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Nutrition through life > 5.1 Reqs during pregnancy > Flashcards

5.1 Reqs during pregnancy Flashcards

Energy, macros, fiber, water, micronutrients

1
Q
  • difference btw BMR, RMR and BEE?
  • PAL = ?
  • TEE = ?
  • recommended PAL? –> recommended PA?
A
  • BMR (in kcal/h) vs BEE (BMR x 24 –> for daily number)
  • RMR: same concept as BMR but less rigorous in terms of measurement, around 10% higher than BMR
  • PAL = TEE/BEE
  • TEE = BEE x PAL
  • PAL: 1.6-1.7 –> active: 60min/day moderate intensity (walking 4mph)
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2
Q
  • what is the major component of increase energy reqs during pregnancy?
  • due to (2)
  • what other component of TEE is affected?
A
  • increase in basal energy expenditure (BEE)
  • due to
    1. metabolic contribution of uterus (placenta) and fetus
    2. increase work of heart and lungs
  • steady decrease in PEL as pregnancy advances (as mother’s weight increases)
    *PAL = TEE/BEE –> if BEE increase, PAL decreases
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3
Q

what is the strongest predictor of BEE for estimated energy reqs during pregnancy?
- that predictor is comprised of 3 things –> low/mod/high energy requiring?

A
  • fat free mass! (bc fat mass is not metabolically active) –> includes kidney, heart, lungs…
    1. increase blood volume –> low energy requiring
    2. skeletal muscle mass –> moderate energy requiring
    3. fetal and uterine tissues –> high energy requiring
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4
Q

late pregnancy:
- how much of mother’s energy expenditure can be attributed to fetus?
- fetus uses ___ kcal/kg body weight/day

A
  • about half!
  • 56 kcal/kg bw/day –> ie for a 3 kg fetus, 168kcal extra to TEE of mother
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5
Q

theoretical energy cost of tissue deposition during pregnancy:
- there is _____ and ______ gain from 7 structures ish in body

A

protein and fat gain!
1. fetus
2. placenta
3. amniotic fluid
4. uterus
5. breasts
6. blood
7. maternal stores! –> key aspect for total caloric expenditure –> need enough stores to support 2nd half of pregnancy

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6
Q
  • how to calculate EER for pregnant woman in 1st trimester?
  • vs 2nd and 3rd trimester?
A
  • 1st trimester: use equation for non-pregnancy active women aged 19+ years
  • 2nd and 3rd trimester –> use specific EER equations with correct PAL category (inactive, low active, active, very active) –> equation includes added increment for tissue/energy deposition!
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7
Q

what are the energy costs for tissue deposition? (ie how much to add onto the EER calculation) separated into what categories?

A

depending on BMI!
- underweight –> 300 kcal/day
- normal weight –> 200 kcal/day
- overweight –> 150 kcal/day
- obese –> -50 kcal>day –> to minimize risk of preeclampsia, edema, hypertension, macrosomia

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8
Q

do pregnancy women need more protein? why?

A

yes!
1. support growth of maternal and fetal tissues
2. maintenance of additional protein stores

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9
Q

protein reqs in pregnancy vary with each trimester due to differences in protein needs for (2)

A
  1. growth (different growth rate of fetus) (need protein deposition)
  2. maintenance of additional total protein accretion that has accumulated at end of each trimester (ie extra protein to maintain increased body weight) (last trimester = biggest kcal increase)
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10
Q

assuming 16kg gained over 40 weeks gestation –> what is the avg total additional protein req for pregnancy women (EAR)?
- vs RDA?

A

EAR = 21g protein/day extra
RDA = around 26g/day extra
*accounts for around 1.5 g/kg/day protein for 3rd trimester pregnancy women

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11
Q
  • protein and/or energy poor diet prior to or during pregnancy associated with increase risk of what? VS what would decrease risk of this?
  • what can lead to higher birth weight and greater birth length?
A
  • increase risk of LBW
  • mothers that consume more daily servings of fairy products, meat and fish = decrease risk of LBW infants
  • provision of protein and energy supplements for 5-7 months prepregnancy (instead of <2 months before conception) = higher birth weight and greater birth length
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12
Q
  • linoleic and a-linolenic acid compete for same what? therefore what is important in diet?
  • AI for n-6 PUFA and n-3 PUFA –> higher for men or women? + which population has a lower AI?
A
  • compete for same desaturase enzymes (add double bonds) –> therefore, ratio of linoleic:a-linolenic acid in diet is important! could skew states of these FA
  • higher in men then women
  • lower in >50 yo bc less E intake
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13
Q

AI for N-6 and N-3 FA during pregnancy?

A

N-6 FA: 13g/day linoleic acid
N-3 FA: 1.4g/day a-linolenic acid

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14
Q

what are the principal essential FA in blood of infants?
- 20:4 n-6
- 22:6 n-3
- 20:3 n-9
- low intake of which of these EFA will lead to what?

A
  • 20:4 n-6: arachidonic acid
  • 22:6 n-3: docosahexaenoic acid
  • 20:3 n-9: eicosatrienoic acid
  • lower intake of AA and DHA leads to low birth weight! (table) VS eicosatrienoic acid competes for desaturase enzyme –> lower intake will lead to higher birth weight
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15
Q

Arachidonic acid vs DHA
- vegetarians vs omnivore, who has more of which?

A

VEGETARIAN:
- richer in arachidonic acid
- lower in DHA
OMNIVORE:
- richer in DHA
- lower in arachidonic acid

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16
Q

carbs recap:
- minimal amount of CHO required determined by what? how much? –> without using glu from (2) + without rise in _________
- EAR?
- RDA?
- difference btw men and women?

A
  • determined by brain’s requirement for glucose: 110-140 g/day
  • without using glucose from protein or TG
  • without rise in ketones
  • EAR = 100g CHO
  • RDA = 130g CHO/d
  • no difference btw men and women
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17
Q

pregnancy = increase ________ rate
- 4 things that explain why there’s more fuel requirement?

A
  • increase metabolic rate
    1. establishment of placental fetal unit
    2. increase energy supply for growth and development of fetus
    3. increase maternal storage of fat EARLY in pregnancy (anabolic phase)
    4. energy to sustain growth of fetus during the last trimester
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18
Q

carb reqs during pregnancy
- 3 adaptations to pregnancy? regarding glucose metabolism

A
  1. decrease fasting maternal blood [glucose]
  2. development of insulin resistance –> hyperglycemic rise –> more glucose goes to fetus
  3. tendency to developing ketosis
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19
Q

is it good or bad for mother to have high glucose and ketones in 1st part of pregnancy

A

bad! high glucose and ketones = teratogenic!

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20
Q

what measurement shows that carb requirements increase during pregnancy?
- increase glu utilization by what?
- glucose transfer from mother to fetus is around __-___g/day in later gestation

A
  • increase mean respiratory quotient (RQ) for BMR and total 24h energy expenditure
  • increase glu utilization by maternal-fetal unit
  • 17-26 g/day in late gestation
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21
Q
  • can fetal brain utilize ketoacids?
  • newborns: brain fuel reqs: how much is glu oxidation? vs non-glucose sources?
  • brain glucose utilization rate = ___g daily –> similar to what? consequence?
  • increase _____ common in pregnant women
A
  • yes! can clearly utilize ketoacids –> arise from natural insulin resistance at end of pregnancy
  • 70% glu oxidation + 30% non-glucose sources
  • brain glu utilization rate = 23g daily (32.5g * 0.7) –> same as avg maternal-fetal glucose transfer rate (range 17-26g –> mean = 22)
    CONSEQUENCE: fetal brain utilizes essentially all glucose derived from mother
  • increase ketoacids common in pregnant women!
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22
Q
  • how much glucose needed for fetal brain considering no use of ketoacids?
  • EAR for CHO for pregnancy women = ? + ?
  • should be consumed as starch or sugar?
  • RDA?
A
  • 33 g/day
  • EAR = EAR for nonpregnancy women (100g/d) + additional req during last trimester (35g/d) = 135g/d CHO
  • no evidence to indicate that a certain portion be consumed as starch or sugar
  • RDA = 175 g/d CHO (based on CV of 15%: 135 * 2SD = 135 * 1.3)
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23
Q

Fiber recap:
- total fiber = _______ fiber + ______ fiber
- for heart health, AI = ____g _______ fiber /1000 kcal, particularly from what?

A
  • total fiber = dietary fiber + functional fiber
  • 14g dietary fiber/1000 kcal
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24
Q

Fiber req for pregnant women?

A
  • no evidence that beneficial effect of fiber is different from nonpregnancy women
  • AI = 28g/day of total fiber
    (considering: 14g/1000kcal * 1978 kcal) considering that pregnancy women will have increase kcal needs
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25
Q

water
- size of water compared to other constituents of human body?
- is thirst well correlated with fluid needs?
- hydration status assessed by what?
- AI for water is to prevent what?
- why no EAR?

A
  • largest single constituent of human body
  • not well correlated with fluid needs
  • hydration status assessed by plasma/serum osmolality
  • prevent acute effects of dehydration
  • bc large variations in water needs (just like energy)
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26
Q

water AI for pregnancy
- median daily intake for drinking and beverage water during gestation = ____L
- intake of water from food = ____L
- total intake?
- AI for water for pregnancy women 14-50 yo: ____L/d total water

A
  • 2.3L
  • 0.6L
    TOTAL = 2.9L
  • AI = 3.0L/day total water
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27
Q

Thiamin:
- reqs increase/decrease in pregnancy? why/why not (2)
- RDA for pregnant?
(nonpregnancy RDA = 1.1 mg/d (19-50yo)

A
  • reqs increase by 30%!
    1. increase growth in maternal and fetal compartments (20%)
    2. small increase in energy utilization (10%)
  • RDA = 1.4 mg/d
28
Q

Riboflavin:
- reqs increase/decrease in pregnancy? why/why not (2)
- RDA for pregnant?
(nonpregnancy RDA = 1.1 mg/d (14-50yo)

A
  • increase by 0.3 mg/d
    1. increase growth in maternal and fetal compartments
    2. small increase in energy utilization
  • RDA = 1.4 mg/d
29
Q

Niacin:
- reqs increase/decrease in pregnancy? why/why not
- RDA for pregnant?
(nonpregnancy RDA = 14 mg/d (14-50yo)

A
  • no direct evidence to suggest a change in niacin requirement during pregnancy
  • EAR –> estimated increase by 3 mg/d of niacin equivalents (bc tryptophan can be used to make B3) –> from increase energy utilization and growth
  • RDA = 18 mg NE/day
30
Q

vitamin B6 and pregnancy
- can fetus take in vit B6?
- maintenance of plasma [bioactive form of B6?] at nonpregnant values requires how much more in 1st trimester vs 3rd trimester?

A
  • significant fetal uptake of vitamin B6
  • maintenance of plasma [pyridoxal phosphate] at nonpregnancy values requires:
  • 2mg/d supplemental B6 in 1st trimester
  • 4-10 mg/d in 3rd trimester
    *poorer vitamin status or normal physiological changes during pregnancy ?…..
31
Q
  • how much B6 does fetus and placenta accumulate in total? how much per day?
  • if 4-10 mg B6 is needed in 3rd trimester to maintain plasma [pyridoxal phosphate] nonpregnant values, why is the additional avg pregnancy need 0.25 mg? (3)
A
  • 25 mg of B6 –> 0.1 mg/day
    1. increase metabolic needs and weight of mother
    2. around 75% bioavailability of food B6
    3. accumulation of folate in fetus and placenta (???)
32
Q
  • increased need of B6 is concentrated in what part of gestation?
  • can B6 be stored in body to substantial extent? –> can this stored B6 be used to for increased needs of B6 later in gestation? consequence?
  • RDA for B6 in pregnancy?
    (RDA nonpregnant = 1.3 mg/day (19-50 yo)
A
  • in 2nd half of gestation
  • B6 is not stored in body to any substantial extent –> unlikely that surplus in early gestation would satisfy the increase need in later gestation –> extra 0.6 mg/day to meet need in 3rd trimester
  • RDA = 1.9 mg/d
33
Q
  • do folate reqs in pregnancy increase or decrease? (2 things + 4 subthings ish)
A

yes! increase substantially!
1. increase single-carbon transfer rxns (methylation)
2. nucleotide synthesis (Cell division) needed for
- uterine enlargement
- placental development
- expansion of maternal erythrocyte number
- fetal growth

34
Q
  • how is folate transferred to fetus?
  • inadequate folate intake leads to (3)
A
  • folate is actively transferred to fetus –> increase [folate] in cord blood vs maternal blood (?)
    1. maternal serum and erythrocyte [folate]s decrease
    2. megaloblastic marrow changes
    3. megaloblastic anemia may develop if inadequate intake continues
35
Q
  • what is the primary indicator of adequacy for folate?
  • how much supplementation with a low-folate diet is considered insufficient to prevent (2)
A
  • erythrocyte folate maintenance (reflects tissue stores)
  • 100 ug/d supplementation with a low folate diet is insufficient
    1. to prevent deficient blood concentrations in 33% of women
    2. to prevent megaloblastic anemia in 5% of women
36
Q
  • how is folate EAR for pregnant women derived? (2 components)
  • RDA for pregnant women?
    *RDA for nonpregnant (14-50 yo) = 400 ug/d DFEs
A

considering that low dietary folate + 100 ug supplemental folate (equivalent to 200 ug/day DFEs) = inadequate:
- EAR = 200 ug/d supplemental DFEs + EAR for non-pregnant women (320 ug/day) = 520 ug/day DFEs (for 15-50 yo)
- RDA = 600 ug/day DFE

37
Q

to decrease risk of NTD for women capable of becoming pregnant, how to reach the RDA for folate? (2 ways)

A

RDA = 600 ug/day
1. 400 ug/d folic acid from fortified foods, supplements or both
2. consuming food folate from a varied diet (accounts for around 200 ug/d)

38
Q
  • vit B12: absorption increase or decrease during pregnancy? why?
  • serum total [B12] increase or decrease in 1st trimester –> more/less could be accounted for by __________
  • month 6: increase or decrease to around ____% of nonpregnancy concentrations –> bc of what?
A
  • increases! bc increase number of intrinsic factor-B12 receptors!
  • serum total [B12] decreases! bc of uptake in tissues + hemodilution!
  • month 6: decrease to 50% of nonpregnancy levels –> some due to hemodilution
39
Q
  • what is the main source of B12 for fetus?
A
  • only newly absorbed B12 is readily transported across placenta!
  • maternal liver stores are a less important source of vitamin for fetus –> ie maternal liver stores are not available to supply fetal needs
40
Q
  • vit B12 during pregnancy: EAR increase or decrease or stays same? explain
  • what’s the RDA?
    *RDA for nonpregnany women (14-50) = 2.4 ug/d
A
  • Fetal deposition = 0.1-0.2 ug/d
  • maternal absorption becomes more efficient –> EAR increase by 0.2 ug/day
  • RDA pregnancy = 2.6 ug/d
41
Q
  • changes in reqs for biotin during pregnancy?
  • what are 2 things that change?
A
  • NO change! ish
  • AI pregnancy (14-50 yo) = 30 ug/d
  • AI nonpregnant (> 19 yo) = 30 ug/d
    *but 14-18 yo = 25 ug/day
    1. increase biotin metabolite (3-hydroxyisovaleric acid) in half of healthy pregnant women in 3rd trimester
    2. decrease urinary excretion of biotin in 50% of women –> normal changes or indicative of low biotin intake vs need?
    *conflicting studies –> not clear if needs increase bc no functional effects are changed
42
Q

choline is important during (2)
- choline delivered to fetus through placenta? consequence?
- AI pregnant?
(AI women > 19yo = 425 mg/day)

A
  • important during embryogenesis and perinatal development! (rats with extra dietary choline had more spatial memory!)
  • INCREASE choline delivered to fetus through placenta = depletes maternal stores of choline
  • AI = 450 mg/d
43
Q

phosphatidylcholine –> choline –> ____A____
- function of A?
- if choline and __A___ are inadequate –> what happens?

A
  • Betaine!
  • needed to convert homocysteine to methionine (along with 5-me-TH4-folate and B12)
  • if choline and betaine are inadequate –> neural tube defect!
44
Q

pantothenic acid:
- need to increase?
- AI pregnancy?
*AI women 14-50yo = 5 mg/day

A
  • no information showing that usual intakes are inadequate for pregnancy
  • rounding up from average intake: AI = 6 mg/d
45
Q

vitamin C and pregnancy:
- additional vit C needed? explain (2)
- how is new req established?
- RDA for pregnant?
*RDA > 19yo = 75 mg/d

A
  • yes! bc maternal plasma [vit C] decreases with pregnancy progression
    1. hemodilution (increase blood volume)
    2. active transfer to fetus
  • no precise data on maternal vit C transfer to fetus BUT 7 mg/d prevent young infants from developing scurvy –> rounded to 10 mg for safety
  • RDA = 85 mg/d
46
Q

which subpopulations (3) of pregnant women may have increased requirements of vit C?

A
  1. street drugs and cigarettes –> vit C used as antioxidant from ROS generated! (> 20 cigarettes/day = require 2x more vit C)
  2. heavy alcohol use
  3. regular aspirin use
    *2 and 3 –> cause poor absorption of vit C
47
Q
  • what is the efficiency of maternal vit A absorption?
  • vit A accumulates mostly fetus in last ____ days
  • vit A EAR during pregnancy based on (2)
  • new req?
    RDA non-pregnant = 700 RAE/day
A
  • 70%
  • last 90 days
    1. accumulation in fetal liver (mostly in 3rd trimester/last 90 days)
    2. assumption that liver contains about 50% body’s vit A when liver stores are low (newborns)
  • RDA = 750 RAE (for 14-18 yo) vs 770 (for 19-50 yo)
    *accounts for increase in requirement by 50 ug during last trimester
48
Q

vit D and pregnancy
- transferred to fetus?
- affects vit D status of pregnant women?
- which biomarker decreases without vit D supplementation?

A
  • small quantities of 25(OH)D transferred to fetus
  • do not affect overall vit D status of pregnancy women
  • serum 25(OH)D levels decrease as pregnancy progresses without vit D supplements
    *25(OH)D = form in liver –> need to be converted to bioactive form in kidney
49
Q

vit D:
- prenatal supplements with 400-600 IU may be insufficient
- how much IU would be necessary? for 3 benefits
- established theory?
- RDA for pregnant?
*non-pregnant: 600 IU/d

A
  • 1000-4000 IU to
    1. decrease preeclampsia
    2. increase neonatal and child bone calcium
    3. decrease tooth enamel defects in children
  • still controversial, not enough evidence
  • RDA pregnant = same as non pregnant = 600 IU
50
Q
  • can vit E deficiency occur in premature newborns? explain
  • pregnant women need more?
A
  • can occur –> leads to hemolytic anemia (bc RBC are more fragile w/o help of vit E as antioxidant)
  • no reports of deficiency during pregnancy + no evidence that maternal supplementation would prevent deficiency symptoms in premature offspring (vit E doesn’t traverse placenta in sufficient amount)
  • same RDA = 15 mg/d of a-tocopherol
51
Q

vit K and pregnancy:
- evidence that pregnant mothers need more?
- AI?

A
  • nope!
  • AI (14-18) = 75 ug/d
  • AI (>19) = 90 ug/d
52
Q

Calcium and pregnancy:
- transferred to fetus?
- depletion of maternal stores?
- what biomarker increases during pregnancy?
- changes in maternal bone mass during pregnancy?
- RDA pregnant?
*RDA non pregnant = 1000 mg/d (19-50 yo)

A
  • yes! 25-30 g, majority during 3rd trimester
  • no depletion of maternal stores bc major physiological adaptation –> increase efficiency in intestinal absorption!
  • blood [1,25(OH)_2 D] (bioactive form of vit D) increases during pregnancy –> role is unclear
  • no changes in maternal bone mass
  • same RDA!
53
Q

Phosphorus and pregnancy
- reqs change? why or why not?

A

reqs don’t change
- 700 mg/d (19-30 yo) because upregulation in absorption!

54
Q

magnesium and pregnancy:
- decrease during pregnancy? why or why not?
- reqs change?

A
  • serum [Mg] decrease during pregnancy –> thought to be due to hemodilution, parallels decrease seen in serum protein
  • increase by 40 mg/d (ie 350 mg/d for 19-30 vs 310 for non-pregnant) –> increase bc increase body mass of 16 kg for pregnant
55
Q
  • pregnancy: what in body requires Fe / what losses do we need to replace? (3) + (1 that we don’t have during pregnancy)
  • what is this modeling called?
A
  1. basal losses (250 mg)
  2. Fe deposited in fetus and placenta (320 mg)
  3. Fe in expansion of Hb mass (500 mg)
    *NO menstrual losses
    - factorial modeling
56
Q
  • what is the normal absorption % of iron? what happens during which specific pregnancy trimesters?
A

18% = normal
- trimester 2 and 3 –> increase to 25%!

57
Q
  • moderate anemia during pregnancy associated with what?
  • vs severe anemia?
  • general maternal anemia is associated with (3)
  • high [Hb] at time of delivery is associated with what?
A
  • moderate –> 2x risk of maternal death
  • severed –> associated with perinatal maternal mortality
  • general anemia –> premature delivery, LBW and increase perinatal infant mortality
  • high [Hb] at delivery (bc decrease plasma volume) associated with adverse pregnancy outcomes (ie small for gestational age)
58
Q
  • iron deficiency anemia common in pregnancy women?
  • health Canada recommends supplement for pregnant women?
A
  • yes! high incidence of Fe-deficiency anemia among pregnant and non-pregnant women
  • yes! bc habitual canadian diet cannot meet Fe RDA –> BUT supplementation assumes inadequate pre-pregnant Fe-stores –> if normal Fe stores, supplement is unncessary
59
Q

iron RDA in pregnancy?
- non-pregnant: 19-30 yo = 18 mg/d

A

27 mg/d

60
Q

potassium in pregnancy
- what is used to set AI?
- AI different than for non-pregnant (2.6g/d)?

A
  • highest median intake among pregnant women used to set AI (bc very small potassium accretion/increase during pregnancy + no data suggests different requirement (except for increase cal intake))
  • AI = 2.9g/day for pregnant
61
Q

sodium in pregnancy:
- need extra sodium for (2) over what period of time?
- AI is different for pregnant?

A
  1. maintain increase in plasma volume
  2. provide products of conception
    - this accumulation of 2.1-2.3 g Na occurs over 9 months –> need 0.07g/day more of Na throughout pregnancy = so minimal
    - AI is the same for pregnant! = 1.5g/d
62
Q

does limiting sodium during pregnancy decrease risk of preeclampsia and hypertension?

A

nope

63
Q

zinc in pregnancy:
- how is zinc EAR during pregnancy established?
- EAR? RDA?
*RDA non-pregnant = 8 mg/d for 19-50 yo

A
  1. mean daily zinc accumulation in maternal and embryonic/fetal tissues during 4 quarters of pregnancy –> numbers
  2. average fractional absorption of Zn is 27%
    SO: EAR = based on additional Zn reqs during 4th quarter –> 0.75 mg/ 0.27 = 2.7 mg/day of zinc
    - EAR = 2.7 + 6.8 = 9.5 mg
    - RDA = 11 mg (vs 8)
64
Q

iodine in pregnancy
- same reqs?
*RDA non pregnant = 150 ug
- iodine deficiency during pregnancy leads to (3)
- can fetus have iodine deficiency?

A
  • RDA = 220 ug/d!
  • miscarriage + still birth + birth defects
  • yes! caused by iodine deficiency in mother –> can cause severe intellectual disabilities, cognitive dysfunction + congenital hypothyroidism (cretinism)
65
Q
  • which 2 microminerals’ reqs increase based on fetal deposition?
  • vs which 3 microminerals’ reqs increase based on increase maternal weight?
A
  • fetal deposition: selenium + copper!
    *copper: reqs increase based on fetal deposition + accounts for lower bioavailability (75%)
  • increase maternal weight: manganese, chromium, molybdenum
66
Q

fluoride in pregnancy
- difference in reqs?

A

nope: 3 mg/day for both pregnant and non-pregnant women
- based on relationship btw caries and water fluoride concentrations and fluoride intake –> AI = 0.05 mg/kg/d
- recommended for all ages > 6 months for high level of protection against dental caries

Nutrition through life (13 decks)

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