147892,
-0.019919700920581818,
0.1272686868906021,
0.025525830686092377,
-0.06979106366634369,
-0.006119504105299711,
0.008069171570241451,
-0.09117254614830017,
-0.07154499739408493,
0.05378304421901703,
0.05398732051253319,
-0.0872550904750824,
0.04468731954693794,
0.0057776086032390594,
0.1026708260178566,
0.04453833028674126,
-0.006258867215365171,
0.025473952293395996,
-0.06279248744249344,
0.025048697367310524,
-0.06731019914150238,
-0.09198301285505295,
-0.05313409864902496,
-0.005982930306345224,
-0.014525411650538445,
-0.07016824185848236,
-0.0437324158847332,
0.005980316083878279,
-0.05658942461013794,
0.027392465621232986,
-0.018218329176306725,
-0.04494369029998779,
0.057466957718133926,
0.023693328723311424,
-0.07325658202171326,
-0.09428942203521729,
-2.3551646453258712e-33,
-0.007219355087727308,
0.0033526720944792032,
-0.06378931552171707,
0.031197963282465935,
-0.05128016695380211,
-0.019579164683818817,
0.004492237698286772,
-0.016736436635255814,
0.029093321412801743,
-0.07248082756996155,
0.05708881840109825,
0.009517853148281574,
0.016623733565211296,
-0.1093059554696083,
-0.0378057137131691,
0.0510377362370491,
0.0064649032428860664,
0.04600038006901741,
-0.025728436186909676,
-0.027383793145418167,
-0.0631299689412117,
0.008240166120231152,
-0.046227507293224335,
0.08419835567474365,
0.05273071676492691,
0.004475331399589777,
-0.02336377277970314,
0.006712202448397875,
0.020196914672851562,
0.03056417964398861,
0.050733622163534164,
-0.04329400509595871,
0.0276381466537714,
0.020096462219953537,
-0.006394134368747473,
-0.005007872357964516,
0.0024522736202925444,
0.013918616808950901,
-0.05405908077955246,
0.030045591294765472,
0.04683477059006691,
-0.0000015017644727777224,
0.06294437497854233,
0.01807434670627117,
-0.005270762834697962,
0.003579421667382121,
-0.09817290306091309,
-0.08375420421361923,
-0.009832628071308136,
0.025119826197624207,
0.11554928123950958,
-0.0019754997920244932,
-0.0008892506593838334,
-0.025452567264437675,
0.050133176147937775,
0.04293886572122574,
-0.010431014932692051,
-0.011846625246107578,
-0.09551724791526794,
0.0193435437977314,
0.028818318620324135,
0.0016725449822843075,
0.04591069370508194,
-0.045230090618133545,
0.10736197978258133,
-0.05245568975806236,
-0.12163437157869339,
0.017449624836444855,
-0.05107041448354721,
-0.05203889310359955,
0.059406451880931854,
0.011561532504856586,
-0.07286152988672256,
-0.08411185443401337,
-0.0038376962766051292,
-0.06774471700191498,
0.0805937647819519,
-0.01391645148396492,
-0.03445212543010712,
-0.016976527869701385,
0.008812549524009228,
0.053623080253601074,
0.02083815447986126,
0.04875700920820236,
-0.020656703040003777,
-0.003045022487640381,
0.0004127059946767986,
0.00005854072514921427,
0.07967168092727661,
0.05761263519525528,
0.007421276997774839,
0.07522086799144745,
-0.006722377147525549,
0.12626561522483826,
0.09120244532823563,
-4.301325873257156e-8,
-0.052890900522470474,
-0.060991447418928146,
-0.024045921862125397,
0.04764360561966896,
0.04489075765013695,
0.04141268506646156,
0.03733689337968826,
0.028911273926496506,
-0.03234587237238884,
-0.09575564414262772,
0.05224335566163063,
0.03930394724011421,
-0.0928303524851799,
-0.01191954780369997,
0.09965362399816513,
0.04228389263153076,
-0.04446646571159363,
0.06134882941842079,
-0.045081350952386856,
-0.026061201468110085,
0.01953914761543274,
0.07947306334972382,
0.015161409974098206,
0.026302160695195198,
-0.05299299582839012,
-0.0315108560025692,
-0.02368571050465107,
0.03506823629140854,
0.05256466567516327,
0.018181655555963516,
0.048750121146440506,
-0.04154656454920769,
-0.016546469181776047,
-0.02208690159022808,
0.025689972564578056,
0.11323406547307968,
-0.07488364726305008,
-0.010562824085354805,
-0.030087878927588463,
0.1276845484972,
0.012099015526473522,
-0.0366121344268322,
-0.056720342487096786,
0.058893270790576935,
0.039287321269512177,
-0.06577826291322708,
-0.07119318097829819,
0.08484316617250443,
-0.04162200912833214,
-0.04470343887805939,
0.004800859373062849,
0.1067095398902893,
0.03437018394470215,
-0.014162988401949406,
-0.02768993005156517,
-0.001758328638970852,
0.04637958109378815,
0.04519539326429367,
-0.020009279251098633,
-0.04025242105126381,
0.052651192992925644,
0.05658278241753578,
0.10319795459508896,
0.02239372581243515
] |
TABLE\t14.13\nReported\tCravings\tand\tAversions\tby\tat\tLeast\t10%\tof\tPregnant\tWomen\tin\tPublished\tStudies\nCountry\nCravings\nAversions\nEthiopia\nMeat\tsauce,\tcheese,\tmilk\nWheat,\tcoffee,\twheat\tbread,\tmeat\nsauce\nTanzania\nMeat,\tmangoes,\tyogurt,\toranges\nRice,\tmeat,\tfish,\teggs\nNigeria\nCereals,\tvegetables,\tbeans,\tyams,\tcassava,\tplantain,
|
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] |
Nigeria\nCereals,\tvegetables,\tbeans,\tyams,\tcassava,\tplantain,\nnonalcoholic\tbeverages,\tfruits,\tmeats,\tmilk,\tfish\nAlcohol,\tplantains,\tcassava,\tyams,\nfish,\tmeat,\tmilk,\tnonalcoholic\nbeverages,\tbeans,\tfruits,\tcereals\nSouth\nAfrica\nFruits,\tsour\tfoods,\tsweets,\tcold\tdrinks\nMeat\nIraq\nMeat,\tchicken,\tmilk,\teggs,\tfruits,\tmilk\nMelons,\tonions,\tleeks,\tradishes,
|
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] |
Melons,\tonions,\tleeks,\tradishes,\nspices\nSaudi\nArabia\nSalty\tfoods,\tsour\tfoods,\n\tmilk\nTea,\tcoffee,\tcola,\tmeat,\tspicy\tfoods\nItaly\nFruit,\tpasta\nMeat,\tsmoke,\tperfumes,\tcoffee\n(taste,\tsmell),\twhite\twine\nEngland\nFruit\tand\tfruit\tjuices,\tincluding\tcitrus,\tsweets,\tchocolate,\nbiscuits,\tice\tcream,\tmilk\tand\tmilk\tproducts,\tvegetables,
|
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] |
biscuits,\tice\tcream,\tmilk\tand\tmilk\tproducts,\tvegetables,\nsweet\tmeats,\tliquids,\tmeats\nTea,\tcoffee,\thighly\tflavored\tor\tspicy\nfoods,\tincluding\tcurries,\tmeats,\nfish,\teggs,\tsmell\tof\tfried\tor\tfatty\nfoods,\tcigarette\n\tsmoke/tobacco,\ncocoa,\tvegetables\nEcuador\nFruit\tand\tfruit\tjuices,\tmeat,\tpoultry,\tfish\tand\tseafood,\teggs\nMeat,\tpoultry,\tfish,\tseafood,
|
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Meat,\tpoultry,\tfish,\tseafood,\nchicken\tand\tquail\teggs,\nvegetables,\twhite\trice,\twheat\nnoodles,\tcorn,\tbarley\nJamaica\nWater,\tice,\tmilk\tand\tmilk\tdrinks,\tfruit\tand\tfruit\tjuices,\nvegetables,\tsweet\tdrinks,\tmeats,\tfish\nMeat,\trice,\twheat\tdumplings,\tyams,\nmilk,\tfruit\tand\tfruit\tjuices,\tsweet\ndrinks,\n\tfish\nUnited\nStates
|
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milk,\tfruit\tand\tfruit\tjuices,\tsweet\ndrinks,\n\tfish\nUnited\nStates\nSweets,\tchocolate,\tfruit\tand\tfruit\tjuice,\tcitrus,\tpickles,\tice\ncream,\tice\tmilk,\tpizza,\tbeef,\tchips,\tspicy\tfoods,\traw\nvegetables,\tmilk\tand\tother\tdairy,\tfish,\tethnic\tfoods,\nmeat,\tgrains,\tnuts\tand\tnut\tbutters,\tsalty\tfoods,\tcookies,\nItalian\tsauce,\tbreads/cereals
|
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Italian\tsauce,\tbreads/cereals\nMeat,\tbeef,\tfish,\teggs,\tvegetables,\nethnic\tfoods,\tgreasy\tfoods,\ncoffee,\ttea,\tlegumes,\talcohol,\ngrains,\tsweets,\tfruits,\n\tcigarettes,\nItalian\tsauce,\tspicy\tfoods\nAdapted\tfrom.\tPatil\tCL,\tAbrams\tET,\tSteinmetz\tAR,\tet\tal:\tAppetite\tsensations\tand\tnausea\tand\tvomiting\tin\tpregnancy:\tan\toverview\tof\tthe\nexplanations,
|
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] |
explanations,\t\nEcol\tFood\tNutr\n\t51:394,\t2012.\nPica.\nConsumption\tof\tnonfood\tsubstances\tor\tfood\titems\tin\tnonphysiologic\tamounts\t(\npica\n)\tduring\npregnancy\tmost\toften\tinvolves\t\ngeophagia\n\t(consumption\tof\tdirt\tor\tclay),\t\namylophagia\n\t(laundry\nstarch,\tcorn\tstarch,\tor\tuncooked\trice),\tor\t\npagophagia\n\t(ice).\tOther\tsubstances\tinclude\tpaper,\tburnt
|
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] |
pagophagia\n\t(ice).\tOther\tsubstances\tinclude\tpaper,\tburnt\nmatches,\tstones\tor\tgravel,\tcharcoal,\trock\tsalt,\tbleach,\tcigarette\tashes,\tbaby\tpowder,\tbaking\tsoda,\nsoap,\ttires,\tand\tcoffee\tgrounds.\tAlthough\tsome\tof\tthe\tcommon\tsubstances\tare\tof\tlittle\tconcern,\nothers\tare\tdangerous\tto\tthe\tmother.\tThe\tlocal\tpoison\tcontrol\tcenter\tcan\tgive\tguidance\ton\twhich
|
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] |
require\timmediate\tintervention.\nPica\tis\tcommon\tin\tpregnancy,\tand\tthe\tincidence\tof\tpica\tin\tthe\tUnited\tStates\tis\testimated\tto\tbe\t14%\nto\t44%,\twith\twide\tvariability\tbetween\tgroups\t(\nScolari\tChildress\tand\tMyles,\t2013\n).\tPica\tis\tnot\tlimited\nto\tany\tone\tgeographic\tarea,\trace,\tculture,\tor\tsocial\tstatus,\tbut\tthere\tare\tcultural\tcomponents\trelated
|
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] |
to\tthe\tsubstances\tchosen\tand\tthe\tacceptability\tof\tdisclosure.\n\tPreferred\tsubstances\toften\tare\nimported\tfrom\thome\tcountries,\tincluding\tsoil\tor\tclay\tand\tblocks\tof\tmagnesium\tcarbonate.\nThe\tcause\tof\tpica\tis\tpoorly\tunderstood.\tOne\ttheory\tsuggests\tthat\tpica\trelieves\tnausea\tand
|
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] |
vomiting,\talthough\tpica\toften\tappears\tlater\tin\tpregnancy\twhen\tnausea\tand\tvomiting\tare\tnot\tso\nprevalent.\tOne\thypothesis\tis\tthat\tit\tis\tdue\tto\ta\tdeficiency\tof\tan\tessential\tnutrient,\tmost\toften\n\tiron,\nbut\tzinc,\tcalcium,\tand\tpotassium\talso\thave\tbeen\tmentioned\t(\nCardwell,\t2013\n).\tAlthough\tit\tis
|
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] |
Cardwell,\t2013\n).\tAlthough\tit\tis\nhypothesized\tthat\tthe\tcraving\tcauses\tone\tto\teat\tthe\tnonfood\tsubstance\tthat\tcontains\tthe\tmissing\nnutrients,\tthat\tis\tseldom\tthe\tcase.\tPica\talso\tcan\tbe\ta\tcraving\tfor\tsmell\tor\ttexture\tas\twell\tas\ttaste.\tIDA\nhas\tbeen\tassociated\twith\tthe\tolfactory\tcraving\tin\tpica\t(\nHansen\tet\tal,\t2017\n)\tand\tchewing\tice\thas\tbeen
|
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] |
Hansen\tet\tal,\t2017\n)\tand\tchewing\tice\thas\tbeen\nshown\tto\timprove\talertness\tand\tresponse\ttimes\ton\ta\tneuropsychological\ttest\tfor\tpeople\twho\tare\nanemic\tbut\tnot\tfor\tothers\t(\nHunt\tet\tal,\t2014\n).\tTaste\tperceptions\toften\tchange,\tbut\twhether\tthat\tis\nassociated\twith\tlower\tzinc\tlevels\tis\tnot\tknown.
|
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] |
associated\twith\tlower\tzinc\tlevels\tis\tnot\tknown.\nMalnutrition\tcan\tbe\ta\tconsequence\tof\tpica\twhen\tnonfood\tsubstances\tdisplace\tessential\tnutrients\tin\nthe\tdiet.\tStarch\tin\texcessive\tamounts\tcontributes\tto\tobesity\n\tand\tcan\tnegatively\taffect\tglucose\ncontrol.\tLarge\tintakes\tof\tbaking\tsoda\tcan\traise\tblood\tpressure\tand\textreme\tdoses\t(1\tbox/day)\thave
|
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] |
caused\trhabdomyolysis\tand\tcardiomyopathy\t(\nScolari\tChildress\tand\tMyles,\t2013\n).\tExcessive\tintakes\nof\tbaking\tpowder\tcan\tmimic\tpreeclampsia.\tSubstances\tmay\tcontain\ttoxic\tcompounds\tor\theavy\nmetals,\tparasites,\tor\tother\tpathogens.\tThe\tabsorption\tof\tiron\tor\tother\tminerals\n\tmay\tbe\tdisrupted.
|
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0.03734331205487251,
0.06881537288427353,
0.09465865790843964,
0.031047960743308067
] |
may\tbe\tdisrupted.\nExcessive\tgeophagia\tcan\tresult\tin\tintestinal\tobstruction\tor\tperforation\t(\nYoung,\t2011\n).\nRecommending\tstopping\ta\tpica\toften\tfails,\teither\tbecause\tof\tthe\tstrong\tphysiologic\tdrive\tor\tthe\ncultural\tperception\tthat\tnot\tcomplying\twith\tthe\tcraving\twill\tcause\tharm\tto\tthe\tfetus.\tRather\tthan
|
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] |
insisting\ton\tcessation,\tresulting\tonly\tin\tless\twillingness\tto\tadmit\tthe\tpica,\ta\tmore\tproductive\napproach\tis\tto\toffer\ta\tbetter\talternative.\tFor\texample,\tallowing\tthe\tmother\tto\tcontinue\tto\tsmell\tthe\nwet\tdirt,\tbut\ttrading\tits\tconsumption\tfor\ta\tburned\ttortilla,\ttoast,\tor\tjicama\toften\tis\tsuccessful.\tPica
|
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] |
often\tis\tassociated\twith\tIDA,\tbut\twhether\tthe\tpica\tis\ta\tresult,\ta\tcause,\tor\ta\tmarker\tof\tother\nconcurrent\tdeficiencies\tis\tunknown.\tHowever,\ttreatment\twith\tvery\thigh\tiron\tfoods\toften\tdecreases\nthe\n\tcravings\tand\tinfusions\tof\tiron\thave\tresulted\tin\ta\tcessation\tof\tthe\tpagophagia,\tas\twell\tas\trestless\nlegs\t(\nAuerbach\tand\tAdamson,\t2016\n).\nDiabetes\tmellitus
|
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] |
legs\t(\nAuerbach\tand\tAdamson,\t2016\n).\nDiabetes\tmellitus\nGestational\tdiabetes\tmellitus\t(GDM)\n,\tcarbohydrate\tintolerance\twith\tonset\tor\trecognition\tduring\npregnancy,\tencompasses\ttwo\tdistinct\tgroups—those\twho\thave\tunrecognized\tpreexisting\tdiabetes\nand\tthose\tfor\twhom\tthe\tpregnancy\tprecipitates\tthe\tcarbohydrate\n\tintolerance.
|
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] |
intolerance.\nWomen\twith\trisk\tfactors\tfor\ttype\t2\tdiabetes\t(including\tbut\tnot\tlimited\tto\ta\thistory\tof\tGDM,\tknown\nimpaired\tglucose\tmetabolism,\tand\tBMI\t≥30)\tshould\tbe\tscreened\tearly\tin\tpregnancy\tusing\tstandard\ndiagnostic\tcriteria\t(\nACOG,\t2018c\n;\t\nAmerican\tDiabetes\tAssociation\t[ADA],\t2019\n;\tsee\t\nChapter\t29\n).
|
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] |
;\t\nAmerican\tDiabetes\tAssociation\t[ADA],\t2019\n;\tsee\t\nChapter\t29\n).\nAccording\tto\tthe\tADA,\tthose\twomen\tidentified\twith\tdiabetes\tin\tthe\tfirst\ttrimester\tshould\tbe\tgiven\n\ta\ndiagnosis\tof\tovert\tdiabetes\trather\tthan\tGDM.\tUniversal\tscreening\twith\ta\themoglobin\tA1C\tat\tthe\tfirst\nprenatal\tvisit\tis\tcommon\tand\twill\toften\tidentify\tthese\tpeople.
|
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prenatal\tvisit\tis\tcommon\tand\twill\toften\tidentify\tthese\tpeople.\nWomen\tidentified\tby\tearly\tscreening,\tas\twell\tas\tthose\twith\tknown\tpreexisting\tdiabetes\t(either\ttype\n1\tor\t2),\tshould\tbe\treferred\tto\ta\tCertified\tDiabetes\tEducator\t(CDE)\tand/or\ta\tdiabetes\tmanagement\nteam.\tFetuses\tof\tmothers\twith\tpoorly
|
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team.\tFetuses\tof\tmothers\twith\tpoorly\n\tcontrolled\tdiabetes\tat\tconception\tare\tat\trisk\tfor\tmultiple\ncongenital\tanomalies.\tSee\t\nChapter\t29\n\tfor\tmanagement\tguidelines.\nAs\tpregnancy\tprogresses\tand\tinsulin\tresistance\tincreases,\tGDM\tresulting\tfrom\tthe\tpregnancy\tmay
|
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] |
appear.\tGDM\trates\tin\tthe\tUnited\tStates\tare\t5%\tto\t6%\tof\tthe\tprenatal\tpopulation\t(National\tInstitutes\nof\tHealth\t[NIH],\t2013),\tbut\tthe\tprevalence\tcan\tbe\tmuch\tgreater\tin\thigh-risk\tgroups,\n\tincluding\nwomen\twith\ta\thigh\tBMI,\tadvanced\tmaternal\tage,\tand\tpersonal\tand\tfamily\thistory\t(first-degree
|
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] |
relative\twith\tdiabetes).\tRates\tare\thigher\tamong\tAfrican\tAmerican,\tAsian,\tHispanic,\tNative\tAmerican,\nand\tPacific\tIslander\twomen\tcompared\twith\tnon-Hispanic\twhite\twomen\t(\nACOG,\t2018c\n).\nA\tdiagnosis\tof\tGDM\tis\tassociated\twith\tincreased\trisk\tof\tgestational\thypertension\tand\tof\npreeclampsia,\tas\twell\tas
|
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] |
preeclampsia,\tas\twell\tas\n\tincreased\trisk\tof\ttype\t2\tdiabetes\tand\tCVD\tlater\tin\tlife.\tFetal\timplications\ninclude\thyperinsulinemia,\t\nmacrosomia\n\t(often\tdefined\tas\ta\tbaby\tweighing\tmore\tthan\t4000\tg),\tand,\ntherefore,\tincreased\trisk\tof\tdelivery\tcomplications,\tincluding\tshoulder\tdystocia\tand\tcesarean
|
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] |
delivery.\tThe\tneonate\tis\tmore\tlikely\tto\trequire\tadmission\tto\tNICU\tand\tto\texperience\trespiratory\ndistress\tsyndrome\tand\tmetabolic\tcomplications,\n\tincluding\thyperbilirubinemia\tand\thypoglycemia.\nInfant\tiron\tlevels\tmay\tbe\tlower\tbecause\tof\tovergrowth\tand\ttherefore\tincreased\tdemand\t(\nMonk\tet\tal,\n2013
|
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Monk\tet\tal,\n2013\n).\tOther\tnutrients\talso\tmay\tbe\tlow.\tFetal\tprogramming,\twith\tincreased\tlong-term\trisk\tof\tobesity\nand\ttype\t2\tdiabetes,\tis\talso\tof\tconcern.\nAlthough\tsome\tpractitioners\tbelieve\tthat\tGDM\tmay\trepresent\tthe\tearly\tstages\tof\ttype\t2\tdiabetes,\nothers\tfeel\tthat\n\twomen\tshould\tnot\tbe\tlabeled\tat\tall\twith\ta\tGDM\tdiagnosis.\tHowever,\ttreatment\tfor
|
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] |
GDM\tis\tmerited\tbecause\tit\tlowers\tthe\trisk\tby\t40%\tfor\tgestational\thypertensive\tdisorders,\treduces\nthe\trisk\tof\tmacrosomia,\tand\ttherefore\treduces\tthe\trisk\tof\tshoulder\tdystocia\tfrom\t3.5%\tto\t1.5%\t(\nNIH,\n2013\n).\nThe\tdiagnostic\tcriteria\tfor\tGDM\tare\tcontroversial.\tHistorically,\tthe\tUnited\tStates\tand\tother\ncountries\thave\tused
|
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] |
countries\thave\tused\n\ta\ttwo-step\tprocess,\twhereas\tthe\tWHO\thas\tadvocated\ta\tone-step\tapproach.\t\nTable\n14.14\n\tsummarizes\tselected\tcurrent\tguidelines\tbut\tother\tcutoffs\tand\ttesting\tprotocols\talso\texist\n(\nAgarwal,\t2015\n).\tRecently\tthe\tInternational\tAssociation\tof\tthe\tDiabetes\tand\tPregnancy\tStudy\tGroups
|
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] |
(IADPSG)\tadvocated\tfor\ta\tuniversal\tone-step\tapproach\tdeveloped\tfrom\tthe\tHyperglycemia\tand\nAdverse\tPregnancy\tOutcomes\t(HAPO)\n\ttrials.\tAll\tprevious\tprotocols\twere\tdesigned\tto\tidentify\twomen\nat\trisk\tof\tdeveloping\ttype\t2\tdiabetes\tlater\tin\tlife\twhile\tthe\tHAPO\tstudy\twas\tthe\tfirst\tto\tcorrelate
|
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0.0007239580154418945,
0.05663435161113739,
-0.014376821927726269,
-0.04570474848151207,
-0.03988895192742348,
0.08622509986162186,
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-0.03395189717411995,
-0.015809984877705574,
0.03904193639755249,
0.05531896650791168,
0.015359359793365002,
0.004273541737347841,
0.01335317362099886,
0.11985725164413452,
0.06869226694107056,
0.10280914604663849,
-0.018853073939681053
] |
glucose\tvalues\twith\tpregnancy\toutcomes.\tBecause\tonly\tone\televated\tvalue\tis\tdiagnostic,\tusing\tthe\nmore\tliberal\tIADPSG\tcriteria\tresults\tin\ta\ttwofold\tto\tthreefold\tincrease\tin\tthe\tnumber\tof\tpeople\ndefined\tas\thaving\tGDM,\tarriving\tat\ta\tnational\n\tprevalence\tof\t15%\tto\t20%\t(\nNIH,\t2013\n).
|
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0.08221246302127838,
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] |
TABLE\t14.14\nScreening\tand\tDiagnosis\tof\tGestational\tDiabetes\tMellitus\t(GDM)\tat\t24\tto\t28\tWeeks\tof\tGestation:\tBlood\nGlucose\tThresholds\tand\tTesting\tProtocols\nApproach\nFasting\nmg/dL\n1-hour\nmg/dL\n2-hour\nmg/dL\n3-hour\nmg/dL\nSource\nTWO\tSTEP:\n\tuniversal\tscreening;\nonly\tthose\t≥\tcutoff\tneed\ndiagnostic\ttest\nScreening:\n\t(nonfasting)\n50\tg\tglucose\tload,\tvalue\t≥
|
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] |
diagnostic\ttest\nScreening:\n\t(nonfasting)\n50\tg\tglucose\tload,\tvalue\t≥\n130,\t135,\nor\t140\nDiagnosis:\n\t(fasting)\n100\tg\tload,\t2\tvalues\t≥\n95\n180\n155\n140\nCarpenter\tand\nCoustan\n100\tg\tload,\t2\tvalues\t≥\n105\n190\n165\n145\nNational\tDiabetes\nData\tGroup\nONE\tSTEP:\n\tuniversal\ttesting\nDiagnosis:\n\t(fasting)\n92-125\n*\n180\n153-199\n*\nWorld\tHealth\nOrganization\n(WHO)\n**
|
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] |
(fasting)\n92-125\n*\n180\n153-199\n*\nWorld\tHealth\nOrganization\n(WHO)\n**\n75\tg\tload,\t1\tvalue\t≥\n75\tg\tload,\t1\tvalue\t≥\n92\n180\n153\nInternational\nAssociation\tof\tthe\nDiabetes\tand\nPregnancy\tStudy\nGroups\n*\nValues\tabove\tthese\tcutpoints\tare\tconsidered\tdiagnostic\tof\tdiabetes\tmellitus\tin\tpregnancy\trather\tthan\tGDM,\tas\tis\ta\trandom\tplasma\tvalue\tof\t≥\t200\nmg/dL\twith
|
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] |
mg/dL\twith\n\tdiabetes\tsymptoms.\n**\nConsidered\tdiagnostic\tof\tGDM\twhen\tfound\tany\ttime\tduring\tthe\tpregnancy.\nAdapted\tfrom\tNational\tInstitutes\tof\tHealth\tconsensus\tdevelopment\tconference\tstatement:\tdiagnosing\tgestational\tdiabetes\tmellitus,\tMarch\t4-6,\n2013,\t\nObstet\tGynecol
|
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] |
2013,\t\nObstet\tGynecol\n\t122:358,\t2013;\tWorld\tHealth\tOrganization:\tWHO\trecommendation\ton\tthe\tdiagnosis\tof\tgestational\tdiabetes\tin\tpregnancy,\nMarch\t8,\t2018\t(website):\t\nhttps://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/antenatal-care/who-\nrecommendation-diagnosis-gestational-diabetes-pregnancy-0\n.
|
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recommendation-diagnosis-gestational-diabetes-pregnancy-0\n.\nBecause\tof\tthe\tincreased\tcost\tto\tthe\tmedical\tsystem\tand\tthe\tpatient,\tincreased\tpatient\tstress\twith\nlikely\tincreased\tinterventions,\tcombined\twith\tconcern\tthat\ttreatment\tmay\tnot\tbe\tas\tbeneficial\tfor\nthose\tat\tthe\tlower\tglucose\tlevels,\ta\tNIH\tconsensus\tcommittee\tconcluded\tthere\tis\tcurrently
|
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] |
insufficient\tevidence\tto\trecommend\tchanging\tto\tthe\tIADPSG\tapproach\t(\nNIH,\t2013\n).\tThose\tconcerns\nhave\tnow\tbeen\n\tstudied\tand\tsome\tpractices\thave\treturned\tto\tusing\tthe\ttwo-step\tapproach\tafter\nfinding\tno\timprovement\tin\tmaternal\tor\tneonatal\toutcomes\tin\tspite\tof\tincreased\tdiagnoses\tand\ninterventions\t(\nPocobelli\tet\tal,\t2018\n).
|
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interventions\t(\nPocobelli\tet\tal,\t2018\n).\nThe\tADA\tand\tACOG\trecommend\tscreening\tall\tpregnant\twomen\tfor\tGDM\t(unless\talready\tidentified\nwith\tdiabetes)\tat\t24\tto\t28\tweeks\tof\tgestation\t(\nACOG,\t2018c\n;\t\nADA,\t2019\n).\tOnly\tthose\twith\tan\nabnormal\n\tresult\ton\tthe\t1-hour\tscreen\treceive\tthe\t3-hour\tdiagnostic\ttest.\tACOG\trecommends\tthat\tthe
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choice\tof\ta\tscreening\tcutpoint\tand\tthe\tchoice\tof\tdiagnostic\ttests\t(using\tthe\tCarpenter\tand\tCoustan\ncriteria\tif\ttesting\tserum\tor\tplasma,\tor\tthe\tNational\tDiabetes\tData\tGroup\tcriteria\tif\ttesting\tplasma),\nbe\tguided\tby\tlocal\tcommunity\tGDM\tprevalence\trates\t(\nACOG,\t2018c\n).\tAlthough\tcurrent\tpractice\nrequires\ttwo\tabnormal
|
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] |
ACOG,\t2018c\n).\tAlthough\tcurrent\tpractice\nrequires\ttwo\tabnormal\n\tvalues\tfor\ta\tdiagnosis\tof\tGDM,\tfurther\tstudy\tis\trecommended\tto\tsee\tif\tthose\nwith\tonly\tone\televated\tvalue\talso\tbenefit\tfrom\ttreatment.\nAs\twith\tpreexisting\tdiabetes,\tthose\twomen\twith\tGDM\tshould\tbe\tfollowed\tcarefully\tduring
|
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] |
pregnancy\tand\tmanaged\tby\ta\tdiabetes\tteam\tthat\tincludes\ta\tCDE.\tSee\t\nChapter\t29\n\tfor\tdiet\tand\nexercise\trecommendations,\tincluding\ttarget\tglucose\tvalues.\tMedications\tmay\tbe\tnecessary\n\tto\nmanage\tblood\tsugars.\tInsulin\tand\tsome\toral\thypoglycemic\tagents\t(e.g.,\tmetformin\tand\tglyburide)
|
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can\tbe\tused.\tLong-term\tuse\tof\tmetformin\tis\tassociated\twith\tdecreased\tvitamin\tB\n12\n\tlevels,\tbut\tits\tuse\nonly\tin\tlate\tpregnancy\thas\tnot\tbeen\tshown\tto\tbe\tproblematic\tfor\tmaintenance\tof\tnormal\tB\n12\n\tlevels\n(\nGatford\tet\tal,\t2013\n).\tThere\tis\tintriguing\tpreliminary\tevidence\tthat\tmyoinositol\tmay\tbe\thelpful\tin\npreventing
|
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preventing\n\tor\ttreating\tGDM\tand\tits\tuse\tappears\tto\tbe\tsafe\t(\nWerner\tand\tFroehlich,\t2016\n).\tHowever,\nits\tuse\tin\ttreating\tGDM\tis\tnot\tendorsed\tby\tthe\tCochrane\tReview\tbecause\tof\tthe\tlimited\tdata\navailable\t(\nBrown\tet\tal,\t2016\n).\tInositol\tdoes\tnot\tappear\tto\tlower\tthe\trisk\tof\tan\tLGA\tbaby\tand\tother
|
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] |
clinically\tmeaningful\toutcomes\thave\tnot\tbeen\treported.\tOptimal\tdose,\tfrequency,\tand\ttiming\tof\nsupplementation\tare\tall\tcurrently\n\tunknown,\tas\tare\tthe\tlong-term\teffects.\tIts\tpreconceptual\tuse,\nalong\twith\tother\tmicronutrients\tand\tprobiotics,\tto\thelp\timprove\tinsulin\tsensitivity\tis\tcurrently\tbeing\nstudied\t(\nGodfrey\tet\tal,\t2017a\n).
|
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] |
studied\t(\nGodfrey\tet\tal,\t2017a\n).\nWomen\twith\tGDM\tshould\tbe\tscreened\tfor\tpersistent\tdiabetes\tat\t4\tto\t12\tweeks\tpostpartum,\tusually\nwith\tfasting\tand\t2-hour\t(after\ta\t75g\tglucose\tload)\tblood\tsugars,\tand\tat\tleast\tevery\t3\tyears\tfor\ndiabetes\n\tor\tprediabetes,\tusing\tnonpregnancy\tdiagnostic\tcriteria\t(\nADA,\t2019\n;\tsee\t\nChapter\t29\n).\nEating\tdisorders
|
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] |
ADA,\t2019\n;\tsee\t\nChapter\t29\n).\nEating\tdisorders\nThe\trates\tof\teating\tdisorders\tduring\tpregnancy\tare\t1%\tfor\tanorexia\tnervosa\tand\tslightly\tmore\tfor\nbulimia,\twith\tthe\tprevalence\tlikely\tunderestimated\t(\nCardwell,\t2013\n)\tbecause\tof\tvoluntary\nnondisclosure\tor\tbecause\tthe\tmedical\tpractitioner\tis\tnot\tassessing\tthe\trisk\t(\nLeddy\tet\tal,\t2009\n).\nAnorexia
|
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] |
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