Metabolic Adaptations of Pregnancy

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From the course by Ludwig-Maximilians-Universität München (LMU)

Nutrition and Lifestyle in Pregnancy

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Ludwig-Maximilians-Universität München (LMU)

Nutrition and Lifestyle in Pregnancy

544 ratings

Nutrition and Lifestyle in Pregnancy offers an overview of the latest research findings and international recommendations on a variety of nutrition-related aspects and outcomes of pregnancy. Ensuring a healthy nutritional status and lifestyle prior to and during pregnancy is one of the best ways to help support the healthy growth and development of the unborn child. We will look at how a healthy diet and lifestyle should ideally be achieved prior to conception and provide recommendations for pre-conception counselling of women. We will also look at the nutritient recommendations for a healthy pregnancy to ensure optimal maternal and fetal outcomes as well as focus on the most common nutrition-related pregnancy complications; obesity and gestational diabetes. The learner will have the opportunity to delve into the cutting-edge world of epigenetic and metabolomic research and appreciate the enormous role that these programming effects have in long-term health and disease outcomes. Finally, we offer real life, everyday situations and questions from pregnant women to aid healthcare professionals in the nutrition-based counselling of pregnant women and their families. In addition to the English original, subtitles in Portugese language are available now!

From the lesson

Unit 2 - Nutrition and Lifestyle for a Healthy Pregnancy

The learner will gain an insight into the current nutrition-related recommendations for healthy pregnancies. We will look at the maternal physiological and metabolic adaptions that occur during pregnancy and what these play in supporting pregnancy and altering nutrient requirements. We will then focus on the changing macro- and micro-nutrient requirements during pregnancy and what outcomes these can have on both the mother and unborn child. Finally, we will focus on food-bourne illnesses and what foods and beverages or lifestyle activities to avoid during pregnancy.

Metabolic Adaptations of Pregnancy7:00

Meet the Instructors

Berthold Koletzko
Professor of Pediatrics
LMU Medical Center Dr. von Hauner Children's Hospital

This video follows on

from the previously covered content on physiological adaptations of pregnancy.

It focuses on the metabolic changes that occur.

If you understand these adaptations,

we are better able to understand

the changing nutritional requirements that are

necessary for optimal maternal and fetal health.

Metabolic adaptations involve coordinated changes

of carbohydrate and lipid metabolism that preserve

maternal homeostasis and allow timely transfer of nutrients

to the fetus in order to optimally support growth and development.

In the first half of pregnancy,

the physiological adaptations of maternal metabolism prepare the body for

the high demands of

rapid fetal growth which occurred then in the second half of pregnancy.

Therefore, we will begin by looking at changes

in carbohydrate and lipid metabolism that take place in early pregnancy

and then discuss how these metabolic pathways differ from changes

occurring in later pregnancy.

In early pregnancy, insulin-secreting pancreatic beta cells become hyperplastic,

resulting in increased insulin secretion.

Insulin sensitivity is enhanced and

the nutrient-stimulated insulin response to our glucose increases.

At the same time, glucose tolerance is either normal or slightly improved with

peripheral sensitivity to insulin or hepatic basal glucose production remaining the same.

Fasting plasma glucose level are slightly reduced with

only small changes in insulin levels during the first trimester of pregnancy.

Hence, the risk of hypoglycemia has increased in

some women during this early stage of pregnancy.

Changes in lipid metabolism are analogous to the alterations and carbohydrate metabolism.

During the first and second trimester, increased estrogen, progesterone,

and insulin concentrations favor lipid deposition and they inhibit lipolysis,

which results in an accumulation of maternal fat stores.

This accumulation peaks between 10 and 13 weeks of gestation before

the fetal demands for energy to support

extensive growth and last trimester increased significantly.

The maternal energy requirements are thus mainly

met by increased efficiency of glucose metabolism.

Being in an anabolic state, excess glucose,

as well as dietary triglycerides are stored as adipose tissue.

This maternal metabolic pattern changes during the second half of pregnancy.

Since glucose is the preferred fuel to the fetus,

a modest insulin resistance date develops.

This leads to a mild elevation of

maternal plasma glucose concentrations to facilitate diffusion across the placenta.

Despite increasing basal and postprandial plasma insulin levels,

the postprandial glucose concentrations are

significantly elevated and the glucose peak is prolonged.

The maternal insulin resistance begins to develop in the second trimester,

and it peaks in the third trimester.

It is generated by the release of

placental diabetogenic hormones such as human placental lactogen,

growth hormone, corticotropin-releasing hormone,

human chorionic somatomammotropin, and progesterone.

In late pregnancy, maternal metabolism shifts

from an anabolic to a catabolic state and it promotes

the use of lipids as a maternal energy source

while preserving glucose and amino acids for the fetus.

This shift allows pregnant women to minimize

protein catabolism and to preserve glucose as the main fuel for the fetus.

Decreasing lipid uptake into adipose tissue

to physiologically relative insulin resistance reduce

lipoprotein lipase and increased

lipolysis and mobilization of lipid stores results

in a constant increase in triacylglycerols,

non-esterified fatty acids, cholesterol,

phospholipase, and lipoprotein concentrations in blood plasma until delivery.

Adapting carbohydrate and lipid metabolism,

which is the different stages of pregnancy,

ensures that the increased energy and nutrient requirements of the mother all match

while providing the required nutrients for

the fetus to ensure optimal growth and development.

The previously explained adaptations involve

fat deposition in the mother usually around the breast and the buttock.

These storages are beneficial to support

maternal homeostasis and fetal growth during the third trimester,

and they are also valuable as an energy resource during the ensuing period of lactation.

However, excess depositions of fat may have

adverse consequences for maternal and fetal health which go

beyond the pregnancy period as explained by

Professor Lucilla Poston who is an expert in the field of maternal obesity.

Obesity is a problem for women even before they become pregnant.

It's a problem in pregnancy and actually it's a problem after pregnancy,

because if they're thinking of becoming pregnant again and they put on weight,

then that's a problem too.

So, if I were to say which is the best time to intervene,

and I don't think there is when,

what we really need to do is think about intervening

before people become pregnant if they are obese to try and make it thinner,

during pregnancy to try and improve the outcome,

and then after pregnancy to try and limit weight gain and weight retention.

If we get the overarching theme of intervention, we're likely to win.

Now that you have an idea on

the physiological and metabolic changes that occur during pregnancy,

let's look on how that translates into altered nutritional requirements.

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