Adolescent Health (2) Flashcards
Alice:
18F - pregnant
PMH:
Teenage acne
Medication:
NKDA
Lymecycline course aged 16, no other courses of antibiotics
Social history:
Substance use: Previously drunk alcohol - binge 2-4 times/month with friends. Unsure of units. No drinking since pregnancy
Attending college for A-levels. Working part-time at local retail outlet
Social support: Lives with parents, older brother at uni. Good group of friends, first in social circle to fall pregnant. Supportive relationship with partner, one regular sexual partner only – does not use barrier protection
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What are the key social determinants and lifestyle behaviours identified in this case that would be important in taking a holistic approach to this woman’s health?
Stress = college - A levels and retail -part-time job
Lack of sleep = education and job
Lack of information on the partner - what is meant by supportive partner?
Possible domestic abuse?
18 - not classified as a teen pregnancy = lesser support services
Past use of antibiotics for acne = can affect microbiota
Good group of friends = good support network
No barrier protected sex = STIs
What is a good question to ask Alice?
Would you mind telling me about a typical day?
Alice’s typical day looks like:
Wakes at 7am, leaves for collage at 7:30. Picks up breakfast on the way to college. Lunch - eats on the go between classes. Saturdays works in retail - on her feet at the tills standing. Catches up on college work in the evening, watches TV, go to bed at 2am. Doesn’t struggle to sleep. Socially - spends time with bf and goes out w/ friends. Not drinking during pregnancy.
With this new information, what other factors in her lifestyle are important to consider?
Oversleeping - high cortisol in the morning
Not much time for relaxing - rushes
Little sleep, only 5-6 hours a night
Why is food and diet so important?
Metabolism =
Food broken down to useable compounds
Hormone regulation
Gut microbiome = interacts with: CNS and ENS (enteric / intrinsic nervous system) Immune system Vitamin and metabolite production Plays a role in appetite
Gut-brain axis = Bidirectional communication between CNS and ENS
Stress mediated response in gut physiology and motility communicates via vagus nerve and cytokines to the CNS = mood
Intestinal permeability =
Ideally, intestines take in nutrients and stop toxins
Permeability increases with poor diet and stress, allows lipopolysaccharides (LPSs) into the blood stream
LPSs = endotoxins
Leads to low grade chronic inflammation
Does the gut microbiome change through the lifecourse?
Yes
Gut microbiome rapidly changing during the early years
Relatively stable during adulthood, though affected by external factors
If chronic insult - can cause harm
Microbiome becomes less diverse and more unstable with age
What should a Lifestyle Medicine prescription for Alice look like?
Eat
Sleep
Move (FITT)
Relax
Eat:
Eat more vegetables - plants very good to get the necessary nutrients, and it (fibre) also helps with constipation
Ensure you get enough B12
Take pre-natal vitamins - folic acid, vitamin D
More meal planning
Conscious eating - try not to multi-task while eating
Pre-natal support groups
Sleep:
Sleeping position - lying on the back puts pressure on vena cava
Morning routine = good
Bedtime routine = random
Reduce screentime before bed
Try going to sleep earlier
Gradual changes
VBA her on good sleep - her sleep schedule will change with the pregnancy so prep her for that
Move (FITT):
Small bursts of regular exercise e.g. walk everyday
Pre-natal classes for swimming etc.
Can make friends with other pregnant women in pregnancy groups - first in her friendship group to fall pregnant
Kegel exercises
Walk around during her work shifts
FITT = frequency intensity type and timing
Relax:
Pack bag and meal prep the night before so her morning routine can be more relaxed
More walks with boyfriend / friends
Management plan for the future how to manage baby and school work
